High ankle sprain return to play
I’ve got to admit, the high ankle sprain is one of my personal favorites. It has everything that I love… murkiness, coachspeak, and weeks of, “will he or won’t he start,” talk from NFL reporters. But I should probably break it down a little for everyone else.
First of all, the high ankle sprain is much more severe than a regular, low ankle sprain. We’ve all had the regular ones. They hurt, but the damage is usually limited and short-lived, so it’s not a huge deal. With a high ankle sprain, however, the damage is to the ligaments that hold your two lower leg bones (tibia and fibula) together at the ankle. If the damage is bad enough, the structural integrity of the whole ankle joint is compromised. In fact, at the extreme end of the spectrum, a high ankle sprain can result in your tibia and fibula actually separating, and that just sounds gross.
There are a few ways to figure out if a player has a high ankle sprain as opposed to a low ankle sprain. Anytime someone refers to the sprain as, “syndesmotic,” that means high ankle. A low ankle sprain will usually be called, “lateral.” There’s another important distinction in how people use the term, “roll.” If someone rolls their ankle, this almost always indicates a low ankle sprain. If, however, they get, “rolled up on,” that usually indicates a high ankle sprain.
You can also tell the difference between the two types of ankle sprains by watching how the injury happened. A low ankle sprain typically occurs when the player’s foot rolls to the outside edge. With a high ankle sprain, you’re more likely to see the the injury occur with a twisting motion that results in the foot pointing to the side rather than straight ahead. For example, if a QB is sacked and twisted around while his foot remains planted to the ground, that’s a pretty sure high ankle sprain… if he’s lucky. In general, about 85% of all ankle sprains are low ankle, leaving only about 15% high ankle sprains.
As I wrote about in my sprain overview here, the severity of a high ankle sprain falls into one of three grades. Grade I indicates only small, often microscopic ligament tears. Grade II indicates that ligaments are partially torn, but not enough to cause any instability. Grade III is the most severe, and indicates a complete tear or rupture of the ligament. Grades I and II don’t need surgery in order to heal. Rest and rehab will do the trick. Grade III absolutely needs surgery. I’ll point out that the actual grades are not always easy to discern when keeping stats, as players and coaches don’t always talk openly about the exact injuries. I’ve logged the individual grades when they specified, but for a chart like the one at the top, we’re looking at all high ankle sprains total, regardless of grade. (If you have questions about the database I used and how I created that chart, read this.) Also, don’t get too hung up on reports that say things like, “sprained, but no ligament damage.” That doesn’t mean anything. All sprains are, by definition, ligament damage.
Finally, let’s get to the real nuts and bolts. How long are we talking with this injury? The media tends to be all over the place with their estimates on this one. I’ve seen anywhere from the cryptic and unhelpful, “week-to-week,” all the way to, “up to six weeks.” The most common media estimate tends to be, “four to six weeks.” Compare that with my chart at the top and you’ll see that it’s not a terrible guess. I’m not so dense as to think that my estimate of, “zero to thirteen weeks,” is really helpful. But I think a good ballpark based on my records would be, “two to four weeks missed.” Note I always make a point of saying, “weeks missed.” I hate it when experts leave that out, and you’re left trying to figure out exactly what they mean.
Here’s what I love with a return-to-play chart though… it really shows the full range. Some players can come back much earlier. Often the less mobile players return from high ankle sprains more quickly. Offensive and defensive linemen, blocking tight ends, and pocket quarterbacks sometimes come back quickly (I’m currently working at backing up that statement). A great example from 2014 is Peyton Manning, who missed zero games after a Week 7 high ankle sprain. On the other end of the spectrum you have running backs, defensive backs, and wide receivers, all of whom rely on their both their speed and cuts. These are the players who tend to need a little more time to recover. Again, not a hard and fast rule, just something to think about. Also, as with all media estimates, the chart helps you see that they’re chopping off the very pessimistic possibilities. Yes, the chance that a player misses more than six weeks with this injury is rare, but it is very real. In my database, I show about 15% (rounds out a little different from the chart) of players with this injury that missed more than six weeks. That’s not insignificant.
