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View Full Version : Chiefs What is really wrong with McCluster?


scho63
11-29-2010, 06:37 PM
When Dexter McCluster came up limping weeks ago with an ankle injury, I figured he would bounce right back. It's now been 5 weeks and still no Dexter. Any insights from anyone on what is really happening here? He is a great weapon that we could use against Denver and San Diego in the next few weeks.
:hmmm:

Bane
11-29-2010, 06:39 PM
Didn't he have a high ankle sprain?

KcMizzou
11-29-2010, 06:39 PM
High ankle sprain

I have no reason to think otherwise. Those things take a while to heal. I bet he's back this week.

HoneyBadger
11-29-2010, 06:39 PM
I think he has an injured ankle.

Marcellus
11-29-2010, 06:41 PM
http://www.sportsinjurybulletin.com/archive/ankle-sprain.htm


lrik Larsen offers guidance on how to spot and treat the kind of lateral ankle damage that can ruin an athletic career.

What is the most common sporting injury? Chances are that anyone who has done any kind of weight-bearing sport has had it happen: a sprained ankle. But there is a vast difference between mild sprains and moderate to severe lateral ankle sprains which actually damage the ankle.

Incorrect management can easily turn a recovery time from 3-4 months into a 12-18 month epic. I’ve seen it happen and made the mistakes myself as a younger clinician!

To establish an accurate diagnosis and treatment schedule you need to know where a sprain fits into the spectrum. The key question is this: what are the signs and symptoms that distinguish a sprained ankle that is damaged? Only by identifying these features can we undertake the crucial early management, and predict which sprains will require longer time frames for recovery.

I am not talking here about mild ankle sprains that will always get better regardless of what is done to them – most athletes will ‘walk them off’ because there is no real damage to the ankle. Nor will I discuss medial ankle sprains, or acute forefoot/mid-foot injuries. And finally, I will not be looking at the obviously severe injuries that need orthopaedic referral: fractures of tibia and/or fibula, talar dome and ankle dislocations. Usually these will be picked up in the emergency department of the local hospital. If the injury happens on the field, the severity of pain would be enough to convince anyone to summon an ambulance and have immediate X-rays!

So what does that leave? Precisely the tricky sprains in which damage to the ankle is unlikely to show up positive on X-ray. Commonly these injuries have a history of having occurred with some heavy weight-bearing and rotary force; they present with significant swelling, pain, lack of normal range of movement; and the client will be unable to walk and/or run without pain and aggravation.

An athlete in this situation is certainly going to be frustrated, because they will probably present after a few weeks have gone by and things are not resolving, having been given the all-important all-clear on X-ray. So their expectations will have been skewed towards thinking that they will be back on the field within two to four weeks.

The most common mistake that clinicians, coaches and athletes make is to underrate the severity of damage and return to activity too early. The fatal assumption is that when the X-ray is negative, then the damage can’t be too bad… Wrong! The best result will often be had by overrating the damage in the first month, and being extra cautious, rather than pushing for progress.

Let’s paint a couple of painful pictures to help us understand how a damaged ankle sprain happens.

Scenario 1

You’re running at speed with the ball and step heavily off your left foot to move quickly to your right. But the ground doesn’t feel quite like you thought it would. In a split second your foot has rolled underneath your leg, resulting in a feeling of more than one ‘crack’ followed shortly afterwards by a searing pain that envelops your whole foot and leaves you writhing in agony on the ground.

Scenario 2

While contesting the ball among a few other players you jump as high as you can to reach it. You land while you are twisting around, catching the edge of another player’s shoe, and causing your foot to land on the ground on its outside edge. The crunch that you feel is nauseating and soon so is the pain.

Both these situations will very likely result in damage to bone, joint, ligament, tendon or nerve that will require profound rest for complete healing to take place. How long and to what degree the rest needs to be enforced (and many athletes will not be happy to hear that they need to be on crutches for two to four weeks if normal weight-bearing is preventing good healing) depends on the all-important diagnosis.

The first few days is the critical phase for diagnosis because it immediately determines the management and time frames for full recovery:

* Are further investigations warranted?
* Do you need to refer the client to a specialist?
* Do they need a cast or crutches?
* Roughly how long will their rehabilitation take?

If you don’t have a good working diagnosis, none of these questions can be answered.
The crucial first week

While there isn’t any hard evidence to back this up, the issue of whether the athlete can reasonably weight-bear during the first week seems to be critical in establishing whether any of the four ‘nasties’ discussed below has occurred. This is because for the foot not to be able to stand simple weight- bearing implies that the weight-bearing surface and/or the stability mechanisms of the ankle must have been severely compromised.

This, therefore, is your first key diagnostic and management judgement: if it is painful to weight-bear on the foot in the first week, significant damage has occurred. The athlete needs to be non-weight bearing, on crutches, to the level that ensures there is no pain.

The option of soft-casting the ankle to hold it still will often need to be considered to achieve complete immobilisation. Any negative secondary effects of non-weight bearing for a week will be far outweighed by further damage caused by painful weight bearing.

From non-weight bearing, you will need to take the client conservatively through each new progression:

* partial weight bearing to…
* full weight bearing to…
* walking to …
* transitional drills to …
* running.

Delay each new step rather than re- aggravate the symptoms. Put the client in the water to practise each successive stage to reduce body weight and rehearse technique. A good idea is to use weight scales to objectify the graduated weight-bearing increases: stand them next to the scales and get them to load to 10kg and listen to how their ankle feels; that may be all they do for the first few days: holding that same level of pressure for 10 seconds, and repeating for 5-10 reps. The action must be pain-free.

There are four main types of primary damage that may in isolation or in combination prevent reasonable weight bearing in the first week.
1. Osteochondral defect (OCD)

This is damage to the surface chondral layer of the bone; the damage may be simple bruising, through to a displaced segment of cartilage. It may occur on the talar dome, the inferior tibial surface (‘tibial plafond’) or the medial fibular surface in the lateral gutter of the ankle.

The damage to various parts of the bony surfaces is commonly the result of the twisting force of landing, which causes the talus to invert and medially rotate in the tight angular ankle joint.

Signs

* usually there is no obvious sign on initial X-ray, but closer inspection or re-X-ray may reveal disruption to the joint margins
* significant pain on weight bearing
* the medial and lateral anterior talar dome, anterior tip of tibia or fibula will be very tender on palpation
* swelling all around joint lCT or MRI should tell all
* if sufficiently disrupted, this may require surgical referral.

Recovery time-frame: three to six months.
2. Bone stress short of fracture

Signs

* not visible on X-ray; bone scan will confirm but is not really necessary
* extreme tenderness on palpation, on medial/lateral malleolus or along shaft of tibia or fibula will confirm diagnosis
* maybe positive to squeeze or stress tests (where the bone is gently stressed as if you were trying to bend a stick).

Recovery time-frame: will heal by itself with sufficient rest over two to six weeks, depending on severity.
3. Lateral ankle ligament tear leading to gross instability

This is significant tearing (Grade II), through to complete rupture (Grade III) of the anterior talo-fibular (ATFL) and/or calcaneo-fibular (CFL) ligaments. Complete rupture of the lateral ligament complex requires immediate orthopaedic referral for stabilisation surgery.

Signs

* the most common result of a plantar-flexion/inversion sprain, rarely occurs in isolation from bony injury
* talocruraljoint demonstrates instability, leading to overloading of capsular and/or ligamentous structures and later possibly synovitis (thickened and inflamed capsule)
* client is unlikely to be able to weight- bear for initial period because of likely involvement of bony structure damage
* trial taping for diagnostic purposes: stirrups and heel locks can artificially stabilise the lateral ankle complex and help to diagnose a pure instability problem
* perform anterior drawer (ATFL) and possible medial glide of talus/calcaneum to gauge the end-feel of ligaments.

Recovery time-frame: three to six months, depending on other damage.
4. Tibio-fibular ligament/syndesmosis damage leading to instability

Also known as ‘high ankle sprain’. Can be very nasty, requiring orthopaedic referral to prevent long-term arthritic changes. The fibula will usually fracture laterally as well, preventing further damage along the line of the syndesmosis.

Signs

* landing with twisting is very likely to stress and drive the tibia and fibula apart, causing a tear of the ligament and syndesmosis (in addition to damage to other structures above)
* palpation of the anterior shin between tibia and fibula will show tenderness; medial/lateral stress test holding the calcaneum will reveal gapping and laxity between tibia and fibula.
* with significant instability, separation of tibio-fibular articulation is likely to be seen on a weight-bearing (heel pressure) X-ray, compared with other side
* it may be useful at a later stage to re-Xray in weight bearing at end-of-range dorsiflexion (if that was not possible at the outset because of pain) to detect any ongoing instability of the tibio-fibular complex compared with other ankle. With luck it may show up negative at the three-month stage with fibrosing and scar tissue doing a sufficient job of holding it together
* tibio-fibular compression taping may help with stabilising in the early weight- bearing phases.

Recovery time-frame: absolutely critical to prevent weight bearing on foot for up to three or four weeks with a more conservative progression through partial to full weight bearing. In total, allow six to eight months to return to sport.
The lateral ankle: key injury sites

The lateral ankle: key injury sites
Continued pain at 4 to 8 weeks

If things are not going well, or you are noticing new symptoms, consider the following secondary damage issues. These may not clearly manifest until the worst of the pain, swelling and disability has receded, but they need to be addressed in their own right as part of the mid- to late- stage rehabilitation process. These are the most common ones:
1. Talo-crural joint hypomobility/restriction

This leads to capsular synovitis/lateral impingement of fibula and talus in the lateral gutter.

Signs

* a very common side effect of any ankle sprain; it is critical to maintain maximum mobility to promote the best rate of healing
* if the talus cannot posteriorly glide during weight bearing it will cause ongoing impingement of anterior bony structures
* after the acute phase, perform manual posterior glides of talus and dorsiflexion testing at a wall to establish the extent of dorsiflexion deficit and the sites of restrictions (based on points of pain). Never stretch forward in weight bearing to improve dorsiflexion, as this risks aggravating the damaged structures
* fibrosis and thickening of the posterior capsule responds well to manual loosening procedures. Deep tissue massage of uninjured soft tissues (especially calf) is very useful in the acute phase. The use of seat belts in the mid to late stages of rehab can help to force the various bones to glide in normal ways again to gain final degrees of dorsiflexion – this should be done by an experienced physiotherapist.

2. Peroneal tendinopathy

Signs

* damage of the peroneal muscles and tendons is possible, but would not prevent normal weight bearing initially. Undertake static muscle testing, especially in dorsiflexion to note pain and weakness (there could be a tear in the muscle belly)
* treat as any muscle injury through to full return to function
* restricted or fibrosed peroneus longus can prevent normal dorsiflexion at later stages of rehab; massage and stretching is the answer
* the peroneal tendon can sublux from a torn tendon sheath posterior to the lateral malleolus, leading to chronic clicking and pain that may require surgery.

