Ankle Sprains for the Dancer

Ankles are one of the many body parts that have the highest incidence
of injury by the performance of dance. Ankle sprains are one of the
most common sprains occurring to the dancer. Even though structurally
the ankle may be considered a moderately strong joint, it is subject to
sudden twists, especially when the dancer steps on some irregular
surface. Serious injury occurring to joints or bones result initially
from impact forces, with carelessness and fatigue playing a major
role. Late in the practice day or just before an opening performance
when the dancer is trying most for perfection, seems to be the time
when most serious injuries occur. The older the dancer the more
susceptible he or she is to serious joint and bone injuries. Many
 ankle injuries may be directly attributed to dancing on a too hard
 surface, or a too soft surface. Going to pointe before a dancer is
 ready can also be detrimental because if proper strength is lacking,
 sprained ankles can result.

The sprain is primarily an injury to the ligamentous supportive
structures of a joint. It seldom occurs

without affecting muscle tendons crossing the joint. The sprain is
categorized into first, second, and third degrees of

intensity. The intensity of a sprain is best determined by the extent
of the dancer^s disability as well as the tenderness

 elicited by feel or palpation and the amount of hemorrhage and
 swelling present. A dancer with a second or third

degree sprain must routinely be referred to a physician for x-ray
examination and diagnosis, because fracture is

commonly associated with a twisted joint. A joint that has lost its
ability to function for more than several minutes

must be considered to have either a second or a third degree sprain.

 The highest incidence of injury is to the outside aspect of the
 ankle and is called inversion sprain of the

ankle. This happens when the dancer turns the foot inward, placing an
abnormal stretch on the outer ankle ligament.

 for the dancer with flat feet and/or pronated feet, inside sprains
 are more common and more serious. Usually a

dancer has a high level of flexibility in the ankle region, and it
takes a great deal of force to actually cause a sprain. If

this force is great enough, ligaments will be torn and even a part of
the outer ankle bone may be pulled away. The

center talus bone may roll underneath and strike against the internal
ankle bone, causing a fracture on the inside of the

ankle. Repeated sprains can lead to an osteoarthritic condition in any
joint of the body.

 The medial, or inside sprain represents a different problem
 than the lateral ankle sprain. Even though it

occurs less often, it is more serious than a lateral ankle sprain
because injuring the inside ligaments also affects the

inner longitudinal arch. With this eversion sprain of the ankle, there
is injury to the deltoid. Often dancers who have

had medial sprains experience difficulties. It is suggested that along
with regular rehabilitation regimens, the dancer

with inside sprains engage in a program of arch and foot conditioning.

 An ankle sprain is treated with ice. The area will usually
 swell with discoloration. The best immediate first

aid is to put an ice pack on the ankle and elevate it. Crushed ice can
be held on the ankle with an elastic wrap. Ice,

pressure, and elevation should be used to control hemorrhage and
swelling in the joint. Icing a joint injury is

important because injured joints rapidly swell with the effusion of
blood and serum. Some compression is needed to

 minimize swelling.

 Sometimes the injury can be temporarily helped if you put a
 compress of undiluted Burrow^s solution on the

ankle and wrap it in a plastic food wrap for an hour. Alternate this
with ice until the swelling goes down. The ankle

will still ache, but the compress draws out the inflammation and allows
blood to circulate and heal the ankle. If the

sprain turns a yellowish this means the sprain is in the process of
healing.

 Some physicians may routinely apply a cast to a second-or third
 degree sprain for a week or longer to ensure

 proper repair. Other physicians will apply a tape support to the
 sprain and instruct the dancer to engage in no weight

bearing for 2 to 3 days. Pain won^t lessen if you still dance. You
have to stop dancing, treat the ankle and rest. Joint

 immobilization assures a speedy recovery. This is often followed by
 a program of physical therapy.

 Strapping is the best preventive procedure, because as in all
 sprains, once ligaments of the ankle

have been stretched, exercise cannot restore joint and stability.
Ankle strapping provides mild support to the ankle

joint and still allows for foot and ankle mobility. Use 1-and 1/2-inch
tape and tape adherent. Another technique used

by itself or with ankle strapping is application of an adhesive felt
horseshoe. This can be used with the chronically

swollen ankle. Using 1/4-inch adhesive felt, a horseshoe is cut to fit
around the outer or medial malleolus. Elastic

material shouldn^t be used for ankle support because it doesn^t
adequately stabilize a joint but it can be used to hold

 another bandage in place when there is swelling.

 Because it is almost impossible to control the dance
 environment when touring, some companies carry their

own portable suspended dance floor. It is generally agreed that there
is a lower incidence of impact injuries such as

sprained ankles when suspended dance floor systems are used.

 A good test for the dancer to determine whether an ankle
 support should be worn is to jump up and down

on the affected foot several times. An ankle that has recovered from
an injury will usually allow the dancer to spring

into the air and support the body on landing.