SEC Championship Football

Alabama quarterback Tua Tagovailoa, left, is carted off the field during the Southeastern Conference championship Saturday in Atlanta.

It is almost unheard of that an injury to a star player would be considered good fortune. However, that seemed to be the case for the Alabama football team when Heisman Trophy finalist Tua Tagovailoa sprained his right ankle during the fourth quarter of the Southeastern Conference championship game.

The sophomore quarterback was 10 for 25 with one touchdown and two interceptions at the time he went down Saturday, with the Crimson Tide trailing Georgia 28-21. Junior Jalen Hurts — he of the 26-2 record as a starter — replaced Tagovailoa and led his team to two unanswered touchdowns, thus preserving Alabama’s unblemished record and top seed in the College Football Playoff.

Had the younger signal caller not been injured and remained in the game, given the way he was playing, Georgia may very well have hung on for the upset.

In the aftermath of the game and again Sunday, Alabama head coach Nick Saban downplayed the severity of the injury, expressing supreme confidence that Tagovailoa would be healthy in two weeks.

Isn’t that what the Bulls were telling us about Denzel Valentine and his left ankle in September?

By October, that “just an ankle sprain” had turned into a bone bruise and two more weeks.

Then Wednesday, the Bulls announced that the third-year guard was done for the season after undergoing stabilization surgery to the joint in, of all places, Green Bay, Wisconsin. This was the second time in 18 months for surgery on that ankle.

If that doesn’t make you reconsider any assumption you may have, that an ankle sprain is a relatively trivial matter, consider a study published in the March issue of the Journal of Science and Medicine in Sport.

Dutch researchers looked at 132 patients five years after they had sprained an ankle. Remarkably, nearly one in five (18.2%) were still having trouble all those years later. Furthermore, nearly one-third (30.3%) had re-sprained the ankle at least once.

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Such a recurrent sprain, which usually occurred within one year of the original, made those long-standing woes more likely.

“Largely what I see is what the study found — that people continue to have pain, three to five years after initial injury, even decades after,” said Dr. Robert Clemency, a podiatrist with Community Care Network in Schererville and Munster. "So, a lot of my practice is improving patients’ quality of life through therapy, injections, arthroscopy and even a ligament reconstruction to prevent what no one wants, that’s ankle arthritis. Because (then), there are not a lot of great options.”

FIFA, the worldwide governing body for soccer, called attention to the JSMS article in a FIFA Medical blog post in June. The post concluded, “This study illustrates the need for better education of players who sustain a lateral ankle sprain and an explanation that the incidence of ongoing symptoms is higher than they might expect. It also potentially highlights the need for closer follow up and for more effective treatment of the initial injury. A better focus on injury prevention strategies (which we know are effective) may also reduce the risk of long-term morbidity (given that re-injury has been demonstrated to be a risk factor).”

More effective treatment means a formal rehabilitation program supervised by a physical therapist and/or athletic trainer. Older studies have demonstrated the greatest risk factor for an ankle sprain is a previous sprain and the primary cause of a re-sprain is incomplete rehabilitation of the first.

“Physical therapy after the first ankle sprain is critical,” Clemency said. “What therapy will do, it prevents re-occurrence by increasing strength about the joint as well as increasing or re-establishing some of those proprioceptive channels (nerves which tell the brain the posture of the joint) that are disrupted in the initial injury. So therapy is a means of preventing re-injury whether you are an athlete or a laborer. It’s critical in keeping the rate of re-occurrence low and having a better functional outcome after the first sprain.”

Rather than go through all the trouble of a sprain, though, the most effective strategy — as outlined in this space in August — is to prevent the injury in the first place by wearing an ankle brace.

Researchers at the University of Wisconsin published studies of 1,400 basketball players and 2,000 football players in the November 2011 and January 2012 issues, respectively, of the American Journal of Sports Medicine. In each study, the numbers of those who wore braces and those who did not were roughly equal. Yet, the ankle sprain rates were not equal at all, with those not wearing a brace suffering injuries at two to three times the rate of those who wore one.

Numbers worth noticing as the basketball season is barely underway.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.