When the joint is a star

Wednesday, February 3, 2010

All it takes is a Super Bowl to make a sprained ankle into front page news. Normally, Dwight Freeney and his damaged joint would be of interested to diehard Indianapolis Colt fans and a few hard core sports bettors, but with the upcoming NFL championship game, the injury has taken on national significance. Timing is everything in sports and the same can be said for Mr. Freeney’s injury. Rumors abound that it is so swollen that he can’t walk, has major swelling of the ankle and may have torn a ligament. It all sounds so bad, but perhaps it’s time to review definitions and anatomy.

The ankle is a joint that connects the tibia and fibula (the shin bones) to the talus of the foot and allows the foot to flex and extend. The lateral part of the ankle (the outside part where the big bump of bone called the lateral maleolus can be felt) has three ligaments that protect the ankle from rolling over, while the medial part of the ankle (the side of the ankle above the big toe) is protected by a thick band of tissue called the deltoid ligament.

Ligaments are thick bands of tissue that attach to bone on each side of the joint and provide stability and prevent the ankle from moving in unintended directions. A sprain occurs if a joint is stressed in one of those unintended directions and causes the ligament to stretch or tear. The severity of damage can be graded. A first degree sprain occurs when the ligament is stretched but no fibers are torn. Second degree means that some fibers are torn but the ligament is still intact and third degree means that the ligament is completely torn.

Lateral ankle sprains are common and due to inversion injuries, where the ankle roles inward and stretched the ligaments on the outside of the ankle, most often the anterior talofibular ligament (the ligaments are named for the bones where they attach). Whether the ligament is stretched or torn, some bleeding occurs and the body activates its inflammatory response. Swelling and tenderness make it hard to walk telling the brain that the joint is injured and needs to be protected. The degree of damage dictates how long it might take for the ligament to completely heal. It takes longer to repair a completely torn ligament than one that is mildly stretched, but given time, the body can repair all.

Sprain treatment relies of RICE: rest, ice, compression and elevation. Add ibuprofen as an anti-inflammatory to help with the pain and swelling and the healing process starts. It may take six weeks or more for the body to repair the ligament completely but most people are good to go in a couple of weeks. Just to be complete, while this treatment usually holds true for lateral ankle sprains, damage to the deltoid ligament may require surgery for a fix.

Mr. Freeney is in a difficult position. The ability to play in the Super Bowl may be a once in a lifetime opportunity and the ability for him to perform will depend upon how much discomfort he can endure from a less than healed injury. Whether it is a first, second or third degree sprain, his ankle injury will be an issue. He may be able to ignore the pain signals from his ankle and play well, or it may be that the body’s defense mechanism may overwhelm his competitive drive. The adrenalin of the situation may allow him to win the battle with his body but it also may impact the quality of his performance. The only certainty is that a sprained ankle will not stop an elite athlete from the attempt to win.

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