December 2009

Ankle sprain research focuses on teens

by Linda Weber

Epidemiological studies confirm what coaches, trainers, parents, and student athletes already know—that ankle sprains are the most common musculoskeletal injury among high school athletes. A study in the August issue of the American Journal of Sports Medicine bears that out, with recurrent ankle injuries accounting for 28.3% of recurrent traumatic sports injuries in teen athletes.

The statistics raise the question of whether adolescent athletes are more susceptible to ankle injuries than their adult counterparts. Jonathan Chang, MD, clinical assistant professor of orthopedics at the University of Southern California in Los Angeles and a former team doctor for both high school and college sports teams, says that in his experience the opposite is true.

“Sprains are actually more common among adults than adolescents due to the fact that teens’ ligaments are stronger than bone in their early teens,” Chang said. “Athletes are still growing and have open growth plates in the early teens. The plates close in the mid-teens, and after that, student athletes have injury patterns more like adults.”

But, he cautioned, since younger athletes tend to be more reckless than adults, they increase their risk of sustaining injuries of all types.

Certain inherent biomechanical and structural vulnerabilities can predispose athletes of any age to ankle sprains, says Craig Bottoni, MD, a St. Petersburg, FL-based orthopedic surgeon specializing in sports medicine.

“Someone who has a cavus foot is predisposed to inversion injuries. The high arch makes it more likely that the foot will roll over,” Bottoni said. “Generalized ligament laxity in all joints is another condition that makes individuals more prone to inversion sprains.”

Studies of high school football players have found that other risk factors include a high body mass index and previous ankle sprains. Injury history may be one of the most significant contributors.

“Certainly, once you’ve had an injury, you’re at greater risk for repetitive injury,” Bottoni said.

The recommended multifaceted treatment program most athletic programs adopt begins with rest, ice, compression, and elevation (RICE) and nonsteroidal anti-inflammatory drugs (NSAIDs), then continues with range-of-motion exercises, progressive strengthening and sport-specific exercises.

Since studies and anecdotal observations have demonstrated that ankle supports mitigate ankle destabilization, the use of taping and bracing is commonplace in high school locker rooms. A study in the November/December 2006 issue of the Journal of Foot and Ankle Surgery, on which Bottoni was a co-author, suggests that both methods may be equally effective. The prospective, randomized trial followed 83 high school football players for an entire season; players with a history of previous ankle injury were excluded. They were divided into two groups: one wore commercially available ankle braces; the other had their ankles taped. Each group sustained three ankle sprains over the season.

Bottoni cautions, however, that taping is most effective when applied by an experienced practitioner. And he recommends choosing a high-quality athletic brace for maximum benefit.

Balance training can also reduce the risk of ankle sprains in high school athletes. In a study published in July 2006  in the American Journal of Sports Medicine, 765 high school soccer and basketball players of both sexes were assigned to either an intervention group that participated in balance training or to a control group that performed standard conditioning exercises. Players with a history of ankle sprain who performed the intervention program decreased their risk of sprain by one half. In a similar study published in the august 2007 issue of the American Journal of Sports Medicine, high school football players with a history of previous ankle sprains had a 77% reduction in injury incidence. These two studies demonstrate that a balance training program can significantly reduce athletes’ risk of ankle reinjury.

Both Bottoni and Chang are strong proponents of proprioceptive training.

“Proprioception training does help,” Bottoni said. “By improving neuromuscular function, the athlete will be able to respond better when the ankle is at risk.”

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One Response to Ankle sprain research focuses on teens

  1. As a practising physical therapist at healthclues, Hyderabad…I want to mention that Balance training is important as it can improve the postural alignment of the body & develop coordinated movement. It’s best to develop balance early in the exercise program. Then all of your cardio, resistance & functional exercises should be performed with your body centered in proper alignment.

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