DEAR DR. DONOHUE: I twisted my ankle playing basketball, and it’s still swollen and hurts three weeks later. Shouldn’t it be better by now? I didn’t use crutches. Should I have?

My brother wants me to ask a question for him. He has sprained his ankle three times in the past year and a half. He’d like to know what’s going on. — P.T.

ANSWER: Ankle sprains are one of the most common athletic injuries. A sprain is an overstretched or torn ligament. Ligaments are straps of dense fibrous tissue that span a joint to give it stability. A grade 1 sprain is one in which the ligament has been stretched beyond its capacity to rebound or one in which a few fiber strains have been torn. This injury usually gets better within a week or two. A grade 3 sprain is one in which the entire ligament has been torn. This can take up to six months to heal. A grade 2 is worse than a grade 1 but not as bad as a grade 3.

The most common ankle sprain is one in which the lateral side of the ankle (the little-toe side of the foot) has ligament damage. When it happens, a person feels a tearing sensation and might hear a pop. The foot can be moved up and down only with pain. Immediate treatment is rest, icing, compression with an Ace bandage and elevation of the leg. Icing should be done for 15 to 20 minutes four times a day for the first two or three days. Aleve, Advil or one of the many other related drugs takes care of pain. Crutches aren’t necessary for grade 1 and grade 2 sprains. An ankle brace, a walking boot or taping keeps the person mobile and protects the joint.

Your brother’s recurring ankle sprains indicate his joint is unstable. He must see an orthopedic doctor. If he’s experiencing these strains while playing a sport, he’d benefit from using an ankle support. Tell him to visit Stromgren Athletics on the Internet at www.stromgren.com. He can see pictures of their many ankle devices. Model 329 is one that can keep his ankle supported. This is only a temporary measure. Seeing the orthopedic doctor is the definitive solution. You might have to see one, too, if your ankle isn’t better in another week.

DEAR DR. DONOHUE: I’ve heard that caffeine improves sports performance. How much do you have to take?

I’m not a regular coffee drinker. The few times I tried it, it made me hyper and my hands shook. Does that go away once you get used to it? — E.A.

ANSWER: Many studies have shown that caffeine is a help in high-intensity exercises like swimming, sprint cycling and strength training.

Two cups of coffee before exercise reduce fatigue, increase endurance and facilitate high-energy outputs like sprinting.

The National Collegiate Athletic Association requires that the caffeine content of athletes’ urine in their competitions be less than 15 micrograms per milliliter. That’s the amount of caffeine from six to eight cups of coffee. That’s way too much coffee for someone not used to drinking it.

If you don’t like coffee and it makes you shaky, you grow accustomed to the taste and the shakiness goes away. However, I don’t encourage you to take up coffee for improving performance. You’re better off training just as you have been without the benefit of caffeine.

DEAR DR. DONOHUE: How come you never write about cheerleading? I am a cheerleader, and it’s demanding exercise. We practice daily. I believe cheerleading qualifies as a sport. — S.B.

ANSWER: I haven’t written about it because, until your letter, I never had any question sent to me about it. I’m in complete agreement with you. Cheerleading is a demanding sport that requires agility, balance, strength and flexibility.

Write me with a question. I’ll give you and cheerleading equal time.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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