48: Recovering from a Sprained Ankle

Mitch: Isn't there like some other scan or something you can do now? The test to find out if your ankle is doing okay is to poke it and ask if it hurts.

Scot: That's the best medicine has done over the past 400 years, Troy?

Troy: This is all we got, poke it and say, "Does that hurt?"

Scot: "Who Cares About Men's Health," giving you the information and the inspiration to live a healthy life now and also be healthy in the future. My name is Scot Singpiel. I'm the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah. And I care about men's health.

Dr. Gee: And I'm Chris Gee. I'm an emergency physician and a sports medicine physician at the University of Utah, and I care about men's health.

Scot: All right. Dr. Gee is on because we want to talk about rolling your ankle. So you're out exercising, you roll your ankle, you sprain it. How do you know whether or not to seek care, if you know if it's going to be okay on its own or if you need to go in? How long does it take to recover? What's actually going on? We're going to talk about all those things with Dr. Gee, because he is a sports medicine expert.

I mean, he's got a cool title, but, Troy, I wanted to run down this list of organizations he's worked with. Are you ready for this list?

Troy: I'm ready.

Scot: All right. He's a team physician for the U.S. Speed Skating team. He's the Chief Medical Officer for the Nitro Circus World Games and Dew Tour Summer and Winter competitions. He's the Medical Director for the High Performance Center at the Utah Olympic Oval. He's the Head Team Physician for the Salt Lake City Stars, the G-league affiliate of the Utah Jazz. He's the Medical Director for the Salt Lake City and South Jordan Marathons. He's provided medical support for the Tour of Utah. And if that's not enough, he's the attending team physician for Copper Hills High School and Jordan High School. And we brought him in to talk about Mitch's ankle.

Troy: I was going to say, Scot, this shows just how creative we are, that Chris has all of this experience and all of this insight and we're like, "Well, let's see. Mitch rolled his ankle, and he saw Chris for it. Let's see if Chris can talk about Mitch's ankle."

Scot: Yeah. Kind of like, I don't know, killing mosquitoes with a bazooka, but, Dr. Gee, we're happy that you're here. Producer Mitch, go ahead and introduce yourself and also then just tell us kind of what happened to your ankle, and then we're going to talk about a sprain kind of through your experience and then generalize it to everybody.

Mitch: Yeah. I'm Mitch Sears. I produce this show, and I also care about my health. So the last couple weeks we've been training for this 5K, the Who Cares About Mitch's Health 5K. I was doing well, and after nine weeks, I was finally actually running a full 5K. I was able to do it a couple times a week. And then that very next Monday, I'm out running. I'm saying how great everything feels. I'm out with my partner, I'm like, "Hey, this feels great. Everything's good," and then all of a sudden, my toe catches a bad paver and I roll and I crunch and I go down.

Limped on back home, and it swelled up. I've never seen my ankle more black and blue. And I eventually was . . . it got to the point where I felt I needed to go see the doctor. And so that's when I went to the Sports Clinic and met Dr. Gee.

Scot: Is there any way to be preventative about an ankle sprain? Is there anything Mitch could have done in advance?

Dr. Gee: That's always a tough one to predict coming forward. Some people have looked at trying to use a brace, to maybe wear that when you run. My concern with that is that it's going to just weaken the muscles around there, and you're going to eventually have a weakened ankle that's more reliant on the brace than on anything else.

And so what I recommend is probably doing some exercises, what we call particularly proprioceptive exercises, that can help to stabilize the ankle and kind of prevent it from catching on that little rock or whatever and rolling so dramatically.

Scot: Gotcha. Do you find that some people tend to roll their ankle a lot, like Troy, and others just really don't, like kind of I have experienced?

Dr. Gee: Oh, for sure. Yeah, it's something that you'll see quite often. I don't know if there's a genetic . . . there probably is a genetic component to it. Some people have looser ankles. Sometimes it's the way you run, but there are definitely people that are more at risk for it.

Troy: Chris, that's interesting you mentioned that about the brace because, like I said, I've rolled my ankle too many times to count, starting since high school or junior high. And it just seems like I keep reinjuring the right one in particular.

