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Sprained ankles, the most common sports injury in America, are also the Rodney Dangerfields of the athletic injury world. And they're particularly common this time of year, as thousands of young athletes in the Atlanta area start fall soccer season.
More than 1 million Americans sprain their ankles every year, and many patients are relieved that they didn't fracture a bone as they fell or twisted a foot.
"I can't believe how much it hurt." That's how Alex Bishop, 15, a sophomore at St. Pius X High School, described her sprained ankle. Alex, a soccer player, was kicked accidentally last spring by an opponent, which caused her ankle to turn in. She is only recently back to full speed. "It just throbbed and throbbed," she said.
Many have found out, painfully, that it is important to respect the ligament damage that results from an ankle sprain, and that a sprain in some cases can be more serious than a fracture. Improperly healed, it can leave someone with weak ankles that are more likely to be injured in the future, especially as the person ages.
"They can bug you for a long time," said David Marshall, medical director of sports medicine at Children's Healthcare of Atlanta.
An ankle sprain is a stretching or tearing of one of the ligaments connecting bone to bone in the foot. Sprains happen when an ankle is stretched beyond its normal range and the ligaments are damaged.
House painters, firefighters, hikers, soccer players and pedestrians just stepping off a curb are all vulnerable, although athletes such as soccer and basketball players who swiftly change direction are especially susceptible.
"If they are properly treated, they do quite well," said Lamar Fleming, professor of orthopedics at Emory University. "The problem is that they are not."
Ankle sprains are ranked in grades from 1 to 3, with 3 the most serious. A Grade 1 sprain involves mild stretching; in Grade 2, ligaments are stretched and partly torn; in Grade 3, there's a full tear.
In all three cases, the ligaments can heal and return to normal strength. But the time it takes will vary greatly.
Complete recovery requires a doctor's attention and physical therapy, even if just at home for a week. Most important is retraining the nerves in the damaged tissue.
Otherwise, "you'll get a loose, sloppy ankle," Marshall explained. "You'll hear people say 'I can't rollerblade' or 'I can't do this' because of their loose ankles."
"You're most concerned about long-term instability," said Bill Prentice, trainer for the University of North Carolina women's soccer team, who treats about 12 sprained ankles a year.
A nonrehabilitated ankle sets a person up for repeated spraining and falls, which become particularly problematic with aging.
Many athletes and others know the so-called ''RICE'' treatment --- rest, ice, compression and elevation. The first and most important thing to do is to get off the ankle, or rest it, ice it, compress it with an elastic bandage and elevate it 4 to 5 inches above the heart level, so that blood will flow away from the damaged soft tissue, decreasing the swelling.
For severe pain, severe swelling and an unstable joint, people should seek immediate medical attention to ensure there is no fracture and to assess the severity of the sprain. Some Grade 3 sprains even need surgery.
Most insurance companies will not pay for physical therapy from a therapist without a prescription.
It is important to finish the course of therapy, the experts said.
Young athletes, parents and coaches can take a few steps to prevent sprained ankles.
"Every tissue has a threshold of injury," said Marshall, of Children's Healthcare. Athletes who play two sports at a time should carefully consider whether they want to double their risk of injury in so doing. They should also take a day off from training at least once a week, stretch before and after exercise, and get plenty of rest.
Copyright 2003 The Atlanta Journal-Constitution