DEAR DR. DONOHUE: What happens when you sprain an ankle? I sprained mine six weeks ago. I went to the doctor, who ordered an X-ray. It didn’t show any fracture. I wore an air brace for two weeks.

My ankle still swells and is sore, tender and stiff. I still limp. I hate getting out of bed. – S.B.

ANSWER:
Ankle sprains are common injuries in sports and in everyday activities. Stepping off a curb, tripping on broken pavement or just getting out of a car are situations where it’s easy to turn your ankle and sprain it. Estimates have it that 23,000 Americans sprain their ankles every day. That sounds like a large number to me, but who am I to doubt?

A sprain is a ligament injury. Ligaments are tough fibers that hold joints in place.

A grade I ankle sprain is one in which ligaments are stretched out of shape. It should heal in a week to 10 days. With a grade II sprain, some ligament fibers have been torn. It takes two or three weeks for this kind of sprain to heal. A grade III sprain involves tearing the ligament in two. It can take six or more weeks to repair this kind of sprain.

I don’t want to be the bearer of bad news, but you should not be in the kind of pain that you are now in. It could be that your ankle ligament hasn’t healed – no scar has bridged the gap between its two broken ends. An MRI – magnetic resonance imaging scan – might be needed to assess what’s going on in your ankle. Don’t dally much longer. Consult an orthopedic surgeon. You need an expert to get in on the act at this point.

DEAR DR. DONOHUE: I play basketball, and it seems that every year I sprain my ankle. Last year I had to sit out half the season because of an ankle sprain. If I wear high-top shoes, would they help get me through this season without a sprain? – D.K.

ANSWER:
They might. It seems logical to assume they would, but there hasn’t been any proof of that.

Taping is another way to support the ankles so they don’t twist. The trouble is, tape loosens in short order. Elastic ankle supports are another option. So is the kind of ankle support that is secured with laces. Kids use to use them to stop their ankles from turning over while ice-skating.

I can’t give you assurance that any of these will work for you, but I wouldn’t hesitate to try them.

DEAR DR. DONOHUE: I am writing in regard to your answer to exercising that included heart-rate information. Heart-rate tables are inaccurate, so inaccurate that they can’t be used. At 45, my maximum heart rate is 194. I cycle with 30-year-olds whose maximum heart rate is 160.

The exercise advice that used to be given was to raise the heart rate so that breathing is elevated but conversation is still possible. If a person finds it difficult to talk while exercising, he or she should slow down. The best advice is to exercise so that breathing is elevated but conversation is possible – a rate that can be sustained for 20 to 30 minutes. – J.P.

ANSWER:
I like J.P.’s approach. Too much emphasis is placed on heart rate as being the criterion for exercise intensity. The conversation test is good advice.

Readers need some background information. To attain a level of exercise that benefits the heart, many experts say it’s necessary to raise the heart rate to a certain level. One way of ascertaining that level is to obtain your maximum heart rate, the fastest your heart can beat. A rough estimation of maximum heart rate is made by deducting your age from 220. Then a person is supposed to take 60 percent to 80 percent of that number to give the lowest heart rate that puts him or her in the training zone and the highest heart rate that is safe for the veteran exerciser.

In truth, the only way to obtain a valid maximum heart rate and a safe training heart rate is to have an exercise stress test. The hang-up is expense.


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