But I went through a phase too, where I had several different braces I was trying and wearing ankle braces anytime I was out. I wasn't running as much then but hiking or things like that. And I guess maybe it kind of made it feel more stable, but, man, I was still rolling it a lot, and so it makes sense. I'm certainly in your camp now where I'm just like, "Yeah, I'm not going to wear an ankle brace just because it weakens everything else there."

Dr. Gee: Yeah, exactly. I think if you . . . there's definitely those high level sports like basketball that they're so at risk of spraining it that sometimes using a brace and doing the exercises is indicated. But you're right. It's one of those things you've got to be really careful and make sure that those muscles are activating and staying as ready to control the motion as possible.

Troy: What exactly do you mean by proprioception and improving that sort of aspect of your foot and your ankle?

Dr. Gee: If you think about proprioception, it's kind of the sense of where your body is in space. So if you take your hand and you put it behind your head, you can't see your hand anymore, but you can still feel its position. You know that your thumb is up or your fingers are splayed out. You know kind of what your hand is doing.

We have that same sense in our feet, where when you're running down the road, you're not watching your foot, but your foot is giving your brain feedback as to where it's moving, what kind of terrain it's on, if it's rough terrain or flat or you're going uphill. It's giving all this feedback to the brain.

And in essence, what should happen is that your brain should know these . . . it should feel a quick little impulse that your ankle is starting to turn. Maybe you step on a small little rock or some grass and it's starting to turn over. And it should be able to give you this quick feedback to say, "Whoa, don't pull that far," and basically use the muscles to kind of pull the ankle back in before it fully rotates over and tears your ligaments.

The issue is that when you sprain your ankle often, you stretch out the nerves, you stretch out the muscles, the tendons, and the ligaments, and now everything is loose, and it has a delay. And so you end up doing that whole episode of stepping on a little rock and then all of a sudden, the whole ankle is turning over before your muscles are even able to engage.

Scot: Wow, I didn't think about that feedback system, that proprioception. That is fascinating.

Dr. Gee: So what we want to do is kind of retrain that. You can see videos of people doing various things, but basically it's things like standing on an uneven wobble board while doing other tasks. So standing on one foot on a trampoline or bouncing a ball against the trampoline while you stand on a wobble board. And what it does is it just really forces your brain to retrain those systems and those neural pathways so that they're quicker and they respond faster.

Troy: And one thing I remember trying just initially was just standing on one foot. And it was interesting to me that, having sprained my ankle so many times, how I struggled with that, with my eyes open standing on one foot and just being able to stand there and keep my balance.

You imagine that this whole system is set up and it works great, but then, like you said, you see after those multiple ankle sprains that just stretches everything out and really affects that ability to know where your body is in space relative to your ankle and everything else.

Scot: So some people that don't sprain their ankle as much then might just have a little bit better proprioception in combination possibly with their ankle is just a little bit more stable?

Dr. Gee: Exactly. When we talk medically, you've got ligaments and tendons and all these big words. Basically, the ligaments are little ropes that attach your bones together. And so they should not be stretched or pulled more than their normal length. When you sprain an ankle, you actually pull those ligaments and tear them.

And some people just naturally have looser ligaments, so maybe they haven't sprained their ankle in the past significantly, but their ankle is a little loose anyway, and so they have to be careful and really kind of try to prevent injury by really activating those muscular systems to try to overcompensate.

Scot: So, Dr. Gee, when somebody like Mitch with a sprained ankle comes into the Orthopedic Injury Clinic to see you, what do you start to do to start to figure out if it's a problem or not?

Dr. Gee: Basically, when I'm coming up, I want to get the history of kind of what they did. Like in Mitch's case, they maybe have not been very active and now they were kind of getting up and going to run a 5K. Or was this an athlete that runs 100-mile races? That's a different injury pattern that I'm looking for.

And then kind of going over what exactly happened, which direction the ankle turned, what they heard or felt, and things that happened, bruising, swelling, all those kind of things after the fact. So that's always the first thing I want to know, is their history.

Scot: All right. So you took a look at his X-ray. Was everything okay?

Dr. Gee: As far as I remember, it must have been.

Scot: Okay. I mean, does that tell you pretty much a definitive story then, the X-ray?