3. Reflex sympathetic dystrophy

Also known as ‘complex regional pain syndrome’ or Sudeck’s atrophy. A relatively uncommon condition of burning pain, pins and needles or numbness, ongoing and excessive swelling, often spreading up the whole shin, and discoloration of the foot and/or leg. It arises from a disturbance in the sympathetic nervous system that controls the blood flow and sweat glands to the limb. The neural disturbance may have its origins in over-stretching of nerve tissue during the ankle sprain, changing the way the nerve impulses are sent and causing a short circuit or overactivity.

Signs

* the risk of developing this may increase with too aggressive a rehabilitation strategy – go slow!
* keep this diagnosis (even in ‘mild’ forms) at the back of your mind if strange things are happening to the ankle that are really slowing down the return to function
* look for positive neural signs and paresthesia
* continueto work on range of movement and pain relief. Personally I find deep tissue massage/ trigger-point release to gastrocnemius and soleus muscles is critical for mobility gains. Acupuncture has occasionally worked wonders for pain relief
* can severely delay return to function, from three to 12 months
* adverse neural tension testing, done by a physiotherapist, can determine what level of nerve tethering or dysfunction is present.

4. Proprioceptive deficit

Reams of research and knowledge have been developed to aid our understanding of how a severe disruption to the normal functioning of a joint or body part can then create long-term damage to the brain-body connection to that body part. The brain’s ability to be aware of and to coordinate reflexes at the injured ankle can set up a chain of injuries elsewhere through the lower limbs unless the proprioceptive deficit is corrected through an exercise programme.

Signs

* do this test on yourself if you have ever badly injured an ankle or knee joint: in a completely dark room, stand on each leg in turn. Note the significant challenge of standing easily on the previously injured leg!
* proprioception in every damaged ankle will have been moderately to severely affected; this will need to be addressed during the mid to late stages of rehabilitation.

Conclusion

Once there is clarity about the nature and severity of damage to structures, you will be able to develop time frames for recovery and then tackle the challenge of restricting the athlete to crutches and prescribing safe exercise for the ankle.

More often than generally acknowledged, a period on crutches can be critical for the initial phase of healing, and to prevent side effects such as ongoing instability, long-term swelling and ankle thickening, and even reflex sympathetic dystrophy.

If you manage the rest and the healing phases thoroughly, you will help your client minimise their time out of action from the sport and they will have long-term reason to be thankful for your patient care.

Ulrik Larsen BThpy MAPA is an APA sports physiotherapist with a special interest in clinical Pilates. He is physiotherapist to Queensland Academy of Sport men’s water polo team

Illustrations by Viv Mullett

scho63
11-29-2010, 06:41 PM
I know he injured his ankle but I didn't think a sprain would take 5 weeks to heal

Wyndex
11-29-2010, 06:42 PM
I think we'll see him this week or at san diego

Bane
11-29-2010, 06:43 PM
I know he injured his ankle but I didn't think a sprain would take 5 weeks to heal

High ankle sprains are a motherfucker.

kcmaxwell
11-29-2010, 06:44 PM
Didn't Haley make a comment about needing players back last night on the postgame show? I figured he was talking about mccluster...

scho63
11-29-2010, 06:46 PM
I'm sure he will be back when ready-I just thought it would be sooner. I think he might be back for Denver. If guys can't play in pain for this weekend, hang it up!
We need to kick the Donks all over Arrowhead

bevischief
11-29-2010, 06:46 PM
http://www.sportsinjurybulletin.com/archive/ankle-sprain.htm


lrik Larsen offers guidance on how to spot and treat the kind of lateral ankle damage that can ruin an athletic career.

What is the most common sporting injury? Chances are that anyone who has done any kind of weight-bearing sport has had it happen: a sprained ankle. But there is a vast difference between mild sprains and moderate to severe lateral ankle sprains which actually damage the ankle.

Incorrect management can easily turn a recovery time from 3-4 months into a 12-18 month epic. I’ve seen it happen and made the mistakes myself as a younger clinician!

To establish an accurate diagnosis and treatment schedule you need to know where a sprain fits into the spectrum. The key question is this: what are the signs and symptoms that distinguish a sprained ankle that is damaged? Only by identifying these features can we undertake the crucial early management, and predict which sprains will require longer time frames for recovery.

I am not talking here about mild ankle sprains that will always get better regardless of what is done to them – most athletes will ‘walk them off’ because there is no real damage to the ankle. Nor will I discuss medial ankle sprains, or acute forefoot/mid-foot injuries. And finally, I will not be looking at the obviously severe injuries that need orthopaedic referral: fractures of tibia and/or fibula, talar dome and ankle dislocations. Usually these will be picked up in the emergency department of the local hospital. If the injury happens on the field, the severity of pain would be enough to convince anyone to summon an ambulance and have immediate X-rays!

So what does that leave? Precisely the tricky sprains in which damage to the ankle is unlikely to show up positive on X-ray. Commonly these injuries have a history of having occurred with some heavy weight-bearing and rotary force; they present with significant swelling, pain, lack of normal range of movement; and the client will be unable to walk and/or run without pain and aggravation.

An athlete in this situation is certainly going to be frustrated, because they will probably present after a few weeks have gone by and things are not resolving, having been given the all-important all-clear on X-ray. So their expectations will have been skewed towards thinking that they will be back on the field within two to four weeks.

The most common mistake that clinicians, coaches and athletes make is to underrate the severity of damage and return to activity too early. The fatal assumption is that when the X-ray is negative, then the damage can’t be too bad… Wrong! The best result will often be had by overrating the damage in the first month, and being extra cautious, rather than pushing for progress.

Let’s paint a couple of painful pictures to help us understand how a damaged ankle sprain happens.

Scenario 1

You’re running at speed with the ball and step heavily off your left foot to move quickly to your right. But the ground doesn’t feel quite like you thought it would. In a split second your foot has rolled underneath your leg, resulting in a feeling of more than one ‘crack’ followed shortly afterwards by a searing pain that envelops your whole foot and leaves you writhing in agony on the ground.

Scenario 2

While contesting the ball among a few other players you jump as high as you can to reach it. You land while you are twisting around, catching the edge of another player’s shoe, and causing your foot to land on the ground on its outside edge. The crunch that you feel is nauseating and soon so is the pain.

Both these situations will very likely result in damage to bone, joint, ligament, tendon or nerve that will require profound rest for complete healing to take place. How long and to what degree the rest needs to be enforced (and many athletes will not be happy to hear that they need to be on crutches for two to four weeks if normal weight-bearing is preventing good healing) depends on the all-important diagnosis.

The first few days is the critical phase for diagnosis because it immediately determines the management and time frames for full recovery:

* Are further investigations warranted?
* Do you need to refer the client to a specialist?
* Do they need a cast or crutches?
* Roughly how long will their rehabilitation take?

If you don’t have a good working diagnosis, none of these questions can be answered.
The crucial first week

While there isn’t any hard evidence to back this up, the issue of whether the athlete can reasonably weight-bear during the first week seems to be critical in establishing whether any of the four ‘nasties’ discussed below has occurred. This is because for the foot not to be able to stand simple weight- bearing implies that the weight-bearing surface and/or the stability mechanisms of the ankle must have been severely compromised.

This, therefore, is your first key diagnostic and management judgement: if it is painful to weight-bear on the foot in the first week, significant damage has occurred. The athlete needs to be non-weight bearing, on crutches, to the level that ensures there is no pain.

The option of soft-casting the ankle to hold it still will often need to be considered to achieve complete immobilisation. Any negative secondary effects of non-weight bearing for a week will be far outweighed by further damage caused by painful weight bearing.

From non-weight bearing, you will need to take the client conservatively through each new progression:

* partial weight bearing to…
* full weight bearing to…
* walking to …
* transitional drills to …
* running.

Delay each new step rather than re- aggravate the symptoms. Put the client in the water to practise each successive stage to reduce body weight and rehearse technique. A good idea is to use weight scales to objectify the graduated weight-bearing increases: stand them next to the scales and get them to load to 10kg and listen to how their ankle feels; that may be all they do for the first few days: holding that same level of pressure for 10 seconds, and repeating for 5-10 reps. The action must be pain-free.

There are four main types of primary damage that may in isolation or in combination prevent reasonable weight bearing in the first week.
1. Osteochondral defect (OCD)

This is damage to the surface chondral layer of the bone; the damage may be simple bruising, through to a displaced segment of cartilage. It may occur on the talar dome, the inferior tibial surface (‘tibial plafond’) or the medial fibular surface in the lateral gutter of the ankle.

The damage to various parts of the bony surfaces is commonly the result of the twisting force of landing, which causes the talus to invert and medially rotate in the tight angular ankle joint.

Signs

* usually there is no obvious sign on initial X-ray, but closer inspection or re-X-ray may reveal disruption to the joint margins
* significant pain on weight bearing
* the medial and lateral anterior talar dome, anterior tip of tibia or fibula will be very tender on palpation
* swelling all around joint lCT or MRI should tell all
* if sufficiently disrupted, this may require surgical referral.

Recovery time-frame: three to six months.
2. Bone stress short of fracture

Signs

* not visible on X-ray; bone scan will confirm but is not really necessary
* extreme tenderness on palpation, on medial/lateral malleolus or along shaft of tibia or fibula will confirm diagnosis
* maybe positive to squeeze or stress tests (where the bone is gently stressed as if you were trying to bend a stick).

Recovery time-frame: will heal by itself with sufficient rest over two to six weeks, depending on severity.
3. Lateral ankle ligament tear leading to gross instability

This is significant tearing (Grade II), through to complete rupture (Grade III) of the anterior talo-fibular (ATFL) and/or calcaneo-fibular (CFL) ligaments. Complete rupture of the lateral ligament complex requires immediate orthopaedic referral for stabilisation surgery.

Signs

* the most common result of a plantar-flexion/inversion sprain, rarely occurs in isolation from bony injury
* talocruraljoint demonstrates instability, leading to overloading of capsular and/or ligamentous structures and later possibly synovitis (thickened and inflamed capsule)
* client is unlikely to be able to weight- bear for initial period because of likely involvement of bony structure damage
* trial taping for diagnostic purposes: stirrups and heel locks can artificially stabilise the lateral ankle complex and help to diagnose a pure instability problem
* perform anterior drawer (ATFL) and possible medial glide of talus/calcaneum to gauge the end-feel of ligaments.

Recovery time-frame: three to six months, depending on other damage.
4. Tibio-fibular ligament/syndesmosis damage leading to instability

Also known as ‘high ankle sprain’. Can be very nasty, requiring orthopaedic referral to prevent long-term arthritic changes. The fibula will usually fracture laterally as well, preventing further damage along the line of the syndesmosis.

