Understanding Anthony Davis’ Grade 2 Ankle Sprain: An Ankle Injury Primer

The 2016-17 NBA season is nearly here as team begin to trim down their rosters and ramp up workloads throughout training camp and the preseason. Unfortunately the increase in activity is accompanied by an increase in injuries as players begin to suffer an assortment of ailments. Over 75 injuries have already occurred since training camp opened league wide with multiple players expected to miss the start of the regular season. One of these injuries was recently suffered by Pelicans big man Anthony Davis during the team’s exhibition game in China. Marc J. Spears of ESPN’s The Undefeated is reporting Davis’ ankle sprain is a Grade 2 sprain.

Davis’ ankle sprain isn’t the first of the season and it certainly won’t be the last. Nearly 200 ankle sprains were reported during the 2014-15 season alone, making it one of the most common injuries in the NBA. As a result, InStreetCltohes.com has dusted off its ankle injury primer to help breakdown this frequently occurring ailment.

Forming the Ankle

Anatomically the ankle joint appears quite simple. It’s made up of three bones, the tibia and fibula of the lower leg and the talus of the foot. However the functional unit that is the ankle is actually comprised of three different joints.

The first is the talocrural joint or the “true” ankle joint. It is formed from all three aforementioned bones and is involved with the up-and-down movement known as plantar flexion and dorsiflexion. Ligaments located on both sides of the leg and foot stabilize this area. On the inside, or medial aspect, of the ankle is the strong deltoid ligament that prevents excessive inward movement or eversion. Three additional ligaments are located on the lateral or outside of the ankle. These ligaments, the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament, (CFL) are the most vulnerable to injury and are sprained while the ankle is forced into inversion following an awkward step or when landing on the foot of another player.

The next joint involved in the ankle is the subtalar joint and is formed between the talus and the calcaneus. Here the motions of inversion and eversion are made possible. Like the talocrural joint, ligaments fortify the subtalar joint.

The final joint included in the ankle is the distal tibiofibular joint. It is located at the bottom of the leg, where the tibia and fibula join with the talus. A strong ligament known as the interosseous ligament stretches across the joint to connect the two lower leg bones while two additional ligaments, the anterior and posterior tibiofibular ligaments, assist in stabilizing the ankle mortise. Any injury that occurs to these ligaments is classified as a “high ankle” or syndesmotic sprain.

Grading Injuries

The ligaments of the body connect bone to bone. To allow for mobility and stability, ligaments have inherent viscoelastic characteristics that allow them to be both viscous and elastic. Simply put, a ligament can withstand an applied stress by rearranging its basic makeup to better provide stability. However each ligament has a very specific yield point and failure point. When the amount of stress pushes a ligament beyond its yield point, a sprain occurs. Microtrauma to the fibers that make up the ligament is considered a mild or Grade I ankle sprain. Basically the ligament has been overstretched but remains intact as a whole. Players with Grade I sprains may not even miss a game.

A Grade II sprain occurs when particular fibers of the ligament fail and is often referred to as a moderate sprain or a partial tear. Grade II sprains are generally more painful and limiting. The associated symptoms are more severe with high amounts of swelling usually occurring. As a result these injuries require intensive treatment and extended rest.

Finally a Grade III sprain is a crippling and severe injury. These injuries result in a total loss of function and stability. Grade III sprains often require a considerable amount of rest and in some rare cases surgery.

Furthermore, Grade II or III sprains are more likely to have long-term ramifications, primarily on the stability of the affected joint and the likelihood of reoccurrence. In these injuries, the ligaments have passed their yield point. Once this has occurred, its strength and integrity remains forever altered. The concept is similar to a rubber band. When a rubber band is new and fresh from the package it is stretchy yet strong. As it is used over and over again, the rubber band is slowly worn down, moving past its yield point. The once strong rubber band becomes stretched out, decreases in strength, and loses its elasticity. A sprained ligament acts in similar fashion. Once a ligament has been stressed past its yield point its physical makeup remains perpetually effected, though various treatments and rehab protocols can return the ankle close to its original state. Still once an ankle has been sprained it remains more susceptible to being aggravated and re-sprained.

