Low-Rider

Recently, Nike and Kobe Bryant introduced their latest basketball shoe.

What's so special about them? They're not the usual high-tops we're used to seeing.
In fact, the low cut design brought back the argument about what type of shoe is best for basketball. Many experts have said that high tops are better at reducing ankle sprains (the most common injury in basketball), while others have said that high-tops limit performance.

During a recent interview with ESPN.com , Mr Bryant brought up lots of reasons for his decision to go to this new model.

• Soccer players cut harder and put more torque on their ankles than basketball players do, but they play in shoes lower cut than his new one.


• "High Tops were becoming more restrictive" and he wanted to make the shoe "as snug as possible" .


• "I've rolled my ankles a lot of times wearing high tops". Like his severe Right Ankle Sprain in 2005 .
  


• "If you come down on somebody's foot - there's nothing you can do about that"


• The current design "cuts the weight of the shoe"


• "gives your foot a little more freedom to change directions"

When asked how it will translate to the average, chubby, middle america basketball playing guy ? "the shoe will actually make you faster" and make you jump higher.

So what do I think? (Thanks for asking)

He's right about several things:

• Soccer players do cut hard and wear even lower-cut cleats.


• If you land awkwardly on someone else's foot, there's a good chance you'll turn your ankle regardless of the type of shoe you're wearing.


• A lighter shoe can help you jump (relatively) higher and move (somewhat) faster. Although I doubt it's going to significantly affect how tired you get on the court.

But Here's One Thing That Nike And Kobe Are Not Discussing - as reported in The Canadian Press , Kobe may be wearing a new low-cut shoe but "Bryant is sticking with plain old athletic tape for ankle support").

Why's that important? Taping ankles and/or wearing ankle supports has been shown to reduce the risk of ankle injuries (especially in athletes who have already injured their ankles before).

Just like the professional soccer players he watches and admires, Mr Bryant has a professional trainer at his disposal who will wrap his ankles before every practice and game.

Do you? Didn't think so.

Take Home Message Number 1
If you want to play in Kobe's low tops, either get someone to tape your ankles (will provide support for a limited time, depending on the type of tape and how it's applies) or put on an ankle support (will provide continuous support) before you hit the court.

Take Home Message Number 2
Regardless of what some people wear, they'll still sprain their ankles. Like Kobe says in his interview, "if you get crossed up, that's your fault" .

Ankle Taping: Good News/Bad News

Those of you who have read some of my past entries know that ankle sprains are the most common injuries in basketball.

Research has shown that, once you sprain your ankle, you are more likely to injure that ankle again.

Research has also shown that ankle taping can decrease the risk of having a second (or third, or fourth or...) ankle injury.

While many players tape up before each practice or game, others do not because they worry that this might impair their performance on the court.

In this article from the Journal of Sports Science and Medicine, researchers from Spain compared the effects that ankle taping had on the vertical jump and the balance of 15 active young men (average age = 21 years).

They found no significant difference in their vertical jump or balance when their ankles were taped or not taped. This information might make people more likely to tape their ankles and not worry that it will impair their performance.

At the same time, however, they also found that the ground reaction force (the force of impact when the body lands) of the vertical jumps was significantly greater on the knees when the subjects had their ankles taped.

This is likely due to the fact that the ankle taping made the ankles "stiffer" and less able to absorb the landing force. In this way, more force was transferred to their knees to act as shock absorbers.

I would like to see a similar study performed with some of the more common ankle braces, which are likely to be less tight than a freshly wrapped ankle. And, to make it more applicable to real-life basketball athletes, the testing should have been performed after letting the subjects play basketball for 15-30 minutes (during which tape jobs often loosen up). And, while we're on the subject of improving the study, it should also include younger athletes of both genders and more tests (agility, speed, etc.)

The take home message? This does not lead to an all-or-none decision for or against taping ankles. For those who worry that ankle taping might decrease their vertical jump and adversely affect their balance - fear not. But for those whose main concerns are patellar tendonitis, Osgood-Schlatter and other knee overuse injuries, keep in mind that taping ankles may play a role in your knee pain.

Coming Back from an Ankle Injury

In a previous post (An Ankle a Day - June 22, 2007) , I mentioned that ankle sprains are the most common injury resulting from playing basketball.

Here, I’d like to talk a little about some important, but often overlooked, parts of a good rehabilitation program designed to not only return an injured basketball player to competition but to decrease his or her risk of further injury.

Since research has shown that basketball players with a history of ankle injury are almost 5 times more likely to sustain an ankle injury than those who have never been injured, it's important to take the extra steps to make sure you appropriately rehabilitate and protect your ankles before you get back in the game.