Signs

* landing with twisting is very likely to stress and drive the tibia and fibula apart, causing a tear of the ligament and syndesmosis (in addition to damage to other structures above)
* palpation of the anterior shin between tibia and fibula will show tenderness; medial/lateral stress test holding the calcaneum will reveal gapping and laxity between tibia and fibula.
* with significant instability, separation of tibio-fibular articulation is likely to be seen on a weight-bearing (heel pressure) X-ray, compared with other side
* it may be useful at a later stage to re-Xray in weight bearing at end-of-range dorsiflexion (if that was not possible at the outset because of pain) to detect any ongoing instability of the tibio-fibular complex compared with other ankle. With luck it may show up negative at the three-month stage with fibrosing and scar tissue doing a sufficient job of holding it together
* tibio-fibular compression taping may help with stabilising in the early weight- bearing phases.

Recovery time-frame: absolutely critical to prevent weight bearing on foot for up to three or four weeks with a more conservative progression through partial to full weight bearing. In total, allow six to eight months to return to sport.
The lateral ankle: key injury sites

The lateral ankle: key injury sites
Continued pain at 4 to 8 weeks

If things are not going well, or you are noticing new symptoms, consider the following secondary damage issues. These may not clearly manifest until the worst of the pain, swelling and disability has receded, but they need to be addressed in their own right as part of the mid- to late- stage rehabilitation process. These are the most common ones:
1. Talo-crural joint hypomobility/restriction

This leads to capsular synovitis/lateral impingement of fibula and talus in the lateral gutter.

Signs

* a very common side effect of any ankle sprain; it is critical to maintain maximum mobility to promote the best rate of healing
* if the talus cannot posteriorly glide during weight bearing it will cause ongoing impingement of anterior bony structures
* after the acute phase, perform manual posterior glides of talus and dorsiflexion testing at a wall to establish the extent of dorsiflexion deficit and the sites of restrictions (based on points of pain). Never stretch forward in weight bearing to improve dorsiflexion, as this risks aggravating the damaged structures
* fibrosis and thickening of the posterior capsule responds well to manual loosening procedures. Deep tissue massage of uninjured soft tissues (especially calf) is very useful in the acute phase. The use of seat belts in the mid to late stages of rehab can help to force the various bones to glide in normal ways again to gain final degrees of dorsiflexion – this should be done by an experienced physiotherapist.

2. Peroneal tendinopathy

Signs

* damage of the peroneal muscles and tendons is possible, but would not prevent normal weight bearing initially. Undertake static muscle testing, especially in dorsiflexion to note pain and weakness (there could be a tear in the muscle belly)
* treat as any muscle injury through to full return to function
* restricted or fibrosed peroneus longus can prevent normal dorsiflexion at later stages of rehab; massage and stretching is the answer
* the peroneal tendon can sublux from a torn tendon sheath posterior to the lateral malleolus, leading to chronic clicking and pain that may require surgery.

3. Reflex sympathetic dystrophy

Also known as ‘complex regional pain syndrome’ or Sudeck’s atrophy. A relatively uncommon condition of burning pain, pins and needles or numbness, ongoing and excessive swelling, often spreading up the whole shin, and discoloration of the foot and/or leg. It arises from a disturbance in the sympathetic nervous system that controls the blood flow and sweat glands to the limb. The neural disturbance may have its origins in over-stretching of nerve tissue during the ankle sprain, changing the way the nerve impulses are sent and causing a short circuit or overactivity.

Signs

* the risk of developing this may increase with too aggressive a rehabilitation strategy – go slow!
* keep this diagnosis (even in ‘mild’ forms) at the back of your mind if strange things are happening to the ankle that are really slowing down the return to function
* look for positive neural signs and paresthesia
* continueto work on range of movement and pain relief. Personally I find deep tissue massage/ trigger-point release to gastrocnemius and soleus muscles is critical for mobility gains. Acupuncture has occasionally worked wonders for pain relief
* can severely delay return to function, from three to 12 months
* adverse neural tension testing, done by a physiotherapist, can determine what level of nerve tethering or dysfunction is present.

4. Proprioceptive deficit

Reams of research and knowledge have been developed to aid our understanding of how a severe disruption to the normal functioning of a joint or body part can then create long-term damage to the brain-body connection to that body part. The brain’s ability to be aware of and to coordinate reflexes at the injured ankle can set up a chain of injuries elsewhere through the lower limbs unless the proprioceptive deficit is corrected through an exercise programme.

Signs

* do this test on yourself if you have ever badly injured an ankle or knee joint: in a completely dark room, stand on each leg in turn. Note the significant challenge of standing easily on the previously injured leg!
* proprioception in every damaged ankle will have been moderately to severely affected; this will need to be addressed during the mid to late stages of rehabilitation.

Conclusion

Once there is clarity about the nature and severity of damage to structures, you will be able to develop time frames for recovery and then tackle the challenge of restricting the athlete to crutches and prescribing safe exercise for the ankle.

More often than generally acknowledged, a period on crutches can be critical for the initial phase of healing, and to prevent side effects such as ongoing instability, long-term swelling and ankle thickening, and even reflex sympathetic dystrophy.

If you manage the rest and the healing phases thoroughly, you will help your client minimise their time out of action from the sport and they will have long-term reason to be thankful for your patient care.

Ulrik Larsen BThpy MAPA is an APA sports physiotherapist with a special interest in clinical Pilates. He is physiotherapist to Queensland Academy of Sport men’s water polo team

Illustrations by Viv Mullett

Where is the cliff notes version too many words...

Tribal Warfare
11-29-2010, 06:48 PM
Easy, his ankle is not absolutely 100% yet. Unlike players who are bigger than he is, Dexter must be fully recovered in every shape and form or he'll get killed out there. It's dire for McCluster to have his quicks at full throttle to survive on the field.

Deberg_1990
11-29-2010, 06:49 PM
Hes got AIDS

Marcellus
11-29-2010, 06:50 PM
Where is the cliff notes version too many words...

High ankle sprains take a long time to heal. Depending on severity it could be 12 weeks. Dex's isn't that bad or he would still be in a boot.

Dex should be back this week, he practiced last week. I think they are being overly cautious. Haley said Dex wants to be back ASAP.

Simply Red
11-29-2010, 06:51 PM
mufucka been peelin' caps

R&GHomer
11-29-2010, 06:53 PM
I could have sworn the Chiefs listed him as "Fully participating" in team practice starting las Wed. I was actually surprised to see he didn't suite up Sunday. I hope they just decided to hold him out so the Donky's wouldn't have any film on how we plan on using him. That's my Homer hope anyhow :thumb:

Tribal Warfare
11-29-2010, 06:55 PM
Hes got AIDS

[South Park reference]wouldn't they help him just like Subway's Jared? [/South Park reference]

:D

the Talking Can
11-29-2010, 06:55 PM
a high ankle sprain on a midget is actually a knee sprain


he'll be out a while

kysirsoze
11-29-2010, 06:55 PM
Rest him as long as he needs. If he's back for SD I'll be happy.

KcMizzou
11-29-2010, 06:56 PM
a high ankle sprain on a midget is actually a knee sprain


he'll be out a while
LMAO

-King-
11-29-2010, 06:59 PM
a high ankle sprain on a midget is actually a knee sprain


he'll be out a while:clap:

JASONSAUTO
11-29-2010, 07:00 PM
Easy, his ankle is not absolutely 100% yet. Unlike players who are bigger than he is, Dexter must be fully recovered in every shape and form or he'll get killed out there. It's dire for McCluster to have his quicks at full throttle to survive on the field. lol at the size reference. i would think they would want him at full strength for the division winning push
Posted via Mobile Device

Fruit Ninja
11-29-2010, 07:03 PM
mu****a been peelin' caps

what the fuck does this mean?

JASONSAUTO
11-29-2010, 07:03 PM
and lol at marcellus' long assed post and whoever quoted it thanks fellas
Posted via Mobile Device

KCUnited
11-29-2010, 07:06 PM
Holtus said it was a game time decision and he should be ready against Denver.

DJ's left nut
11-29-2010, 07:10 PM
What is really wrong with him?

High ankle sprains are a bitch and a half, that's what.

I had one that wasn't even that bad and it took 9 months or so to get my full range of motion back. After several weeks it didn't hurt anymore and it didn't hinder me at all, but the ankle clearly didn't move like my left ankle did. They're just very irritating and very very lingering.

For a guy that relies on his speed in and out of cuts, a high ankle sprain is nearly as bad as just breaking the thing altogether. It would've been hard to imagine an injury more debilitating for DMC.

veist
11-29-2010, 07:14 PM
Its a high ankle sprain, even a minor one takes 2-3wks before you can get back. Rushing him back does no good because it just increases the likelyhood of it becoming a nagging injury.

Saul Good
11-29-2010, 07:16 PM
I thought I heard something about him vomiting during a practice. I only caught a piece of it, but it made me think that he might have gotten a concussion.

Bacon Cheeseburger
11-29-2010, 07:22 PM
I heard it was a high ankle sprain and those can take a long time to fully heal.

DJ's left nut
11-29-2010, 07:22 PM
I thought I heard something about him vomiting during a practice. I only caught a piece of it, but it made me think that he might have gotten a concussion.

Well, with a bad wheel, his conditioning is going to suffer.

I wonder if that would've been a conditioning issue? If he's vomiting in practice 4 weeks after a concussion, that's ICU time. Vomiting should not stick around that long after the concussion.

But if he's been off that leg for a long time, his cardio could've suffered. Get him out there running gassers and maybe he didn't have the legs or the lungs for it yet. That's a good way to end up losing lunch.

If so, that could explain why he practiced this week but didn't play.

Dante84
11-29-2010, 07:28 PM
what the fuck does this mean?

means snitches get stitches, that's what.

And he gotta whole lotta string.

Chiefaholic
11-29-2010, 07:29 PM
I know he injured his ankle but I didn't think a sprain would take 5 weeks to heal

Mine took about 6 weeks to heal back in my younger teenage years.

salame
11-29-2010, 07:30 PM
HE BREAKS SHOES GUYS
I'm sure his ankles take a beating

Simply Red
11-29-2010, 07:39 PM
what the **** does this mean?

lol, i don't even know, i just typed it out because there's nothing else really to do.

aturnis
11-29-2010, 07:53 PM
A high ankle sprain is AT LEAST a 4 week injury. I was very surprised when they first noted his injury that they guessed 3-4 weeks. It's a bad injury that is easily aggravated if you try to do too much too early. I've heard it's way more painful than breaking you leg...

Red Beans
11-29-2010, 07:55 PM
Shit, sometimes a sprain takes longer to heal than a break.

Hog Farmer
11-29-2010, 08:01 PM
He needs to suck it up! I jumped out of the bed of a pickup truck and sprained my ankle the night before heading to baseball camp in Branson for two weeks. My ankle was the size of a cantelope and i won MVP for the session against players all over the country.

tk13
11-29-2010, 08:03 PM
Plus they would never say this... but you'd have to bet money they'd rather wait a couple weeks and have him as healthy as possible for our division games coming up instead of rushing him back too soon against Arizona and Seattle.

