Antoine Vu, PT, and Sylvain Girard, writer.
Patrick Mahomes has once again suffered an ankle injury during the Super Bowl, following his previous injury against the Jaguars in late January. It is a recurrence with the same diagnosis as last time: a high sprain of the right ankle.
ANATOMY
A high ankle sprain differs from a typical ankle sprain in terms of the location where the ligaments are damaged. In Patrick Mahomes’ case, the injury is higher than a usual sprain, hence its name, high ankle sprain. As a reminder, a ligament is a fibrous connective tissue that serves to bind the tibia and fibula together, stabilizing them and preventing excessive separation between the two bones during twisting and dorsiflexion movements of the ankle.
The interosseous ligament can be damaged in this manner under two conditions. First, when the foot is firmly planted on the ground in dorsiflexion, meaning that the toes are pointing towards the shin. Second, when, in addition, there is a strong external rotation of the foot. This often occurs during a collision, as was the case with Patrick Mahomes during the Super Bowl.
PAINFUL MOVEMENTS
The movements that will cause pain are any impact and twisting movements of the ankle. In other words, any movement that requires planting the foot on the ground. Therefore, the athlete’s ability to return to the game depends on the grade of ligament tear and the movements required in their position in the sport.
Even simple walking can cause pain. With each step, the bones of the ankle push upward against the tibia and fibula, creating a separating force between them. The damaged ligament will not be able to properly stabilize the bones.
RETURN TO PLAY WITH TAPING
Return to play can be facilitated with the use of Leuko P taping. By wrapping around the tibia and fibula, the taping helps compress the bones together. This provides the athlete with external stabilization of the ankle, acting similarly to the role of the damaged ligament.
It is also possible to use cortisone after an injury to reduce short-term pain and enable almost instant return. However, there are harmful effects associated with its use. Cortisone diminishes the quality and structural integrity of ligaments and tendons. It is likely for this reason that Patrick Mahomes, for instance, declined injection treatments during halftime of the Super Bowl.
TREATMENT OF THE INJURY IN PHYSIOTHERAPY
The role of physiotherapy in a clinical setting will primarily involve modifying physical activities to avoid irritating the ligament and allowing it to heal. It will also be important to increase mobility around the ankle to ensure proper movement and reduce stress on the ligament. Exercises will be prescribed to improve mobility, strength, motor control, shock absorption, and balance of the ankle.
Exercises to perform:
Clock Lunges = strength for change of directions
Drop Squats = shock absorption capacity
Single Leg Romanian Deadlift (SL RDL) = dynamic balance
Sled Push = ability to push a load
Sled Pull = ability to pull a load
Twisting Med Ball Throw against a wall = ability to generate twisting force
