Below is the latest article in a series of exclusive articles written by Dr. Kenneth Ransom for the Buckeye Prep Report. The series of articles represent both Buckeye Prep and Dr Ransom’s commitment to youth basketball. Enjoy!
Rolled Ankle Injury in Adolescent Basketball Players
The inversion ankle sprain is the most common traumatic injury in basketball players and the injury occurs more frequently in basketball than any other sport (7.74 per 10,000 high school basketball athlete exposures). A sprain is defined as the stretching or tearing of a ligament. There are three ligaments that attach the fibula to the foot that can be stretched or torn when the ankle is turned in, or inverted. (Fig 1) This injury usually occurs when the player is landing from a rebound or making a sharp lateral cut. Besides pain, especially with weight baring, there is frequently swelling and even bruising depending on the severity of the ligamentous damage. Grade I, stretch with minimal swelling and no bruising; Grade II a partial tear with swelling and minimal bruising; Grade II is a complete tear with extensive swelling and bruising.
The injury that adolescents suffer may be different than what happens in young adults. Since the bones are still growing and the growth plates have not fused in boys up to 15 or 16 years of age, they are weaker than the surrounding ligaments especially in the area of a growth plate. So when an adolescent basketball player rolls his ankle he is more likely to injure the bone where the ligament attaches than the ligament itself. Of more concern is the possibility of damaging or even fracturing the growth plate, which is actually the weakest portion of the bone. (Fig 2) Injury or fracture of the growth plate can result in abnormal growth if the injury is not recognized and properly treated. Swelling and bruising of the ankle after an inversion injury in an adolescent athlete should be evaluated by a physician and possibly x-rayed or undergo an MRI to make sure that there is not a fracture.
Minor ankle inversion injuries with little or no swelling and no bruising can be treated with rest, ice and elevation for the first 24 hours to minimize the swelling. Anti-inflammatory medication can also be given to reduce the pain and inflammation. In 48 hours the player usually can start passive range of motion exercises but only weight bare to pain tolerance. If the ankle hurts to walk on, crutches or additional time at rest may be necessary. Activity is increased as the soreness subsides but “if it hurts don’t do it”. Stretching and movement of the ankle within 48 to 72 hours is important therapy to prevent the joint from getting stiff and weak which can prolong recovery. Typically 5 to 7 days of rest and therapy are needed with a minor injury before the player can resume some basketball play. It is very important not to re-injure the ankle so activity that produces inversion forces on the ankle should be initially avoided.
A program of continued stretching and exercising the ankle and lower leg is an important part of rehabilitation and continued maintenance following an ankle injury. There may also be some benefit of wearing an ankle brace or taping the ankle for additional support when playing. The highest risk factor for suffering an ankle sprain is having had a previous ankle sprain. In one study 75 % of high school basketball players that sustained an ankle injury had had a previous ankle injury versus only 33% that had not had a previous injury. Repetitive ankle injuries can result in a chronic problem and hinder the player’s ability to progress in the sport.
When should the player be seen by a physician? Anytime there is swelling and associated bruising, especially in the adolescent. Not only is initial treatment important to promote proper healing but continues rehabilitation and maintenance therapy is necessary to prevent further recurrent injuries and possible long term pain and disability. In addition, players that routinely stretch out and exercise their leg muscles have a decreased risk of sustaining an injury even if they roll an ankle. And finally, good nutrition with plenty of carbohydrates, protein, calcium and vitamin D makes the bones and soft tissues stronger and less susceptible to injury, especially in adolescent athletes.