SenselessChiefsFan
11-29-2010, 08:10 PM
The reality is that his ability to cut is what makes him effective. If he were a blocking TE, he would already be playing. He was cleared last week, but the Chiefs gave him an extra week to get healthy. I fully expect him to play in six days.

Phobia
11-29-2010, 08:19 PM
I heard high ankle sprains can take 4-12 weeks or even more sometimes. I don't know, it's just what I heard.

Saul Good
11-29-2010, 08:22 PM
Well, with a bad wheel, his conditioning is going to suffer.

I wonder if that would've been a conditioning issue? If he's vomiting in practice 4 weeks after a concussion, that's ICU time. Vomiting should not stick around that long after the concussion.

But if he's been off that leg for a long time, his cardio could've suffered. Get him out there running gassers and maybe he didn't have the legs or the lungs for it yet. That's a good way to end up losing lunch.

If so, that could explain why he practiced this week but didn't play.

My assumption was that he was practicing after the ankle had healed and that he had then taken a shot to the head.

Mr. Laz
11-29-2010, 08:24 PM
http://www.sportsinjurybulletin.com/archive/ankle-sprain.htm



Where is the cliff notes version too many words...holy shit

who is the bigger dumbass that guy that posted the entire 2 page article or the doofus who quoted the guy who posted the entire 2 page article

:doh!:

Phobia
11-29-2010, 08:26 PM
http://www.sportsinjurybulletin.com/archive/ankle-sprain.htm


lrik Larsen offers guidance on how to spot and treat the kind of lateral ankle damage that can ruin an athletic career.

What is the most common sporting injury? Chances are that anyone who has done any kind of weight-bearing sport has had it happen: a sprained ankle. But there is a vast difference between mild sprains and moderate to severe lateral ankle sprains which actually damage the ankle.

Incorrect management can easily turn a recovery time from 3-4 months into a 12-18 month epic. I’ve seen it happen and made the mistakes myself as a younger clinician!

To establish an accurate diagnosis and treatment schedule you need to know where a sprain fits into the spectrum. The key question is this: what are the signs and symptoms that distinguish a sprained ankle that is damaged? Only by identifying these features can we undertake the crucial early management, and predict which sprains will require longer time frames for recovery.

I am not talking here about mild ankle sprains that will always get better regardless of what is done to them – most athletes will ‘walk them off’ because there is no real damage to the ankle. Nor will I discuss medial ankle sprains, or acute forefoot/mid-foot injuries. And finally, I will not be looking at the obviously severe injuries that need orthopaedic referral: fractures of tibia and/or fibula, talar dome and ankle dislocations. Usually these will be picked up in the emergency department of the local hospital. If the injury happens on the field, the severity of pain would be enough to convince anyone to summon an ambulance and have immediate X-rays!

So what does that leave? Precisely the tricky sprains in which damage to the ankle is unlikely to show up positive on X-ray. Commonly these injuries have a history of having occurred with some heavy weight-bearing and rotary force; they present with significant swelling, pain, lack of normal range of movement; and the client will be unable to walk and/or run without pain and aggravation.

An athlete in this situation is certainly going to be frustrated, because they will probably present after a few weeks have gone by and things are not resolving, having been given the all-important all-clear on X-ray. So their expectations will have been skewed towards thinking that they will be back on the field within two to four weeks.

The most common mistake that clinicians, coaches and athletes make is to underrate the severity of damage and return to activity too early. The fatal assumption is that when the X-ray is negative, then the damage can’t be too bad… Wrong! The best result will often be had by overrating the damage in the first month, and being extra cautious, rather than pushing for progress.

Let’s paint a couple of painful pictures to help us understand how a damaged ankle sprain happens.

Scenario 1

You’re running at speed with the ball and step heavily off your left foot to move quickly to your right. But the ground doesn’t feel quite like you thought it would. In a split second your foot has rolled underneath your leg, resulting in a feeling of more than one ‘crack’ followed shortly afterwards by a searing pain that envelops your whole foot and leaves you writhing in agony on the ground.

Scenario 2

While contesting the ball among a few other players you jump as high as you can to reach it. You land while you are twisting around, catching the edge of another player’s shoe, and causing your foot to land on the ground on its outside edge. The crunch that you feel is nauseating and soon so is the pain.

Both these situations will very likely result in damage to bone, joint, ligament, tendon or nerve that will require profound rest for complete healing to take place. How long and to what degree the rest needs to be enforced (and many athletes will not be happy to hear that they need to be on crutches for two to four weeks if normal weight-bearing is preventing good healing) depends on the all-important diagnosis.

The first few days is the critical phase for diagnosis because it immediately determines the management and time frames for full recovery:

* Are further investigations warranted?
* Do you need to refer the client to a specialist?
* Do they need a cast or crutches?
* Roughly how long will their rehabilitation take?

If you don’t have a good working diagnosis, none of these questions can be answered.
The crucial first week

While there isn’t any hard evidence to back this up, the issue of whether the athlete can reasonably weight-bear during the first week seems to be critical in establishing whether any of the four ‘nasties’ discussed below has occurred. This is because for the foot not to be able to stand simple weight- bearing implies that the weight-bearing surface and/or the stability mechanisms of the ankle must have been severely compromised.

This, therefore, is your first key diagnostic and management judgement: if it is painful to weight-bear on the foot in the first week, significant damage has occurred. The athlete needs to be non-weight bearing, on crutches, to the level that ensures there is no pain.

The option of soft-casting the ankle to hold it still will often need to be considered to achieve complete immobilisation. Any negative secondary effects of non-weight bearing for a week will be far outweighed by further damage caused by painful weight bearing.

From non-weight bearing, you will need to take the client conservatively through each new progression:

* partial weight bearing to…
* full weight bearing to…
* walking to …
* transitional drills to …
* running.

Delay each new step rather than re- aggravate the symptoms. Put the client in the water to practise each successive stage to reduce body weight and rehearse technique. A good idea is to use weight scales to objectify the graduated weight-bearing increases: stand them next to the scales and get them to load to 10kg and listen to how their ankle feels; that may be all they do for the first few days: holding that same level of pressure for 10 seconds, and repeating for 5-10 reps. The action must be pain-free.

There are four main types of primary damage that may in isolation or in combination prevent reasonable weight bearing in the first week.
1. Osteochondral defect (OCD)

This is damage to the surface chondral layer of the bone; the damage may be simple bruising, through to a displaced segment of cartilage. It may occur on the talar dome, the inferior tibial surface (‘tibial plafond’) or the medial fibular surface in the lateral gutter of the ankle.

The damage to various parts of the bony surfaces is commonly the result of the twisting force of landing, which causes the talus to invert and medially rotate in the tight angular ankle joint.

Signs

* usually there is no obvious sign on initial X-ray, but closer inspection or re-X-ray may reveal disruption to the joint margins
* significant pain on weight bearing
* the medial and lateral anterior talar dome, anterior tip of tibia or fibula will be very tender on palpation
* swelling all around joint lCT or MRI should tell all
* if sufficiently disrupted, this may require surgical referral.

Recovery time-frame: three to six months.
2. Bone stress short of fracture

Signs

* not visible on X-ray; bone scan will confirm but is not really necessary
* extreme tenderness on palpation, on medial/lateral malleolus or along shaft of tibia or fibula will confirm diagnosis
* maybe positive to squeeze or stress tests (where the bone is gently stressed as if you were trying to bend a stick).

Recovery time-frame: will heal by itself with sufficient rest over two to six weeks, depending on severity.
3. Lateral ankle ligament tear leading to gross instability

This is significant tearing (Grade II), through to complete rupture (Grade III) of the anterior talo-fibular (ATFL) and/or calcaneo-fibular (CFL) ligaments. Complete rupture of the lateral ligament complex requires immediate orthopaedic referral for stabilisation surgery.

Signs

* the most common result of a plantar-flexion/inversion sprain, rarely occurs in isolation from bony injury
* talocruraljoint demonstrates instability, leading to overloading of capsular and/or ligamentous structures and later possibly synovitis (thickened and inflamed capsule)
* client is unlikely to be able to weight- bear for initial period because of likely involvement of bony structure damage
* trial taping for diagnostic purposes: stirrups and heel locks can artificially stabilise the lateral ankle complex and help to diagnose a pure instability problem
* perform anterior drawer (ATFL) and possible medial glide of talus/calcaneum to gauge the end-feel of ligaments.

Recovery time-frame: three to six months, depending on other damage.
4. Tibio-fibular ligament/syndesmosis damage leading to instability

Also known as ‘high ankle sprain’. Can be very nasty, requiring orthopaedic referral to prevent long-term arthritic changes. The fibula will usually fracture laterally as well, preventing further damage along the line of the syndesmosis.

Signs

* landing with twisting is very likely to stress and drive the tibia and fibula apart, causing a tear of the ligament and syndesmosis (in addition to damage to other structures above)
* palpation of the anterior shin between tibia and fibula will show tenderness; medial/lateral stress test holding the calcaneum will reveal gapping and laxity between tibia and fibula.
* with significant instability, separation of tibio-fibular articulation is likely to be seen on a weight-bearing (heel pressure) X-ray, compared with other side
* it may be useful at a later stage to re-Xray in weight bearing at end-of-range dorsiflexion (if that was not possible at the outset because of pain) to detect any ongoing instability of the tibio-fibular complex compared with other ankle. With luck it may show up negative at the three-month stage with fibrosing and scar tissue doing a sufficient job of holding it together
* tibio-fibular compression taping may help with stabilising in the early weight- bearing phases.

Recovery time-frame: absolutely critical to prevent weight bearing on foot for up to three or four weeks with a more conservative progression through partial to full weight bearing. In total, allow six to eight months to return to sport.
The lateral ankle: key injury sites

The lateral ankle: key injury sites
Continued pain at 4 to 8 weeks

If things are not going well, or you are noticing new symptoms, consider the following secondary damage issues. These may not clearly manifest until the worst of the pain, swelling and disability has receded, but they need to be addressed in their own right as part of the mid- to late- stage rehabilitation process. These are the most common ones:
1. Talo-crural joint hypomobility/restriction

This leads to capsular synovitis/lateral impingement of fibula and talus in the lateral gutter.

Signs

* a very common side effect of any ankle sprain; it is critical to maintain maximum mobility to promote the best rate of healing
* if the talus cannot posteriorly glide during weight bearing it will cause ongoing impingement of anterior bony structures
* after the acute phase, perform manual posterior glides of talus and dorsiflexion testing at a wall to establish the extent of dorsiflexion deficit and the sites of restrictions (based on points of pain). Never stretch forward in weight bearing to improve dorsiflexion, as this risks aggravating the damaged structures
* fibrosis and thickening of the posterior capsule responds well to manual loosening procedures. Deep tissue massage of uninjured soft tissues (especially calf) is very useful in the acute phase. The use of seat belts in the mid to late stages of rehab can help to force the various bones to glide in normal ways again to gain final degrees of dorsiflexion – this should be done by an experienced physiotherapist.

