ANKLE SPRAINS
Ankle injuries are one of the most common injuries seen
at sports medicine clinics. Ankle
sprains are the most common type of ankle injury, with injury predominantly
involving the lateral ankle ligaments following a plantar flexion - inversion
stress. Ankle sprains are particularly prevalent in
the sports of Australian Rules Football (AFL), basketball, soccer and netball (1). Health care and socioeconomic costs
associated with ankle sprains are significant both during initial management
and post-injury. Many people who have
ankle sprains suffer from residual problems such as instability, weakness,
activity restriction and osteoarthritis (2). Injury prevention is thus pertinent to the
athlete and society.
RISK FACTORS
Risk factors can be classified as intrinsic or
extrinsic. Intrinsic factors are
inherent to the athlete and can be modifiable (e.g. strength, flexibility, skill
level) or non-modifiable (age, gender, genetics). Extrinsic factors are not inherent to the
athlete and include training load, equipment and the environment.
Previous ankle injury has been shown, by a number of
studies, to be a significant risk factor for recurrent ankle injuries (3). A recent review of risk factors by Noronha et
al., (2006) suggested that preliminary evidence shows reduced ankle
dorsiflexion range of motion may increase the risk of ankle sprains. This is supported by the research findings of
Willems et al., (2005).
The literature is divided on other proposed risk factors
including athlete height and weight, limb dominance, joint laxity, muscle
strength, reaction times and postural sway (3).
A small study by Beynnon (2001) found that women with
increased tibial varum and calcaneal eversion range of motion are at greater
risk of suffering ankle ligament injury, while men with talar tilt are at
greater risk.
Baumhauer et al., (1995) reported college athletes with
greater plantar flexion strength and smaller dorsiflexor to plantar flexor
strength ratios had an increased number of inversion ankle sprains. The 2006 review by Noronha et al., suggested
postural sway and proprioception may be predictors of ankle sprain, however the
quality of the studies reviewed makes it difficult to draw conclusions.
There is no evidence to suggest shoe type affects ankle
injury rates in basketball. However, in
soccer there appears to be a relationship between cleats and playing surface,
but this requires further research (4).
PREVENTATIVE STRATEGIES
The last Cochrane review of preventative measures against
ankle sprains was published by Handoll et al., in 2001. A number of studies had and have since
investigated prophylactic ankle bracing or strapping and balance or
proprioceptive training programs as preventive measures.
There is now extensive evidence that both bracing and
strapping decrease the incidence of ankle sprains. These interventions appear most effective in
those who have previously sprained an ankle and are important in preventing
recurrent ankle sprains (5). The financial and time costs of bracing
versus strapping must be considered. In
the long term bracing is more economical than strapping (6)
There is strong evidence that balance training is
effective in reducing the risk of ankle sprain.
Again this appears to be more effective in those with previous ankle
sprains (7). Typically balance training programs have
focussed on single leg stance activities as well as utilising balance boards,
foam pads, hopping and jumping tasks and technical training (McKeon &
Mattacola, 2008). Balance programs have varied between studies and were
implemented for between four weeks and two years. There is no consensus on optimal length of
training or the optimal time to implement a training program.
PREVENTION PROGRAM
My recommendations are: 1) For athletes who have never sprained an ankle, it would be the athlete’s choice to use an external ankle support. There is no harm in the athlete wearing a brace or strapping, so it may be beneficial to do so prophylactically. For example, a club may implement compulsory bracing in an attempt to minimise time and money lost to injury.
2) All athletes who have had an ankle sprain within the last 2 years should use ankle strapping or bracing. Two years after injury, injury risk appears to be similar to those who have never had a previous ankle sprain (7, 9) so after this time it would return to being the athlete’s choice.
3) Teams should implement a neuromuscular and balance program which would include education about injury mechanisms and technique, single leg stance tasks, balance board exercises and sports specific drills (10-12). This would begin as an extensive training program during the pre-season. It would then be reduced, but still continued during the competition season and could easily be directed within a standard training session.
4) All previous ankle sprains should be identified and treated as an important part of preventing recurrent ankle sprains. Treatment should target the active stabilising system, which emphasis on sensorimotor control as well as dorsiflexion range of motion.
LB
REFERENCES
|
One of the knowledgeable blog about musculoskeletal injury and physiotherapy, Helpful blog!
ReplyDeletemusculoskeletal physiotherapist perth