Accompanying Injuries

Sprains rarely occur in an isolated manner. The violent nature of the injury often includes damage to neighboring structures. Strains to the muscles of the ankle are common with a sprain as the involved tendons are also overstretched. Injuries to bone are another regular occurrence.

Avulsion fractures frequently accompany medial ankle injuries as the deltoid ligament pulls away a small piece of bone. A bone contusion or bone bruise can occur if the stress of the incident causes damage to the outer layer of one of the involved bones. The injuries are not as severe as a fracture but require additional time to heal. The body’s recovery response treats bone bruises just like a fracture filling in the damaged area with new bony tissue.

Recovery and Rehab

The timeline of recovery widely varies based on the severity of damage, the involved tissues, and a multitude of other variables. Generally speaking the first phase of recovery involves controlling the associated symptoms like swelling and pain. An injured player may be placed on crutches or immobilized in a walking boot to minimize the amount of weight placed on and through the injured joint. A progressive rehab protocol can be initiated once the medical professional involved feels the player is ready. The preliminary focus of rehab is on regaining and retaining range of motion. The next step concentrates on strengthening the area and insuring proper muscle function. Finally the athlete will transition to basketball specific drills. Additional work on lateral movement is often necessary to assure the ligaments are capable of withstanding the applied stress.

Davis’ progression over the next few weeks will ultimately determine his availability for Opening Night. He has previously missed time in his career due to multiple ankle sprains and a stress reaction in his ankle, though each of those injuries occurred on the opposite ankle. Regardless this isn’t the start the Pelicans or Davis envisioned as they collectively look to move past the injury woes that defined last season.

Understanding Cupping and Its Role in Professional Sports

Every four years the spotlight shines on the athletes of the Olympic games. With individuals participating from all corners of the globe, the games bring with them a wide range of approach and technique in multiple facets, including sports medicine. Whether it’s magnetic pulse therapy for downhill skiers or kinesio tape on beach volleyball players, each Olympics it seems like a new form of alternative treatment captures the attention of the viewers.

This year in Rio, cupping therapy is all the rage with Olympic athletes like Michael Phelps competing with the distinctive round bruises on their body. Cupping therapy is a form of treatment often utilized by acupuncturists and other therapists. Instead of needles, cups are placed onto the skin, often near pressure points. A vacuum is created inside the cup, lifting the skin and causing blood vessels to dilate. The suction can be created with heat or by a handheld or electric pump.

The theory behind cupping is that the process stimulates the healing process by increasing blood flow to the applied area. It also reportedly reduces tension within both the soft and connective tissue of the muscle, similar to a normal massage. The combination of the two is believed to provide the athletes with a reduction in pain and an improvement in flexibility. The unfortunate side effect of the technique is the circular bruises that Phelps and others are now wearing as a makeshift badge of distinction.

However the technique remains unproven. Multiple studies have suggested cupping could have the “potential” to alleviate pain though the efficacy of the process remains unknown. Many medical professionals attribute the success of cupping to the placebo effect, meaning the injured athlete’s apparent improvement should be attributed to a perceived effect rather than the procedure itself. Still a mental improvement can be beneficial to an athlete, especially for those in sports where a fraction of a second could be the difference between medaling and going home empty handed.

While the Rio Olympics have ignited cupping hysteria, the technique has been used for years in professional sports. However it hasn’t quite gained the same level of notoriety as the bruises can be hidden behind the uniforms or jerseys of most professional athletes, an option not available to swimmers or bikini-clad volleyball players.

Teams in Major League Baseball, including the New York Mets and Oakland Athletics, have been linked to cupping. Super Bowl Champion DeMarcus Ware has endorsed the technique’s benefits, as have other former NFL players including James Harrison and Chad Johnson. Cupping has even made its way to the NBA. In 2014, then-Trail Blazer Nicolas Batum and other teammates opted to try cupping when Chris Stackpole, the team’s Director of Health and Performance, introduced the technique. Cupping may have even played a small role in Golden State’s 2015 title run as several round bruises were visible on the left shoulder of Stephen Curry during the Finals.