2. Peroneal tendinopathy

Signs

* damage of the peroneal muscles and tendons is possible, but would not prevent normal weight bearing initially. Undertake static muscle testing, especially in dorsiflexion to note pain and weakness (there could be a tear in the muscle belly)
* treat as any muscle injury through to full return to function
* restricted or fibrosed peroneus longus can prevent normal dorsiflexion at later stages of rehab; massage and stretching is the answer
* the peroneal tendon can sublux from a torn tendon sheath posterior to the lateral malleolus, leading to chronic clicking and pain that may require surgery.

3. Reflex sympathetic dystrophy

Also known as ‘complex regional pain syndrome’ or Sudeck’s atrophy. A relatively uncommon condition of burning pain, pins and needles or numbness, ongoing and excessive swelling, often spreading up the whole shin, and discoloration of the foot and/or leg. It arises from a disturbance in the sympathetic nervous system that controls the blood flow and sweat glands to the limb. The neural disturbance may have its origins in over-stretching of nerve tissue during the ankle sprain, changing the way the nerve impulses are sent and causing a short circuit or overactivity.

Signs

* the risk of developing this may increase with too aggressive a rehabilitation strategy – go slow!
* keep this diagnosis (even in ‘mild’ forms) at the back of your mind if strange things are happening to the ankle that are really slowing down the return to function
* look for positive neural signs and paresthesia
* continueto work on range of movement and pain relief. Personally I find deep tissue massage/ trigger-point release to gastrocnemius and soleus muscles is critical for mobility gains. Acupuncture has occasionally worked wonders for pain relief
* can severely delay return to function, from three to 12 months
* adverse neural tension testing, done by a physiotherapist, can determine what level of nerve tethering or dysfunction is present.

4. Proprioceptive deficit

Reams of research and knowledge have been developed to aid our understanding of how a severe disruption to the normal functioning of a joint or body part can then create long-term damage to the brain-body connection to that body part. The brain’s ability to be aware of and to coordinate reflexes at the injured ankle can set up a chain of injuries elsewhere through the lower limbs unless the proprioceptive deficit is corrected through an exercise programme.

Signs

* do this test on yourself if you have ever badly injured an ankle or knee joint: in a completely dark room, stand on each leg in turn. Note the significant challenge of standing easily on the previously injured leg!
* proprioception in every damaged ankle will have been moderately to severely affected; this will need to be addressed during the mid to late stages of rehabilitation.

Conclusion

Once there is clarity about the nature and severity of damage to structures, you will be able to develop time frames for recovery and then tackle the challenge of restricting the athlete to crutches and prescribing safe exercise for the ankle.

More often than generally acknowledged, a period on crutches can be critical for the initial phase of healing, and to prevent side effects such as ongoing instability, long-term swelling and ankle thickening, and even reflex sympathetic dystrophy.

If you manage the rest and the healing phases thoroughly, you will help your client minimise their time out of action from the sport and they will have long-term reason to be thankful for your patient care.

Ulrik Larsen BThpy MAPA is an APA sports physiotherapist with a special interest in clinical Pilates. He is physiotherapist to Queensland Academy of Sport men’s water polo team

Illustrations by Viv Mullett

See, most of the info in here is correct. Good post.

KCChiefsFan88
11-29-2010, 08:26 PM
A high ankle sprain on a speed guy is a lengthy injury.

McCluster has actually been more active on the sideline in street clothes than Chambers has been while in uniform on the field.

BryanBusby
11-29-2010, 08:28 PM
I heard high ankle sprains can take 4-12 weeks or even more sometimes. I don't know, it's just what I heard.

Took me about 8 weeks before I actually felt fully recovered from a high ankle sprain and I don't play football nor run anywhere near as quick as McCluster.

Red Beans
11-29-2010, 08:30 PM
He needs to suck it up! I jumped out of the bed of a pickup truck and sprained my ankle the night before heading to baseball camp in Branson for two weeks. My ankle was the size of a cantelope and i won MVP for the session against players all over the country.

Well he didn't have the benefit of have an adolescent fascination with boar semen. Obviously, those youthful dreams gave you superhuman recovery strength as they've enabled you to locate terrorists and fully amuse thousands of people in your later years.

Jive Ass
11-29-2010, 08:32 PM
I'm pretty excited for any play time in the near future for McCluster. If it's Denver, good, but we'll truly need him in SD.

One thing I worry about is using Bowe as the successive go-to guy for our passing game. Keeping it dynamic is going to be essential in the upcoming games, and I really hope to see McCluster as a part of that.

GloryDayz
11-29-2010, 08:34 PM
So, are we clear on it being an ankle issue, and it takes a while to heal? It's like a concussion of the foot...

patteeu
11-29-2010, 09:00 PM
I could have sworn the Chiefs listed him as "Fully participating" in team practice starting las Wed. I was actually surprised to see he didn't suite up Sunday. I hope they just decided to hold him out so the Donky's wouldn't have any film on how we plan on using him. That's my Homer hope anyhow :thumb:

Nick Wright must know something that others don't know because last week he tweeted that McCluster would miss Sunday's game while the rest of the KC media were talking about how things looked good because McCluster was fully participating. Whatever it is, he seemed to know it well before gameday.

Edit: Either that or he was just guessing and got lucky.

-King-
11-29-2010, 09:17 PM
http://www.sportsinjurybulletin.com/archive/ankle-sprain.htm


lrik Larsen offers guidance on how to spot and treat the kind of lateral ankle damage that can ruin an athletic career.

What is the most common sporting injury? Chances are that anyone who has done any kind of weight-bearing sport has had it happen: a sprained ankle. But there is a vast difference between mild sprains and moderate to severe lateral ankle sprains which actually damage the ankle.

Incorrect management can easily turn a recovery time from 3-4 months into a 12-18 month epic. I’ve seen it happen and made the mistakes myself as a younger clinician!

To establish an accurate diagnosis and treatment schedule you need to know where a sprain fits into the spectrum. The key question is this: what are the signs and symptoms that distinguish a sprained ankle that is damaged? Only by identifying these features can we undertake the crucial early management, and predict which sprains will require longer time frames for recovery.

I am not talking here about mild ankle sprains that will always get better regardless of what is done to them – most athletes will ‘walk them off’ because there is no real damage to the ankle. Nor will I discuss medial ankle sprains, or acute forefoot/mid-foot injuries. And finally, I will not be looking at the obviously severe injuries that need orthopaedic referral: fractures of tibia and/or fibula, talar dome and ankle dislocations. Usually these will be picked up in the emergency department of the local hospital. If the injury happens on the field, the severity of pain would be enough to convince anyone to summon an ambulance and have immediate X-rays!

So what does that leave? Precisely the tricky sprains in which damage to the ankle is unlikely to show up positive on X-ray. Commonly these injuries have a history of having occurred with some heavy weight-bearing and rotary force; they present with significant swelling, pain, lack of normal range of movement; and the client will be unable to walk and/or run without pain and aggravation.

An athlete in this situation is certainly going to be frustrated, because they will probably present after a few weeks have gone by and things are not resolving, having been given the all-important all-clear on X-ray. So their expectations will have been skewed towards thinking that they will be back on the field within two to four weeks.

The most common mistake that clinicians, coaches and athletes make is to underrate the severity of damage and return to activity too early. The fatal assumption is that when the X-ray is negative, then the damage can’t be too bad… Wrong! The best result will often be had by overrating the damage in the first month, and being extra cautious, rather than pushing for progress.

Let’s paint a couple of painful pictures to help us understand how a damaged ankle sprain happens.

Scenario 1

You’re running at speed with the ball and step heavily off your left foot to move quickly to your right. But the ground doesn’t feel quite like you thought it would. In a split second your foot has rolled underneath your leg, resulting in a feeling of more than one ‘crack’ followed shortly afterwards by a searing pain that envelops your whole foot and leaves you writhing in agony on the ground.

Scenario 2

While contesting the ball among a few other players you jump as high as you can to reach it. You land while you are twisting around, catching the edge of another player’s shoe, and causing your foot to land on the ground on its outside edge. The crunch that you feel is nauseating and soon so is the pain.

Both these situations will very likely result in damage to bone, joint, ligament, tendon or nerve that will require profound rest for complete healing to take place. How long and to what degree the rest needs to be enforced (and many athletes will not be happy to hear that they need to be on crutches for two to four weeks if normal weight-bearing is preventing good healing) depends on the all-important diagnosis.

The first few days is the critical phase for diagnosis because it immediately determines the management and time frames for full recovery:

* Are further investigations warranted?
* Do you need to refer the client to a specialist?
* Do they need a cast or crutches?
* Roughly how long will their rehabilitation take?

If you don’t have a good working diagnosis, none of these questions can be answered.
The crucial first week

While there isn’t any hard evidence to back this up, the issue of whether the athlete can reasonably weight-bear during the first week seems to be critical in establishing whether any of the four ‘nasties’ discussed below has occurred. This is because for the foot not to be able to stand simple weight- bearing implies that the weight-bearing surface and/or the stability mechanisms of the ankle must have been severely compromised.

This, therefore, is your first key diagnostic and management judgement: if it is painful to weight-bear on the foot in the first week, significant damage has occurred. The athlete needs to be non-weight bearing, on crutches, to the level that ensures there is no pain.

The option of soft-casting the ankle to hold it still will often need to be considered to achieve complete immobilisation. Any negative secondary effects of non-weight bearing for a week will be far outweighed by further damage caused by painful weight bearing.

From non-weight bearing, you will need to take the client conservatively through each new progression:

* partial weight bearing to…
* full weight bearing to…
* walking to …
* transitional drills to …
* running.

Delay each new step rather than re- aggravate the symptoms. Put the client in the water to practise each successive stage to reduce body weight and rehearse technique. A good idea is to use weight scales to objectify the graduated weight-bearing increases: stand them next to the scales and get them to load to 10kg and listen to how their ankle feels; that may be all they do for the first few days: holding that same level of pressure for 10 seconds, and repeating for 5-10 reps. The action must be pain-free.

There are four main types of primary damage that may in isolation or in combination prevent reasonable weight bearing in the first week.
1. Osteochondral defect (OCD)

This is damage to the surface chondral layer of the bone; the damage may be simple bruising, through to a displaced segment of cartilage. It may occur on the talar dome, the inferior tibial surface (‘tibial plafond’) or the medial fibular surface in the lateral gutter of the ankle.

The damage to various parts of the bony surfaces is commonly the result of the twisting force of landing, which causes the talus to invert and medially rotate in the tight angular ankle joint.

