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Ask Dr. Rick – January 2011

January 12, 2011

Athletic Ankle Injuries

Athletic ankle injuries are one of the most common sports-related injuries. Approximately 50-percent of these injuries are followed by residual pain, instability or swelling, and the majority of ankle injuries are created by occasional stress to the ankle.

An ankle sprain is actually a tear in the ligamentous complex of the ankle. There are three main structures that stabilize the ankle, the most common being the anterior talofibular ligament. That is the ligament in the front outside part of the ankle and this is most commonly injured ankle when the ankle inverts or you “roll” your ankle. This ligament is injured in 85-percent of lateral ankle sprains and can be the ligament that is most likely to create residual discomfort and possible impingement after an
ankle sprain.

The majority of ankle sprains create pain and swelling. Commonly, there is a pop heard, and commonly, it is difficult to bear weight after an ankle sprain. Ankle sprains are graded on a severity of one to three and the majority of ankle sprains can be treated non-surgically with ice, elevation, evaluation by a physician to rule out a fracture and subsequent physical therapy.

A light elastic wrap or an ankle brace commonly is used. and these can be very helpful post-injury and also be very helpful to prevent further damage to the ankle.

Current treatment of ankle sprains include protection, ice, elevation, physical therapy and prophylactics against ankle injuries should include strengthening exercises, tape or a light brace and appropriate footwear. If after four-to-six weeks continued pain is noted after an ankle sprain, the athlete should immediately see a physician to make sure there is no more severe damage either to the ligamentous structure or more severe damage to the bone or articular cartilage.

These injuries are not benign and should be treated with an evaluation by a sports physician and appropriate post-injury care and post-injury prophylactics.

Ask Dr. Rick

“Dr. Rick: I very much appreciate your column. I have been having discomfort in my neck after wrestling practice and it has not improved with two weeks of rest. What are your thoughts?”
– Larry Z.

Larry: Thank you very much for your question. Commonly, wrestling injuries occur to the muscles of the neck and should be treated with anti-inflammatories, heat and rest. If after three weeks this has not resolved your pain, you need to see your physician for an x-ray and possibly a MRI to rule out any type of nerve- or disc-related trauma. If you have any pain going down your arm or tingling in your fingers, I would see a physician immediately and avoid any stress to your neck.

“Dr. Rick: I have a popping in my knee when I go up or down stairs or squat. This has not gotten worse and has not gotten better over the last two years. Do I need to see a doctor? Thank you very much.”
– Allison P., Chesterfield, MO

Allison: Popping in the joints is very common, so common and popping underneath the kneecap in particular. If you are not experiencing any pain, weakness or swelling in your knee, I do not believe you need to see a physician. If you are experiencing either the sense that your kneecap is slipping, you are experiencing pain or swelling, you need to be evaluated by your physician with an x-ray and possibly a MRI and appropriate physical therapy should be instituted. Popping can be common, and as long as you are having no pain, you do not need to be concerned. Thank you very much.

Dr. Rick’s medical tip for the month of December: When working out during the winter and especially if you are outside, use multiple layers and keep your joints and extremities warm.

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