Dr. Gee: No. Honestly, you see an X-ray, it doesn't have much on it, but you go in the room and they have a huge black and blue ankle and it's really swollen. And that just indicates a level of trauma there that those ligaments and soft tissues have been torn and there's a lot of bleeding in the tissues.

And I basically examine them and try to figure out where it hurts and what the laxity of their ligaments and their muscle inhibition is at the time that I'm evaluating them, because that gives me an indication of how quick they'll be able to get back to routine activities.

Mitch: Yeah, there was a lot of twisting of the ankle and poking it and all different parts of the foot to make sure like, "Hey, does this hurt? Hey, does that hurt? Hey, does this hurt?" So you were just checking for stability and maybe more dramatic tearing, or what was going on there?

Dr. Gee: Exactly. I know people think we're just trying to torture them half the time. And it sounds kind of stupid when you're pushing over certain areas, but we're actually trying to use the anatomy to say, "Hey, this is right where this ligament is. Does it hurt in that spot?" If it does, and it's swollen, that tells me that it's torn more than likely.

So, yeah, I'll push along the joint lines and then I'll see what their motion is, how far they can bend their foot up or point their toes. Can they bend it in and out? And sometimes, it's so painful they can't do that. And that, again, just indicates a higher injury.

I do oftentimes grab the ankle and pull it forward. So if I were to grab their lower leg and put my hand on the back of their heel and pull forward to see how loose that is, that's called an anterior drawer. In some people, it's really loose. I imagine Troy's is probably super loose from what he's saying.

Troy: Yeah. Like I said, my sister, she examined it and said, "Wow, that's impressive." So you know that's not good when that's her specialty and she's been examining ankles for five years.

Scot: So during that period of recovery, which could be six to eight weeks give or take, what does treatment look like at that point if it's just a sprain, just kind of a run-of-the-mill sort of sprain that doesn't need surgery or that sort of thing?

Dr. Gee: So the first and biggest thing that I try to get people to do is get the fluid out of it, get the swelling down. So that involves keeping it elevated, staying off of it, maybe using a wrap like an ACE bandage around it to kind of keep it from swelling or push that fluid back up the leg. And icing it for the first couple of weeks has been shown to be the most helpful.

As patients start to get that fluid out of it, that feels so much better because a lot of that fluid has a lot of inflammatory chemicals in it that basically just keep bothering things. And so that's the first step.

Oftentimes, we'll then start having them do some just light motion exercises, so stuff like pointing your toes and pulling your toes back towards your nose, or spelling letters with your toes or picking up marbles off the floor. Those things just activate the muscles a little bit and get it just a little more recovered than it was before.

Scot: And then after that, kind of a gradual return to just regular activity?

Dr. Gee: The first step is getting the fluid out, and then the second thing is really just trying to get back on your feet, get walking again normally. And so if it's just a sprain, sometimes we can get you walking in one of those fracture boots, those black boots, sometimes an ankle brace, just so that you're able to put some weight on it and start to stimulate the muscles to kind of activate and heal.

And then, gradually increasing your time out of the boot over those next few weeks until you're able to get just back to daily life without a boot, walking around without any pain.

Once you're at that point, then we can really start to increase your activity. So kind of like what Mitch has been doing, starting to do a little jogging, starting to do biking or swimming, or things like that that you're trying to get back into.

Troy: It sounds like you're on the recovery though, right, Mitch? You're doing all right?

Mitch: Yeah. I've been able to actually get back out and kind of jog on it a little bit. It's feeling okay. I mean, we're on, what, week three now? I've been icing it, I've been elevating it, and I've been going on daily walks. I'm doing that little kind of active recovery, doing what I can. And it's getting better, but it still hurts. It's not the ankle necessarily. It's the base of the toes, the bottom of the calf, and the inside of the heel. What is that all about?

Scot: Well, that's when Dr. Gee was grabbing you by the toes and the heel and jerking things around. That's what that's from.

Yeah, what is going on there? Because I've experienced the same thing, and I imagine a lot of people have, where you hurt something, and then a couple weeks later, that something is better, but now a new something is hurt. What's going on?

