Conservative Management for Stable High Ankle Injuries in Professional Football Players

Abstract

Context: High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management.

Evidence acquisition: PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation.

Study design: Clinical review.

Level of evidence: Level 3.

Results: When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process.

Conclusion: Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

Keywords: ankle; football; high ankle; rehabilitation; syndesmosis.

Figure 1.

T2-weighted magnetic resonance imaging of the left ankle in the axial plane demonstrating surrounding edema and tearing of the anterior inferior tibiofibular ligament (a, green arrow) with associated defect within the interosseous membrane (b, red arrow). (c) Coronal section demonstrating edema and swelling to the interosseous membrane (red arrow) and lateral malleolus (green arrow).