This week’s Ask Dr. GeIer column focuses on an injury all too familiar in college football, and many other sports. An ankle sprain is extremely common in sports. If you have suffered multiple sprained ankles, how can you get better and return to sports? A brace? Taping? Physical therapy? Surgery?
My 19-year-old collegiate player has a weak ankle, which means she has overturned/sprained it multiple times usually losing weeks of play time. There are no breaks showing up on x-ray. She is now about 5-6 weeks past her latest sprain – the trainer is taping her and then she is wearing a trilok brace. Is there anything special that can be done to strengthen a weak ankle and what do you advise – is the taping/brace combo better than just a brace or just tape???? Thanks so much for your time and opinion.
I’m not sure that there’s a right answer to this question, but I can certainly give you my opinion on taping and bracing ankle sprains in general.
Taping for sprained ankles
Taping ankles is a common practice in sports at all levels. Probably close to half of the Charleston Battery players get their ankles taped prior to practices and games. I have heard of a professional coach who would fine a player with a history of an ankle injury who did not get his ankles taped. I even know a basketball coach who makes all of his players get their ankles taped, even if they’ve never had an ankle injury.
A brace for an ankle sprain
Acute ankle sprains, meaning that the injury happened very recently, have a very accepted initial course of treatment. The acronym RICE stands for rest, ice, compression, and elevation and is known widely among coaches and athletic trainers. The athlete should avoid the offending activity, which usually means being out of sports for days or even several weeks. He or she should ice the ankle to help decrease swelling and inflammation. He or she can also use a compression dressing and elevate the leg to decrease swelling. Early weightbearing as tolerated can be helpful as well. Sometimes adding an ankle brace, such as a lace-up ankle corset or an air stirrup, can provide added stability during weightbearing and help decrease the athlete’s comfort while walking. As motion and swelling improve and pain decreases, the athlete can slowly work his or her way back to sports.
Bracing or ankle taping for return to sports
When the athlete gets back to sports after a sprained ankle, there is always the question of whether or not to tape the ankle. To be fair, I’m not at all opposed to tape. I’ve seen many athletes who swear by the practice. In general, my concern is that the tape stretches out in the first 10 to 15 minutes, so I question how much stability the tape actually provides. Whether or not taping actually decreases the chance of spraining the ankle again is debatable. I think it’s much more likely to help with proprioception, or position and balance sensation, of the ankle. If the ankle truly lacks stability, I usually feel that lace up ankle corset is more rigid and in theory should provide more stability. It is hard to know if a combination of taping and bracing would be much better than bracing alone.
Physical therapy and rehab for sprained ankles
What I think is often missing in rehab of ankle sprains, or in athletes with recurrent ankle sprains, is an ankle rehabilitation program. In my experience, especially at the high school level, athletic trainers don’t have the time to devote to putting an athlete with a new ankle sprain through a rigorous ankle stabilization program due to the time it takes to treat other players. In athletes with a recent ankle sprain, especially if they are in the middle of the season, I usually have them work with a sports physical therapist. Not being a physical therapist myself, I can’t articulate exactly the specifics of these programs, but the therapist will usually work very aggressively to increase the range of motion of the ankle and decrease the swelling initially. As motion, swelling, and weight-bearing ability improve, the therapist will work on exercises to increase proprioception. These exercises will involve balance on soft and even moving surfaces, requiring the athlete to recruit muscles around the ankle and leg to stabilize the ankle dynamically. As balance and proprioception improve, the therapist will put the athletes through exercises that simulate the demands of their particular sports. In my experience, these ankle rehabilitation programs not only get a player back to sports more quickly, but they also seem to make it more likely that ankle instability doesn’t become a recurrent problem.
What can be done for repeated ankle sprains?
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