Campaign pushes ways to fight ankle sprains

Orthopedists estimate an astounding 27,000 Americans a day sprain an ankle. It's the top orthopedic complaint and most common sports injury, among regular athletes and weekend warriors alike.

"People try to play through it, work through it," laments Dr. Glenn Pfeffer of the University of California, San Francisco, who sees half a dozen patients daily who improperly treated a sprain and thus months later remain in pain.

Why? Because "no one's ever said to us, 'If you don't take care of your ankle sprain, you can run into trouble."'

A sprain is a stretching or tearing of the elastic ligaments that connect bones in the ankle, caused when your ankle sharply turns inward or outward.

Studies show up to 40 percent of sprained ankles lead to recurring sprains, unstable joints, arthritis-like pain or other complications. And the earlier in life that first sprain, the higher the risk for repeat problems.

So the American Orthopedic Foot and Ankle Society this month is mailing all high schools a video explaining how young athletes can prevent sprains by wearing ankle braces -- and joint specialists are advocating at-home exercises to help many sprain sufferers prevent future injury.

For initial sprain treatment, think RICE: rest, ice, compression with an elastic ankle wrap, and elevation.

But significant sprains need more -- a brace to protect the recovering joint, range-of-motion exercises to prevent stiffness, and muscle strengthening and balance-restoration exercises to prevent future injuries, says Dr. Michael Bowman, a Pittsburgh orthopedist who also helps treat the Pittsburgh Steelers.

Can you do that at home? Bowman studied 64 patients with moderate to severe sprains. Everyone got a brace. Half got physical therapy three times a week; the rest got an at-home kit Bowman designed with day-by-day exercise instructions. It also included such equipment as elastic bands, sold in sporting-good stores, to put around chair legs and stretch the ankle inward or outward, and rocking boards to stretch and flex.

Both groups recovered equally well, Bowman will tell a meeting of the American Academy of Orthopedic Surgeons this week. But at-home treatment cost about $120, versus $650 for physical therapy.

Pfeffer stresses that anyone with a severe sprain or continuing pain should see a specialist. But he says many sprain sufferers can buy a drugstore brace for $25 to $50 and then -- once swelling diminishes enough to walk normally -- try three even simpler versions of Bowman's exercises without buying special equipment:

-- Put the front of your foot through the handles of a plastic grocery bag containing a can or two of soup and lift your toes toward the ceiling. Hold it for 3 seconds; repeat 10 times twice a day.

-- Stand on a stair and stretch the heel downward over the edge, keeping the knee straight, until you feel a pull in the calf and bottom of the foot. Stretch for 30 seconds, four to six times a day.

-- For balance, stand on just the injured leg with your eyes closed, building up to 30 seconds and repeating three times twice a day.

But preventing that first sprain is best -- and Dr. Carol Frey of Los Angeles' West Coast Sports Performance says wearing a brace during sports, especially sprain-prone ones like volleyball or tennis, can help.

Many athletes tape their ankles, but tape begins loosening after just 10 minutes of exercise. So Frey studied bracing among 402 Southern California high school volleyball players.

Seven of the 140 male players suffered a sprain in a season, none of whom wore the brace. Fifteen of the 262 female players sprained ankles, only five while wearing the brace.

Frey's study is continuing to follow more than 3,000 additional players to see if other factors like weight or preseason conditioning play a role, and if girls' ankles truly are more vulnerable.

Lauran Neergaard covers health and medical issues for The Associated Press in Washington.<