How Is It Possible…
that a 14 year old star soccer player did not recover from an ankle sprain even though he was told by a top orthopedic surgeon he was cleared to return to play?
A 14 year old male soccer player came to Greenwich Sports Medicine with no pain but a severe decrease in athletic performance. According to his father, a former professional soccer player, his son was cleared to return to soccer by his orthopedist after rolling his ankle 12 weeks ago. However, while observing his performance, both his father and his coaches noticed a very different athlete.
“It looked like he was running with cement shoes tied to his feet. He told me he was trying his hardest, and I believed him, but he just did not look like his old self” the soccer players father noted.
His coaches suggested he see a running coach. However, his dad, a former patient of Greenwich Sports Medicine, called Dr. Gil Chimes.
According to his dad, “We just returned from the orthopedist. He reviewed an updated MRI of my son’s ankle and said everything looks great. His torn ankle ligaments have fully healed. But he couldn’t answer my question on why my son was not the athlete he was prior to his injury.” Dr. Chimes asked the father,
“What treatment did he have for the injury?”
The dad explained they saw they “best” physical therapist and they were very thorough. “My son had extensive treatment on his ankle did every ankle exercise asked of him. He was very diligent and we saw the PT several times a week for 6 weeks. The PT and the orthopedic surgeon both agreed that his ankle was as good as new. So, it is very frustrating that he is not playing like his old self.”
When he rolled his ankle, the soccer player saw his orthopedist for x-rays and an MRI. A grade III ankle sprain and put in a boot and given crutches was the diagnoses.
“Was there any evaluation or treatment beyond the ankle?” Dr. Chimes asked. “What I mean is did they look at anything other than the ankle?”
“No” answered the father. “Why do you ask?”
“Well, It’s very common that injuries to the foot or ankle can have a deleterious effect on the leg above the ankle.”
Dr. Chimes explained to the young soccer player and his father that when a joint, like the ankle, becomes non-weight bearing and put in a brace, as well as on crutches, many of the associated muscles and joints can suffer.
“It frustrates me when I hear stories like this. The orthopedist is usually concerned with the ankle healing but not the consequences of unloading the extremity,” Dr. Chimes explained. “What usually follows is atrophy (muscle wasting)and decreased neo-vascularization (new blood vessel formation which is important to bring nutrients and oxygen to the tissue which is more critical to athletes). There are also neurological consequences (muscles shut off, tensile forces are decreased) due to this unloading period.”
Dr. Chimes described what he would be assessing. “We have to evaluate the whole chain from the low back down to the toes. Testing each muscle to ensure it hasn’t atrophied or inhibited due to the lack of loading for those 6 weeks. The muscles flexibility then needs to be tested. We need to make sure he has the pliability and elasticity he needs for those soft tissues to absorb and disperse the weight of his body. Joints stiffen and they lose their range of motion. This effects the bodies ability to move fluently and propel oneself.”
“When we evaluate him, we will know exactly what he needs to do in order to get back to where he was prior to the injury.”
“There have been dozens of times in my 20 years of practice that a young person ended up with another injury because their initial injury was not completely treated.” – says Dr. Gil Chimes
We have come to understand that if we do not evaluate the complete chain, the whole leg, unfortunately that athlete NEVER completely recovers from their injury. And, most importantly, it has lifetime consequences!
It’s no surprise to us here at Greenwich Sports Medicine that modern research has backed up this observation. “Researchers have reported that patients with CAI (Chronic Ankle instability) are restricted occupationally, have more functional limitations, and have a poorer health-related quality of life.” according to a research article from PubMed titled “Physical Activity Levels in College Students With Chronic Ankle Instability.”
Greenwich Sports Medicine makes sure your recovery is complete and through. Don’t trust your body to just anybody.