Ankle Sprains: New Remedies

Athletic as Boulder is, I thought this would be an interesting article for you all. As an avid trail runner, I can't even count how many times I've rolled my ankle. Actually, now that I think about it, the worst sprain I've gotten was unclipping on the trail while mountain biking--watch where you step!!! Regardless, Dr. Pete has always set me straight--literally :) and the cold laser has quickened the healing process immensely.

So for all of us ankle-injured masses, here is a great article about some new remedies written by Deborah Franklin from The Consumer (July 18, 2006).


Emergency room statics suggest that every day in this country, an estimated 23,000 people--athletes, stylists in stilettos, middle-aged accountants in sensible shoes--severely turn an ankle, stretching and tearing the ligaments, tendons, and neuromuscular connections that keep the jumble of bones in place.

Torn-up knees and dislocated shoulders get more press and sympathy. But doctors know that a bad ankle sprain is not only more common, but can be at least as far reaching in its effects. A broken bone usually takes weeks to heal, but the worst ankle sprains may require three months of rehabilitation.

Any wrenching turn that swells the ankle like a water balloon and leaves it too painful to walk on for a day or longer weakens the joint and primes it for more bad sprains and osteoarthritis years later, according to Bruce Beynnon, a biomechanical engineer at the University of Vermont who has spent decades studying knee and ankle injuries.

Dr. Beynnon said [sic] that many athletic coaches used to routinely tell players after a sprain to "just walk it off." But, he said [sic], "People who know the reseach on sprains don't recommend that anymore."

In the hope of finding better ways to prevent such injuries and help them heal faster, Dr. Beynnon and colleagues have been looking for risk factors that may make some people more vulnerable to sprained ankles than others.

Their most recent findings, presented this month in hershey, Pa., at a meeting of the American Orthopaedic Society for Sports Medicine, suggest tha men and women tend to have a different set of risk factors that should perhaps change the ways the two groups train if they want to avoid sprains.

"Basically, what they found was that for women, the risk for injury had to do with balance and strength in opposing muscle groups, whereas for men it's more often about range of motion in the joint," said [sic] Dr. Timothy E Hewett, director of the Sports Medicine Biodynamics Center at Cincinnati Children's Hospital. "That's important and exactly what I would have expected them to find, based on what we're learning about sex differences in knee injuries."

Statistics gathered in the 1990s by the National Collegiate Athletic Association showed that depending on the sport, female athletes were two to four more liekly than men to suffer a tear or other injury to the knee's anterior cruciate ligament, or A.C.L.

Dr Beynnon and his team recruited 901 members of men's and women's varsity soccer, basketball, lacrosse, and field hockey teams from several high schools and two universities in New England. Each student was put through a variety of tests to measure, among other things, laxity or "wobbliness" of the ankle, flexibility, and the relative strength of the muscles that help keep the hinge from rolling inward or outward in an off-kilter landing.

The researchers also measured the general alignment of the knee, ankle, and lower leg and the range of motion of each joint.

None of the students had suffered an ankle injury before the start of the four-year study or took any special precautions to avoid sprains. By the end of the final season, 43 students had suffered an ankle sprain severe enough to require medical attention and force them to miss at least one game or practice.

According to the results, women might be best able to help protect their ankles by doing exercises a few times a week that isolate and symmetrically strengthen the muscles that roll the foot inward and outward, Dr Beynnon said [sic]. In contrast, balance taining and traditional stretching excercises for calves and the Achilles tendon that increase the ankle's up and down range of motion may be more useful for men.

Unfortunately, improved training will not be able to remedy all the differences that turned up between those who got hurt and those who did not. The women identified in the preseason screening as having extra looseness in an ankle, for example, were significantly more likely to go on to sprain it, as were the men who had undergone previous non-joint-related surgeries to lower a leg.

But Dr. Beynnon and others have found in previous research that wearing a lace-up ankle brace--a semi-rigid stocking without toes that is worn over the sock--can lend needed support to the lax joint and reduce injury in athletes who have that risk factor. Knee braces have not been shown to be effective in preventing a first injury, he added [sic], "but we now now that bracing can help ankles."

Interestingly, taping the ankle--a timeworn effort to guard the joints in many sports--may make an athlete feel more secure but offers little benefit, Dr Beynno and other researchers studying the problem say.

Dr Mitchell Cordova, chairman of the department of kinesiology at the university of North Carolina at Charlotte, cites studies showing that the adhesive tape loosens during excercise, losing about 50 % of its ability to stabilize the joint in the first 10 or 20 minutes of play. A brace, he said [sic], stays tightly supportive much longer.

Dr Cordova recommends the braces primarily as a part of rehabilitation for previously injured joints. Dr Beynnon, however, is convinced that ankle braces may be useful in prevention as well, at least for those who have been told by coaches or doctors that they have "loose joints." At his suggestion, Dr Beynnon's two tennage daughters wear braces when playing basketball.

The ultimate goal is not to recommend braces or special exercises for everyone, Dr Beynnon said [sic], but to figure out who is at risk and why and then tailor a training program to produce an athlete who safely maximizes his or her physical potential. Dr Hewett is already at work on simple screening tests that can be used in middle schools and high schools with accompanying exercises on balance boards, for example, that could easily be added to the school weight room.

"We're talking about sort of a paradign shift in training,, " Dr Beynnon said [sic]. coaches in most sports have never thought about this. They never get an athlete to work on isolating the muscles on the ouside of the leg. The focus has been on running and drills that get you down the court or field faster to make more points."

Whether the finding directly apply to older or less dedicated athletes, summer hikers and ill-stepping accountants remain to be seen. But Dr Hewett is convinced that the exercises emphasizing balance, stability, flexibility, and core body strength get more important as people age.

"These techniques will not only make you safer," Dr Hewett said [sic], "but a better athlete too."