Ankle sprain injuries plague even NBA players (1)
September 20, 2023 | by pondokslot.com
Unfortunately, sports and injuries are inseparable. That’s why injury management is so important in modern sports. Reducing the risk of injury in advance and managing it well after it happens can be the difference between a player and a team’s fortunes.
Rookie has a new feature where we’ll be discussing injuries in depth. It’s called ‘Medical Report. We talk to Dr. Doohan Kim, a clinical assistant professor of orthopedics at Kyomyung University and a member of the Korean Basketball Association’s medical committee, about various injuries.
This time, the topic is ankle sprains.
Organized by: Donghwan Lee
Answers and advice: Dr. Doohan Kim
*This article was originally published in the September 2023 issue of Rookie.
Q. What exactly is a sprain?
A. A sprain is often referred to as a “sprain” in common parlance. In the body, bone-to-bone connections are called joints, and ligaments are the structures that stabilize them so they don’t move out of alignment. When a joint is impacted and becomes “slightly” out of alignment, the ligaments partially tear, which is called a sprain. The most common sprain in basketball and other sports that involve running and jumping is in the ankle. It’s estimated that there are about 10 sprains per 1000 events in all sports, so it’s pretty common. According to the epidemiology of ankle sprains studied by the NCAA in 2016, basketball was the sport with the highest frequency, followed by soccer, volleyball, football, and gymnastics.
Q. It seems like ankle sprains are often injured by twisting inward – is there a reason for that in terms of human physics? What is a typical ankle sprain injury, and what is the anatomy of the ankle?
A. The ankle joint is made up of three bones: the tibia, fibula, and talus. [Figure 1] It must be able to bend and extend back and forth for movement, but there are many ligaments to keep it from wobbling medially and laterally. These ligaments include the deltoid ligament on the medial side, and the anterior talofibular, longitudinal, and posterior talofibular ligaments on the lateral side.
As you mentioned, about 80% of ankle sprains are caused by supination, where the ankle turns inward. This is because the outer radial bone (fibula) is longer and more stable than the inner radial bone in the ankle joint, and the anterior talofibular ligament is the weakest ligament. In addition, the talus bone, which forms the base of the ankle bone, moves in a pronation motion, making the ankle more vulnerable to supination. Therefore, ankle sprains can occur in various situations, but the most common case in basketball is stepping on the opponent’s foot. Stepping on an opponent’s foot causes the foot to turn inward while the ankle is still extended (plantarflexion), which can lead to ligament damage.
It can also happen during a sharp change of direction. It is also more likely to occur when exercising on unstable ground. On the other hand, the medial ankle ligament is stronger and more stable, so it takes more external force to damage it, so the rehabilitation period is longer.
Q. I know that ankle sprains are graded according to the severity of the injury. What are the grades based on, and will the recovery time and treatment be different depending on the grade?
A. In general, it is most common to divide ligaments into micro-tears, partial tears, and complete tears (grades 1, 2, and 3) based on the extent of the tear. Depending on the anatomical ligaments involved, it can also be divided into anterior cruciate ligament alone, two ligaments (anterior cruciate ligament and longitudinal ligament), and three ligaments (anterior and posterior cruciate ligament and longitudinal ligament). There is also a classification based on the athlete’s clinical presentation. A stage 1 injury is a minor ligament tear, with minimal tenderness and swelling, little instability, and the athlete is able to walk but with discomfort. A stage 2 injury is one where there is some instability, along with pain and swelling, and you are able to walk but with discomfort. Stage 3 is a complete tear of the ligament, with pain and instability that severely impairs ambulation.
The recovery process looks like this When the body’s tissues are damaged, there is an initial inflammatory response to prevent further damage. Over the next five to six weeks, new nerves, blood vessels, and other tissues will grow and repair to about 50% of their normal strength. The tissue then undergoes a process called remodeling, which gradually transforms it back into the original tissue, which can take up to a year or more to be completely replaced with normal tissue. In the case of ligaments, because joints are in constant motion, it is not uncommon for them to “stretch” a bit more than their normal strength or length. This leaves a persistent instability. In the case of the ankle, it is reported that around 30% of cases have chronic residual instability.
Q. I’ve seen basketball players play without surgery after an ankle sprain that damages or even ruptures a ligament. Is this possible?