Signs

* usually there is no obvious sign on initial X-ray, but closer inspection or re-X-ray may reveal disruption to the joint margins
* significant pain on weight bearing
* the medial and lateral anterior talar dome, anterior tip of tibia or fibula will be very tender on palpation
* swelling all around joint lCT or MRI should tell all
* if sufficiently disrupted, this may require surgical referral.

Recovery time-frame: three to six months.
2. Bone stress short of fracture

Signs

* not visible on X-ray; bone scan will confirm but is not really necessary
* extreme tenderness on palpation, on medial/lateral malleolus or along shaft of tibia or fibula will confirm diagnosis
* maybe positive to squeeze or stress tests (where the bone is gently stressed as if you were trying to bend a stick).

Recovery time-frame: will heal by itself with sufficient rest over two to six weeks, depending on severity.
3. Lateral ankle ligament tear leading to gross instability

This is significant tearing (Grade II), through to complete rupture (Grade III) of the anterior talo-fibular (ATFL) and/or calcaneo-fibular (CFL) ligaments. Complete rupture of the lateral ligament complex requires immediate orthopaedic referral for stabilisation surgery.

Signs

* the most common result of a plantar-flexion/inversion sprain, rarely occurs in isolation from bony injury
* talocruraljoint demonstrates instability, leading to overloading of capsular and/or ligamentous structures and later possibly synovitis (thickened and inflamed capsule)
* client is unlikely to be able to weight- bear for initial period because of likely involvement of bony structure damage
* trial taping for diagnostic purposes: stirrups and heel locks can artificially stabilise the lateral ankle complex and help to diagnose a pure instability problem
* perform anterior drawer (ATFL) and possible medial glide of talus/calcaneum to gauge the end-feel of ligaments.

Recovery time-frame: three to six months, depending on other damage.
4. Tibio-fibular ligament/syndesmosis damage leading to instability

Also known as ‘high ankle sprain’. Can be very nasty, requiring orthopaedic referral to prevent long-term arthritic changes. The fibula will usually fracture laterally as well, preventing further damage along the line of the syndesmosis.

Signs

* landing with twisting is very likely to stress and drive the tibia and fibula apart, causing a tear of the ligament and syndesmosis (in addition to damage to other structures above)
* palpation of the anterior shin between tibia and fibula will show tenderness; medial/lateral stress test holding the calcaneum will reveal gapping and laxity between tibia and fibula.
* with significant instability, separation of tibio-fibular articulation is likely to be seen on a weight-bearing (heel pressure) X-ray, compared with other side
* it may be useful at a later stage to re-Xray in weight bearing at end-of-range dorsiflexion (if that was not possible at the outset because of pain) to detect any ongoing instability of the tibio-fibular complex compared with other ankle. With luck it may show up negative at the three-month stage with fibrosing and scar tissue doing a sufficient job of holding it together
* tibio-fibular compression taping may help with stabilising in the early weight- bearing phases.

Recovery time-frame: absolutely critical to prevent weight bearing on foot for up to three or four weeks with a more conservative progression through partial to full weight bearing. In total, allow six to eight months to return to sport.
The lateral ankle: key injury sites

The lateral ankle: key injury sites
Continued pain at 4 to 8 weeks

If things are not going well, or you are noticing new symptoms, consider the following secondary damage issues. These may not clearly manifest until the worst of the pain, swelling and disability has receded, but they need to be addressed in their own right as part of the mid- to late- stage rehabilitation process. These are the most common ones:
1. Talo-crural joint hypomobility/restriction

This leads to capsular synovitis/lateral impingement of fibula and talus in the lateral gutter.

Signs

* a very common side effect of any ankle sprain; it is critical to maintain maximum mobility to promote the best rate of healing
* if the talus cannot posteriorly glide during weight bearing it will cause ongoing impingement of anterior bony structures
* after the acute phase, perform manual posterior glides of talus and dorsiflexion testing at a wall to establish the extent of dorsiflexion deficit and the sites of restrictions (based on points of pain). Never stretch forward in weight bearing to improve dorsiflexion, as this risks aggravating the damaged structures
* fibrosis and thickening of the posterior capsule responds well to manual loosening procedures. Deep tissue massage of uninjured soft tissues (especially calf) is very useful in the acute phase. The use of seat belts in the mid to late stages of rehab can help to force the various bones to glide in normal ways again to gain final degrees of dorsiflexion – this should be done by an experienced physiotherapist.

2. Peroneal tendinopathy

Signs

* damage of the peroneal muscles and tendons is possible, but would not prevent normal weight bearing initially. Undertake static muscle testing, especially in dorsiflexion to note pain and weakness (there could be a tear in the muscle belly)
* treat as any muscle injury through to full return to function
* restricted or fibrosed peroneus longus can prevent normal dorsiflexion at later stages of rehab; massage and stretching is the answer
* the peroneal tendon can sublux from a torn tendon sheath posterior to the lateral malleolus, leading to chronic clicking and pain that may require surgery.

3. Reflex sympathetic dystrophy

Also known as ‘complex regional pain syndrome’ or Sudeck’s atrophy. A relatively uncommon condition of burning pain, pins and needles or numbness, ongoing and excessive swelling, often spreading up the whole shin, and discoloration of the foot and/or leg. It arises from a disturbance in the sympathetic nervous system that controls the blood flow and sweat glands to the limb. The neural disturbance may have its origins in over-stretching of nerve tissue during the ankle sprain, changing the way the nerve impulses are sent and causing a short circuit or overactivity.

Signs

* the risk of developing this may increase with too aggressive a rehabilitation strategy – go slow!
* keep this diagnosis (even in ‘mild’ forms) at the back of your mind if strange things are happening to the ankle that are really slowing down the return to function
* look for positive neural signs and paresthesia
* continueto work on range of movement and pain relief. Personally I find deep tissue massage/ trigger-point release to gastrocnemius and soleus muscles is critical for mobility gains. Acupuncture has occasionally worked wonders for pain relief
* can severely delay return to function, from three to 12 months
* adverse neural tension testing, done by a physiotherapist, can determine what level of nerve tethering or dysfunction is present.

4. Proprioceptive deficit

Reams of research and knowledge have been developed to aid our understanding of how a severe disruption to the normal functioning of a joint or body part can then create long-term damage to the brain-body connection to that body part. The brain’s ability to be aware of and to coordinate reflexes at the injured ankle can set up a chain of injuries elsewhere through the lower limbs unless the proprioceptive deficit is corrected through an exercise programme.

Signs

* do this test on yourself if you have ever badly injured an ankle or knee joint: in a completely dark room, stand on each leg in turn. Note the significant challenge of standing easily on the previously injured leg!
* proprioception in every damaged ankle will have been moderately to severely affected; this will need to be addressed during the mid to late stages of rehabilitation.

Conclusion

Once there is clarity about the nature and severity of damage to structures, you will be able to develop time frames for recovery and then tackle the challenge of restricting the athlete to crutches and prescribing safe exercise for the ankle.

More often than generally acknowledged, a period on crutches can be critical for the initial phase of healing, and to prevent side effects such as ongoing instability, long-term swelling and ankle thickening, and even reflex sympathetic dystrophy.

If you manage the rest and the healing phases thoroughly, you will help your client minimise their time out of action from the sport and they will have long-term reason to be thankful for your patient care.

Ulrik Larsen BThpy MAPA is an APA sports physiotherapist with a special interest in clinical Pilates. He is physiotherapist to Queensland Academy of Sport men’s water polo team

Illustrations by Viv Mullett

FWIW, I think this covers it.....

-King-
11-29-2010, 09:18 PM
Nick Wright must know something that others don't know because last week he tweeted that McCluster would miss Sunday's game while the rest of the KC media were talking about how things looked good because McCluster was fully participating. Whatever it is, he seemed to know it well before gameday.

Edit: Either that or he was just guessing and got lucky.

He has a good relationship with players so he can get that kind of info. He's useless in every other insider info though.

stevieray
11-29-2010, 09:19 PM
I was always under the impression that high ankle sprains take 6-8 weeks.

they are a bitch to recover from....

siberian khatru
11-29-2010, 09:21 PM
I haven't read thru the thread, but if I had to guess, based on his limping and the time he's missed, I'd say it sounds like a high-ankle sprain.

Here's a few thoughts I threw together on it:

What is the most common sporting injury? Chances are that anyone who has done any kind of weight-bearing sport has had it happen: a sprained ankle. But there is a vast difference between mild sprains and moderate to severe lateral ankle sprains which actually damage the ankle.

Incorrect management can easily turn a recovery time from 3-4 months into a 12-18 month epic. I’ve seen it happen and made the mistakes myself as a younger clinician!

To establish an accurate diagnosis and treatment schedule you need to know where a sprain fits into the spectrum. The key question is this: what are the signs and symptoms that distinguish a sprained ankle that is damaged? Only by identifying these features can we undertake the crucial early management, and predict which sprains will require longer time frames for recovery.

I am not talking here about mild ankle sprains that will always get better regardless of what is done to them – most athletes will ‘walk them off’ because there is no real damage to the ankle. Nor will I discuss medial ankle sprains, or acute forefoot/mid-foot injuries. And finally, I will not be looking at the obviously severe injuries that need orthopaedic referral: fractures of tibia and/or fibula, talar dome and ankle dislocations. Usually these will be picked up in the emergency department of the local hospital. If the injury happens on the field, the severity of pain would be enough to convince anyone to summon an ambulance and have immediate X-rays!

So what does that leave? Precisely the tricky sprains in which damage to the ankle is unlikely to show up positive on X-ray. Commonly these injuries have a history of having occurred with some heavy weight-bearing and rotary force; they present with significant swelling, pain, lack of normal range of movement; and the client will be unable to walk and/or run without pain and aggravation.

An athlete in this situation is certainly going to be frustrated, because they will probably present after a few weeks have gone by and things are not resolving, having been given the all-important all-clear on X-ray. So their expectations will have been skewed towards thinking that they will be back on the field within two to four weeks.

The most common mistake that clinicians, coaches and athletes make is to underrate the severity of damage and return to activity too early. The fatal assumption is that when the X-ray is negative, then the damage can’t be too bad… Wrong! The best result will often be had by overrating the damage in the first month, and being extra cautious, rather than pushing for progress.

Let’s paint a couple of painful pictures to help us understand how a damaged ankle sprain happens.

Scenario 1

You’re running at speed with the ball and step heavily off your left foot to move quickly to your right. But the ground doesn’t feel quite like you thought it would. In a split second your foot has rolled underneath your leg, resulting in a feeling of more than one ‘crack’ followed shortly afterwards by a searing pain that envelops your whole foot and leaves you writhing in agony on the ground.

Scenario 2

While contesting the ball among a few other players you jump as high as you can to reach it. You land while you are twisting around, catching the edge of another player’s shoe, and causing your foot to land on the ground on its outside edge. The crunch that you feel is nauseating and soon so is the pain.

