By Willem Kramer for PrepVolleyball.com

Overcoming an Ankle Sprain - PART 1

Most of you have been there, sitting on the side of the court with a bag of ice on a throbbing and painful ankle. You are not alone. Of all injuries that can sideline or hinder an athlete, a sprained ankle is ranked high in the list of most suffered sport injuries.

An inversion trauma (overstretching the outside ligaments of your ankle, the most common ankle sprain) is a pain in many ways. It can keep you of the court for weeks even months, take valuable inches of your vertical, and put a dent in your confidence.

Fortunately the damage caused by an ankle sprain can be limited or prevented with the right approach. In case you do suffer a sprain, the proper treatment can help you get back on the court fast.

All you need to do is prepare your body for what you want from it, in your case lots of volleyball, and if you get hurt after all, guide it back to health.

Sprains
There are several ways to hurt or sprain your ankle joint. You can hurt the inside of your ankle with an eversion, and the outside of your ankle, with an inversion sprain or trauma (see Fig. 1). An inversion trauma, hurting the outside of your ankle, is more common than an eversion trauma.

An ankle sprain can cause pain, swelling, bruises, and a limited mobility. After spraining your ankle there can be a permanent loss of joint stability. This depends however on the amount of damage your ankle suffered.

The amount of damage an ankle trauma can cause is expressed in degrees. Physicians and therapists talk about a first, second, or third degree ankle sprain.

General indications of an Ankle Sprain

First Degree: A Grade I or First Degree sprain is a mild sprain. The ligaments are over-stretched and slightly damaged but not torn in any way. A first degree sprain does not cause a loss of stability.

Second Degree: If your ankle sprain is referred to as a Grade II or Second Degree sprain it means that the doctor thinks your ankle ligament(s) are damaged (partially torn). This sprain is more serious than a First Degree sprain. Although your ankle does not lose much of its stability, it is probably not as stable as it was before your sprain.

Third Degree: If the doctor tells you that you have a Grade III or Third Degree sprain it means that you ruptured or tore at least one ligament. Because of this your ankle has permanently lost part of its stability.

Prevention
For obvious reasons preventing a sprain is better than treating it.

By improving your body’s own joint protection, using a brace or tape, and by making sure you are not over-trained you can limit the damage caused by an inversion trauma or prevent it all together.

Proprioception
Your sensory system (also known as proprioception) is a crucial part of your joint protection.

It consists of fascia, muscle, tendon and joint capsule sensors, nerves that transport signals coming from these sensors and your Central Nervous System (CNS) that interprets the signals. The sensors tell your CNS about every occurring change in muscle length, muscle and tendon tension, and joint position.

Depending on the signals your CNS receives, it takes action. In reaction to an extreme inversion movement for example (when you are about to sprain your ankle) your CNS can decide to counteract the movement (this is called a stretch or myotatic reflex) or give into it and relax your leg muscles (this is called a Golgi reflex).

With an accurate and fast working sensory system your joints are protected from potentially harmful movements. This prevents or limits damage to joints, ligaments, and muscles. A poorly working sensory system informs our CNS too late with as result damage or more damage than necessary.

With exercises that challenge your proprioception you can make your sensors and CNS communicate more efficient and improve the protection of your ankle.

Example exercises are:

• standing on one leg, solid surface, use arms to balance
• one legged calf raises, solid surface, use fixed object to balance (i.e. hand on wall)
• one legged calf raises, soft or instable surface (i.e. a balance board), use fixed object to balance (i.e. hand on wall)
• one legged leg press
• one legged squats, solid surface, do not use arms to balance (hands on hips)
• one legged leg press with volleyball under foot (use horizontal leg press)

The execution of the exercises is crucial. You have to learn to control your body.

Dynamic Strength
Your joint protection depends heavily on your strength. If your muscles are not strong enough to reverse a movement, if they cannot answer to a sudden and extreme inversion movement, your ligaments get damaged.

It is important to build and maintain a sufficient amount of strength. How much strength you need to protect your ankle joint is determined in part by your bodyweight and the amount of power you have (how explosive you are). In general the joints of heavier and more explosive athletes are under more stress.

Just being strong is not enough. Your muscles have to help protect your ankle joints during the first and last game, and first and last match of your day. It is therefore important to train your strength- and speed-endurance as well.

Example exercises are:

• one legged calf raises, solid surface, use fixed object to balance (i.e. hand on wall)
• jumping rope (with two feet)
• one legged leg press
• one legged squats, solid surface, do not use arms to balance (hands on hips)
• 15 sec Counter Movement Jumps (CMJ) with hands on hips

You have probably noticed that the exercises to improve your coordination are similar to the exercises you can do to improve your strength. The main difference is that, to improve your strength, you can add resistance.

Recovery/Being well rested
With overtraining or a lack of recovery our body does not work as well as it can. Among other systems our joint protection, muscle strength and endurance declines.

In this situation the chances of spraining your ankle are more prevalent. Because of this it is important to balance your workouts with sufficient recovery.

Waking up tired, feeling sore, sluggish, slow or out of focus are signs of too much practice and a lack of recovery.

You know you are doing well when you wake up well rested, feeling fresh, strong, powerful, snappy, sharp and focused.

What you can do to promote recovery:

• sleep at least 8 hours each night
• eat healthy (fruit, veggies, whole grain products, and lean protein)
• take an ice bath after an intense workout or tournament
• stretch before going to bed
• take a multi vitamin (discuss other supplements like glutamine with your physician or trainer)

Braces and Tape
Ankle braces and tape can be helpful as well when trying to prevent an ankle injury.

In general research shows that braces help limit the range of motion in your ankle, especially extreme inversion movements. Tape on the other hand does not limit motion as much but might support your proprioception. It is believed to be less effective than a brace when it comes to the protection of your ankle.

Bear in mind that an ankle brace or tape will not prevent an ankle injury if our body’s own protection systems does not work the way it should. Without the proper proprioception, strength and recovery you can get hurt regardless of the braces or tape you wear.

Treatment
If you do sprain your ankle after all you can help your body heal faster by guiding it down the path of recovery.

Part 2 of this article will provide some information on the treatment of an ankle sprain.