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NFL Week 2 Injury Profile: Odell Beckham Jr. (High Ankle Sprain)

September 13, 2017

This is the first in a series of reports this NFL season that will evaluate injuries to players of local (Patriots, Giants and Jets) or national interest with commentary by Hartford HealthCare's sports orthopedic specialists.

Player: Odell Beckham Jr., New York Giants receiver.

Injury: Mild high ankle sprain.

How it happened: Beckham left an exhibition game Aug. 21 against the Cleveland Browns after a low hit to the knee by cornerback Briean Boddy-Calhoun in the second quarter. He was inactive for the Giants' first regular-season game Sunday night against the Dallas Cowboys.

Expected time missed: Although Beckham's status was a game-time decision Sunday, a high ankle sprain can linger. Recovery typically takes 4-6 weeks. The Giants' game Sept. 18 against the Detroit Lions will mark the fourth week since Beckham's injury.

Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine: "The recovery timetable depends on the extent of the injury.  Nearly all ankle sprains are managed non-surgically. Mild injuries can often be rehabilitated quickly, with players returning to play the following week. More severe ankle sprains, and those involving the end of the tibia and fibula (high ankle sprain) like Beckham's, require a much longer period of rest and rehabilitation."

What is an ankle sprain?: When the ligaments, the flexible tissue that bonds your bones and keeps your joints stable, are stretched or torn. The injury usually affects one or more ligaments on the outside of the ankle

The three types of ankle sprains:

  • Grade 1: Stretched ligaments that will improve with light stretching.
  • Grade 2: Partially torn ligaments that could require a splint or cast.
  • Grade 3: Fully torn ligaments that might require surgery. When it happens, you'l feel severe pain.

When does an ankle sprain turn black and blue?: Grades 2 and 3 sprains could include tears in small blood vessels. Blood that then leaks into tissues causes the discoloration, even though it might not show for several days. The blood is usually absorbed from the tissue within two weeks.

What's the difference between a low ankle sprain and high ankle sprain?:  A low ankle sprain affects the ligaments supporting the subtalar joint, just below the true ankle joint -- a set of of three bones, the tibia (inside part of ankle), fibula (lateral, or outside) and the talus (lower). A high ankle sprain affects the ligaments connecting the tibia and fibula, the lower leg's two bones. Note that in pregame warmups Beckham ran fluidly straight ahead, but grimaced after cutting: A high ankle sprain hurts whenever you place rotational force on the ankle. "Cutting puts more stress laterally, which is where the ankle sprain commonly occurs," says Dr. Rios. "A severe high ankle sprain would not tolerate even straight running for up to 8-12 weeks."

Recovery/Treatment: A low ankle sprain is usually caused by an inward twisting motion. It's less serious than a high ankle sprain  -- most athletes will return anywhere from a few days to a month. Recovery from a high ankle sprain, often caused in the NFL when a player plants a foot on the ground before an extreme outward twist of the foot, can take 4-6 weeks. The Browns' Myles Garrett, the NFL's No. 1 pick in this year's draft, suffered a high ankle sprain when a teammate fell on the back of his leg in a practice before the season's first game.  The Browns' starting defensive end is expected to miss several more weeks.

Severe high ankle sprains can take up to six months and might require surgery. An X-ray, CT scan or MRI can help determine if you have a high ankle sprain or possible fracture.

A cast, splint or brace and physical therapy could part of the recovery plan, depending on the injury's severity.

If you suffer a mild ankle sprain:

  • Apply ice hourly during waking hours, 20 minutes at a time, for the first 24 hours after the injury.
  • After the initial 24-hour period, apply ice for 20 minutes three or four times a day.
  • Warning: Even though pain medications (ibuprofen) can reduce pain and swelling, do not use them for 24 hours after the injury because it could increase the risk of bleeding.

Dr Clifford Rios, a sports medicine surgeon with Orthopedic Associates of Hartford, is Site Director for orthopedic resident education at the Bone & Joint Institute. Click here to find out why the Bone & Joint Institute is the athlete's choice, with a Motion Lab for performance analysis, the area's most comprehensive sports rehabilitation facility and 30 fellowship-trained orthopedic surgeons.