The injury occurred in San Diego. The wailing, however, began in Seattle soon after left tackle Russell Okung began limping on his injured left ankle last Thursday.

Again?

Yes, the player the Seahawks picked to be the cornerstone of their offensive line for the foreseeable future left last Thursday's exhibition game with his third ankle injury in two seasons.

This injury wasn't as serious as either of the two high ankle sprains Okung suffered as a rookie last season. Coach Pete Carroll has already indicated Okung could be ready when Seattle begins its regular season in San Francisco on Sept. 12. But Okung's ankles have become a cause for concern. Fans have mentioned everything from Okung's shoes to the way his ankles are taped to someone creating a decidedly mean-spirited Twitter feed dedicated to the big fellow's ankles. If only the Alaskan Way Viaduct got this much attention.

Let us interrupt the hand-wringing over Okung's health to interject some actual expertise on the injury.

"No one's prone to this," said Dr. Erik C. Nilssen of The Andrews Institute of Orthopaedics & Sports Medicine in Florida.

Nilssen was one of two physicians interviewed by phone Tuesday to talk in general terms about a high ankle sprain, which is the type of injury Okung suffered as a rookie. Carroll said the injury Okung suffered to his left leg was "in the same area."

"You wouldn't look at someone and say you're going to be a high-ankle sprainer," said Dr. John O'Kane, head team physician at University of Washington.

Nilssen and O'Kane were asked to provide general information on high ankle sprains. Neither doctor was asked to discuss Okung specifically, and neither has evaluated him.

Okung's history and his toughness are something that make his injuries so puzzling. He is a uniquely powerful lineman with an exceptionally long reach and a documented record of dependability.

He never missed a game in four years at Oklahoma State, starting 47 in a row from his freshman to senior years. Anyone who thinks it's a question of toughness should look back to last season, when Okung suffered a high ankle sprain in his right leg in August and his left in October. In both instances, he was back sooner than the general recovery guideline of six to eight weeks.

A high ankle sprain is fundamentally different from what is conventionally referred to as a sprained ankle. That injury affects the ligaments in the ankle joint itself, often occurring when the ankle itself rolls, weight coming down on the side of the foot.

A high ankle sprain is different. It involves the large ligaments above the ankle, which hold together the tibia and fibula, the two bones of the lower leg.

"It's the black box of orthopedics," Nilssen said. "When we figure that out, it will be a Nobel Prize type of thing."

The injury is not difficult to diagnose. It is, however, very tough to predict when an athlete can return to play.

Once the injury heals, it doesn't generally reoccur. But does suffering a high ankle sprain once make someone predisposed to repeat injuries?

"It's not as well studied," O'Kane said. "But in general, soft tissue does not heal quite as good as new."

That wouldn't make this specific injury unique, though. It's true for stress fractures as well as torn anterior cruciate ligaments.

"With almost every single injury, one of the greatest risk factors is almost always having had it before," O'Kane said.

That's very different from saying it will happen again, though.

Danny O'Neil: 206-464-2364 or doneil@seattletimes.com