While the effectiveness of cupping remains unverified, it appears to have found its footing amongst professional sports. With the success of Phelps and other Olympics athletes are currently having in Brazil, don’t be surprised to see that characteristic round bruise appear on other athletes in the near future.

Reviewing the Injury Totals for the 2015-16 NBA Season

The 2015-16 NBA season is over and injuries once again helped shaped the narrative of an amazing year. The overall health of teams influenced playoff-seeding, lottery positioning, and ultimately played a role in the Cleveland Cavaliers winning the franchise’s first long-awaited championship.

As a whole, the league lost 4,496 regular season games to injuries, including games lost to bed bugs, severe testicular trauma, and other more common ailments. The 2015-16 total settles in lower than the two previous seasons and just below the league average (4,570 game lost) for the previous 11 seasons. Nine teams lost fewer than 100 games to injury, the highest number for an 82 game season in the InStreetClothes.com database that dates back to the 2005-06 season. Included in those nine were the league-best 23 total games lost to injury by the Oklahoma City Thunder. The 23 games lost marks the fewest number of games recorded since the league abolished the injured reserve list prior to the start of the 2005-06 season. It also signifies an impressive turnaround for a franchise that lost 224 games to injury in the previous season, including 55 games attributed to Kevin Durant and his foot injury alone.

The Los Angeles Lakers also finished with a remarkable improvement in health. After losing over 300 games to injury in each of the previous two seasons, the Lakers surrendered just 73 games to injury this year. The reversal was also marked by a sizeable decline in salary dollars lost to injuries. The $5.9 million lost this year is roughly one-fifth the size of their 2014-15 bill and one-eighth of the $44.3 million total amassed in the 2013-14 campaign.

Not every team was quite as fortunate as injuries down the stretch radically impacted the bottom line for multiple teams. The final 20 games of the regular season were particularly rough on the Memphis Grizzlies and New Orleans Pelicans who combined to lose 275 total man games played to injury during the final quarter of the season. Multiple players on each roster sustained season-ending injuries including Mike Conley, Marc Gasol, Anthony Davis, and Jrue Holiday, resulting in the considerably high total.

The consequences of regular season’s injuries had a lasting effecting on the playoffs as several notable players, including Conley, Gasol, and Miami’s Chris Bosh never appeared in their respective team’s postseason run. Injuries accrued during the playoffs, including those to Blake Griffin, Chris Paul, and Hassan Whiteside, also negatively impacted team performance. The Golden State Warriors withstood six missed postseason games from Stephen Curry following ankle and knee injuries but struggled in the Finals after Andrew Bogut’s went down with bone contusions on his distal femur and proximal tibia. The total number of games lost to injury per playoff game was down (1.82) when compared to the 2015 playoffs (2.42). However as ESPN’s Tom Haberstroh and Baxter Holmes pointed out, games lost by rotation players (top seven players per team in minutes played per game) were at their highest totals in decades.

The importance of player health continues even with the Finals over as team are now preparing for Thursday’s NBA Draft. Multiple outlets have already reported numerous medical concerns about this seasons’ crop of talent. Selecting players ready to withstand the grind of the NBA season is a key component of minimizing total games lost. Last year’s first round picks combined to miss 367 total games to injury during the season or roughly 8 percent of the league total, the third highest total of the last 11 drafts. Look for teams to emphasize rookie health even more than ever as they look to maximize the production of a financially efficient addition to the roster.

Maintaining player health continues to evolve with the 2015-16 season showing small signs of progression. However considerable work still needs to be done to ensure sustained success in injury prevention and management. Look for all invested parties to examine various ways to guarantee the best talent is healthy and able to contribute to the 2016-17 NBA season.

