ANKLE SPRAIN: WHEN CAN I PLAY AGAIN

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Recovery and return to play after ankle sprains will vary depending on the severity of the injury, and the injured athlete’s unique healing response
  • Sport specific reconditioning after an ankle sprain often takes much longer than you think
  • For the common Grade 1 sprain, I typically see return to play with a brace at 1-2 weeks after injury
  • For the common Grade 2 sprain, I typically see return to play with a brace at 4-5 weeks after injury

There’s never a good time to be injured. As we come up to the end of many winter sports, SwollenAnkle_2players often have their eyes on championships or important tournaments. When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?” Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.” The reality, however, is that full recovery as I outline below can often take much longer than that. Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play after ankle sprains.

Treating the Injury

The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches, and typically “RICE”: rest, ice, compression, and elevation. Ankle sprains are classified by physicians in “grades”, ranging from Grade 1 (mild) to Grade 3 (severe, with complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. This will often involve referral to a qualified physical therapist or working with your athletic trainer. The physical therapist and athletic trainer are highly trained in techniques to restore function of the injured ankle, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries we’ve learned over the years that early involvement by an athletic trainer or physical therapist speeds up return to play.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports. Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together- How Long Until You Can Play Again?

ssd.bannerI’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Additionally, each person responds differently to injury and healing. So each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on real world experience from my orthopedic practice.

  • “Mild” or Grade 1 ankle sprain: Brace or Ace wrap for 3-5 days, Return to play with ankle brace 1-2 weeks
  • “Moderate” or Grade 2 ankle sprain: Brace 2 weeks, Rehab and conditioning 2 weeks, Full return to training 4-5 weeks after injury
  • “Severe” or Grade 3 ankle sprain: Boot or brace 3 weeks, Rehab and conditioning 4-6 weeks, Full return to training 7-9 weeks after injury
  • “High Ankle” or syndesmosis sprain (highly variable return times): Boot or cast 3 weeks, possibly crutches as well, Rehab and conditioning 6-12 weeks, Full return to training 9-15 weeks after injury

OSTEOARTHRITIS & YOUR KNEES

More than 27 million Americans have OA and the knee is one of the most commonly affected joints. There are many treatment options available including several non-pharmaceutical and non-surgical choices.

WHAT IS OA OF THE KNEE?

Osteoarthritis is commonly known as “wear-and-tear arthritis,” but did you know that young people get it, too? Osteoarthritis, or OA, is the most common type of arthritis; it happens when the body’s natural cushioning—cartilage—wears away between joints. Think of cartilage as a shock absorber for your knees; less cushion results in bone rubbing against bone, and that can cause stiffness, pain, swelling decreased mobility and bone spurs. OA typically develops slowly and becomes worse over time. There is no cure for OA, but there are many treatments available that can ease the pain and help people to retain or regain their mobility.

WHAT CAUSES OA?

The ability of cartilage to heal decreases as people age, but the causes of knee OA vary. It can be hereditary or can be the result of injury, infection, overuse or excess weight.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As it does the protective spaces between the bones decrease resulting in bone rubbing on bone, producing painful bone spurs.
  • Obesity is the No. 1 driver of knee OA and the No. 1 cause of disability in the U.S.
  • Weak muscles around the knee can cause OA
  • Every extra pound of weight adds 3 to 4 pounds of extra weight to the knees; extra weight increases pressure on knees
  • Genetic mutations can make a person more likely to develop knee OA; abnormalities of bones surrounding the knee joint can also cause OA
  • Women ages 55 and older are more likely to develop knee OA
  • Athletes who play soccer, tennis or run long-distance may be at higher risk
  • Activities that cause a lot of stress on the joint—kneeling, squatting, lifting heavy weights of 55 pounds or more—can cause OA of the knee due to repetitive stress
  • Those with rheumatoid arthritis or metabolic disorders are at higher risk to develop knee OA

WHO GETS KNEE OA?

  • More than 27 million Americans have OA; the knee is one of the most commonly affected joints with more than 11 million people diagonosed in the U.S.
  • Chances of developing OA increase after age 45 and according to the Centers for Disease Control, the average onset of knee OA is 55 years old.
  • More than 40 percent of knee replacements happen over the age of 65, so many people have to find other forms of conservative, non-invasive and non-addicting methods to control pain and maintain an active lifestyle.
  • Women aged 55 and older are more likely than men to develop knee OA.

WHAT ARE MY OPTIONS IF I HAVE KNEE OA?

There are many options available for those with knee OA, including several that are non-pharmaceutical and non-surgical choices. You’ll want to talk with your health care provider about the treatment or combination of treatments that’s best for you; here are some you may want to explore and consider:

MOTION IS MEDICINE

  • Activities; walking, strength training, swimming, biking, yoga, tai chi and other low-impact activities may help with pain and function of the knee
  • Lighten up; a 2007 review found that overweight people who lost a moderate amount of weight had reduced pain and disability from knee OA
  • Braces, sleeves other devices can help reduce pain and stiffness, take weight load off the affected joint and improve confidence and function for those with knee OA
  • Transcutaneous electrical nerve stimulation, or TENS uses electrodes to send a mild current to the affected joint, which can help alleviate pain
  • Acupuncture, balneotherapy (soaking in warm mineral springs) or heat or cold therapy may help ease joint pain for some people with knee OA
  • Medications can include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, prescription medications, corticosteroid or hyaluronic acid injections and more
  • Glucosamine and chondroitin sulfate, some studies have shown, can reduce pain and improve physical function; natural supplements, including avocado, soybean, capsaicin and turmeric, may have anti-inflammatory benefits for some people
  • Joint replacement or joint-preserving surgery may be an effective option for some people

DJO 600

HOW CAN DONJOY HELP?

If you have mild to severe knee OA and experience intermittent to chronic knee pain, or if you are not a candidate for surgery, ask your doctor about the science of bracing. DonJoy pioneered the concept of functional knee bracing more than 30 years ago and offers the most advanced technologies available.

Most importantly, they can help people return or continue to live an active lifestyle. No one person with knee OA is treated the same, so it’s important to look at all of the available solutions to find what is right for you. Some people may need a lot of off-loading capabilities, while others need just a slight push and comfort that surrounds the muscles around the knee.

Meniscal Tear: Is Physical Therapy a Good Option?

Authored by Dennis Carter, PT, MPT, physical therapist and clinic director at ATI Naperville South

meniscalA meniscal tear in the knee is an injury to the cartilage that absorbs weight through the joint. Tears can occur as a result of sudden trauma such as twisting, or over extending the knee. Tears can also develop due to degenerative changes over time. Meniscal tears can limit a person’s ability in squatting, twisting, athletics, or performing activities at work and at home. A recent article in The New England Journal of Medicine supports that there is a high percentage of successful outcomes for patients seeking physical therapy as their first choice of care for a torn meniscus in the knee. This is a welcome statement to those who may have been recently given the diagnosis of a meniscal tear, and are weighing options for a plan of care.

Many times when patients are given a diagnosis, they form the opinion that they are set on a defined path without options.  A diagnosis of a “tear in the knee” is often associated with it getting “fixed”, which can be upsetting and discouraging when patients consider their future activity level.

Growing evidence supports physical therapy as a viable alternative to early surgical intervention. Physical therapy can provide treatments that reduce the pain and inflammation associated with the acute nature of a tear. Modalities such as electrical stimulation, compression, and ice are frequently used to reduce acute swelling and pain. Manual care provided by a Physical Therapist can help to restore range of motion, improve joint mechanics, decrease swelling, and increase muscle flexibility. Specifically prescribed therapeutic exercises can address deficiencies in strength and muscle control that may have resulted from, or even contributed to events leading to the tear.

Physical therapy has been a successful option for many. More research is needed to identify what factors determine the characteristics that will identify who will be successful with either treatment option. Deciding if it is right for you should be done as part of a team. The decision should be made with your doctor and therapist based on several factors: the mechanism of injury, history of progressive symptoms, a thorough clinical examination, diagnostic studies (x-rays, MRI), and your goals/aspirations for future activity level. The decision is not simply black and white and often comes down to individuality.

When the conservative approach of therapy is chosen, patients should be well educated in the nature of the injury, the avoidance of activities that could negatively impact their progress, and the expected progressions they will encounter. Treatment will focus on progressive strengthening, range of motion, flexibility, balance, gait training, and functional activities. Considerations are also given to address individual deficiencies that may have contributed to the nature of the injury: weakness of hip and thigh muscles, foot mechanics such as over pronation (flat feet), inflexibility of the calf and hamstring muscles.

ATI 300x250Whenever affected by any health issue or concern, awareness of options is prudent. Meniscal tears are no different. Custom treatments in physical therapy and dedication to prescribed home program allow many people to return to a high functional level following a meniscal tear in the knee. Please be sure to discuss details of your injury and all options with your doctor. If you have more questions please reach out to one of your local physical therapists who can help to answer your questions.

Why Every Man Needs To Incorporate Yoga Into His Workout Routine

Why Every Man Needs To Incorporate Yoga Into His Workout Routine Hero Image

If you’re a guy and you’re not doing yoga, you’re missing out.

For some men, yoga is still considered soft and fluffy—a “non-workout” or something just for the girls. But this is far from reality. These days, more guys are starting to pay attention and take note. If you’re serious about your sport, or overwhelmed with the everyday chaos of life, then the practice of yoga will benefit you on all levels, inside and out.

Now, whether you’re new to the mat or you’re already a seasoned sun saluter, you know that yoga is more than just physical. It’s the full package. It’s the workout you may want, but what it does on the inside is where the magic is. For guys, yoga helps to cultivate calm, alleviates stress and anxiety, and brings a quieter perspective to your life. Yoga can be a workout and work-in.

Yoga is a practice of finding space through the body, through the mind, and through the daily grind. This is something that all men could use a little more of.

So now is the time to step in and step on the mat, to give it a go and see how your mind, body, and life change for the better.

The truth is, some guys think that yoga makes them less of a man. That couldn’t be further from the truth.

If that’s not enough of case for you, here are five reasons why every man should practice yoga:

1. Yoga will make you better at your workout of choice.

Whatever your workout is, yoga will help. Whether you’re a casual CrossFitter, a pavement-pounding runner, or an everyday adrenaline junkie, yoga will help you get better.

A regular yoga practice strengthens and lengthens muscles, rehabilitates the joints, and helps to open and restore the body after high-impact and explosive workouts. Regardless of what you do, yoga is something that every athlete (and guy) needs more of.

Practicing yoga doesn’t mean you need to stop or give up what you’re already doing, it means you’ll just getter better.

2. It will increase your balance.

For guys, finding balance is tough; we’re just not that graceful. But doing yoga can help to bring balance into the body and, more importantly, into our everyday lives.

Guys are notorious for taking on too much—hectic jobs, busy lives, endless social activities, nights out, morning workouts, and lots more. We like to keep busy, so finding the balance can be tricky. On the mat, yoga cultivates strength, flexibility, and mobility, the three essential attributes for balance in the body. No other physical discipline can do that.

But practicing yoga not only helps balance the physical body, but it adds softness to a hard-hitting life on and off the mat.

3. Yoga will help you wake up.

Doing yoga in the morning is better than drinking three cups of coffee. Moving the body first thing will wake you up, oxygenate the blood, fire up the brain, and activate your metabolism, digestion, and mental fortitude. And what’s best is that it’s all-natural, no additives needed.

But practicing in the morning isn’t the only way to get the benefits; doing yoga anytime will wake you up. A simple flow or a few minutes of mindful movement throughout the day will keep the body healthy, the mind calm, and help you find the focus anytime throughout the day.

4. It keeps you young.

It’s not the Fountain of Youth, but it’s pretty damn close. Practicing yoga regularly will keep you feeling young in the body and mind. A regular practice will give you strength and flexibility, nurture the joints, and restore the body. Your energy levels will increase through a regular practice, and you’ll feel more awake and alive and ready to take on the world each and every day.

5. It cultivates quiet.

Life is busy, and the world we live in is noisy. The truth is, there is no off-switch to the chaos, but the practice of yoga can help to turn the volume down and cultivate the quiet in body and mind. The more you practice, the more you start to see the benefits of stillness in your everyday life.

There are enough things that are on full-blast in our lives, and yoga simply helps to turn the volume down.

Yoga helps manage stress and anxiety. Yes, guys get stressed and anxious, but oftentimes we just don’t show it. Through yoga, mindfulness, and meditation techniques, we can learn to manage stress and quiet the mind.

By Michael James Wong for MindBodyGreen