Dr. Gee: Most of the time, what it'll be in the ankle is that there are other muscles that are trying to compensate. You're not walking the way you normally do, and so because of that, you're trying to avoid maybe putting weight on the outside of your foot or the inside of your foot, and that's just using muscles differently in your leg and ankle and that can start to irritate those things. Your calf will start to get sore. The peroneals and posterior tib on the sides of the ankle, those muscle groups will get sore. And so we'll see that a fair bit.

The other thing that can do it is if you . . . and I can't remember if Mitch was in this case or not. If we put them into some kind of a fracture boot or a walking boot, that can definitely throw off your walking. And so it tends to cause problems in other joints, knees and hips and the other side as well.

Scot: And could it also be possible . . . this is my hypothesis, so I'd like somebody to prove me right or wrong. I like being right mainly. That Mitch was experiencing a lot of pain in the ankle and maybe some of those other parts were injured, but then the ankle starts not feeling as much pain, then your body, you start noticing those other things?

Dr. Gee: I think you're right. There's that issue of when you sprain your ankle, yes, your ankle gets turned but you're also falling on your face, and there are a lot of other things happening. And so those other small bruises and injuries may not have been noticed at first.

And I've had that a number of times where I'll see a patient after falling down or breaking their wrist and they come in and they're like, "My wrist feels better now that it's casted, but my ankle is killing me." And you look at their ankle, and they've got a break there or something.

Scot: Wow, that's crazy. Mitch, did you want to ask Dr. Gee any questions? You're three weeks into your recovery. You're starting to kind of get back in the game. I know it's been a little frustrating for you.

Mitch: Yeah, I guess that's what it kind of is. Yeah, we can talk about foot perception, or whatever the word was, and how to prevent it, but I mean, this is my first time getting back on. I haven't run since high school. I had a knee injury that we'll probably talk about some other time, but . . .

Scot: Because the whole point of this podcast is to get free medical advice for us.

Troy: It's pretty much why we do it.

Mitch: But for real, there is a real frustration and almost a fear that kind of has come over the whole thing. I mean, we joke about this and we laugh about this, but for nine weeks, I reached a goal I felt pretty good about. And then all of a sudden, I'm back to square one. And not only am I back to square one, it's, "How can I make sure that this doesn't happen again?" I hate to do the toxic masculinity, but is it just like, "Buck up and keep on going or trudging on"? What do you tell to those kinds of people where it's just like, "Well, I tried that and I hurt myself, so I'm going to go not do that ever again"? I don't know.

Dr. Gee: For sure. The first thing that I tell people is that the first few three to four weeks are the worst, because you feel exactly like Mitch says. You've had this injury, you've made all this progress, and now you feel it slipping away. And suddenly, even just walking, even just getting back to your normal activities, not even working out, is difficult.

But that's all just because that first few weeks is when most of the healing is going on. You're getting the inflammation down. You're getting the stability back. The good news is that, yes, it will get better, and you're through the worst of it. And the fact that you're able to do some jogging is fantastic. That tells me you you've got enough stability, that it's progressing, it's healing. It's just hard that it takes so long, but it will get better.

Scot: And is that just something that you find most people just kind of inherently know, whether or not I'm doing this too soon or not? Did Mitch get back to jogging too soon, or does your body do a pretty good job of telling you that?

Dr. Gee: Sometimes it will, but there are definitely those patients . . . and that's a question we run into all the time, is, "Hey, when should I? When can I get back to activities?" And I think you have to kind of listen to your body and see how it feels.

There are those people that they sprained their ankle and they're back at it in two weeks. And medically, you wonder how they're able to do that, but they're able to kind of progress a little faster, I guess.

But you always want to just listen to what you're feeling, what your body is doing. If it's swelling, if it's causing pain, or clicking, or other kind of symptoms, then yeah, it's a little too fast, and maybe you need to have it looked at again.

Scot: All right. Mitch, did you have any last questions?

Mitch: No, I'm good.

Dr. Gee: Are you going to do the 5K?

Mitch: I'm obligated.

Troy: You're obligated. It's peer pressure. I mean, the 5K is named after you, Mitch. You've got to do it.