Both these situations will very likely result in damage to bone, joint, ligament, tendon or nerve that will require profound rest for complete healing to take place. How long and to what degree the rest needs to be enforced (and many athletes will not be happy to hear that they need to be on crutches for two to four weeks if normal weight-bearing is preventing good healing) depends on the all-important diagnosis.

The first few days is the critical phase for diagnosis because it immediately determines the management and time frames for full recovery:

* Are further investigations warranted?
* Do you need to refer the client to a specialist?
* Do they need a cast or crutches?
* Roughly how long will their rehabilitation take?

If you don’t have a good working diagnosis, none of these questions can be answered.
The crucial first week

While there isn’t any hard evidence to back this up, the issue of whether the athlete can reasonably weight-bear during the first week seems to be critical in establishing whether any of the four ‘nasties’ discussed below has occurred. This is because for the foot not to be able to stand simple weight- bearing implies that the weight-bearing surface and/or the stability mechanisms of the ankle must have been severely compromised.

This, therefore, is your first key diagnostic and management judgement: if it is painful to weight-bear on the foot in the first week, significant damage has occurred. The athlete needs to be non-weight bearing, on crutches, to the level that ensures there is no pain.

The option of soft-casting the ankle to hold it still will often need to be considered to achieve complete immobilisation. Any negative secondary effects of non-weight bearing for a week will be far outweighed by further damage caused by painful weight bearing.

From non-weight bearing, you will need to take the client conservatively through each new progression:

* partial weight bearing to…
* full weight bearing to…
* walking to …
* transitional drills to …
* running.

Delay each new step rather than re- aggravate the symptoms. Put the client in the water to practise each successive stage to reduce body weight and rehearse technique. A good idea is to use weight scales to objectify the graduated weight-bearing increases: stand them next to the scales and get them to load to 10kg and listen to how their ankle feels; that may be all they do for the first few days: holding that same level of pressure for 10 seconds, and repeating for 5-10 reps. The action must be pain-free.

There are four main types of primary damage that may in isolation or in combination prevent reasonable weight bearing in the first week.
1. Osteochondral defect (OCD)

This is damage to the surface chondral layer of the bone; the damage may be simple bruising, through to a displaced segment of cartilage. It may occur on the talar dome, the inferior tibial surface (‘tibial plafond’) or the medial fibular surface in the lateral gutter of the ankle.

The damage to various parts of the bony surfaces is commonly the result of the twisting force of landing, which causes the talus to invert and medially rotate in the tight angular ankle joint.

Signs

* usually there is no obvious sign on initial X-ray, but closer inspection or re-X-ray may reveal disruption to the joint margins
* significant pain on weight bearing
* the medial and lateral anterior talar dome, anterior tip of tibia or fibula will be very tender on palpation
* swelling all around joint lCT or MRI should tell all
* if sufficiently disrupted, this may require surgical referral.

Recovery time-frame: three to six months.
2. Bone stress short of fracture

Signs

* not visible on X-ray; bone scan will confirm but is not really necessary
* extreme tenderness on palpation, on medial/lateral malleolus or along shaft of tibia or fibula will confirm diagnosis
* maybe positive to squeeze or stress tests (where the bone is gently stressed as if you were trying to bend a stick).

Recovery time-frame: will heal by itself with sufficient rest over two to six weeks, depending on severity.
3. Lateral ankle ligament tear leading to gross instability

This is significant tearing (Grade II), through to complete rupture (Grade III) of the anterior talo-fibular (ATFL) and/or calcaneo-fibular (CFL) ligaments. Complete rupture of the lateral ligament complex requires immediate orthopaedic referral for stabilisation surgery.

Signs

* the most common result of a plantar-flexion/inversion sprain, rarely occurs in isolation from bony injury
* talocruraljoint demonstrates instability, leading to overloading of capsular and/or ligamentous structures and later possibly synovitis (thickened and inflamed capsule)
* client is unlikely to be able to weight- bear for initial period because of likely involvement of bony structure damage
* trial taping for diagnostic purposes: stirrups and heel locks can artificially stabilise the lateral ankle complex and help to diagnose a pure instability problem
* perform anterior drawer (ATFL) and possible medial glide of talus/calcaneum to gauge the end-feel of ligaments.

Recovery time-frame: three to six months, depending on other damage.
4. Tibio-fibular ligament/syndesmosis damage leading to instability

Also known as ‘high ankle sprain’. Can be very nasty, requiring orthopaedic referral to prevent long-term arthritic changes. The fibula will usually fracture laterally as well, preventing further damage along the line of the syndesmosis.

Signs

* landing with twisting is very likely to stress and drive the tibia and fibula apart, causing a tear of the ligament and syndesmosis (in addition to damage to other structures above)
* palpation of the anterior shin between tibia and fibula will show tenderness; medial/lateral stress test holding the calcaneum will reveal gapping and laxity between tibia and fibula.
* with significant instability, separation of tibio-fibular articulation is likely to be seen on a weight-bearing (heel pressure) X-ray, compared with other side
* it may be useful at a later stage to re-Xray in weight bearing at end-of-range dorsiflexion (if that was not possible at the outset because of pain) to detect any ongoing instability of the tibio-fibular complex compared with other ankle. With luck it may show up negative at the three-month stage with fibrosing and scar tissue doing a sufficient job of holding it together
* tibio-fibular compression taping may help with stabilising in the early weight- bearing phases.

Recovery time-frame: absolutely critical to prevent weight bearing on foot for up to three or four weeks with a more conservative progression through partial to full weight bearing. In total, allow six to eight months to return to sport.
The lateral ankle: key injury sites

The lateral ankle: key injury sites
Continued pain at 4 to 8 weeks

If things are not going well, or you are noticing new symptoms, consider the following secondary damage issues. These may not clearly manifest until the worst of the pain, swelling and disability has receded, but they need to be addressed in their own right as part of the mid- to late- stage rehabilitation process. These are the most common ones:
1. Talo-crural joint hypomobility/restriction

This leads to capsular synovitis/lateral impingement of fibula and talus in the lateral gutter.

Signs

* a very common side effect of any ankle sprain; it is critical to maintain maximum mobility to promote the best rate of healing
* if the talus cannot posteriorly glide during weight bearing it will cause ongoing impingement of anterior bony structures
* after the acute phase, perform manual posterior glides of talus and dorsiflexion testing at a wall to establish the extent of dorsiflexion deficit and the sites of restrictions (based on points of pain). Never stretch forward in weight bearing to improve dorsiflexion, as this risks aggravating the damaged structures
* fibrosis and thickening of the posterior capsule responds well to manual loosening procedures. Deep tissue massage of uninjured soft tissues (especially calf) is very useful in the acute phase. The use of seat belts in the mid to late stages of rehab can help to force the various bones to glide in normal ways again to gain final degrees of dorsiflexion – this should be done by an experienced physiotherapist.

2. Peroneal tendinopathy

Signs

* damage of the peroneal muscles and tendons is possible, but would not prevent normal weight bearing initially. Undertake static muscle testing, especially in dorsiflexion to note pain and weakness (there could be a tear in the muscle belly)
* treat as any muscle injury through to full return to function
* restricted or fibrosed peroneus longus can prevent normal dorsiflexion at later stages of rehab; massage and stretching is the answer
* the peroneal tendon can sublux from a torn tendon sheath posterior to the lateral malleolus, leading to chronic clicking and pain that may require surgery.

3. Reflex sympathetic dystrophy

Also known as ‘complex regional pain syndrome’ or Sudeck’s atrophy. A relatively uncommon condition of burning pain, pins and needles or numbness, ongoing and excessive swelling, often spreading up the whole shin, and discoloration of the foot and/or leg. It arises from a disturbance in the sympathetic nervous system that controls the blood flow and sweat glands to the limb. The neural disturbance may have its origins in over-stretching of nerve tissue during the ankle sprain, changing the way the nerve impulses are sent and causing a short circuit or overactivity.

Signs

* the risk of developing this may increase with too aggressive a rehabilitation strategy – go slow!
* keep this diagnosis (even in ‘mild’ forms) at the back of your mind if strange things are happening to the ankle that are really slowing down the return to function
* look for positive neural signs and paresthesia
* continueto work on range of movement and pain relief. Personally I find deep tissue massage/ trigger-point release to gastrocnemius and soleus muscles is critical for mobility gains. Acupuncture has occasionally worked wonders for pain relief
* can severely delay return to function, from three to 12 months
* adverse neural tension testing, done by a physiotherapist, can determine what level of nerve tethering or dysfunction is present.

4. Proprioceptive deficit

Reams of research and knowledge have been developed to aid our understanding of how a severe disruption to the normal functioning of a joint or body part can then create long-term damage to the brain-body connection to that body part. The brain’s ability to be aware of and to coordinate reflexes at the injured ankle can set up a chain of injuries elsewhere through the lower limbs unless the proprioceptive deficit is corrected through an exercise programme.

Signs

* do this test on yourself if you have ever badly injured an ankle or knee joint: in a completely dark room, stand on each leg in turn. Note the significant challenge of standing easily on the previously injured leg!
* proprioception in every damaged ankle will have been moderately to severely affected; this will need to be addressed during the mid to late stages of rehabilitation.

Conclusion

Once there is clarity about the nature and severity of damage to structures, you will be able to develop time frames for recovery and then tackle the challenge of restricting the athlete to crutches and prescribing safe exercise for the ankle.

More often than generally acknowledged, a period on crutches can be critical for the initial phase of healing, and to prevent side effects such as ongoing instability, long-term swelling and ankle thickening, and even reflex sympathetic dystrophy.

If you manage the rest and the healing phases thoroughly, you will help your client minimise their time out of action from the sport and they will have long-term reason to be thankful for your patient care.

Chiefs Rool
11-29-2010, 09:22 PM
IT'S BECAUSE HE'S TOO SMALL FOR THE NFL DAMNIT!!!



just kidding

-King-
11-29-2010, 09:29 PM
Heres some more info about it


Definition
A "high" ankle sprain is an injury to the ligaments between the two major bones of the lower leg (Tibia and Fibula) at the level of the ankle.

