What's the status of Sidney Crosby?

The Pittsburgh Penguins will have to continue their march without the services of center Sidney Crosby ; he is sidelined for an indefinite period of time with what is currently being called a high ankle sprain. According to an Associated Press report, the Penguins' medical staff examined Crosby on Saturday, and the presence of swelling in his injured ankle remains a limiting factor in determining the true extent of his injury.

A slow-motion review of Crosby's crash shows that the mechanism of injury was, in fact, a perfect recipe for a high ankle sprain. Crosby slid on his back into the rear boards, right foot first, with his right leg rotated slightly outward. The impact of the skate with the boards locked his foot into place, while the momentum of his slide carried his body forward, forcing his right knee to bend and bringing his lower leg rapidly forward over his ankle.

This combination of ankle eversion (the ankle is turned outward) and excess dorsiflexion (the ankle flexes upward towards the shin) creates enough stress across the top of the ankle joint to damage ligaments. This, in essence, is the high ankle sprain, so called because the injured ligaments (tibiofibular) are located at the top of the ankle joint where the two leg bones (tibia and fibula) meet, about an inch higher up on the ankle than the location of the more typical lateral ankle sprain. A particular concern with a high ankle sprain is that it may be accompanied by a fractured fibula (the skinny outer leg bone) as a result of torsion that occurs to the leg during the injury. So far there is no word of a fracture in Crosby's case, which would be good news as far as his overall healing time. Severe high ankle sprains, with or without a fibula fracture, can require surgery to restore the integrity of the joint, but again, there has been no mention of this so far in Crosby's case. That would leave Crosby with a high ankle sprain, plain and simple, which typically means a minimum four-to-six week absence from sport while the ligaments heal, depending on the severity of injury.

So why does a high ankle sprain take so much longer to heal? It's simple really. The same mechanism that results in the injury happens to a lesser degree every time we take a step. As the leg moves over the foot during normal walking, the ligaments at the top of the ankle are stressed. If the ligaments are damaged and this motion continues to occur, the joint can permanently widen, leading to problems with instability and arthritis down the road. This explains why athletes are typically placed in immobilization boots after such an injury. The rocking surface on the bottom of the boot prevents the athlete from placing undue stress on the injured ligaments. Rehabilitation often includes a period of non weight-bearing, followed by gradual progressive weight bearing in a boot, then a return to a normal shoe. Throughout that time the athlete is undergoing treatment to decrease pain and swelling, and is working on exercises to restore range of motion and strength. Once the athlete can put full weight on the leg, rehab activity increases in vigor to progressively stress the ankle while it heals.

For a hockey player, this is a particularly significant injury, because of the position of the leg during skating. Whereas the ligaments involved in a typical ankle sprain may actually be protected by the stiff, bootlike nature of the skate, in the case of a high ankle sprain, the stress across the top of the ankle is exacerbated by the forward position of the athlete's body while skating. Following a high ankle sprain, an athlete might reach the point of being able to walk or jog on level ground, but could still have difficulty pushing off the edge of a skate because of the ankle stress during that activity. Catching a toe on the ice can also exacerbate the symptoms of a high ankle sprain, as could another crash, so an athlete will not be returned to the ice until the risk of reinjury has seriously decreased.

Working in Crosby's favor are his youth, conditioning and overall health (Crosby has missed only four games due to injury in three NHL seasons). Nonetheless, the recovery time on these injuries can be unpredictable. Just look at Crosby's teammate, goaltender Marc-Andre Fleury, who sustained a high ankle sprain on Dec. 6 and remains sidelined. No matter how you look at it, this is yet another devastating blow to the Penguins, as the league MVP and All-Star will now be absent from their lineup indefinitely. The team plans to re-evaluate Crosby's ankle early next week at which point the swelling should have further subsided, and a more accurate assessment of the injury, as well as a projected timetable for Crosby's return should be forthcoming.