Issue link: https://read.uberflip.com/i/1547037
A S K D R . H O C K E Y A s y n d e s m o t i c i n j u r y — c o m m o n l y r e f e r r e d t o a s a high ankle sprain—is not the typical ankle sprain that occurs when the ankle rolls inward. It involves the strong ligaments connecting the tibia and fibula just above the ankle joint. These ligaments function like a clamp, keeping the two lower-leg bones securely positioned. In hockey, a high ankle sprain often occurs when the skate is planted or trapped while the leg rotates over the foot. A defender can be particularly vulnerable while battling along the boards, pivoting to defend the oncoming rush, or absorbing contact with the skate fixed against the ice. Hockey players commonly report pain a b ove t h e a n k l e r a t h e r t h a n d i r e c t l y over the outside ankle bone. Pushing off, turning, crossing over, stopping or skating backward may be especially painful. The swelling can be relatively modest, so the injury sometimes looks less serious than it actually is. T h e c r i t i c a l q u e s t i o n i s w h e t h e r t h e syndesmosis is stable or unstable. A stable injury means the ligaments have been stretched or partially torn, but the tibia and fibula remain properly aligned. These injuries are generally treated without surg ery. Initial treatment may include a walking boot, potential u s e o f c r u t c h e s, i c e , c o m p r e s s i o n a n d r e h a b i l i t a t i o n . T h e r a p y t h e n p r o g r e s s e s t h r o u g h a n k l e m ot i o n , strength, balance, single-leg control and hockey-specific skating. A n u n st a b l e sy n d e s m o s i s m e a n s the ligament complex can no longer h o l d t h e t i b i a a n d f i b u l a s e c u r e l y together. This may be associated with a complete ligament tear, widening between the bones, an avulsion fracture, or another ankle fracture. Special X-rays called stress radiographs, weight-bearing CT imaging or even an MRI may be needed when stability remains uncertain. U n s t a b l e i n j u r i e s f r e q u e n t l y r e q u i r e surgery to restore and maintain the normal relationship between the tibia and fibula. Fixation may be performed with a flexible suture-button device or in some cases a screw. The goal is not simply to make the ankle feel better—it is to allow the syndesmosis to heal in the correct position and protect the long- term health of the ankle joint. Stable injuries may allow a return to play within several weeks, but syndesmotic sprains generally take longer than routine lateral ankle sprains. More severe or surgically stabilized injuries often require six to 12 weeks or longer, depending on the extent of injury and the athlete's progress. Ta p i n g , b r a c i n g o r t e m p o r a r i l y s t i f f e n i n g t h e s k a t e m a y p r o v i d e a d d i t i o n a l s u p p o r t d u r i n g t h e transition back, but equipment cannot fully compensate for an ankle that remains unstable. For an athlete who has sustained a h i g h a n k l e s p r a i n , t h e fi n a l t e st is not merely skating in a straight line. They must be able to transition skating forwards to backwards, open their hips, battle along the boards and react without protecting the injured side. If pain increases above the ankle, swelling returns after skating, or they lack confidence during rotation and contact, the player is not ready to return. The good news is that the outlook is usually excellent when the injury is recognized early, stability is accurately assessed and the return is not rushed. With a high ankle sprain, patience is not lost ice time— it is part of the treatment. P 18 // OCTOBER 2026 USAHOCKEYMAGAZINE.COM Why Can A High Ankle Sprain Keep Players Out So Long? p By Charles A. Popkin A T H E D O C I S I N A N D R E A D Y T O A N S W E R Y O U R H O C K E Y M E D I C A L Q U E S T I O N S My son is a high school defenseman who injured his ankle when his skate became caught beneath him during a collision along the boards. He was diagnosed with a high ankle sprain. When can he return to hockey? – Henry E in Dallas, Texas Q If you have questions for Dr. Hockey, please email USAHPlayer Safety@ usahockey.org ? Tibia Fibula Syndesmosis Talus Return to hockey should be based on function rather than the calendar. Before playing, the hockey player should be able to: Walk and climb stairs without pain or a limp. Demonstrate nearly full ankle motion. Regain strength comparable with the opposite side. Hop repeatedly on the injured leg without pain. Skate forward and backward at full speed. Perform crossovers, pivots, stops, starts, and transitions confidently. Absorb contact and compete in practice without pain, instability, or swelling afterward.