A. Yes, as I mentioned earlier, the ligaments in our ankle are not single, so if one tears or becomes weak after a tear, the other ligaments compensate. In addition, in athletes, the muscles around the joint are very well developed compared to the general population, so it is possible to play after ligament damage. However, if you return to play incompletely, there is always a chance of further ligament injury or cartilage damage.
Q. I want to know specifically what the surgical and non-surgical treatment of an ankle sprain injury is.
A. In the case of an acute, non-serious ankle sprain, non-surgical treatment is the priority. (1) Initially, ice is applied to control pain and swelling and a splint or brace is worn to limit excessive movement of the ankle. (2) Then, once the pain and swelling are stable, stretching exercises are performed to increase flexibility and range of motion of the ankle. (3) Perform exercises to regain strength and balance that have been lost since the injury. (4) Begin sport-specific training to maximize ankle function.
There are no absolute criteria for when surgery should be performed, as opinions vary from specialist to specialist. Surgical treatment is preferred when there is persistent instability despite adequate non-surgical rehabilitation, when the athlete feels unstable, when there is complex instability involving not only the ankle but also the subtalar joint, and when there is a tear of a ligament in a poorly healing area (such as both ends of the peroneal ligament or a tendon fracture).
Q. I spoke with a Korean basketball player who suffered an anterior cruciate ligament tear. He explained that he had been doing a lot of ankle strengthening exercises to prevent recurrent ankle sprains, but that they were putting his ankle in a dangerous position and causing his knee to twist. Is this explanation medically reasonable? If it is reasonable, how should I manage my ankle to avoid injuring other joints like my knee?
A. There’s not a lot of research on the link between anterior cruciate ligament and ankle injuries, but there’s a lot of consensus that there may be a link. There are a couple of reasons for this. The first is if you have physical characteristics that make you more prone to injuring your joints. People with congenitally overly flexible joints are more prone to injuring not only their ankles, but also their knees, shoulders, and other joints. The second is changes in the lower extremity’s musculoskeletal system after an injury. There are studies that have reported decreased muscular nervous system responses in the hip and hamstring muscles after an ankle sprain, which suggests that this may also play a role in knee ACL injuries, as the most important risk factor for ACL injuries is lower extremity misalignment due to weakness in the pelvic and thigh muscles. Finally, there is a link between ACL injuries and ankle flexibility. There is a study that reported less flexibility in the ankle in a group with an ACL injury, and the authors don’t know which comes first (they actually call it a chicken-and-egg situation), but they say that there must be a link between knee and ankle injuries.
Q. When I look at athletes who have suffered an ankle sprain injury, it seems that many of them continue to injure their injured ankle chronically. Why is that, and what can be done to prevent an ankle sprain injury from becoming chronic? Q. How can ankle sprain injuries be prevented?
A. Taping and bracing are the most widely used preventative measures, and they are known to help for physical, musculoskeletal, and psychological reasons. Physically, it prevents damage by restricting movement at different angles of the ankle, which has some negative connotations as it reduces the efficiency of exercise. Musculoskeletally, there are reports that taping or bracing effectively affects proprioception, muscle activation, and postural stability around the ankle. While there are many studies that show that the first two aspects are not medically beneficial, there are also studies that show that they are psychologically reassuring to athletes, so bracing and taping are often recommended for prevention. On the field, many athletes use taping as a routine, but only a limited number of athletes seem to use braces. One of the most prominent athletes who requires braces is Steph Curry. Steph Curry, who is known for his weak ankles, always wears a brace for prevention after two ankle surgeries, but I also have chronic ankle instability, so I actually bought and tried the same model, and when I tried it, it was very uncomfortable because it was difficult to fit the shoe size and the area pressed against the brace was painful. Because of this discomfort, I think not all basketball players are wearing it. 스포츠토토
The second is ankle joint-specific muscle and nervous system training. It’s not just about restoring range of motion or building ankle strength, it’s about training the muscles that are specific to the ankle sprain and training the nerve sensation of the ankle together. Strength training to strengthen the peroneal tendons, which are the muscles that oppose the ankle from turning inward, and training to maintain balance in unstable situations are very helpful in preventing recurrence. [Figure 6]