Oct. 29, 2004
ACC Sports Sciences Main Page
Josephine Lee, MS, ATC, LAT
Volleyball has become a very competitive sport. Girls are playing year round for their high schools, club teams and at sports camps. This increase in the number of matches and practices also increases the number of exposures to injury. Shoulder, knee, back, hand and ankle injuries are common in the sport of volleyball. Ankle sprains, one of the more acute injuries seen on the court, will usually lead to loss of playing time. At Georgia Tech, our volleyball team usually has one significant ankle sprain each season.
Ankle sprains occur when the ligaments that connect the bones in the ankle are stretched or torn. A ligament is a strong, non-elastic, fibrous tissue that connects bone to bone at a joint and holds them together. A sprain is a stretch or tear of the ligaments. When one sprains their ankle, he or she will typically have swelling, pain, tenderness to touch and sometimes discoloration. The severity of a sprain usually depends on how much tearing of the ligament has occurred. The most common way volleyball players sprain their ankle occurs when a player lands on another player's foot. Good jumping and landing technique, and court positioning can significantly help decrease your chances of injuring yourself, your teammate or an opposing player. An example of this would be when a blocking player or hitter lands on another player's foot that has come underneath the net crossing the court centerline. Regardless of how a volleyball player injures her ankle, appropriate first aid care is necessary.
Many programs utilize the services of a certified athletic trainer (ATC). Certified athletic trainers are qualified healthcare professionals, educated and trained to assess, manage and treat acute, traumatic injuries. Athletic trainers work under the direction of physicians. An ATC can help provide care and make decisions ranging from referring an athlete in an emergency situation to determining if it is safe for an athlete to return to play. If you have a certified athletic trainer, team physician or another qualified healthcare professional, they should be utilized in managing this injury.
What action should be taken when an athlete injures an ankle?
The first objective when an athlete injures her ankle is to identify how serious the injury is. Observing how the athlete injured their ankle and the position of the ankle at the time of injury are important. You must first determine if there is a deformity, which would indicate a fracture or dislocation. If an athlete with no deformity can bear weight on the injured ankle, this will help you determine the severity of the injury. If an athlete is not able to bear weight, this may indicate instability or fracture, thus indicating a more severe injury. Athletes who present with deformities or are unable to bear weight should be protected from further injury. Possibly splinting and immobilization will be required. These athletes need to seek medical attention immediately.
Obtaining a history from the injured athlete can also help determine the extent of injury and subsequent care required. Questions to ask the injured athlete are:
How did you injure your ankle?
Where does it hurt?
Were you able to bear any weight right away?
Did you hear a "pop"?
Have you injured this ankle before?
In addition to these questions, one must also determine if there is moderate to severe pain or rapid, extreme swelling. Does the athlete have any numbness or tingling that lasts after the initial injury? Did the athlete hear a "pop"? If the answer is yes to any of these questions this injury may warrant immediate referral to a healthcare professional. Remember, if you are without the assistance of a qualified healthcare professional, err on the side of caution and refer appropriately.
Please note: If the athlete is a young child, what appears to be an ankle sprain is more likely to be an injury to the child's bone growth plate. During childhood, these growth plates are not as strong as the ligaments. Therefore, they are more prone to injury. The growth plate injury is a far more serious injury. An ankle injury with swelling or bony pain in a child needs to be evaluated by a medical professional.
First aid: Care and Management
If your athlete has a significant injury, appropriate first aid care should include protecting and immobilizing the injury before the athlete is transported for acute medical care. For most ankle sprains, the next step in first aid involves the R.I.C.E. principle. RICE stands for Rest, Ice, Compression and Elevation. These are the basic principles to first aid management of many acute injuries. An alternative to RICE is P.R.I.C.E where others will add P for Protection. The area of injury needs to be protected from further injury. Protection can range from the use of splints, immobilizers, crutches, ankle taping and bracing. Rest includes no activity. Ice is an important element for treatment of acute or new ankle injuries for the first 24 to 72 hours or until swelling goes down. Compression is the use of an elastic compression wrap that will help decrease swelling. One must be cautioned not to apply the compression wrap too tightly. Elastic compression wraps can be purchased at local drug stores. Finally, elevate the injured ankle. All of these basic first aid management tips are used to help decrease pain and swelling, prevent further injury to the ankle and help expedite the injured athlete's road to recovery. A physician may prescribe nonsteroidal anti-inflammatory drugs to help control the pain acutely as well as during rehabilitation.
Most Division I volleyball programs will place their players in some type of prophylactic ankle brace or provide ankle taping. All Georgia Tech volleyball players are required to wear an Active AnkleTM brace, ankle tape job or both. By doing this we hope to prevent injury or decrease the severity of the injury. Another reason why use of ankle bracing is important for our program is because a large percent of our roster is in the starting rotation, which leaves few individuals as back-up players. Losing key players in our line up affects the success of our program and a less severe ankle sprain will help decrease the amount of time away from the court. There are several different brands and models of ankle braces available for purchase. To be considered prior to purchasing an ankle brace: the athlete's medical history (previous injuries to the foot, ankle, lower leg), soft braces, hard braces, material used, durability and cost. Most ankle braces range from $20 - $50 per brace.
Coaches can prevent injury by training athletes to avoid the centerline during practice. Jumping straight up verses forward momentum into the conflict zone under the net can help prevent injury. Teaching good landing techniques and instituting a balance or a proprioceptive program can help reduce the incidence of an ankle injury and also help decrease the risk of knee injuries.
Adequate rehabilitation is often overlooked by the athlete and subsequently places them at increased risk for re-injury. The overall goals of rehabilitation for an ankle sprain are: decrease swelling, decrease pain, increase range of motion, return to normal gait and function and regain lost strength. Modalities commonly used by athletic trainers in the initial care of ankle sprains include ice, cold whirlpool and electric stimulation. As symptoms improve, athletic trainers will include the use of ultrasound, moist hot packs and warm whirlpool. The use of these modalities is an important factor in the high performance athlete returning to play faster than the recreational athlete. To regain strength and motion, athletic trainers often add stretching activities such as calf stretching and range of motion exercises. Calf raises, rubber tubing exercises and balancing are other forms of exercise one would commonly see in an ankle sprain rehabilitation program.
The athlete may be able to return to practice and competition prior to a complete recovery. If this is the case, continuing to strength the muscles surrounding the ankle while improving balance are essential tasks to avoid re-injury.
After the Injury
After an athlete sprains his or her ankle they should be protected from re-injury for return to practice or competition. In addition to strengthening exercises athletes should be taped or required to wear an ankle brace to prevent re-injury. If an athlete attempting to return to activity experiences increased pain or abnormal function they should return to their physician or their healthcare professional.