High Ankle Sprains Are Difficult To Heal

Typical ankle sprains are minor problems that heal fairly quickly. But college football is seeing more high ankle sprains than in the past. These are not well understood, and their healing time can vary widely. As Fighting Illini football trainer Nick Richey explains, there is no consensus yet on how best to treat these injuries.

All attempts at progress are predicated on the idea of making life better for people. In the world of football, equipment and artificial surfaces have improved to the point some injuries are less common than in the past. However, new injuries crop up to replace previous ones.

There has been an increase in high ankle sprains among football players according to Illinois football trainer Nick Richey.

"Because the athletes are bigger, faster, stronger, and they're seeing more artificial surfaces, I think we're seeing an increase in the number of high ankle sprains."

Trainers and equipment people all over the country are looking for solutions, with only modest progress.

"There aren't many products, whether it's taping or bracing, that are going to prevent most of these, if it's going to happen, it's going to happen.

"What we try to do is work with our guys in the weight room on balance protocols, ankle strengthening exercises and flexibility in the lower body"

No one has developed a guaranteed solution to aid healing and return an athlete to playing condition in quick fashion.

"You ask 10 people in the country right now on management plans and return-to-play protocols for high ankle sprains, and you might get 10 different answers. There's no real great anecdotal evidence on what is right and what's not.

"You've got people who inject these and then put them in a cast. You've got people that put them in a cast. You have people who put them in a walking boot. You've got people who put them on crutches and walking boot or a cast for different periods of time.

"And then you follow that up with a progression of return to activity. And a progression from activity to a return to full participation. We've tried several different combinations of those things."

Richey has now developed general guidelines for dealing with high ankle sprains.

"Realistically, we have our own standards now, from time of injury to return to play, depending on the degree of severity of the high ankle sprain. It's just not one of those things that has a simple fix to it. It's not one of those things guys are coming back really quick from.

"With the amount of running and cutting these guys have to do, they have to be feeling 100% before they can return. Otherwise the confidence isn't there, the ability isn't there, and the likelihood of them getting reinjured is there. That doesn't serve anybody.

"I get them to the point where I make the recommendation to the doctor, and then the doctor makes the final call. The coaches abide by that decision."

All health care professionals are dependent on accurate information from their patients. Many football players are good at playing through pain, making a proper diagnosis and treatment regimen more difficult.

"I think that's something that's gone on ever since football's been played. For the most part, our guys are all pretty good. Even in Michael's (Hoomanuwanui) case, Michael was wonderful to work with. You could push Michael, you could tell he wanted to get better. He wanted to play, he wanted to practice and go do his thing.

"I think the first time Michael got hurt, he was out about a month. And then he reinjured it, and it was another three weeks before he played again.

"Unless you have a broken bone, a huge gash or something pointing in the wrong direction, it's hard to tell sometimes exactly what a guy is feeling. You can tell him what he should be feeling, what he's going to feel, what he should expect.

"We try to educate our kids as much as possible on what they're dealing with. But then we have to rely on them as a primary source of information, for whether we can progress them to the next level of activity."

Recurrent stress fractures and concussions are also becoming more prevalent in football. Richey discusses those issues in part five of this 8-part report.

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