Ankle Advice

By Dana Lynn Varon, Seattle WA
Ultimate First Aid (http://www.discnw.org/firstaid/index.htm)

It doesn't take a survey to know that sprained ankles are the most common injury in Ultimate. Attend one night of league play and watch the players hit the potholes and drop like flies.

On-Field Management

When an ankle injury occurs, the player should stop immediately. The player should not try to walk or limp on the ankle until it has been evaluated. The sock and shoe on each foot should be removed so swelling, color, and temperature can be assessed and compared to the uninjured foot. If severe swelling occurs immediately, the ankle is unstable, the area below the ankle is pale or bluish, cold or numb, or the ankle appears deformed or bent the wrong way, the player should immediately be helped to the nearest medical facility. Every care should be taken that the player avoids putting weight on the affected ankle.

If compromised circulation or an obvious break is not suspected, and the player is not in too severe pain to have the ankle touched, an ACE bandage should be applied. Wrap the ACE two times around the ankle, apply an ice pack to the bandage, and continue to wrap the ankle and ice pack. The ACE should be wrapped upward, in the direction of the heart, to encourage return circulation.

The ACE bandage should be snug, but not tight. You should be able to easily fit two fingers under the ACE wrap. Be careful to reassess the wrap frequently to make sure ankle swelling doesn't cause the bandage to be too tight.

After the ankle has been wrapped with the ACE and ice, the ankle should be elevated and the player should be offered some water and either ibuprofen or acetaminophen (Tylenol). Aspirin should be avoided immediately following an injury as it can lead to increased bleeding. Keep in mind that the player may be dazed or confused, and make sure to ask directly if he/she has ever had an allergic reaction to the medication you are offering.

If there is swelling, the player should remain with the ice in place and the ankle elevated for ½ an hour. Then the player should attempt to stand and shift weight slowly onto the ankle. If absolutely no weight-bearing can be tolerated, the player should be assisted off the field. If able to tolerate weight-bearing, the player should remain out of play for the rest of the game and begin home care measures. (See home care for ankle injuries).

If there is no swelling and the player can bear weight without pain, the player can slowly begin testing the ankle to decide if the ankle is stable enough to return to play. The player should try hopping up and down on the affected ankle. If this does not cause pain, the next test is to try jumping from side to side, then running and cutting. If none of this produces pain, the player can return to regular play. If, however, any discomfort is noted, the player should leave the game, and home care measures initiated, until the ankle can withstand regular play without pain or discomfort.

Home Care for an injured ankle

RICE treatment is the hallmark of home care for an injured ankle. RICE stands for rest, ice, compression and elevation. Anti-inflammatories are also an important part of the healing process.

Rest, in terms of ankle rehabilitation and management, means avoiding activities that cause pain or discomfort. With a severe sprain, ankle immobilization may even be necessary. This is done either with a cast or a brace.

Ice helps reduce pain and swelling and promotes healing. Ice should be used in place of heat as long as swelling persists. Ice should be applied for 20 minutes on then 40 minutes off either every hour or several times a day, depending on the extent of the swelling. Ice should not be applied directly to the skin.

A pillowcase or a T-shirt or over two wraps of the ACE bandage are a good thickness between the ice and the skin. Compression is used to support and immobilize the ankle. An ACE bandage or an ankle brace works well. When using either, make sure that at least two fingers can easily be slipped between the compression device and the ankle.

Elevation: the ankle should be elevated at or above the level of the heart whenever possible as long as swelling persists to minimize swelling and encourage circulation return to the heart.

Anti-inflammatory and/or analgesic medication can assist in decreasing swelling and pain. Ibuprofen is good for both pain and swelling, but is hard on the stomach and can cause kidney damage if used in large doses or for long periods. Make sure you don't exceed 2400 mg/day unless advised to do so by a medical professional, and it should not be used regularly or for longer than 4-6 weeks. Aspirin, acetaminophen (Tylenol) and naproxen sodium (Aleve) can also be used for short periods for pain and/or swelling. Aspirin should be avoided for players under 21 years of age due to the potential risk of Reye's Syndrome.

The amount of time it takes for an ankle injury to heal depends on the severity of the sprain. Ankle sprains are categorized by three grades of severity.

Ankle Rehabilitation

Strengthening and flexibility exercises are crucial in the treatment of an ankle sprain. Without them, a sprained ankle has a tendency to become stiff and weak and can sprain again easily. These exercises should be initiated as soon as they can be done without causing pain or discomfort.

Flexibility exercises are aimed at restoring and maintaining range of motion and should be done at regular intervals throughout the day.

When to Seek Professional Care

Many Ultimate players are either uninsured or underinsured and are reluctant to seek professional care and advice. Although few ankle injuries will require surgical repair, many may need stabilization. Severe sprains, some Grade 2 and all Grade 3, require professional medical advice and intervention, as home care may result in improper healing and a resulting weak or stiff ankle.

You should seek immediate medical care if:

Medical care should be sought within 24 hours if:

Consult with a provider within 3-5 days if: