There’s No Such Thing as a “Simple” Ankle Sprain

Ankle sprains are some of the most common injuries that affect athletes.  A sprain is caused by injury to a ligament, or a band of tissue that connects a bone to a bone.  (A strain doesn’t happen to a ligament—it happens to a muscle or a tendon, a piece of tissue that connects a muscle to a bone.)  Ligaments in the ankle help to keep the joint stable, so a sprain can be a serious issue, especially in an athlete.

Ankle sprains are usually caused by a sudden twist or roll of the joint while an athlete’s weight is on it, causing a stretch or tear of the ligaments.  90% of ankle sprains are caused by an inward and downward movement of the foot, injuring the ligaments on the outside of the ankle.

Many athletes describe a loud “snap” or “pop” or “crack” when they twist their ankle, and pain follows immediately.  Swelling and bruising can develop very quickly, and the athlete may have difficulty walking.  If this is the case, an x-ray may be necessary to determine if there may be a fractured bone.

Most ankle sprains can be treated with ice, anti-inflammatory medicines, and a wrap, brace, or walking boot.  Crutches may be necessary for the first few days.  As soon as he or she can, an athlete should start a rehabilitation program, concentrating on moving the joint, strengthening the muscles around the joint, and eventually balance training.  Functional, sport specific training is helpful to get the player back on the field.  Often, working with a physical therapist can help quicken return to play.  However, returning too early can put an athlete at risk of reinjury and more lost playing time.  The athlete should never just rest and wait for the ankle to heal without working on strengthening, because a “weak” ankle is more likely to have problems down the line

.

An athlete who has had an ankle sprain is more likely to injure it again, especially within the next 6-12 months.  Continuing the rehabilitation exercises is one of the best ways to avoid problems, as is wearing a good ankle brace with sports. 

Thankfully, most ankle sprains are healed within about four weeks.  If an athlete is still struggling after that period of time with good rest and rehabilitation, it may indicate there is another problem, like a cartilage injury or an unstable joint. 

Attack of the Common Cold

Tis the season for colds and sinus infections, and athletes are not immune to these common illnesses.  In fact, infections of the upper respiratory tract, or URIs, are the most common illnesses in the general population, as well as athletes.  Infections can target the throat and/or the sinuses, and can be referred to by many names.  “Common cold, “ “strep throat,” and “sinusitis“ are just a few.

The symptoms of URI include a variety of complaints like cough, nasal congestion, sneezing, sore throat, runny nose, muscle aches, and fever.  Taking into account the history of the illness and how long it has been present helps to make the diagnosis.  Occasionally, lab tests for strep, influenza, or mononucleosis may be ordered if those illnesses are suspected.

I often am asked for antibiotics for common URI illnesses.  The problem is that most of these conditions are caused by viruses, so antibiotics—which treat bacterial infections—are not active against the bugs and do not help to treat or shorten the illness.  Mostly, symptomatic treatment like a decongestant or cough suppressant in combination with good hydration and lots of sleep will get an athlete on the road to recovery.  Occasionally, medicines like acetaminophen or ibuprofen can be used for headache, sore throat, or muscle aches.

The best way to avoid a URI is to wash hands, cover mouths when coughing, and avoid others who are sick.  You know, the things we’ve told our kids since they were old enough to listen.  The problem is that athletes train and play in close contact with their teammates, so illnesses often spread quickly through the population.  Athletes should avoid drinking from the same container as a sick teammate, and should consider getting an annual flu shot to prevent influenza.  They should also get plenty of rest and avoid over-training, which decreases the body’s immune system and increases the risk of infection.

When an athlete gets sick, he or she should not practice or compete with a fever.  Otherwise, most of the time an individual may participate if feeling well enough to do so.  I use the “above the neck rule.”  If the symptoms are in the throat, head, and sinuses, the athlete is okay to play.  But if he or she is suffering from chills, body aches, or chest congestion, return to play is not recommended.  Of note, the guidelines for mononucleosis are different, so one should consult a physician if that diagnosis has been made. 

Happy playing!  Now go wash your hands!

Knee Pain? Join the Club!

Knee pain is by far the most common issue I see in my sports medicine practice.  In children and adolescents, pain may be the result of acute trauma or repetitive overuse.  And sometimes, it’s both.  An athlete may be nursing a chronic injury that becomes more severe due to a traumatic event.  Now the athlete has worsening pain, swelling, instability, and stiffness.  That’s usually when they come in to see me.

There are several causes for knee pain in young athletes.  We’ll start with the most common—patellofemoral pain syndrome.  “Patella” is another word for kneecap.  This condition results from inflammation and irritation of the back of the patella as it moves over the front of the knee joint.  If the alignment of the patella is off just a little due to muscle weakness, inflexibility, and to variations in knee anatomy, it will become painful with running, jumping, an

d climbing activities.

The patella tendon in the front of the knee, which connects the patella to the tibia (shinbone), can also get irritated.  This results in patella tendonitis and difficulty with running and jumping.  If the growth plate where the patella tendon attaches to the bone gets pulled on too much, it can cause a common condition known as Osgood-Schlatter disease.  Undoubtedly, someone on your team has suffered from this condition.  Maybe even you or your child!

The knee also has several ligaments that can be sprained or torn.  We’ve talked about ACL tears before, so today we’ll mention another very commonly injured structure—the medial collateral ligament, or MCL.  This ligament lives on the inside part of the knee and usually gets sprained when an athlete is hit on the outside of the knee.  This forces the knee inward and stretches the ligament.  Thankfully, most MCL sprains can be treated without surgery.

