The Kansas City Chiefs ended up Saturday’s divisional-round playoff game on a high note, triumphing over the Jacksonville Jaguars by a score of 27-20. However, apparently, Chiefs quarterback Patrick Mahomes suffered a different type of high during the game: a high ankle sprain. According to ESPN, a MRI (magnetic resonance imaging) on Sunday has confirmed this type of injury in Mahomes’s right ankle. Now, the “high” in the high ankle sprain has nothing to do with one’s mental state, although when his injury forced Mahomes out of yesterday’s game, it did leave Chiefs’ fans feeling pretty low. No, the “high” referred to where on his ankle the injury occurred. It also gave you an idea of what actions led to the injury and how long recovery may take.
High ankle sprains are less common than low ankle sprains, which is why low ankle sprains are often referred to as common ankle sprain. High ankle sprains comprise about 14% of all ankle sprains, according to a post by sports medicine physician Nicholas Sgrignoli, MD, on the Hospital for Special Surgery website. To understand the difference between going high and going low, so to speak, we’ll have to go over some ankle anatomy.
But first, let’s explain what’s meant by a sprain. A sprain is the stretching or the tearing of a ligament. Ligaments are the fibrous tissues that connect one bone with another. You can thank ligaments for all of your joints not being all jiggly and unstable when you twerk. The picture below shows the bones and ligaments of your foot and ankle, assuming that you are human and not a centipede:
The two bones that form your lower leg are your larger tibia and your smaller fibula This matched pair of bones then sit on top of your talus which is highest bone of your foot. Together these three bones form your ankle joint. Several ligaments connect these bones together to make your ankle more stable. The names of these ligaments are giveaways as to what they connect and where they are located. For example, your anterior talofibular ligament (ATFL) connects the front of your fibula and your talus. Anterior means front and posterior means back, which is why when you say that you spent all of Saturday night getting your posterior spanked, you’re referring to what happened to your bottom.
Low ankle sprains involve the ligaments lower down on your ankle, most commonly the ATFL. These typically result when you’re on a roll, so to speak. Most often, it happens when your ankle rolls inwards for a so-called inversion injury such as when you accidentally step on the Groot figurine that you left on the kitchen floor. Less commonly, you can suffer a low ankle sprain when your ankle rolls the opposite direction, outwards for a so-called eversion injury.
By contrast, a high ankle sprain involves a stretching or a tear of the ligaments that are “higher” up on your ankle that connect your two lower leg bones: your tibia and fibula. One of these ligaments is the anterior inferior tibiofibular ligament that connects the fronts of the tibia and fibula. Another is the posterior inferior tibiofibular ligament, which connects the backs of these two bones. A third is the not really called a ligament but instead is known as the interosseous membrane, as it sites in the space between the tibia and fibula and helps hold them together.
Given the anatomy, the mechanism by which high ankle sprains occur is different. They can happen when your foot is flexed upwards and then is turned inwards or outwards. In other words, when your foot is dorsiflexed, meaning that your foot is bending towards your shin, something causes your foot to rotate one direction or the other. In this case, one direction doesn’t refer to the musical group but is what happens when your foot gets twisted either to the right or the left. This can happen when you are cutting while running, jumping or falling, such as when you are playing sports like football, soccer, lacrosse, and basketball or running up a hill so that the person that you hooked up with after a Tinder date with last year doesn’t see you.
The location of the high ankle sprain can mean that symptoms aren’t as severe as the damage, making you underestimate your injury. You may say, “This feels OK,” soon after the injury and not feel as much pain or see as much swelling or bruising. It may not be until you actually try to do things like run, cut, and twist that you realize, “Uh oh, something’s really not right.”
Such injuries usually don’t require surgery unless a ligament was completely torn apart. Typically, the initial treatment is RICE and less weight bearing for two weeks. In this case, RICE does not refer to the stuff that you put in your sushi. It is the acronym for Rest, Icing, Compression, and Elevation. Rest means keeping weight off the ankle and foot. Icing means applying ice for 15 minute at a time, once every few hours. Compression means wrapping the area with an elastic bandage to keep the swelling down. Of course, don’t wrap it so tight that it feels like your foot is going to fall off your leg. That would be counter-productive. Finally, elevation means keeping your ankle above heart. All of these will help reduce the swelling and pain in your ankle and promote healing.
After this initial period, the next step is to restore the strength and range of motion to the ankle through physical therapy and various exercises. Of course, every injury and every person is different, but you can normally expect to return to sports in about six to 12 weeks after the injury, assuming that all goes well. Even after you return, it can help to wear an ankle brace while playing sports for a while to keep the ankle protected against re-injury. Sometimes symptoms may persist as long as six months.
Of course, if you are a Chiefs fan, you may say, “But the AFC Championship game is in one week.” Clearly, the stakes are a little different from that West Side evening adult league flag football game against the team captained by the person that once called you “doggo” at a Happy Hour. So the Kansas City team trainers may try to push the timeline earlier, much earlier, depending on what Mahomes can handle. This will mean that Mahomes will definitely not be 100% for next Sunday’s game against the Cincinnati Bengals. Ideally, you want to have full range of motion and full strength in the ankle before returning. You’ll want to make sure that your balance, coordination, and proprioception are back to normal as well. Proprioception is the ability to know where different parts of your body are in space at a given time, which is why you don’t regularly slap yourself in the face.
The team trainers will have to make adjustments to such expectations if Mahomes is to take the field next Sunday in GEHA Field at Arrowhead Stadium or whatever the Chiefs’ home field is called these days. Just remember that Mahomes situation is probably a little bit different from any situations that you may face. So don’t rush your return to sports such a manner after such an injury. Otherwise, you may be saying, “Hi” to some more lows pretty soon.
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