This month the American Orthopaedic Foot and Ankle Society, in cooperation with the National Federation of High School Associations, will send a six minute video titled, "Stay in the Game," to every high school in the Unites States.

"Our goal is to prevent permanent ankle injury in young athletes," said Glenn Pfeffer, MD, UCSF assistant professor of orthopaedic surgery, who developed the idea and wrote the script for the video. The most common ankle injury, a sprain, occurs when ligaments that connect bones are stretched or torn when the ankle turns sharply inward or outward.

"Targeting young athletes is important because we know that the earlier a sprain occurs in life, the higher chance of recurring sprains, unstable joints, arthritis-like pain or other complications like tendon or cartilage damage. It's important to properly treat initial sprains," he said.

If a sprain occurs and it hurts to run, athletes need to sit out, he explained. "You can't play through a bad sprain." Once a sprain has occurred athletes should think in terms of three steps.

Step 1: RICE it as often as possible for three days. RICE is an acronym for Rest, Ice, Compression (with an elastic ankle wrap), and Elevation (toes above the nose). For significantly swollen ankles or if limping persists for more than three days, the athlete should see a doctor.

Step 2: Rehabilitation. To prevent permanent damage to the ankle, athletes should take steps to achieve better range of motion (flexibility), balance, and strength. Many of these exercises can be done at home.

- Range of motion exercise: Stand on chair with one foot slightly in front of the other. Allow the back heel to stretch downward over the edge. Hold each foot in this position for 30 seconds.

- Balance restoration exercise: Stand on one leg with your eyes closed. Gradually build up to standing 30 seconds on each leg. Repeat three times.

- Strength exercise: Lie on your side on the sofa, with the upper leg hanging over the edge. Place the top of your foot through the handles of a plastic shopping bag filled with one to two pounds of weight (one or two cans of soup). Slowly lift your toes toward the ceiling and hold for three seconds. Repeat ten times.

Step 3: Support. Athletes should wear an ankle brace. "No matter how much you rehabilitate the ankle, it may never give you the same support again," said Pfeffer. "High top tennis shoes are not enough and taping doesn't always do the job because it is hard to do correctly."

Orthopaedists estimate that 27,000 Americans a day sprain an ankle. This is the top orthopaedic complaint and the most common sports injury among regular athletes and weekend warriors alike, said Pfeffer. "People try to play through it, work through it. We need to let athletes young and old know that if they don't take care of their ankle sprain, they can run into lifelong trouble."

The video was funded by an educational grant from Aircast Company and the American Orthopaedic Foot and Ankle Society (AOFAS). For more information about the video, contact Pfeffer at 415-923-3700 or the AOFAS at 1-800-235-4855.

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