Ankle Injuries

 

Image from SMART-Servier Medical Art, Servier Laboratoires; freely reusable under Creative Commons Licence

Here we have very nice diagrams of different levels of severity of ankle sprains:

Top left: healthy

Top right: grade 1 strain

Bottom left: grade 2, depicting a partial tear of around 50% 

Bottom right: grade 3: surgery level because the tear is 100% 

Alcaraz stated that he was told that an MRI scan showed he has a grade 2 lateral ankle sprain. 

Lateral means the outside of the ankle, near the ankle joint, as opposed to the ligaments on the inner side of the foot. These outside ligaments are vital for strength, stability, flexibility and mobility. Typically, the lateral ligaments sprain and tear more easily. As you can see in the chart, the lateral ankle ligaments are a combination of three connecting ligaments: posterior talofibular ligament (PTFL, top left of the three), anterior talofibular ligament (ATFL, top right of the three) and the calcaneofibular ligament (CFL, the bottom one in the triangle of lateral ligaments). 

Why are ligaments important? They are a type of tissue that, in this case, attach the leg bones to the foot bones and they keep the ankle joint in place.

If you didn't have these ankle ligaments, your foot would just flop about. Therefore, although there are different levels of seriousness, a grade 2 is a red light that you need to take an extended rest period to fully heal the tear in your ligaments. That takes about 4-6 weeks just to get to the stage of letting your ankle take your body weight and carefully walk around on it. More than that could cause additional damage and further tears, until you end up with a grade 3 complete tear after which your ankle will never be the same again. 

So there's the concern that, if Alcaraz plays an exhibition match with Nadal this weekend, he's having to risk either a sudden traumatic injury on-court resulting in surgery, or he'll be seemingly fine in the short term but he'll shorten his career and chances of following in the footsteps of the record breaking GOATs, Djokovic, Nadal and Federer. 

So, is it worth playing an exhibition match and potentially sacrificing his long-term career and chances of future titles 🏆 and weeks at number 1️⃣? 

Why would Alcaraz be advised to do something so biologically unsound? Even if he has access to the best sports injury care to speed up his recovery time, this still may introduce different problems further down the line. For instance, treatments may seem to solve the initial problems of swelling, pain and large, tender tears. However, some of these short term inconveniences have a function: swelling is both good and bad. We try to reduce swelling to reduce discomfort, speed up recovery and prevent it from causing additional damage. But the body isn't stupid: swelling is also a natural process the body triggers in order to immobilise you and prevent you from causing further injury. Overriding the body's wishes to stop you from using the injured area for a period of time carries with it a greater chance of causing avoidable, severe damage. 

Furthermore, the body may make more errors during the healing and pain management process if it's been medically sped up. The apparently healed over area may be left weaker than if it had been given the time to go through the slower, natural, healing cycle the body expects. 

So why would Alcaraz risk it all, and in an Olympic year, just for an exhibition match and a few ATP tournaments? Some say it's likely to be pressure from his management team. Perhaps the focus has been centred too much on gossiping whether someone is a pushy parent or a coach or fitness trainer is potentially abusive. Maybe it's time to assess a far greater issue: how much are management teams demanding that players risk their health and fitness that reap short term financial benefits for agents and managers, and possibly for the player, but harms the tennis player's body, health and tennis career in the long run? It's all very well for the management team and sponsors: if one player becomes too ill or injured to continue on the tour, managers and agents can just continue their career by making money out of 'flogging' a different player.