Ankle Injuries Article for Southern Standard

Although the UT-Knoxville Volunteers shut out the UT-Martin Shyhawks, 50-0, it was not without a little suffering. In addition to other injuries, two Volunteers suffered from ankle injuries. While Jarrod Shaw, offensive lineman, and Denarius Moore, wide receiver, were questionable, they played against Oregon.

The University of Tennessee Department of Sports Medicine does not release specific injury reports or more specificity beyond: Out, Questionable, Probable, or Active, so lets speculate what injuries these athletes could have sustained.

The most common ankle injury is a “sprain” resulting from a twist in the ankle. The most common are call inversion ankle sprains and is when the heel and bottom of the foot roll inwards. This can happen when a player steps on another foot, the player cuts but the player’s weight is on the outside of the foot, or when the player gets tackled low. Another name for these sprains is lateral ankle sprains. Lateral means outside, most of the damage with ankle sprains is on the outside of the ankle.

Inversion or Lateral ankle sprains have three grades of severity. The severity is dependent on how many ligaments are damaged. If you make the “OK” sign with you hand and then place it on the outside of you ankle with palm in and fingers down, your three fingers are roughly in the places of the three outside ligaments. For any future anatomists out there they are call (from front to back): the anterior talofibular ligament, calcaneal fibular ligament, and posterior talofibular ligament.

There are a couple grading systems for ankle sprains, but for simplicity, grade 1 is when the front ligament is injured, grade 2 is when the front two are injured, and grade 3 is when all three are injured.

Often athletes can get back in the game with a grade 1 ankle sprain, but grade 2 ankle sprains require more time off due to the increased instability. Acute treatment for ankle sprains, whether you are a Volunteer on the field or a Volunteer fan that stepped off the tailgate wrong, is RICE: Rest, Ice, Compression, and Elevation. The next step is getting motion and mobility back. Specific training of the outside muscles with strengthening and balance exercises are crucial to increasing the bodies ability to protect the damaged ankle.

Ligaments unfortunately do not shrink once stretched, so often the strengthening and balance is the most important to prevention and is often overlooked because it is generally after the pain has diminished and people return to general activity.

A couple newspapers reported that Denarius Moore was using a walking boot, a big bulky immobilizer that covers the entire foot and shin, but can be used with walking. This is a form of rest. By allowing the ankle not to have to control shifting while walking, there is decreased stress to the ankle joints.

Although ankle sprains generally pull all at the ligaments on the outside to cause the damage, the inside of the ankle can often have damage because of the compression, which results in swelling and bruising, but does not hurt the stability of the inside of the ankle.

Two other somewhat common results can occur with a lateral ankle sprain: a fracture of the fibula, the outside bone at the ankle, or a “high” ankle sprain. The fracture of the fibula will require cast immobilization or a surgical fixation.

The high ankle sprain is a tear in the ligament between the two bones of the lower leg, the tibia and the fibula. While these bones do spread as our ankle moves, too much will cause a tear. High ankle sprains generally occur with grade 2 or 3 ankle sprains and will require a much longer healing time. If the high ankle sprain is very unstable, it is not uncommon for an orthopedist to place a temporary screw to hold the two bones together to allow for healing.

Because of the quick return to active status, as a spectator in the peanut gallery, I assume that the ankle injuries sustained by Jarrod Shaw and Denarius Moore were grade 1 or 2 with no high ankle sprain involvement.

The Volunteers will see many more ankle injuries this year, lets just hope that they don’t make the grading scale and they get back to the field ASAP. Go Vols!

Zach Sutton, PT
Doctor of Physical Therapy
Master of Exercise Science
Board Certified Orthopaedic Specialist
Certified Athletic Trainer

Prenatal and Postpartum Exercise

On the first weekend of college football, you may ask, why in the world is there an article on prenatal and postpartum women in this week's sports medicine moment? Well, last week I became a proud father of a little baby girl, who was born at River Park Hospital’s awesome Family Birth Center.

To my wife and all mothers, you have my respect and admiration and therefore this sports medicine moment is dedicated to you.

I think it is obvious that I a proponent of exercise, and the benefits of exercise do not skip prenatal and postpartum women. During these times, exercise helps decrease low back and pelvic pain, maintain appropriate weight and increase Endorphins that lower risk of depression.

Recreational exercise such as walking, running and swimming can be continued throughout the prenatal period, but women should check with their OB specialist before beginning any new exercise program. Weight lifting for “toning” can often be continued during the first two trimesters. Team sports and recreational activities that have a higher risk for trauma, such as softball and bicycling, should be limited, but are best if avoided.

Robin Bell, a certified nurse midwife with Innovative Women's Health and Dr. Rene del Valle, endorses exercise, but states that exercise should be avoided if you experience extreme fatigue, have been placed on bed rest or have poorly controlled disorders such as blood pressure, diabetes, or seizures.

Recent medical literature links unnecessary pregnancy weight gain to childhood obesity. The Kaiser Foundation estimates that 36% of all children in Tennessee are overweight or obese. Childhood obesity increases many medical risk factors including diabetes, premature joint pain, and cardiovascular diseases.

Robin Bell states that she individually determines for her patients what amount of weight gain is necessary for a healthy baby utilizing a Body Mass Index (BMI) calculation. Generally, if a person is overweight prior to the pregnancy, less weight gain is necessary and but more weight gain may be recommended for someone who is underweight.

Low back pain is a common complaint due to the increased looseness of the pelvic bones from the hormone called Relaxin. Relaxin increases as early as 14 weeks and can remain into postpartum as long as breastfeeding is occurring.

Christi Gilliam, PT, who specializes in orthopedics and women's health at River Park Hospital, recommends an evaluation with a women's health physical therapist for women who experience pelvic or low back pain during the prenatal or postpartum period. She states that specific pelvic exercises during prenatal and postpartum can help control these episodes of back pain.

If you are expecting, talk with your OB specialist because prenatal and postpartum exercise could play a major role in the health and well being of you and your baby!

Zach Sutton, DPT, MS, OCS