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January 30, 2008

As high ankle sprains go, Brady's apparently is the least serious

BY MIKE SZOSTAK
Journal Sports Writer

The Patriots are extremely fortunate that Tom Brady suffered what was apparently the mildest possible high ankle sprain. Had the injury been more serious, he might not be available to play in the Super Bowl Sunday.

A high ankle sprain is damage to the ligaments that connect the lower portions of the tibia and fibula, the two bones that extend from knee to foot. It is more serious that its cousin, the simple ankle sprain, because it involves weight bearing structures and can take twice as long to heal. Athletes with high ankle sprains can be sidelined as long as 12 weeks.

Kim Bissonnette, head athletic trainer at the University of Rhode Island and the lead trainer for the URI football team, agreed that the Patriots took the proper approach with Brady by having him avoid any undue stress on his right leg last week. The All-Pro quarterback caused quite a stir when he was photographed wearing a protective boot while walking in Manhattan.

“Take the initial window of three days and extend it to four or five days and let him rest,” Bissonnette said. “Then tape it up and see what happens.”

Brady practiced Monday and completed the entire workout, even running a couple lengths of the field with the rest of the squad. A pool reporter noted that was limping slightly. If Brady did, indeed, suffer a low-grade high ankle sprain, the limp could have been the result of putting weight on that right ankle.

The Patriots never disclosed the specific injury.

A simple ankle sprain, usually the result of the foot twisting inward (or rolling so the arch faces up), involves stretching or tearing of the ligaments that connect the small bones in the ankle joint. Treatment involves rest, ice, compression and elevation to reduce swelling and provide support. Depending on the severity, recovery can take a few weeks.

A high ankle sprain, or syndesmosis injury, named for the rough edges of the two leg bones held together by the ligament, is usually the result of the foot being twisted out (so the arch faces down) or by the toe being forced up. There can be pain in the middle of the ankle joint and tenderness in front of the ankle but less swelling than in a simple ankle sprain.

Athletic trainers and doctors will suspect a high ankle sprain when squeezing the calf or rotating the ankle out causes pain. An x-ray made when the ankle is stressed will show abnormal motion of the lower ends of the leg bones in a high ankle sprain victim.

“The higher the soreness, the longer the person will be out. You can have pain going all the way up the leg,” Bissonnette said.

- Mike Szostak, projo.com

Sources: clevelandclinic.org, orthogate.org, about.com and thedisabledlist.com

Patience is a necessary virtue in healing a high ankle sprain. Patients must let the ligaments heal so they can maintain the proper distance between the ends of the tibia and fibular. The proper functioning of other bones in the ankle joint depends on correct spacing.

Bissonnette said that athletes who come back too early run the risk of further injury that could require surgery to correct. Serious high ankle sprains can necessitate the insertion of screws through the fibula and into the tibia to stabilize the joint.

High ankle sprains account for about 10 percent of ankle sprains, although they seem to be occurring with increasing frequency.

“We have seen a lot more of them,” Bissonnette said. He is not sure if medical personnel are more knowledgeable than they were a generation or two ago or if the forces to which athletes are subject are greater because athletes are bigger, faster and stronger than a generation or two ago.

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