Kneecaps can also be injured traumatically, resulting in a dislocation or partial dislocation.  This can occur from a collision or a forceful twist of the knee during a noncontact cut on the field.  The patella will actually move off of the front of the knee to the outside.  It usually causes a pop, and is sometimes followed by another pop if the patella moves back to its normal position.

All of these injuries and conditions are common in sports and cause difficulty with playing and practicing.  Most of the time, they resolve with rest and rehabilitation exercises.  However, any injuries that causes a visible deformity or causes an athlete to be unable to put weight on the leg should trigger a trip to the doctor.  Most other situations will improve within 2-3 days with rest, ice, and elevation.  If the problem persists longer than that, pay your friendly sports medicine physician a visit.

Heel Pain in the Young Athlete

Heel pain is one of the most common symptoms I see in young athletes.  Often, the pain is so bad that it keeps kids from being able to practice and compete.  Occasionally, the heels become so severely painful that it is difficult for the athlete to even walk without limping.

So what is the cause of this scourge of the active young athlete?  Chances are someone on your team or in your league, or even an older sibling has suffered from it—Sever’s Disease.

Sever’s Disease is an inflammation of a small growth plate at the back of the heel.  It’s not a growth plate that is active to make a child taller.  Rather, this growth plate, called the calcaneal apophysis, is where the Achilles tendon attaches to the heel.  As the bones of the leg grow longer, the muscles and tendons don’t lengthen at the same speed, causing them to get tighter.  The job of the calcaneal apophysis is to allow for some wiggle room so the tendon doesn’t just pull off the bone as the bone grows.  Unfortunately, when an athlete is growing quickly, the tension of the Achilles on the apophysis can become too much, causing it to inflame.

In addition to the inflammation, athletes are constantly banging on the bottom of the heel in their cleats and shoes.  Cleats in any sport, from soccer to baseball, are usually less cushioned and cause more stress on the heel—and the growth plate.  This causes more pain.

Athletes with Sever’s Disease are usually between ages 8 and 13 and usually report pain with running, jumping, and landing.  They describe the pain as starting slowly, without any obvious injury, and feeling like the heel is “bruised.”

Once the diagnosis is made, the treatment is pretty simple. The first and most important treatment is rest.  But the athlete doesn’t have to just stick to the couch.  He or she can participate in activities that do not cause pain, like cycling or swimming, to keep their fitness up while they rest the foot.  Parents can provide ice and anti-inflammatory medicines.  I recommend a silicone heel cup to provide some cushion and pain relief.  The athlete can perform one of the most important treatments him or herself—and that’s stretch, stretch, stretch, stretch, stretch that Achilles.  The more flexible it is, the less it will pull on the growth plate.

Other problems can cause heel pain, as well.  Diagnoses like stress fractures and bone cysts can also be to blame, and the differences are subtle.  If pain persists despite rest and stretching for more than a week or so, the athlete should consult his or her physician.

What To Eat and When To Eat It

Athletes focus much of their effort on physical training and honing their skills on the field.  Countless hours of thought and practice are put in to improve and master their sport.  However, most don’t put the same energy into their nutrition routine.  I see an awful lot of candy wrappers and empty chip bags on the sidelines and in the gyms.  Obviously, these choices aren’t ideal for optimizing health and performance.  By following basic nutrition guidelines, athletes can ensure that they are at their best before, during, and after activity.

                                                                                            Before Exercise

The amount of energy, or calories, an athlete should consume is dependent on his or her gender, height, weight, and activity level.  So making broad recommendations is difficult. Most teenagers and adults burn about 1400 calories a day just going about their routine at school and work.  So athletes need more than that to cover the energy used during practices and games. Consult with your doctor or a sports dietician to determine your proper calorie needs.

Carbohydrates are essential for peak athletic performance, as the body uses this nutrient more efficiently during exercise than fats and protein.  The best recommendation is to eat 1 to 4 grams of carbohydrate per Kg of body weight one to four hours before exercise (1 Kg = 2.2 pounds).  A longer-lasting carbohydrate combined with a protein is a good choice.  This could be something like peanut butter on whole-wheat toast.  For endurance training (7-10g/kg/day) and high intensity activities (5-8 g/kg/day), the recommendations change a bit.

For protein, the advice again depends on the individual athlete.  More protein is required for athletes in critical growth periods or around puberty.  But a good rule of thumb for daily dietary protein intake is 1.2 to 1.7 g/kg/day.

Fat has a bad reputation among athletes, but it serves several important functions.  It’s a source of more energy when the carbohydrate stores run low.  Fats provide essential fatty acids the body can’t make on its own and helps to absorb certain vitamins.  So fat isn’t evil—it’s helpful!  20 to 35% of total calories should come from fat, with less than 10% from saturated fat sources.

During Exercise

Carbohydrates are key during exercise, especially glucose and electrolytes.  For longer lasting activities (more than one hour), try to consume an additional 30-60 grams of carbohydrates.

After Exercise

Recovery requires carbs, ideally within 15-30 minutes after the activity.  The body’s cells are especially receptive to glucose absorption during this period.  1-1.5 g/kg of rapid-acting carbohydrate is recommended immediately after exercise.  Or, take in a ratio of 4 g or carbohydrate to 1 g of protein.  Lowfat chocolate milk is a tasty choice that fits the bill.  After 30 minutes, focus on a good balance of the three nutrients (carbs, protein, and fat) for your next meal.

As you can see, a little bit of planning can go a long way toward making sure an athlete is making healthy choices and performing at his or her best with enough of the right kind of gas in the tank.  Good nutrition can help keep you performing at your best and keep you from running out of energy at the wrong time.