Football AND Ankle Injuries 
Ross Hauser, M.D.

Ankle sprains account for 10 to 15 percent of all time lost to injuries in football on the professional, college, and high school levels. One study reported that these players lost an average of five weeks with each injury. Artificial turf may increase the risk of sprains, but retrospective studies have not confirmed this. Defects in grass fields can also contribute to ankle injuries.It is safe to say a good number of football players, because of the amount of running they do, will suffer at some time from significant ankle sprains.
 

For the athlete who is prone to ankle sprains or already hears or feels cracking in the ankles, a visit to the Prolotherapist is definitely warranted. By palpating the ankles a Prolotherapist can determine if the ankle ligaments are weakened and prone to injury. If palpation produces tender points, the athlete should receive Prolotherapy to strengthen the ligaments and prevent a significant ankle sprain from occurring.
 

Grading the Sprain

Sprains anywhere in the body, including the ankle, are graded according to severity. A grade 1 sprain involves a stretched ligament with minimal swelling or pain. A grade 2 sprain is a partial tear of the ligament which causes moderate pain and swelling, and a grade 3 sprain is a complete tear of the ligament with instability, and noticeable bruising and swelling. The vast majority of ligament sprains are grade 1 and 2 but rarely a grade 3, complete tear. Prolotherapy is warranted for grade 1 and 2 ligament sprains. Surgery is generally performed for grade 3, complete tears. The difficulty lies in being able to differentiate between a partial tear (grade 2) and a complete tear. Prolotherapy cannot cause two ends of a ligament to rejoin if a complete tear is present.
 

The problem is that there is no 100 percent completely accurate test to diagnose a grade 3 tear unless the joint is obviously unstable. Even injecting the ankle joint with dye (arthrography) to aid in determining complete tears is unreliable because of the following reasons.
 

Unreliability of Arthrography:

There is a variable, but normal communication between the ankle joint and various bursae (fluid-filled sacs) that are located outside of the joint and the peroneal tendons which frequently give false-positive readings on the test. Hematomas (blood clots) from the injury may block the dye through a true rupture, thus giving a false-negative study. The major lateral ligament, the calcaneofibular ligament is outside the joint, therefore, the anterior and posterior talofibular ligament tears cannot be differentiated using this test.
 

If an athlete does have a grade 3 ligament injury, surgery is still not necessarily warranted. The ankle and foot are seas of ligaments. Prolotherapy can strengthen all the ligaments surrounding the damaged ligaments, often causing a complete stabilization of the injured joint. This is another reason why, prior to surgical intervention, the athlete undergoes a trial of Prolotherapy for any type of ligament sprain (except for obvious joint instability).
 

Treatment of Ankle Sprains and Fractures
Have you ever wondered why 30 to 40 percent of ankle sprains remain unhealed and result in residual weakness, clicking, and pain? The likely cause is that the usual and customary treatments are stopping the healing process. These typical treatments are called the RICE treatments and consist of rest, ice, compression, and elevation. These treatments decrease the blood supply to the area and limit healing. On top of this, athletes are given NSAIDS (nonsteroidal anti-inflammatory drugs) which further stop the natural inflammatory healing process. A better choice for healing is movement, exercise, analgesics, and treatment, as depicted in other articles on this website.
 

If you have an unstable ankle or an orthopedist believes you have a grade 3 ligament injury, casting will be recommended. Athletes, do not do it. Casting is another word for complete immobilization and usually lasts three to four weeks. This is usually followed by a period of protective range-of-motion exercises, which lasts another four to five weeks. If surgery is performed on the ankle, the same process is followed. Remember, for every day you are not playing, an additional day of rehabilitation is needed to return you to your previous level of play. If you start adding up the days, it will be a long-long time before you are ready to play again. Think about this: you are off for four weeks after the initial injury with a cast; prior to being cleared to return, you are off for another five weeks doing protective range-of-motion exercises; so far we are up to nine weeks. Now add another nine weeks for significant training and rehabilitation. Now our total is 18 weeks or four and a half months for an ankle sprain. I think not. Most athletes do not have four and a half months to wait for an ankle sprain to heal. A much better approach is to stimulate the body to heal the ankle sprain with Prolotherapy. Perhaps this is why many athletes are choosing to cure their sports injuries and enhance their athletic performance with Prolotherapy.