JOHN DOHERTY: Taking ankle lightly can be heavy burden

2013-07-15T17:45:00Z JOHN DOHERTY: Taking ankle lightly can be heavy burdenJohn Doherty Times Columnist nwitimes.com
July 15, 2013 5:45 pm  • 

Athletes affected by head, heat and heart injuries or conditions attract immediate attention in the media.

Not far behind in the headline battle are the torn anterior cruciate ligament in the knee and the ulnar collateral ligament in the elbow — also known as the ACL of the arm. Reconstructive surgery is typically required for both.

Mention the ankle, however, to the typical sports fan and you will probably see a shrug of the shoulders. Injuries to that joint are so common and so minor. So, who cares?

The New York Yankees do. At least they do now. When shortstop Derek Jeter broke his left ankle making a seemingly routine defensive play during last year's playoffs, the Yankees first said he wouldn't need surgery. He did.

Then they said the 39-year-old would be ready for opening day. He wasn't. Last week, just two games into a rehabilitation assignment, he was called back up much earlier than planned due to injuries to other Yankees. Whereupon, he suffered a right quadriceps strain and will be sidelined until after tonight's All-Star game. Two games does not a rehabilitation assignment make, particularly given Jeter's age and injury. Will the pros never learn?

The National Athletic Trainers' Association cares about ankles, too. So much so, that it will be publishing a position statement on evaluation and treatment of ankle sprains in the Journal of Athletic Training next month. Considering that ankle sprains — at 10,000,000-plus per year in the United States — are by far the most frequent injury in sports, such a document is more than timely.

Some of the guidelines it contains — such as ice, compression, and elevation — are nothing new and universally accepted. However, others may be more controversial: a stress x-ray is not reliable for diagnosing the severity of an ankle sprain but — and insurance companies are sure to not like this — an MRI is.

Before ordering x-rays or more imaging expensive tests, though, the guidelines urge sports medics to follow the scientifically validated Ottawa Ankle Rules: search for tenderness at the tip or the back half of both the medial and lateral ankle bones and evaluate weightbearing status. If there is tenderness in any of those areas or the victim is unable to bear weight, then an x-ray is necessary.

Otherwise, the injury is a sprain. If it is mild or moderate, the guidelines recommend early and aggressive rehabilitiation. For severe sprains, 10 days of immobilization are recommended followed by a careful but progressive therapy program.

Regardless of severity, the goal is to restore full range of motion, strength, and balance — especially balance. Incomplete rehab is a recipe for re-injury. So is a failure to have the injured ankle braced or taped. The costs of daily taping can add up. At $50-$80 a pair, a good set of ankle braces pays for itself in less than a month.

For the complete guidelines go to www.nata.org/sites/default/files/ankle-sprains.pdf.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at ptatcsport@sbcglobal.net. Follow him on Twitter @JDohertyATCPT.

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