Grade 3 Sprain
• There is complete tearing or avulsion of the ligament.
• The ankle is totally unstable, and walking or weight
bearing is impossible.
• There is a complete tear of the ATFL and a partial tear
of the CFL.
• Surgical intervention is needed to reattach the torn
ligament.
Treatment of Ankle Sprains
Immediately following the injury you must do
everything possible to reduce swelling. The faster this
is done the quicker you will recover, and the injury will
resolve faster. Ignoring the injury results in prolonged
pain, swelling and a slower recovery. Perform the following
RICE treatment and continue for the first 48 hours:
• Rest (Immobilization) – Do not play pickleball and
avoid weight bearing on the affected side.
• Ice – Cool the area for 10-15 minutes using ice packs
or cold water; this should be done many times a day,
and avoid direct contact of ice pack with bare skin by
using a towel.
• Compression – Apply a compressive bandage
immediately to slow the bleeding and reduce swelling.
• Elevation – Elevate the foot and ankle above the heart
to reduce swelling.
With more serious sprains, visiting a health care
professional is recommended to rule out a fracture
or serious damage requiring surgery. He/she can also
determine if crutches or a cast or boot is needed.
Rehabilitation: It is very important to introduce
motion into the joint by doing non-weight-bearing
exercises such as circles and writing the alphabet with
the foot, and moving a towel with your toes. Also light
stretching of the calf, cycling on a stationary bike and
swimming are helpful. After 2-5 days, or when the pain
and swelling are down to a minimum, rehabilitation can
begin in earnest. Begin putting weight and balancing on
the ankle; when walking, try to maintain a normal gait
pattern. Use rubber tubing or Thera Bands to strengthen
the muscles around the ankle. After you can walk and
stand without pain, continue to build up strength and
flexibility. This can be accomplished with a balance or
wobble board, increased walking, an elliptical machine and
a slow return to pickleball.
Surgical treatment for ankle sprains is rare and used
only when there is persistent ankle instability with
a failure to respond to conservative treatment and
rehabilitation. Fortunately, with proper rehabilitation,
most ankle sprains resolve favorably and the injured
athlete is able to return to normal activities. Sometimes,
damage to the ankle ligaments will result in a chronic
ankle sprain with instability. Once you have had a sprained
ankle, the ligaments in the ankle are unstable and weaker,
making recurrence more likely. If instability persists,
consider the use of an ankle brace to help stabilize the
ankle and reduce the risk of future injury.
Prevention of ankle sprains involves maintaining good
muscle strength, balance and flexibility. Proper warm-up
prior to activity and exercise, along with paying attention
and being careful while playing are important. The use
of proper footwear for pickleball is critical; playing in
running, basketball or hiking shoes is a recipe for disaster.
Finally, when you are overly tired and fatigued, rest or stop
playing before you get injured. •
Alan Bragman is a chiropractor living in
Atlanta, Georgia. He is an IPTPA-certified
coach and a 4.5 level player. In addition, he is
a former Cat 3 cyclist, nationally ranked table
tennis player and inline speed skater. He was
on the medical advisory board at Bicycling
magazine for 10 years and has written for
numerous other sports publications.
MARCH/APRIL 2017 |
MAGAZINE
63