Wednesday, January 30, 2008

Just what the Doctor Ordered: A Very Brady Ankle Sprain

Welcome to's newest column, "Just what the Doctor Ordered." I am Dr. Smiley, a Rheumatology practitioner in Central New York, and I am writing alongside my colleague, Dr. Moretz, who specializes in Orthopaedics/Sports Surgery. As the newest columnists for SportsJudge Blog, we will introduce to you a frequent sports injury in each article, and explain its implications in terms of fantasy sports.

This week's topic is ankle sprains: "regular" ankle sprains and "high ankle" sprains. A sprain is basically a stretching of body tissue. This topic is especially pertinent to fantasy sports fans this week given the status of Tom Brady heading into this week's Super Bowl.

Out of necessity, first lets begin with some terminology. With regard to the foot and ankle, "lateral" refers to the pinky-toe side of the foot, and "medial" refers to the big toe side of the foot. We will also discuss various ligaments. A "ligament" is tough, fibrous tissue structure that attaches two bones together.

Now, onto the injuries.

Amongst the two types of ankle sprains, a “regular” ankle sprain is less serious and more common than a high ankle sprain. The high ankle sprain is a more serious injury because the high ankle sprain involves a ligament that is attached to the lower leg bones: the tibia and fibula. The tibia and fibula are the two bones that are below the knee, connected to the ankle. The ligaments that are involved are the anterior and posterior tibia-fibular ligaments, also known as the syndesmotic ligaments (Note: the ligament is usually named for the two bones it connects).

The key to understanding this injury, and why it is so serious to the health and mobility of an athlete, is that the high ankle sprain involves ligaments that attach to the tibia and fibula. In essence, the high-ankle sprain involves the lower leg bones, whereas the regular ankle sprain does not involve them at all.

Because the lower leg bones are involved, the injury can affect the way that the bodies bears its weight, and the ability of the athlete to shift weight, or at least the ability to do so without pain. Bones are the body’s supporting structures, so when there is an injury to ligaments that have a role in weight bearing, it becomes very difficult for the injured to pivot, plant or make any delicate or fine moved involved in any contact sport.

A regular ankle sprain is also a ligament issue, but of less consequence to an athlete because the ligaments of the lower ankle do not have such an intricate role in weight bearing and shifting.

An ankle sprain commonly occurs when another player strikes an athlete, while the athlete is twisting. The high-ankle sprain is usually diagnosed on the field by using the “squeeze test.” The doctor squeezes the calf, compressing the fibula against the tibia, testing to see whether the athlete experiences pain.

The treatment involves rest and immobilization. The recovery time for an athlete varies significantly based on the severity of the sprain and the athlete’s tolerance for pain. Some players have a very high tolerance for pain, and will play through extreme pain in order to return to competition quicker. Others are less able, and less willing to do so.

The most salient point is this: the high-ankle sprain involves the lower leg. The weight of the whole body is using the ligament that is sprained. You can tape up an ankle, but it is simply not possible to “tape” a bone. Often a lineman can overcome the injury because their movement is limited to a confined space, often just run blocking and pass blocking; but for a running back, defensive back or wide receiver, a high-ankle sprain is a serious limitation.

As for Tom Brady, we shall see. Expect him to remain in the pocket and not run around much, which is where he does his best work anyway.

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Joe Romano said...

Dr. Smiley,

Sidney Crosby is currently injured with a high ankle sprain and is expected to be out 6-8 weeks. We are being told that a high ankle sprain can be worse for a hockey player than other sports because of the differences in the movement of the legs and most importantly the ankle. Could you please, expand on this and give me some sort of explanation. Thanks.


John said...

Great article Dr. Smiley and Dr. Moretz. Whats the best anti-inflammatory for an ankle sprain?...LOL

Brett Smiley said...

Because the Drs. do not yet have a blogger account, I have relayed the question to them and they provided this response:

Hockey players have to push off, skating more side to side. This creates a larger twisting force at the ankle, with more irritation to the syndesmosis (see previous article). By contrast, running in other sports is for the most part a more straight and forward motion. Thus, Mr. Crosby would be expected to take longer to heal.

- Dr. Smiley and Dr. Moretz

Joe Romano said...

I figured it had something to do with the rolling of the ankle and the twisting motion. I just know from experience that the boot of the skate added so much support that most ankle and foot injuries were minimized because of the support received from the skate. Thanks a lot.