Ankle Health

ANKLE INJURIES IN VOLLEYBALL
Researched and Prepared by Andrew Nicholson MS, ATC

What is an ankle sprain?

An ankle sprain occurs when ligaments are stressed beyond their capacity to stretch. A minor sprain occurs when the ligament is just stretched out and there is no tearing of its fibers. A moderate injury occurs when some fibers of the ligament have been torn but the ligament remains connected. A severe sprain results when the ligament completely tears or is ruptured. The vast majority ankle sprains fall into the minor to moderate categories.

How likely is it that I will get an ankle sprain?

According to the most current research:

· Each year about 50% of all high school and college athletes receive an injury that causes them to miss at least 1 practice/game

· Volleyball is a relatively injury free sport with only 22% of players missing at least 1 practice each year.

· 78-82% of volleyball injuries are ankle sprains. So ankle injuries are a common volleyball injury.

· Once a player has suffered an ankle sprain, they are 8x more likely to sprain it again. This is significant. It means you should work hard to keep from getting an ankle sprain, and even harder once you sprain your ankle to prevent it again.

How should I treat an ankle sprain?

The standard care for all acute injuries can be summed with the acronym RICE. Which stands for REST, ICE, COMPRESSION, ELEVATION.

· REST- Rest does not mean do as little as possible. Actually it means do as much as possible without causing pain. If you can walk without pain and a limp do so. If not, you should be on crutches but never for very long. As soon as you can, begin walking normally. Sometimes athletes use crutches as little as 12 hours before they can walk again.

· ICE - The importance of ice can not be understated. Ice helps remove fluids and chemicals from the injured area and prevents them from damaging healthy cells making your injury worse. The damaging of these healthy cells is called secondary injury. Ice can be applied in many forms; bags, slushes in buckets, cups or whirlpools. Ice should be applied for 10-15 minutes at a time. Wait to ice again until your skin temperature is the same as the other ankle. This usually takes 1 -1 1/2 hours. Ice should be used as long as there is pain and the injury in actively inflamed. This can continue for 1 week or more and is sometimes difficult to determine. See your athletic trainer or health care provider for more information. The old saying "Use ice for the first 48-72 hours" is wrong. Ice can be used effectively long after 72 hours. Never apply heat in any form to a new injury.

· Compression - Applying continuous pressure to an acute injury can greatly help reduce swelling. An ace bandage or compression sock can be used continuously unless you are icing or bathing. If you use an ace bandage, wrap it tighter at the toes than at the calf, but do not cut off circulation. The idea is to move the swelling up the leg where your lymphatic system is stronger and can reabsorb the fluid. The quicker the swelling gets out of the area the quicker it will heal.

· Elevation- Keeping your injury above your heart lets gravity move the swelling away from the injury also. Try to keep your ankle up as much as possible. In school put it on the desk or prop it on chair in front if possible. Explain to and ask permission from your teachers first though. At night take a drawer from your dresser and put it between the mattress and box springs. This will elevate the entire foot of your bed keeping your ankle elevated all night. Using pillows is not effective because when you roll over at night your ankle rolls off the pillows.

Prevention

Once a player has suffered an ankle sprain, they are 8x more likely to sprain it again. This is significant. It means you should work hard to keep from getting an ankle sprain, and even harder once you sprain your ankle to prevent it again. While prevention of every ankle injury is impossible, several simple things can be done to drastically reduce your chances of ankle sprains.

Strengthening Exercises

Strong ankles are important for preventing as well as recovering from ankle sprains, strains, and fractures. Strengthening exercises should be performed on a regular basis and could be incorporated into practice times. There are several types of strengthening exercises. The easiest to begin with is isometric exercises, which essentially is pushing against a fixed object with your ankle. If you have ever sprained your ankle before you should be do these exercises daily until they are mastered. Once this has been mastered, you can progress to isotonic exercises, which essentially is range of motion of the ankle, but against resistance. Here the isotonic exercises are performed with the use of a resistance band, see Andy if you are interested in obtaining low cost resistance band.

Isometric: Place your ankle in the "down and in" position against a fixed object such as a couch. Hold this position for a count of 10. Repeat 10 times.

Isometric: Place your ankle in the "up and out" position against the same object. Hold this position for a count of 10. Repeat 10 times.

