The League

Mackie Shilstone
Sports Performance Manager, MA, MBA

Mackie Shilstone

Executive Director, The Fitness Principle with Mackie Shilstone at East Jefferson General Hospital

Talk to the ankle


To play or not to play, that is the Super Bowl question for Indianapolis Colts Dwight Freeney. The Pro Bowl defensive end who, tore a ligament in his right ankle in a playoff game against the Jets is listed as questionable -- you can get competing views with the Colts' organization.

Media reports say that Colts' president Bill Polian predicts Freeney will play in the Super Bowl against the Saints this Sunday. Team spokesman Craig Kelly said "nothing we have seen changes our diagnosis that he is questionable." Freeney is quoted as saying "I've really just been dealing with this, literally, day-to-day from the moment I wake up in the morning."

But we have left out one important entity to talk to -- the ankle. Here is what it might say: I do not feel too good and right now. I have a third degree low sprain (basketball type). I am walking in a boot. It hurts to push off. I wish it were a grade 1 or 2 sprain, because chances are I would be just fine but, with a grade 3 sprain, the torn ligament means that I have much healing ahead and little time before I have to push very hard against my large body weight in pursuit of the Saints' QB Drew Brees and that elusive Saints running back Reggie Bush.

So, what is being done to speed my healing. Right now I am enduring hyperbaric treatments to speed my tissue repair. This process involves putting my body in a chamber of increased pressure which forces oxygen in higher concentrations into the damaged area. The hyperbaric chamber has been used in similar sports like the NHL, NBA, to not only accelerate recovery, but also to speed the repair time of damaged soft tissue.

A 2003 issue of the journal of American Podiatric Association reported that "in various studies the location of the injury seemed to influence the effectiveness of the treatment. Injuries at areas of reduced perfusion such as muscle-tendon junctions and ligaments seemed to benefit more from hyperbaric oxygen treatment than injuries at the muscle belly."

Freeney is also said to be using a system called ARP- Accelerated Recovery Performance- which uses bio-electrical current, simultaneously with active range of motion and other exercise techniques, to significantly speed up the body's natural healing process. While this therapy is still questionable, I have a podiatrist friend in sports in Canada who swears by this mode of therapy.

My question is, is everything but the kitchen sink being thrown at the ankle in the hope of having it ready for at minimum 65 push-offs in a regulation NFL game? Is there a management plan in place or is desperation at hand? Time will tell.

When it comes to game day there are always those injections to reduce pain and inflammation (I am not talking about a race horse here) and the tightest tape job imaginable. And please do not forget that the ultimate body hormones and pain killers -- adrenaline and endorphins -- will be on hand as well.

But, with the ankle locked with tape and still able to roll in an unstable environment, what might the risk be to a knee injury based on the lower extremity kinetic chain being impaired? What about those unfriendly Saints' players on offensive that will roll up Dwight like a big rug, if given the opportunity on a pitch out. And, maybe one of the most important facts is that Freeney, who lines up on the right side, will need to push off with the right ankle. So, why not move him to the left side? This might, to a slight degree reduce the overuse trauma to the ankle. Ironically, it would have better if he broke his ankle in terms recovery ability.

On game day, when the team orthopedist examines Freeney, the Anterior Drawer Test will tell all. If the ankle when grabbed and pulled forward has no end point, then it's time to call it quits and wait for another Super Bowl. The big question is will Freeney play anyway?

Playing for the moment -- a Super Bowl moment -- may be well worth it in the eyes of the players and fans but, in the long run, it's more about quality of life later. After the game and career, when the fans forget who you are and what sacrifices you made to keep your team in the game will it be worth it?

By Mackie Shilstone  |  February 3, 2010; 6:54 AM ET  | Category:  Medical , Super Bowl Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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