Atlanta Hawks guard Trae Young and Indiana Pacers big Myles Turner both suffered mild grade 1 inversion (inwards) ankle sprains last week. However, Trae was listed as “day to day” and set to be re-examined the following Monday whereas Myles was listed as  “week to week” and ruled out by the team for approximately two weeks.

Same diagnosis, different timelines….so what gives? In this article, I’ll take you down into the underbelly of a grade 1 inversion sprain diagnosis to peer at potential factors and details which may help explain the different return to play (RTP) timelines.

If you prefer video, I got that base covered as well:

Ankle position during the injury

In both cases, the players ankle rolled inwards (inversion) and stressed the ligaments on the lateral (outer) aspect of the talocrural (ankle) joint. These lateral ligaments are like rubber bands that stabilize the ankle talocrural joint when it moves past it’s normal inversion range of motion, typically around 20 degrees.

The extent to which each ligament is stressed depends on the position of the ankle during that inversion moment (inward roll):

Inversion + plantarflexion

When the ankle is inverted and plantar-flexed, the anterior talo-fibular ligament (ATFL) takes on the most stress.

Inversion + neutral

When the TC joint is inverted and near neutral, the calcaneo-fibular ligament (CFL) takes on the most stress.

Inversion + dorsiflexion

When the ankle (TC joint) is inverted and dorsiflexed, the posterior talo-fibular ligament (PTFL) takes on the most stress.

It’s a spectrum, not binary

I want to re-emphasize that these distinctions exist on a spectrum, not silos, and speak to degrees of stress on the ligament. Nearly all inversion sprains load multiple ligaments but one takes on a higher degree of stress due to the extent of plantarflexion at the moment of injury. It’s not binary in that only one ligament is stressed and others aren’t. 

That leads us to Trae and Myles ankle position at their respective moment of injury:

Young and Turner mechanism of injury (MOI)

Young’s ankle was certainly plantar-flexed when he rolled it inwards (inverted). However, Turner’s ankle was in a higher degree of plantarflexion as he was up on the ball of his foot when his ankle inverted.

Trae’s ankle being in a relatively neutral (aka less plantar-flexed) position may have distributed the stress to both the ATFL and CFL whereas Turner being in that highly plantar-flexed position could have placed the majority of load – and therefore damage – on the ATFL.

In line with that, a grade 1 sprain diagnosis only indicates that a ligament was less than 25% torn, it doesn’t speak to quantity or severity within that range. For example – completely hypothetically – if Trae’s ATFL and CFL are torn 10% and 5%, respectively, whereas Myles’ ATFL is 20% torn, each would be diagnosed as a grade 1 but the higher damage to Turner’s ligament would indicate a higher severity within that grade 1 spectrum and a longer return to play (RTP) timeline.

Direction of force

The specific directional forces imparted into the ankle during the moment of injury may have also factored into the differing injury severity and timetable.

Young was coming down from a jump at a combination ventral and lateral force (downwards and outwards) whereas Turner’s ankle was pushed outwards by an acute lateral external force. The latter places a direct stress on the lateral talocrural (ankle) joint ligaments.

Laxity

Every individual has a different level of soft tissue laxity – looseness or mobility of muscles, tendons, ligaments, etc. This leads to individual differences in things like muscle flexibility and joint mobility. 

There’s a possibility that Young has more inherent ligament laxity than Turner which allows Young’s ligaments to stretch farther without overt tearing, thus reducing injury severity.

A recent example of this was Kansas City Chiefs QB Patrick Mahomes who dislocated his right patella (kneecap) but suffered only mild tearing to one kneecap ligament due in part – as was reported by a team source in the aftermath – to high inherent laxity of his soft tissue.

That being said, too much laxity is also a problem. Research has shown, repeatedly, that excessive laxity – known as hypermobility – significantly increases injury risk. An easy and reliable way to test for hypermobility is known as the Beighton index.

All in all

All in all, although both Trae’s and Myles’ ankle sprains were classified as grade 1 inversion sprains, there are important differences and details that may have influenced the relative severity, reflected by Young’s “day to day” timeline vs Turner’s “week to week” timeline.

In this case, those differences may have been the extent of ankle plantarflexion when the injury occurred, the direction of force, and intrinsic ligament laxity specific to each player.

That’s a wrap for this piece, thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and twitter @3cbperformance. Make sure to sub to the blog below and the YouTube channel for the latest updates. 3CB out.