Mitch: No, I'm planning on still doing it. And every other day . . . well, every day I'm going out and walking and every other day, I'm trying to little bit of jogging. And I'm up to like a minute or two of jogging, and then I walk for a little bit. So it's right back to where I started. So I'm going to at least walk it. We'll at least walk the 5K and go from there.

Scot: Yeah, it sounds like the recovery is not a linear thing, though. It sounds like, from what Dr. Gee says, the first three, four weeks is when most of the healing is done. And then after that you'll probably notice . . . tell me if I'm right or wrong, again, Dr. Gee. You'll probably notice a much better increase over the next month than you did the previous month.

Dr. Gee: It does seem to kind of take off like that when the first few weeks are just so disheartening and frustrating. And then it seems to kind of get better and you're noticing, "All right . . ." Then you can kind of see more progress. But to take three weeks just to get walking again is frustrating for most healthy people.

Scot: All right. You've got a great list of credentials that I read at the beginning of the show. Can I add another bullet to that? And the personal physician for the Who Cares About Mitch's Health 5K.

Troy: Oh, that's right. Yeah, you could be our medical director too. Please put that on your CV. That would be great.

Scot: Dr. Gee, thank you for being on the show, and thank you for caring about men's health.

Dr. Gee: Thanks for the invite.

Scot: All right. Time for "Odds and Ends" on "Who Cares About Men's Health." We've got two items. Item number one is the Who Cares About Mitchell's Health 5K. We are less than two weeks away. Can that be right?

Mitch: Yeah, that is correct.

Scot: Wow. How are you doing? You had that ankle problem.

Mitch: I'm still having that ankle problem. But I'm walking. I'm doing a bit of jogging. And at this point, I'm going to do it. If it takes me two hours . . . I can walk on it. My ankle is stable. We'll get it done. I worked hard enough to get there and we're going to do this.

Troy: You can do it. You got it. And so walking, are you are you walking a significant distance right now, or is it just kind of getting around the house and that sort of thing?

Mitch: Jonathan and I have been waking up early and walking for 30 minutes or so, so we're getting all the way up to the Smiths and wherever. So it's a mile or two.

Troy: Yeah, if you can do that, you can do it. I'm sure. You'll get through it.

Scot: Absolutely. There's no shame in walking it given what's happened. No shame at all. So I look forward to running this with you, man. You've come so far. This is really cool. I'm getting really, really . . . I'm getting stoked for it now, so this is going to be a lot of fun.

If you'd like to join Mitch and support him, he went from couch to 5K in the Who Cares About Mitch's Health 5K. He's also done some great other health adjustments, including quitting smoking and that sort of stuff. If you want to celebrate or if you've always kind of wanted to run a 5K, you can do it your way. You could walk it. You could run it. Are we letting people cycle it? Is that fine?

Mitch: Sure.

Scot: All right. So go to facebook.com/whocaresmenshealth, download the bib and print it out and put it on, and then join us for the Who Cares About Mitch's Health 5K, which will be run virtually on Saturday, June 20. That's facebook.com/whocaresmenshealth.

All right. Item number two. Somebody must have posted our testosterone episode somewhere because we got this huge influx of emails, men asking us about testosterone treatments.

We absolutely love the questions, so send those in. Of course, if you ever have questions, you can just email us at hello@thescoperadio.com.

But since we got so many testosterone questions, we wanted to kind of hit a couple things. First of all, if you have questions, check out Episode 22 where we talk to a urologist about testosterone treatments, the good, the bad, why you should see a professional. That aired in October of 2019, Episode 22.

But the other thing was, just kind of in general when it comes to testosterone treatments, if you're considering them, some things to keep in mind.

Troy: Yeah, I think the biggest thing is . . . and my big takeaway from this episode going into it really knowing very little about testosterone treatment is there's a lot that can go wrong. So it's one of those things you don't want to mess around with.

My thought after hearing all this is if I were ever considering it, I would want to go see someone like Dr. Pastuszak, someone who's a urologist, who specializes in testosterone treatment, who can do a test to say, "Yes, you need this," or, "No, you don't," and then can continue to monitor my levels after that to make sure I'm not taking too much or too little, or have any of the side effects from it.

So I think that's probably the biggest thing, is just making sure you are seeing someone who can give you the information you need and monitor your treatment to make sure it's successful.

