This is the first post in a series on common injuries suffered in Ultimate Frisbee.
In this post, we will discuss everything an ultimate frisbee player needs to know about ankle sprains including what ligaments are injured, when x-rays are needed, and how ankle sprains are commonly treated.
There are two main types of ankle sprains. The majority of ankle sprains are inversion sprains, which occur when the foot rolls in. During an inversion sprain, the anterior talofibular and calcaneofibular ligaments on the outside of the ankle are injured. The lesser common eversion ankle sprain occurs when the foot rolls out causing stress to the deltoid ligament on the inside of the ankle.
The primary concern with an ankle sprain is the possibility of a fracture. While it is best to have the ankle evaluated by a medical professional, the Ottawa ankle rules can help determine if X-rays are necessary to determine if there is a fracture.
The Ottawa ankle rules state that images should be taken if there is:
- Tenderness along the posterior edge or tip of the lateral/medial malleolus
- Tenderness on the base of the 5th metatarsal or navicular bone
- Inability to bear weight on the ankle
The Ottawa ankle rules have a high sensitivity, which means that if the tests are negative we can be confident there is not a fracture. Rehabilitation for the ankle can begin after an ankle fracture has been ruled out.
In the beginning stages of rehabilitation, the focus will be on reducing the ankle pain and facilitating movement. RockTape (kinesiology tape) and Voodoo floss are two methods to help improve movement after an acute ankle injury.
RockTape is a stretchy taping technique used to stimulate the receptors in the skin which can help reduce the pain with movement. Below is an example of one way to RockTape an ankle sprain but there are many effective ways to tape an ankle sprain.
Voodoo floss is another technique that uses a large rubber band to help decrease pain with movement. One approach with Voodoo floss is to wrap the ankle and start with gentle range of motion exercises (ie. ankle alphabets, ankle circles, heel raises, etc…). When using Voodoo floss, it is important that you don’t wrap the band too tight where it cuts off circulation (your ankle and foot shouldn't feel tingly or numb when using voodoo floss). It should be snug, but not too snug.
Quick note on inflammation: There is frequently an emphasis on reducing the inflammation after an ankle sprain by using ice or some sort of massage. Inflammation is actually beneficial in the beginning stages of an ankle sprain because it brings nutrients to the area to rebuild. While the ligaments in the ankle are healing, focus on improving mobility and strength in the ankle instead of controlling the inflammation.
Once the ankle is able to tolerate load without pain, the next step is to strengthen the ankle. The rehabilitation program can start with localized ankle strengthening and then progress gradually to more Ultimate specific movements. Here is an example rehabilitation program for an ankle sprain.
Theraband exercises are a common place to start after an ankle sprain. The goal is to start gradually strengthening the ankle with light resistance. When performing these exercises you want to include all ranges of motion (up, down, side to side, circles, etc).
To increase the loading on the ankle, the next strengthening progression would be heel raises. If you need help with balance, use a wall for support. Begin by performing heel raises with both feet on the ground then switch to single leg heel raises once you are more comfortable. Heel raises can also be performed with weights to further strengthen the muscles around the ankle.
Proprioception exercises (ie. balance) are an important part of the rehabilitation after an ankle sprain. An example of a proprioception exercise would be a single leg balance drill using a medicine ball. The first progression would involve standing on a single leg while holding a medicine ball for 15-30 seconds. Then progress to throwing the medicine ball against a wall or with a partner while standing on one leg. Another proprioception exercise would be disc tosses on an unstable surface (ie. Bosu ball or air disc).
The final stage of the rehabilitation program should include plyometric and quick changes of direction (commonly referred to as agility drills) that are common in Ultimate. Plyometric exercises could include stationary double and single leg jumps as well as jumping in different patterns (ie. diagonals or squares). Exercises that require quick changes of direction include zigzag hops, Ickey shuffles, or a T-shuffle.
In summary, ankle sprains are a common injury in Ultimate Frisbee. The primary concern with an ankle sprain is to make sure that there is not a fracture. Once a fracture has been ruled out, rehabilitation of the ankle can be started. RockTape and voodoo floss can be used in the beginning stages of an ankle sprain to help reduce pain and improve the range of motion in the ankle. The rehabilitation program can then progress to balance and strengthening exercises to ensure a safe return to Ultimate.
In the next post, we will discuss common knee injuries in Ultimate.