Manchester City and Belgium superstar Kevin De Bruyne has picked up his fair share of injuries over the past year, including thigh strains, facial and eye socket fractures and, most recently, an ankle injury in the last-16 of Euro 2020.
The injury, based on mechanism (how it happened) with De Bruyne being tackled from behind and his ankle twisting outwards, was most likely a “high ankle sprain” also known as a syndesmotic tear injury.
Even in the case of Grade 1 “mild” syndesmotic injuries, players average a time loss of four to six weeks. For example, Arsenal’s Thomas Partey missed roughly four weeks with a similar injury recently and, for a different sport example, Los Angeles Lakers’ extremely well-conditioned and fit superstar LeBron James missed nearly five weeks.
In summary, high ankle sprains are a serious injury that need to be taken with high precaution. However, De Bruyne – who was seen with ice strapped to the inside part of his ankle after being taken off against Portugal – missed no time and played in the quarter-finals vs Italy for 90 minutes. This wasn’t a surprise as De Bruyne has either played through numerous injuries in his career or returned quite quickly.
However, he paid the price in this case. When De Bruyne reported to Manchester City’s pre-season camp a month later, he was still having pain and discomfort in the ankle. After receiving clearance from renowned Barcelona specialist (and manager Pep Guardiola’s preferred medical provider) Dr. Ramon Cugat, he was cleared for team training but the ankle needed to be closely monitored for any swelling and risk/reward needed to be taken very seriously as any further damage could result in surgery being required.
The Belgian didn’t feature in pre-season and after another visit with Dr. Cugat, played 11 minutes as a substitute in City’s opening weekend loss to Tottenham. That bounce game cameo didn’t go over well with the ankle and De Bruyne was once again ruled out – this time missing Man City’s matchday squads to face Norwich and Arsenal, and then Belgium’s World Cup qualifiers.
In the last few days, De Bruyne has finally returned to training and looks poised to return against Leicester City on Saturday, although in what capacity or role is still to be determined. If the player does indeed go on to play and respond well, that will have been 11 weeks since his initial injury – nearly double the typical time required and the potential for significant fitness fluctuations as well (which leads to increased injury risk in other body regions).
Harkening back to the LeBron James example, he came back in five weeks but even then still felt excessive pain in the ankle which then led to another week off and limited acceleration and push-off that leg for the rest of the season and into the playoffs.
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Even in the case of milder ankle injuries, current Arsenal and former Real Madrid man Martin Ødegaard suffered a Grade 1 inversion sprain injury (the ankle twisting inwards) while on international duty with Norway last season and played through it. After returning to the Emirates, he experienced irritation and discomfort which led to a dip in form and a 2+-week break to get the ankle right again.
Those examples and De Bruyne’s saga are a case in point of the dangers and high risk/reward of playing through these injuries and there are countless other example as well of how playing through foot and ankle injuries can lead to significant downstream issues.
Once you fall behind this type of injury, you’re constantly playing catch-up and digging out of a hole. That’s never easy to do and I hope these examples lead to a newfound respect for foot/ankle injuries and recalibration of the risk/reward calculation process.
Dr Rajpal Brar, DPT, is a physiotherapist, movement expert, fitness trainer, and mindfulness coach. He runs the LA-based wellness and athletic development/performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more) by going here.