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Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Understanding Klay Thompson’s High Ankle Sprain

The Finals saga between the Golden State Warriors and Cleveland Cavaliers has been riddled with injury intrigue since the team first met four years ago. In their initial meeting, Cleveland forward Kevin Love was unavailable after dislocating his shoulder in the opening round of the playoffs and point guard Kyrie Irving played just one game after suffering a fractured patella. In 2016, Warriors center Andrew Bogut sat out the final two games of the series after suffering significant bone bruises to his left knee. Last year Golden State head coach Steve Kerr was unable to coach Game 1 due to complications from back surgery.

Now injuries are once again attempting to alter the series with two Golden State players questionable for Game 2. Andre Iguodala, the 2015 Finals MVP, has not played since Game 3 of the Western Conference Finals after sustaining a bone contusion to the lateral aspect of his leg. The area of concern is near the knee and continues to cause Iguodala pain and discomfort. Iguodala’ teammates survived a stellar performance from LeBron James in Game 1 but now face the possibility of playing without Klay Thompson as well.

Thompson was injured in the first half of Game 1 when Cleveland’s JR Smith crashed into his leg while diving for a ball. The play twisted Thompson’s knee and ankle and briefly forced him from the game. While he was able to return to action, the injury worsened over the last few days.

Thompson provided an enigmatic description of the injury that failed to hint at the nature of his problem.

The injury was later reported as a high ankle sprain, according to Yahoo Sports’s Shams Charania.

A high ankle sprain or syndesmotic sprain is different from the “common” ankle sprain.  Most ankle sprains involve the ligaments located on either side of the ankle, most commonly on the outside aspect of the joint.  However, a high ankle sprain occurs to a different joint completely, the distal tibiofemoral joint. Here the distal ends of the tibia and fibula form the ankle mortise. At the mortise, a strong ligament known as the interosseous ligament stretches across the tibia and fibula connecting the two leg bones. In addition to the interosseous ligament, two more ligaments, the anterior and posterior tibiofibular ligaments, assist in stabilizing the area.  A high ankle sprain involves excessive stretching and disruption of one or more of these ligaments.

The timeline of recovery for ankle sprains widely varies based on a number of factors including the severity of damage, the involved joint, and any other accompanying injury. Treatment for a high ankle sprain is the same as a normal medial or lateral ankle sprains but generally take longer to heal. A big reason for this extended recovery time is linked to the disruption of overall stability and potential widening of the ankle mortise.

Over the last six seasons, the average missed time for an isolated high ankle sprain is roughly 10 games. However the variability is high and a quicker return is possible. For example, earlier this season Indiana’s Myles Turner was able to return to action from a high ankle sprain after just three days and one game lost.

The Warriors have been providing Thompson with non-stop treatment and he is currently listed as questionable. However, even if Thompson is able to play, an injury of this magnitude could negatively impact his ability to make hard cuts and come off of screens. With uncertainty lingering, it seems this is just the latest injury to influence this recurring Finals matchup.