Causes
A "high" (syndesmotic) ankle sprain is caused by an outward twisting of the foot and ankle. This is opposite of a typical ankle sprain where the foot and ankle are twisted inward. Football, soccer and basketball are the most common sports associated with a high ankle sprain. Proper stretching and training may help prevent some "high" (syndesmotic) ankle sprains.
Symptoms


Pain accentuated with external rotation (rotating out) of ankle
Inability to walk
Severe pain
Usually significant bruising

Considerations
A "high" (syndesmotic) ankle sprain is diagnosed when a patient has a history of an outward twisting motion to the ankle and pain just above the ankle joint. The patient initially may not be able to walk on injured leg. Squeezing the leg at the midpoint of the calf or gently moving the foot outward may reproduce the patient's pain. X-rays are taken to rule out fractures that can be associated with this injury. Occasionally, an MRI may be needed to confirm the diagnosis.
Treatment
An ankle sprain is named because the injury is above the level of the joint. It is a tearing of the syndesmotic ligaments of the tibia and fibula bones.
An inversion injury, the most common cause of ankle sprains, occurs when the ankle rolls outward and the foot turns inward. It results in stretching and tearing of the ligaments on the outside of the ankle. In a "high" ankle sprain, a less common type of inversion injury, the ligaments at the top and outside of the ankle are also torn, increasing the sprain's severity and healing time. The high ankle sprain is different from a typical sprain because it is more severe and may, though rarely, require surgery early in the treatment course.
A "high" (syndesmotic) ankle sprain is diagnosed when a patient has a history of an outward twisting motion to the ankle and pain just above the ankle joint. The patient initially may not be able to walk on injured leg.
Damage to the ligament varies from simply stretched or slightly torn to completely torn. Your doctor will grade your sprain accordingly.


Grade I is stretching or slight tearing of the ligament with mild tenderness, swelling, and stiffness. It is usually possible to walk with minimal pain.
Grade II is a larger but not complete tear with moderate pain, swelling, and bruising. The damaged areas are tender to the touch, and there is pain with walking.
Grade III is a complete tear of the affected ligament with severe swelling and bruising Walking is usually not possible because of the ankle gives out, and there is intense pain, although initial pain may quickly subside.

<center> Nonoperative: Most "high" (syndesmotic) ankle sprains can be treated in a manor similar to typical ankle sprains with PRICE. P: Protection from further injury via a splint, R: Rest, I: Icing, C: Compression wrapping, E: Elevation (see sprained ankles (http://www.usgyms.net/Sprained_ankles.htm)). Syndesmotic sprains, however, will require much longer to heal and will also need more physical therapy to strengthen the muscles around the ankle.

Operative: Severe "high" (syndesmotic) ankle sprains with significant displacement of the bones (Tibia and Fibula) require surgical stabilization.
Call Immediately For Emergency Medical Assistance if
a) a broken bone is suspected or if there has been a serious injury or persistent pain.
b) there is an audible popping sound and immediate difficulty in using the joint.
How to Rehabilitate
Rehabilitation can begin a few days after the injury, when the swelling starts to go down. There are three goals to aim for in rehabilitation.

1. Restore motion and flexibility. Gently move the ankle up and down. After 5 to 7 days, start restoring motion to the hindfoot by turning the heel in and out.

You should also begin to restore flexibility to the calf muscles. One way to do this is to face a wall with one foot in front of the other and lean forward with your hands on the wall, bend the front leg while keeping the back leg straight and both heels on the floor. Lean forward until you feel a gentle stretch, and hold for ten seconds. Switch legs and repeat.
2. Restore strength. After 60 to 70% of the ankle’s normal motion has returned, you can begin strengthening exercises using a rubber tube for resistance. Fix one end of the tube to an immovable object like a table leg, and loop the other end around the forefoot. Sit with your knees bent and heels on the floor. Pull your foot inward against the tubing, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.

You can also sit on the floor with your knees bent and the tube looped around both feet. Slowly pull outward against the tube, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.
3. Restore balance. As strength returns, balance is restored by standing on the injured leg, hands out to the sides. You may want to warm the ankle before doing these exercises by soaking it in warm water. Warmed tissue is more flexible and less prone to injury. Use ice when finished with the exercises to minimize any irritation to the tissue caused by the exercise.

When Can I Return To Sports?

Return to sports only after you have met these goals:
1. You have full range of motion in all directions (up and down, side to side, and in and out).
2. You have good strength in all muscles around the ankle.
3. You have good balance.
4. You have no pain or swelling with exercise or activity.
How to bandage a sprain
1. Wrap a sprained ankles with a compression bandage in a figure 8 pattern. Make two loops around the instep, then stretch bandage diagonally across the foot.
2. Bring the bandage around the ankle to the front of the foot. Then wrap it diagonally across the foot.
3. Continue wrapping the bandage in figure 8 turns. Each turn should overlap the previous turn by about three fourths of the bandage’s width.
4. When the foot and ankle are wrapped, secure the bandage with a pin. Leave toes bare. If they become numb or discolored, the bandage is too tight.


Also, here are some athletes who have suffered from high ankle sprain






Colt McCoy (http://en.wikipedia.org/wiki/Colt_McCoy)<sup id="cite_ref-4" class="reference">[5] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-4)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2010)
Jake Delhomme (http://en.wikipedia.org/wiki/Jake_Delhomme)<sup id="cite_ref-5" class="reference">[6] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-5)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2010)
Seneca Wallace (http://en.wikipedia.org/wiki/Seneca_Wallace)<sup id="cite_ref-6" class="reference">[7] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-6)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2010)
Dez Bryant (http://en.wikipedia.org/wiki/Dez_Bryant) NFL (http://en.wikipedia.org/wiki/NFL) (2010)
Ian Kinsler (http://en.wikipedia.org/wiki/Ian_Kinsler) MLB (http://en.wikipedia.org/wiki/MLB) (2010)
Michael Leighton (http://en.wikipedia.org/wiki/Michael_Leighton) NHL (http://en.wikipedia.org/wiki/NHL) (2010)
Bradley Bussell (http://en.wikipedia.org/w/index.php?title=Bradley_Bussell&action=edit&redlink=1) WWE/ECW Circuit (http://en.wikipedia.org/w/index.php?title=WWE/ECW_Circuit&action=edit&redlink=1) (1/2010)
Pantelis Palioudakis (http://en.wikipedia.org/w/index.php?title=Pantelis_Palioudakis&action=edit&redlink=1) PTM (2010)
Dexter McCluster (http://en.wikipedia.org/wiki/Dexter_McCluster) NFL (http://en.wikipedia.org/wiki/NFL) (2010)
René Bourque (http://en.wikipedia.org/wiki/Ren%C3%A9_Bourque) NHL (http://en.wikipedia.org/wiki/NHL) (2009)
Ryan Miller (http://en.wikipedia.org/wiki/Ryan_Miller_%28ice_hockey%29)<sup id="cite_ref-7" class="reference">[8] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-7)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2009)
LaDainian Tomlinson (http://en.wikipedia.org/wiki/LaDainian_Tomlinson) NFL (http://en.wikipedia.org/wiki/NFL) (2009)
Matt Schaub (http://en.wikipedia.org/wiki/Matt_Schaub) NFL (http://en.wikipedia.org/wiki/NFL) (2009)
Marc Colombo (http://en.wikipedia.org/wiki/Marc_Colombo) NFL (http://en.wikipedia.org/wiki/NFL) (2009)
Tracy McGrady (http://en.wikipedia.org/wiki/Tracy_McGrady)<sup id="cite_ref-8" class="reference">[9] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-8)</sup> NBA (http://en.wikipedia.org/wiki/NBA) (2009)
Milan Lucic (http://en.wikipedia.org/wiki/Milan_Lucic)<sup id="cite_ref-9" class="reference">[10] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-9)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2009)
Michael Turner (http://en.wikipedia.org/wiki/Michael_Turner_%28American_football%29) NFL (http://en.wikipedia.org/wiki/NFL) (2009)
Bob Sanders (http://en.wikipedia.org/wiki/Bob_Sanders) <sup id="cite_ref-10" class="reference">[11] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-10)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2008)
Sidney Crosby (http://en.wikipedia.org/wiki/Sidney_Crosby)<sup id="cite_ref-sports.espn.go.com_11-0" class="reference">[12] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-sports.espn.go.com-11)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2008)
Brian Rolston (http://en.wikipedia.org/wiki/Brian_Rolston)<sup id="cite_ref-12" class="reference">[13] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-12)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2008)
Joffrey Lupul (http://en.wikipedia.org/wiki/Joffrey_Lupul)<sup id="cite_ref-13" class="reference">[14] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-13)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2008)
Tom Brady (http://en.wikipedia.org/wiki/Tom_Brady)<sup id="cite_ref-14" class="reference">[15] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-14)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2008)
Dirk Nowitzki (http://en.wikipedia.org/wiki/Dirk_Nowitzki)<sup id="cite_ref-15" class="reference">[16] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-15)</sup> NBA (http://en.wikipedia.org/wiki/NBA) (2008)
Kyle Orton (http://en.wikipedia.org/wiki/Kyle_Orton) NFL (http://en.wikipedia.org/wiki/NFL) (2008)
Brian Westbrook (http://en.wikipedia.org/wiki/Brian_Westbrook) NFL (http://en.wikipedia.org/wiki/NFL) (2007)*Marc-André Fleury (http://en.wikipedia.org/wiki/Marc-Andr%C3%A9_Fleury)<sup id="cite_ref-sports.espn.go.com_11-1" class="reference">[12] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-sports.espn.go.com-11)</sup> NHL (http://en.wikipedia.org/wiki/NHL) (2007)
Terrell Owens (http://en.wikipedia.org/wiki/Terrell_Owens)<sup id="cite_ref-16" class="reference">[17] (http://en.wikipedia.org/wiki/High_ankle_sprain#cite_note-16)</sup> NFL (http://en.wikipedia.org/wiki/NFL) (2007)


</center>

Shaid
11-29-2010, 09:33 PM
He needs to suck it up! I jumped out of the bed of a pickup truck and sprained my ankle the night before heading to baseball camp in Branson for two weeks. My ankle was the size of a cantelope and i won MVP for the session against players all over the country.

la tee fucking da. That's baseball. This is pro football and his entire game is making explosive cuts. This is a huge injury for McCluster. I'd rather he take an extra week off and be back for the division games.

Chiefshrink
11-30-2010, 08:29 AM
Rest him as long as he needs. If he's back for SD I'll be happy.

THIS!!! We don't need him for Denver:shake: We will destroy Denver!! I can officially say they are "NOW" in 'meltdown mode' and our Chiefs won't need any additional motivation after getting their asses handed to them especially by a "Cheater". Haley's dissing made perfect sense now that we know the rest of the story:thumb:

Chiefshrink
11-30-2010, 08:32 AM
Let's just hope this is "not" a sign of the Dante Hall syndrome for Dex. Which I know most here on the board are thinking the same.

gblowfish
11-30-2010, 08:34 AM
Where is the cliff notes version too many words...

By the time I read that post, McCluster will be HEALED!

Dayze
11-30-2010, 08:34 AM
they're saving him for the Super Bowl.

Tribal Warfare
11-30-2010, 12:53 PM
IT'S BECAUSE HE'S TOO SMALL FOR THE NFL DAMNIT!!!



just kidding

if a player loses what makes them dynamic when they are extremely undersized, yeah he'll become a sitting duck waiting to get destroyed. Dex needs to be 100% when it deals with his meal ticket which are his legs.

Awesome Aric
11-30-2010, 01:02 PM
Doesn't want to play for the Chiefs. OBVIOUSLY.