Posts tagged ankle sprain
Athletes With Hip Weakness Experience Twice As Many Ankle Sprains
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Ankle sprains remain one of the most common musculoskeletal injuries treated by Physical Therapists.  Our previous blog posts have highlighted the importance of early diagnoses and treatment including manual therapy, as well as, strengthening and balance exercises.  This treatment approach has been proven superior to both R.I.C.E. (rest, ice, compression, and elevation) and usual medical care.  Many ankle sprains become recurrent without treatment secondary to the alterations in agility, balance, and muscle recruitment across the leg.  We often find weakness in both the hip and leg musculature in patients after ankle sprain, but a new study indicates this weakness may have been present before the sprain.

Powers and colleagues in the Journal of Athletic Training followed 210 competitive male soccer players after a preseason clinical examination (2017).  Athletes underwent multiple clinical tests, including a hip strength assessment prior to beginning their competitive season.  Authors report 12% of the soccer athletes sustained a lateral ankle sprain during the season.  Athletes categorized as high risk were unable to produce >34% of their body weight during the hip strength assessment.  These high risk athletes experienced twice as many ankle sprains as their stronger peers.   

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Increased Ankle Stiffness Reduces Proprioception and Balance
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Injuries to our spinal and extremity joints can impact a variety of structures including muscle, ligament, and nervous system receptors.  The sensors or proprioceptors are critical in providing real time feedback to our spinal cord and brain on the positions of our limbs.  This feedback system is disrupted by injury leading to slower information processing and in turn a loss of balance.  Most commonly this cascade is seen in patients with ankle sprain.  Without balance training and physical therapy our proprioceptive system remains impaired.

A recent study in the Journal of Orthopedic and Sports Physical Therapy (Rocha Marinho, H. et al. 2017) examined the proprioceptive and balance abilities of patients complaining of ankle joint instability and their uninjured peers.  The authors also evaluated the passive movement in the subjects ankles.  Consistent with previous research the patients complaining of ankle instability demonstrated the worst proprioception or balance.  Those with limited ankle mobility and higher levels of stiffness demonstrated reduced balance or proprioceptive ability.  This research highlights the importance of retraining the nervous system after joint and muscle injury.  
For more information on proprioception training contact your local Physical Therapist.

Hip Weakness Shown To Be A Predictor For Future Ankle Sprains
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Ankle sprains are one of the most common sports injuries we encounter in our Boulder Physical Therapy practice.  In our previous blogs we have written on the importance of early interventions such as manual therapy and proprioceptive exercise to help accelerate the recovery after these sprains.  Prior research has shown a higher recurrence rate in athletes who return to play without Physical Therapy, as well as, higher rates of hip weakness in athletes who have sustained an ankle sprain.  Recent research indicates hip weakness also increases the risk of future ankle injury in healthy athletes.

Powers and colleagues examined the leg strength of over 200 competitive soccer players prior to the start of their season (J Athletic Training. 2017).  Athletes were then followed over the season for any incidence of ankle injury.  Twelve percent of all the athletes sustained an ankle sprain with a higher rate of injury found among athletes with hip weakness.  This study highlights the injury risks associated with hip weakness.  Athletes are encouraged to participate in a strength training  program to both improve their performance and reduce their future injury risk.

 

Risk Factors for Ankle Sprain

Ankle sprains are one of the most common sports and orthopedic injuries encountered in Physical Therapy.  In previous blog posts we described the effectiveness of Physical Therapy treatments over other treatments including rest, ice, compression, and elevation (R.I.C.E.).  In addition, we have good evidence supporting the use of Physical Therapy clinical testing to determine which sprains are most likely to develop into chronic symptoms.  A recent review article highlighted the modifiable risk factors, which make patients more likely to sustain a first ankle sprain. 

Authors in the journal Sports Health (Kobayashi et al. 2016) reviewed 8 published articles to determine the ability of risk factors to predict a future ankle sprain.  The authors reported patients have a greater risk of ankle injury with increased weight, weakness in the leg and ankle musculature and limited balance ability.   Recreational and professional athletes are advised to work with a local Physical Therapist to identify and treat these impairments to reduce their risk of future injury.

Predicting Lasting Symptoms After An Initial Ankle Sprain

Ankle sprains are one of the most common orthopedic injuries we see in our Boulder Physical Therapy practice.  These injuries create local pain, swelling, loss of motion, weakness, and balance difficulties.  In past years these injuries were treated with R.I.C.E. (rest, ice, compression, and elevation), but more recent research has demonstrated improved outcomes and faster recovery with a more active approach.  Athletes treated with manual therapy and exercise by a Physical Therapist demonstrate superior outcomes than those treated with R.I.C.E.  The greatest limitation of the R.I.C.E. and wait and see approach involves prolonging treatment which may lead to lasting chronic symptoms throughout the lower extremity.  

A recent article in the American Journal of Sports Medicine attempted to identify predictors of chronic symptoms and balance difficulties among athletes after an ankle sprain (Doherty et al. 2016).  The authors followed 82 patients who sustained a first time ankle sprain.  The athletes were examined at 3 times points: 2 weeks, 6 months, and 12 months post injury.  At 12 months patients with lasting, chronic symptoms were identified and their data was analyzed to determine if prior clinical data could predict their lack of recovery.  The authors noted patients who were unable to complete landing and jumping tasks at 2 weeks post injury and/or were unable to demonstrate balance in multiple planes of movement demonstrated the greatest risk of lasting pain and symptoms.  

Individuals who sustain an ankle sprain are advised to contact their local Physical Therapist as soon as possible to accelerate recovery and prevent chronic symptoms. 

 

Predicting Future Ankle Sprains

Ankle sprains are one of the most common sports injuries and one of the most common we encounter at Mend Physical Therapy.  These injuries lead to pain, lost practice and games, as well as chronic balance impairments up to 1 year after the injury.  As our manual therapy and exercise treatments have evolved we are seeing athletes return to play faster with less long term implications.  With any athletic injury "an ounce of prevention is worth a pound of cure" and this is true with ankle sprains as well.  In a previous post we discussed the ability to prevent ankle injuries in basketball and this post will discuss emerging evidence on the ability to predict ankle sprains in high school and collegiate football players.

The star excursion balance test (SEBT) is a clinical test used to assess the ability of the athlete to maintain their balance as they move their uninvolved leg in three directions.  The distance this leg travels is recorded and compared against their noninvolved side.  The test requires significant amounts of range of motion, strength, and balance to perform correctly.  Most importantly Physical Therapists are interested in symmetry between sides when determining return to sport and future risk of ankle injury.  Prior researchers have reported a side to side difference is predictive of future lower extremity injury among basketball players (Plisky et al. 2006).  A recent article in the American Journal of Sports Medicine analyzed the predictive value of the SEBT among high school and collegiate football players.  

Gribble and colleagues evaluated >500 football players on the FMS, SEBT, and body mass index and then tracked the number of injuries these athletes sustained over the course of the season.  The authors reported 54 lateral ankle sprains among the athletes with significant differences on BMI and SEBT performance between the injured and non injured groups.  The injured group had significantly higher BMI scores and lower reach distances compared to the uninjured group.  The most powerful predictor was forward reach distance on the SEBT.  Conversely, the pre season FMS did not help differentiate between injured and non injured athletes in season.

Coaches, athletes, and Physical Therapists should consider using the SEBT to help predict future injury among high school athletes.