By Dev K. Mishra, M.D., President, Sideline Sports Doc
A lot of attention in the sports media this week is focused on Patriots tight end Rob Gronkowski’s injured ankle. It seems the betting line will move considerably once the fate of this famous ankle is known. (“No boot on the ankle today! Does this mean he will play?”)
Gronkowski apparently has something called a “high ankle sprain”. A high ankle sprain- medically known as a “syndesmosis” sprain- is not very common in the younger age groups but it can happen in adolescents and definitely in teenagers.
The syndesmosis is a sheet of tissue that helps to hold the two main leg bones together in the correct position. Injuries to the syndesmosis happen in a very different way than a common ankle sprain. The common sprain happens typically by “rolling” the ankle. By contrast the high ankle sprain happens with a twisting type of movement such as a planted cleat staying in place and the body rotating the other way, or sometimes by another player falling onto the back of a player’s ankle. Gronkowski’s injury was a severe twisting injury that occurred when he was being tackled.
The young athlete with a high ankle sprain will usually be able to tell you that the injury occurred by twisting or during a tackle. It’s possible that they will tell you there was a “pop” or “tearing” sensation. Swelling can set in quickly, sometimes even within a few minutes. They will typically be unable or unwilling to put weight on the ankle. A young athlete with significant pain and some of the above signs and symptoms should be seen in the local emergency department urgently.
You have a high ankle sprain. Now what?
If the physician determines that the young athlete has a high ankle sprain the treatment is usually based upon the “grade” of the sprain. With a mild sprain there may be a brace, ice, and need for crutches. With moderate or severe sprains I will typically place the ankle in a boot, with the amount of time in the boot based upon the severity of the sprain and the progress over a couple of weeks. We start physical therapy as early as possible.
Healing of a high ankle sprain can take a long time. For “moderate” sprains I’ve seen these take 12 weeks to return to comfortable sports participation with good ability to sprint, cut and jump. For severe sprains it can take 16 weeks to get back, depending on the sport.
The importance of physical therapy
For high ankle sprains I feel it’s very important to get the young athlete in to a good physical therapist. One of the most important parts of healing is to get a sense of balance back. This is quickly lost after a high ankle sprain, and getting good balance sense back is needed for return to sport, and to minimize the chance of another sprain.
A high ankle sprain can take a long time to heal, and can cause problems that last even longer. Treat these properly and treat them with respect, right from the start.