Understanding Steph Curry’s Grade 1 MCL Sprain

The 2016 NBA postseason took a dramatic turn Sunday evening when Warriors guard Stephen Curry suffered a right knee injury as the first half came to a close. He attempted to return to the start the third quarter but quickly retreated to the locker room before being ruled out for the game with a sprained knee.

The reigning MVP and heartbeat of a record-breaking Warriors team underwent a MRI on the injured joint Monday where it was determined he suffered a Grade 1 MCL sprain.

The injury occurred after Curry appeared to slip on a wet spot left by Houston big man Donatas Motiejunas, who also slipped just seconds before Curry hit the ground. Curry’s left leg extended backward while his right knee bent forward. His right foot appeared to remain planted on the court and the resulting valgus force of the fall overloaded the inside aspect of his knee, the location of the medial collateral ligament (MCL).

The MCL, along with the ACL, PCL, and LCL, serves as a primary stabilizer of the knee. Given its location, the MCL is critical in lateral or side-to-side movement. Damage to the medial meniscus often accompanies a MCL sprain as fibers of the ligament adhere to the fibrocartilage disc. Fortunately Curry appears to have avoided any meniscus involvement.


When a ligament like the MCL is sprained, the injury is often assigned a grade based on the amount of associated damage. A minor or Grade 1 sprain is given when partial or micro tearing of the effected ligaments has occurred. A more moderate Grade 2 sprain is more commonly referred to as a partial tear and is more painful and limiting. Grade 2 injuries are often accompanied by a considerable amount of swelling and require rest and more intensive treatment. A Grade 3 sprain is relatively uncommon in sports but is a devastating injury. Grade 3 injuries result in a loss of function and mechanical stability and often require a long period of inactivity and in some cases surgery.

Fortunately for the Warriors, Curry’s mild MCL sprain can heal without surgical intervention. Instead conservative treatment and modalities will be used to address the associated symptoms and help stimulate the body’s natural healing process. The amount of time needed varies from person to person though the team has already determined he will sit for at least two weeks. When he does return expect Curry to wear a protective brace to help stabilize the area. Lateral movements, particularly on the defensive end, will be his biggest obstacle moving forward.

While Curry recovers, the inevitable questions regarding whether or not he should have been playing or if the ankle injury contributed to this latest injury will be asked. Determining a definitive answer is problematic but there is reason to believe his ankle was a non-factor in the knee injury. To start, Golden State’s medical team is one of the most proactive teams in the league, using various degrees of injury analytics and data to help shape their decisions regarding a player’s availability. Their partnership with Catapult Sports is well documented and was considered a major advantage in last season’s run to the title. It’s hard to imagine a medical team risking the health of the team’s MVP with these valuable tools at their disposal.

Furthermore the injury itself was a bit of a fluke. Even if a limitation at the ankle created a small breakdown in the kinetic chain of his right lower extremity, it seems unlikely that Curry could have avoided slipping in the wet spot created by Motiejunas. Additionally, the side of the ankle that was involved in the fall was the side opposite Curry’s lateral ankle sprain.

The estimated recovery window guarantees Curry will miss a part of the second round but how many games that will be remains unknown. During the 2015-16 regular season at least 11 MCL sprains were publicly diagnosed. The list includes several notable point guards including Washington’s John Wall and Dallas’ Deron Williams. Both players sustained low-grade MCL sprains and missed minimal time. Williams sat out just one game while Wall played through the injury without missing any action. However these two appear to be exceptions as the average missed time for the other low-grade sprains was roughly 15 days. The numbers are in line with Golden State’s initial estimated timeline of two weeks.

Closing out the series against the Rockets becomes top priority. Any additional recovery time the team can buy themselves and Curry between now and Game 1 of the second round of the postseason is a much-needed luxury. Furthermore the Warriors will hope the Trail Blazers can extend their matchup with the Clippers to further delay the start of the next round.

While the Warriors may not be “the most healthy team” in league history as LeBron James suggested in November, they did catch a major break Sunday. By avoiding a catastrophic injury, it seems likely that Curry will be able to rejoin his Golden State teammates at some point this postseason and help them cap off a record breaking season with their second consecutive NBA title.