Doc on Deck: Ankle injuries in youth sports

March 27, 2019

By Dr. Erin Hassler, DAT, MS, ATC, LAT, PES

Athletes, coaches, parents and fans want thee winning edge. Well, as athletic trainers, we can be that edge. The level of care that we are able to provide for our athletes and patients, can be the difference in the next touchdown, buzzer beater or first place medal. In order to provide this care, athletic trainers must stay abreast of the latest information and current standards in healthcare.

One of the things that makes athletic training so unique is the ability to develop your own approach to an injury. Let’s take a lateral ankle sprain for example. Athletic trainer “A” may choose to apply pre-wrap, while Athletic Trainer “B” applies the tape to bare skin. AT “A” may choose to apply the figure-8 first, while AT “B” opts for the stirrups and horseshoes first. Both clinicians provide a reliable form of protection and support to the ankle, but is one better than the other?

ankle injuryHow many of us are asked questions like this in our everyday lives? Last week at my son’s basketball game, another player sustained a lateral ankle sprain. Because you know who always has a fully stocked kit and table in the “mommy wagon”, and I am an awful spectator, of course I performed a quick evaluation and taped this player. It was then that he told me that this was a reinjury.

After the game, I gave the care instructions to the parents. I recommended that the ankle needed to be protected and supported by ankle tape or bracing for at least the rest of the season. From the crowd of surrounding parents came a load of comments and suggestions on care like:

• “Soak it in Epsom salt.”

• “Don’t walk on it.”

• “Make sure to ice it.”

• “Braces make your ankles weak.”

Enough! I was reminded at this point how athletic trainers are sorely missed at the youth sports level. The opportunity to change the trajectory of these athletes and keep them healthy by educating them and their parents is wide open. So I’ll get the ball rolling.

Here are Doc’s 5 Tips on ankle injury care and prevention for youth athletes:

  1. Prepare – Do your homework. No matter whose name is on the shoe, injury prevention is no guarantee. Most athletic shoes are mass produced and designed to fit a wide range of people. It is important to know what shoe is appropriate for what sport. For example, using a running shoe in a court sport is not wise. It places the foot in a less stable position when landing from a jump. Does the athlete pronate or have a narrow foot? An off the shelf orthotic or heel cup may lend some stability to things.

  2. Protect, protect, protect – By ensuring that an ankle is taped or braced in high impact sports, the severity of injury is reduced. One of the great debates is whether this weakens the ankles or not. Regardless of varying opinions on the matter, I recommend that an injured ankle be taped or braced during athletic activity until full strength has returned. Ligaments are generally slow to heal and the athlete may need to play with tape or bracing the entire season. The opportunity to be taped properly prior to a youth competition may be difficult based on access to the properly trained professionals. In the interim, ankle braces a reasonable alternative. One of the benefits is that the braces can be applied whenever and wherever, no professional required.

  3. R.C.E. – No, it’s not a typo. The acronym R.I.C.E. (rest, ice, compression and elevation) has been used to manage acute injuries. Recently in my clinical practice, I have relied less heavily on the application of ice. While ice is useful for the reduction of pain, I have found that many my athletes and patients respond and recover more quickly with early active rest, compression and elevation without ice application. The goal for me is to keep the body’s natural inflammatory process going and allow the blood flow to continue carrying the healing agents to the injury. Lowering the temperature at the site can slow this process.

  4. Put in the work - The mobility of the ankle and power that can be generated at the joint is dependent upon the development and training of the surrounding tissues. This can be accomplished by incorporating flexibility, balance and strength rehabilitative exercises into a training regimen.

  5. Advocate – Properly credentialed athletic trainers can be the difference in not only the outcome of a competition but the outcome of the athletes. By requesting that athletic trainers be employed for youth sporting events, injury prevention and safe competition become more of a priority and not an afterthought.

Dr. Erin Hassler has almost 2 decades of hands-on experience at multiple levels of Sports Medicine and Sports Performance Enhancement. Credentials include but are not limited to: Advisory Board of Athletic Trainers, Board of Certification and National Academy of Sports Medicine Performance Enhancement Specialist.

Twitter: @drhassler

Facebook: @drerinhassler

Instagram: @drerinhassler

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