The Spurs Team Physicians are David Schmidt, M.D. and Paul Saenz, D.O. Together with Ralph Curtis, M.D., Tim Palomera, M.D., Marque Allen, D.P.M. and Richard Steffen, M.D. they comprise Sports Medicine Associates of San Antonio, whose mission is to be the preeminent provider of medical and surgical care to all athletes and active individuals.

PAINFUL SPRAIN
Manu Ginobili falls to the floor after spraining his ankle against Shaquille O'Neal (L) on January 20, 2006. (Victor Baldizon/NBAE/Getty)

Prognosis Spurs: Ankle Sprains

by Tim Palomera, M.D.
Sports Medicine Associates of San Antonio

Many patients come into the office with complaints of chronic ankle pain. Their concerns typically center around stress fractures or early arthritis. More often than not, however, a review of prior injuries reveals a history of an ankle sprain that did not receive the proper rehabilitation. Perhaps only rest was prescribed with a return to normal activity soon afterwards. Patients then notice that their pain limits the activity they wish to pursue or that they reinjure the ankle in a much easier fashion.

Most ankle injuries -- from the “twisted” ankle to severe sprains with significant swelling and bruising -- require not only rest but also some degree of restrengthening. We are not talking about strengthening to produce a bunch of Arnold Schwarzeneggers, but simply retraining the protective musculature of the ankle and lower leg itself.

The ligaments that connect the bones in the foot, ankle, and lower leg are stretched, torn, or otherwise injured during an ankle sprain. Physicians grade the severity of the sprain based on the damage done to the ligaments themselves, ranging from mild (grade I), to moderate (grade II), to severe (grade III). During the injury, however, some damage is done to the muscles themselves, particularly to the nerves within them. These nerves give feedback to the muscles firing them to protect the ankle. It is these nerves and muscles that need retraining to protect the ankle and be the “shock absorber” for the joint so the ligaments have a chance to heal.

The rehab process usually begins with a two- to three-day period of rest, elevation, and ice to reduce swelling and begin the healing process. This initial period may even encompass a course of immobilization and non-weight bearing in the more severe ankle sprains. To return the joint to its normal function, range of motion is begun early and weight bearing as tolerated with a walking splint is promoted.

ANKLE SPRAIN ILLUSTRATION
Courtesy A.D.A.M. and National Institutes of Health.
After good range of motion is achieved, a series of strengthening exercises is begun that involve moving the ankle in its four major directions: towards the head, towards the floor, to the left, and to the right. All of these can be done at home in a relatively simple manner with an exercise rubber band or tubing.

Activity is then progressed using the patient’s sensation of pain as a guide. Finally, any activity involving hard running or change of direction may be done last. Soreness with return to activity is common. However, it is usually transient and not detrimental to the healing process itself. Surgery is uncommon and the patient can expect a return to normal activity.