Isometric: Push your ankle down against a fixed object and hold for a count of 10. Repeat 10 times. Push your ankle up against a fixed object and hold for a count of 10. Repeat 10 times.

Isotonic Band Exercises: Using a resistance band around your forefoot, hold the ends of the band with your hand and gently push your ankle down as far as you can and then back to the starting position. Repeat 30 times each day.

Isotonic: Tie the resistance bands around a fixed object and wrap the ends around your forefoot. Start with your foot pointing down and pull your ankle up as far as you can. Return to the starting position and cycle your ankle 30 times each day.

Isotonic: Tie the bands around an object to the outer side of your ankle. Start with the foot relaxed and then move your ankle down and in. Return to the relaxed position and repeat 30 times per day.

Isotonic: Tie the ends of the bands around an object to the inside of your ankle and hold your foot relaxed. Bring your foot up and out and then back to the resting position. Repeat 30 times each day.

Balance Training

A targeted balance training exercise reduces the risk of ankle injuries, according to the American Orthopaedic Society for Sports Medicine. The latest study found that these ankle injuries can be avoided by performing a simple balance exercise for five minutes several times a week. Balance training can reduce the occurrence of ankle sprains by as much as 77%. Balance training is a simple, low-cost strategy to reducing injuries. Balance routines and exercise can be easily incorporated into practices. Athletes can use a foam pad or any soft surface to stand on while watching TV or reading a book at home, bumping or setting the ball with a partner or against the wall. Once balancing become easy on two feet, try it with one foot. See Andy for ways to make balance training fun and challenging.

Ankle Braces

There is no evidence that ankle braces prevent the initial ankle sprain from happening. If you have never sprained your ankle you do not need an ankle brace. Studies show that ankle braces only help prevent re-occurrences of sprains. Ankle strengthening and balance training are far more effective in preventing injury than ankle braces.

There are several different types of ankle braces. All provide some level of protection from ankles injuries. The degree of which varies and athletes should be prepared to give up a little comfort for support.

Types of Braces

· Neoprene/Canvas with heel lock strapping (Brand Names: Rocketsoc, ASO ): Several studies have suggested that these are the most effective braces at preventing recurring ankle sprains. They provide maximal support when the ankle moves too far. These braces attempt to control ankle motion by controlling the foot motion and absorbing force. They also tend to be more expensive and have a little more bulk in the shoe than some other braces.

· Semi-Rigid Upright Braces- (Active Ankle, AirCast): These have 2 usually plastic struts with stabilizing connection at the bottom and utilize straps around the ankle and calf to hold the uprights snug to the leg and provide support. Studies have raised serious issue with the bio-mechanic legitimacy of these types of braces for athletics. While studies exist that support the use of these braces for a non athletic population, there is little evidence ( 1 study ) that these braces prevent ankle motion with the amounts of force placed on the foot during sports. These braces may help prevent minor sprains. However, they may not help prevent moderate or severe sprains or reduce the severity of injury. Athletes like these braces because they are comfortable and affordable. These braces have been highly marketed and promoted to the "volleyball world."

· Canvas Lace Up Braces - ( Swedo ): These braces incorporate a plastic stay within the canvas brace. They attempt to control ankle motion through rigid support. They do provide a moderate amount of support and have been shown to reduce the recurrence and severity of injury. They are uncomfortable for most athletes and will reduce the athletes agility and speed because of the restricted ankle motion. These have been around the longest time and are highly affordable.

· Custom Braces- ( Velocity ): This brace is a hybrid of the heel lock strapping and upright bracing. It utilizes a moldable plastic around the athlete's ankle and heel with heel lock strapping. Three studies have suggested that this brace is a very good option when other braces fail to prevent injury and the athlete has had multiple ankle sprains. The brace is expensive and must be fitted by a medical professional. Please see Andy if you interested in this brace.

Please Contact me with any questions or concerns.

This Summary was constructed using standard Evidence Based practices. 119 studies varying from evidence levels 1-6 were evaluated. Studies were random controlled, random controlled blind, case and group series, and clinical practice in nature. Information provided is not intended to be a substitute for regular or standard medical care.

Kidron Volleyball Club 2018