Major Sprain

Q. Recently, my son was playing baseball and suffered a severe sprain to his ankle. Can you tell me what the best way is to treat this? For example, should this be treated with cold or heat? When can he start playing baseball again?

A. A lateral ankle sprain, or inversion-type ankle injury, is one of the most common injuries in sports. Although these injuries are often considered minor, occasionally they can lead to persistent problems in athletes, especially if associated with a fracture. Multiple fracture patterns of the ankle and foot are associated with inversion-type ankle injuries and are often very subtle on x-rays. I would recommend you seek medical attention for evaluation of a severe ankle sprain to rule-out such fractures, especially if there is any bony tenderness or weight-bearing difficulty.

In regard to treatment of lateral ankle sprains, recent studies have shown that early physical therapy and treatment have proven to be more successful than immobilization in returning athletes more quickly to pre-injury activity levels.

Your son may still need a short period of immobilization depending on the severity of the ankle sprain and his symptoms, but physical therapy and rehabilitation should begin as quickly as possible.

As a relative rule, the PRICE (Protection, Rest, Ice, Compression, and Elevation) guidelines are utilized immediately after injuries. Ice should be used instead of heat to decrease soft-tissue swelling and pain.

In general, an athlete should not return to play unless they have full motion and full strength of the injured joint. Athletes should also complete a sport-specific therapy program preparing them for their respective sport. Depending on the severity of the ankle sprain, your son may need up to four weeks of relative rest and physical therapy before returning to baseball at his pre-injury activity level.

Jason A. Robertson, MD

Non-operative Sports Medicine Physician

Center for Sports Medicine and Orthopaedics

2415 McCallie Avenue, Chattanooga, TN