In the old days, basketball players were told to take some Non-Steroidal AntiInflammatory Drugs (NSAIDs) and Rest, Ice, Compress, and Elevate (RICE) their injured ankles for the first 24-48 hours after injury. That's still good advice because this first aid for ankle sprains will reduce the swelling (and pain, and amount of time you miss). After that, they were told to slowly "get back into it" and return to play when they could manage it.

Here's the problem with just returning when you feel ready -- the damage from an ankle sprain not only causes swelling, pain, stiffness and bruising,

but it also decreases the body's ability to avoid future injury.

• When ligaments and muscles are overstretched, they become less strong, and less able to support the body.
• When there's pain and swelling around the ankle, the muscles that move and support the ankle are used less often and can weaken, again becoming less able to support the joint and more likely to be re-injured.
• The body's ability to respond and right itself from a fall onto uneven surfaces (like someone else's foot) depends on the athlete's balance (which can decrease from disuse) and proprioception (your ability to feel a joint's position). These split-second reactions depend upon your body's ability to provide quick and accurate information about where it is in space and an overstretched or injured muscle,tendon, and/or ligament doesn't provide it as well as an uninjured or fully rehabilitated one.

So, if you're one of the walking/running/jumping wounded who have sprained your ankle and completed your RICE program, you might want to add these to your rehabilitation regimen:

1) Get it Checked Out - If you're a couple of days past injury and you still can't bear weight on your akle, you should get it checked out by a health care provider to make sure that it's not something more serious.

Once you know that you're dealing with a sprained ankle, and know that it's safe to begin some serious rehabbing, you should find a physical therapist or athletic trainer and get a home instruction program that includes...

2) Range of Motion - You should have full ankle range of motion in all directions (think of being able to write the entire alphabet, in cursive, using your big toe as a pen) before returning to play.

3) Strength - You should have returned to (almost) full strength of your ankle, knee, and hip muscles on the side that was injured. Some experts like to especially focus on ankle dorsiflexion and eversion muscles that place the ankle in a more stable position.

4) Balance and Proprioception - You should work on your static and dynamic balance and proprioception before getting back on the court.

5) Ankle Supports - Some studies have shown ankle supports (stirrups, laceups, etc.) to be the most effective intervention to prevent severe sprains in unstable ankles.

While I wouldn't recommend it over professional help, you can find some basic ankle rehab exercises from the American Orthopaedic Foot and Ankle Society here .

One last tip - When you do return to practice, try out the offensive drills first before you go to defensive drills. That way, you'll know where you're (supposed to be) going and be more in control of your body than when you have to react to other people's moves on defense.

Include the extra steps above in your ankle rehab program and you'll be less likely to reinjure yourself when you step back onto the court.

An Ankle a Day....

OK, maybe Sports Medicine doctors don't see an ankle injury each day, but it's pretty close.

Ankle injuries (mostly sprains) are the most common basketball injury and can range from a "tweak" that you walk off to a career ending event.

Take a look at this clip a few times and then read on for a few things to learn from it.

• While guards and wings like to "break ankles" with a good crossover driblle during transition or on the perimeter, most ankle injuries occur in the paint, where people are jumping and landing while going for rebounds, blocked shots, etc.

• The vast majority (about 85%) of ankle sprains occur when you land awkwardly or on top of someone else's foot and roll your foot over the outside border. This inversion injury can stretch or tear ligaments (tissue that joins bone to bone) and cause significant pain. In this instance, the player lands on someone else's foot and suffers an inversion sprain.

• Immediate management of the injury includes getting off the floor to be evaluated. If you hear a pop, roll your ankle the other way (eversion), or can't walk or bear weight on the ankle, it's probably a more serious injury. If an athletic trainer, physical therapist or physician is present, they can assess the tenderness and stability of the ankle ligaments by performing a series of maneuvers. You can see some of this on the video.

This should be done quickly, because as soon as any swelling starts, it will become more difficult to figure out any specific tender points (because the entire side of the ankle will be tender!)

• Whether you're in a pickup game or in the middle of the NBA Finals, you should take immediate steps to keep the ankle from swelling (too much). This means starting the R.I.C.E program that includes Rest, Ice, Compression, and Elevation. In the video, you can see this player (Kristen Rasmussen of the Adelaide Lightning) limping off the court while her foot is in a compression boot.

• Another important point is that once you sprain your ankle, you become 5 times more likely to sustain another injury to that same ankle. I'm guessing that "Raz" had previously sprained her ankle(s) as she can be seen to be wearing black ankle supports under her basketball shoes (more about this in a future post).

The good news is that ankle injuries, when treated appropriately, can be overcome. Ms. Rasmussen was able to return later in the season and she's currently playing for the WNBA's Connecticut Sun.

In a future blog post, I'll go over some of the important, but often overlooked, parts of a good rehabilitation program designed to not only return an injured basketball player to competition but to decrease his or her risk of further injury.