Scot: Yep, and that includes over-the-counter stuff that is intended to try to manipulate your testosterone levels. There are just a lot of variables involved that you really do need an expert to guide you through that.

We're going to try to get another urologist on and take perhaps your specific questions on that topic because the questions we were getting were very kind of specific to individual people's situation. So keep those questions coming. And if you ever have a question, you can reach out to us at hello@thescoperadio.com.

"Just Going To Leave This Here." It could have something to do with health or it could just be a random thoughts. Let's go ahead and have Troy start off with "Just Going To Leave This Here."

Troy: Well, Scot, I'm just going to leave this here. I think I might have found a sort of replacement for sports. I am going through major, major sports withdrawal right now. There's nothing to watch. There are no sports on TV. This is killing me. This feels like the middle of July, because I'm not into baseball, when after basketball is over and I'm waiting for football to start. This is like an eternal July.

And so here's my replacement -- rocket launches, the space station. Me along with another 10 million people saw the rocket launch, the first manned launch from U.S. soil. The SpaceX launched. And that was just the coolest thing to see.

And it really was cool because just by dumb luck, Laura, my wife, and I happened to be there at Kennedy Space Center three years ago, in May. And just happened to be at the Space Center when they had a launch. It was just dumb luck that we happened to be there to see that. And it was just it was awe-inspiring. It was breathtaking to see that. It was an unmanned launch. They launched from the same pad where we saw that happen. It's a historic pad, 39A, where a lot of the previous launches to the moon and different launches went from that pad. So it was really kind of a cool thing to see.

But since then . . . I mean, I'm going to tell you what a nerd I am. There's this thing where you can track the International Space Station and you can go outside at like 9:25 p.m. It's usually 9:25 p.m. or about 10:15 p.m. in the evening, and you can look in the sky and see the space station flying overhead. So this is my new sports. I'm like, "Oh, yeah, the space station is flying overhead at 10:13 tonight. I'm going to go out and see it." So this is what it's come to. I'm a super nerd now, but that is my sports.

Scot: I'm just going to leave this here. I don't want to get super heavy here, but I do want to talk briefly about some thoughts that I've had about COVID-19. Because we're starting to see around the country . . . like here in Utah, we've got the color-coded system, right? So we were red, then orange, then yellow, and then possibly moving to green at some point.

I just wanted to say that just because we're seeing those colors change doesn't necessarily mean that the virus is going anywhere. Troy, if I'm not mistaken, we actually have more cases now than we did when it first broke out, right?

Troy: Right. We're seeing more cases now in the ER than we were in April. And you just think how anxious we all were in April and all these precautions and social distancing. And now I think we have gotten beyond that anxiety a bit and feeling a little more relaxed. But I think the risk of catching it is probably greater now than it was then, just at least based on the numbers we're seeing.

Scot: Yeah. So for me as a communication scholar . . . because that's my other job. I don't know if you knew that or not, but that's my other job. There's this disconnect between, again, this manmade constructed/conceived color-coding system, which is indicating green light, which is great. But the reality is, as Troy described it, there are actually more and more cases out there.

We know how to deal with it much better, but I would just like to ask everybody remain vigilant, wear your facemask, be sure you're washing your hands, not touching your face, continue to physical distance. If you can do something outside as opposed to inside, do that so you can still get that social contact. But just be safe because we want all of our listeners to continue to be healthy.

Was that a little too heavy? I mean, I didn't want to be heavy.

Troy: It was a little on the heavy side for a "Just Going To Leave This Here," but we'll let it slide, Scot. We'll let it slide.

Scot: Hey, well, sometimes that's what's on my mind, man. That's just what's on my mind.

Troy: You've got to say what's on your mind. Yeah, that's right.

Scot: All right. Time for the things that you say at the end of podcasts. It seems like every podcast does this, so why should we be any different, right? So thing number one is always, hey, we'd love to hear from you, and it's true. You can do so by emailing us at hello@thescoperadio.com.

Troy: And you can check us out on Facebook, facebook.com/whocaresmenshealth. Also, the website is whocaresmenshealth.com. Subscribe wherever you get your podcasts. And thanks for listening and thanks for caring about men's health.