As the Indianapolis Colts travel to Miami today to take on the New Orleans Saints in Super Bowl XLIV, reports surfaced last evening that Pro Bowl defensive end Dwight Freeney flew to South Florida on Friday to initiate treatment on a right ankle injury.
An ankle sprain occurs when a force, which typically occurs while running, jumping, or with a sudden change in direction, results in a stretching or a tear occurs in the ligaments of the foot and ankle complex.
Eighty to eighty-five percent of ankle sprains occur when the foot or ankle “rolls” in, or underneath the body. This causes damage to the complex ligamentous structure on the outside of the ankle.
The main ligament effected is usually the anterior talofibular ligament, which can be found at the four o’clock position of the lateral malleolus, or outside ankle bone. With more severe sprains, the calacaneofibular ligament, which can be found at the seven o’ clock position, is affected as well.
These two major ligaments are a part of a larger group which are designed to protect one of the most complex joints in the human body from excessive movement.
Though the Colts have insisted in multiple reports that Freeney has a low ankle sprain and not a torn ligament, a team spokesman has classified the injury as a third degree low ankle sprain.
Based on the severity, ankle sprains are classified as one of three grades. A Grade I ankle sprain is classified as a stretching of the ligaments without tearing; Grade II is classified by some tearing and abnormal joint movement; Grade III usually describes complete tearing and severe ankle instability. After injury the area becomes swollen and painful to the touch, normal movement such as walking is very difficult.
The foot and ankle complex is to the body what wheels and tires are to a vehicle. They are the contact with the ground, controlling the body, giving it traction, and create a great deal of fine motor movements decreasing the amount of force translated to the rest of the body.
Just as vehicle performance would be affected by under inflated tires, Freeney’s injury, if he attempted to play, would limit the ability to cut and change direction.
One of the most impressive defensive players in the NFL, who Tom Brady once described as “the most intimidating player” in the league, would find that his bull rush, speed, and spin move would be vastly compromised, if possible at all.
Initial treatment involves elevation, ice, and rest. Ultrasound, electric stimulation, and treatment with the ML 830 cold laser may be indicated to reduce swelling and pain. A walking boot or crutches may be utilized to relieve the increased symptoms that occur with normal movement.
Moving forward, it is very important that physical therapy treatment focuses on increasing strength of the foot and ankle to improve stability and prevent re-occurrence.
Be wary of treatment programs that only rely on ultrasound or electric stimulation to reduce swelling. Additionally, programs must focus strengthening the muscles contained in the foot and ankle, as well as dynamic ankle strength of the muscles that cross the ankle joint. Treatment cannot be limited to traditional ankle strength testing.
Many patients receive and are prematurely discharged from physical therapy because of strength testing. Ankle sprains rarely occur because of a lack of strength; many times, the person presents with maximum strength in testing. Sprains tend to occur many times because, from a neuro-muscular standpoint, the muscle cannot recruit the strength fast enough to prevent injury.
Treatment programs usually focus on a return to traditional strength patters versus dynamic strength, which could be one of the reasons that re-injury rate, which is 20 percent in the everyday population, and is higher in the athletic population, is so prevalent.
As with any injury or illness, prevention is key; participating in a comprehensive Prehab or injury prevention program can actually help to prevent this injury or reduce the severity when injury occurs. If an injury does occur, it is important to be armed with knowledge on how to evaluate proper protocols in order to give yourself the best chance at a full recovery.
Christopher Stulginsky, PT is the managing partner of Ayrsley Town Rehabilitation, in Charlotte, NC. He is a Prehab Network Specialist, an 830 Cold Laser Certified Premier Provider and certified by the prestigious Titleist Performance Institute. Christopher has provided injury coverage to numerous websites most notably Deadspin, Redskins.com and NFLSportchannel.