Sprained Ankle

Introduction

Ankle sprains are the most common injury in sports1,2,3,4,5. This is how almost all the articles started out. This is an injury I have seen over the past years as a player and coach. A player on my team this year suffered this injury during our basketball season and she was out for a few weeks. This really hurt our team since I only had 7 players on my team this year.

This had me wondering if there was anything I could have done differently as a coach to prevent her injury since it was done during a drill. There are several ligaments surrounding the bones to form the ankle, which are the syndesmotic ligament, lateral collateral ligament, and medial collateral ligament.5 Lateral ankle sprains can occur in several different ways when playing sports. Players can step on another player or landing from a jump.

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From doing this research, I would like to find some different ways to treat ankle injuries and if there are different outcomes from these treatments.

Methods

To conduct my research, I used the resources from the Southern Utah University Online Library. I used the search engine to find peer reviewed articles. I was searching for articles about ankle sprains and treatment of those injuries. I searched for words such as, ankle injury, prevention, and treatment.

I found several peer reviewed articles about ankle sprains and different methods of treatment. There was also an article that was very useful from the National Athletic Trainers' Association that had a lot of different topics of information that very helpful. Discussion Ankle sprains can occur through many different activities. It is the most common sports injury among athletes1,2,3,4,5. This injury happens because of a plantar flexion and inversion.

3 The ligaments that are affected by ankle sprains are the anterior talofibular, calcaneofibular, and posterior talofibular ligament. 2 After an ankle injury occurs it must be determined what kind of sprain has happened. It can be classified as a grade I, grade II, or grade III with grade I being mild and grade III most severe. 2 When an ankle sprain occurs there can be inflammation of the ankle, loss of function, and instability. 1 There are different ways to diagnosis an ankle sprain such as range of motion, special tests, and MRI are just a few ways that an ankle sprain can be diagnosed. 2 There have been many different ways to treat ankle sprains.

If not properly treated, ankle sprains can be reoccurring, 10-40% of people who have suffered from ankle sprains will have another sprain occur.6 Several different studies have been conducted to help with the treatment and rehabilitation of ankle sprains. Three different studies were used to help gain a better understanding about the treatment and rehabilitation of ankle injuries. In these studies, ankle taping, isometric testing and physical therapy were used to help with ankle injury recovery.

In one study, ankle taping was used to see if it would reduce the "latency of the perneus longus and increase dynamic stabilization of the ankle" 4 pg. 54 Two groups were used, one group with no previous ankle injuries and another group who had suffered from a pervious ankle injury and the testing occurred over two days. 4 The leg that was being tested would either be taped or not depending on the trial. The foot would be inverted at 25 degrees.

This was done for 10 trials and EMG was used to record the data. 4 After this study was conducted it showed that the ankle taping was helpful in providing more stability to the ankle compared to the ankle not being taped. 4 This shows that ankle taping can be a useful tool when trying to prevent the ankle from inversion. It also showed that it could be helpful for people who have had an ankle sprain and also for those who have not had an ankle injury. When thinking about injury prevention, someone who has not suffered from an ankle sprain might not think it is important to have his or her ankle taped.

This was a good study to look at and see how this could be a beneficial tool to use for ankle injuries and how isometric training can be used help with rehabilitation after an injury. Treatment of ankle sprains is an important part of recovery so an athlete or any other person can go back to normal physical activities, whether it is sports or other activities. In another study, the rehabilitation after an ankle sprain was looked at using isometric testing.

Two groups were used for this study and both groups had at home protocol that they completed.1 Each group had exercises to complete at home, an ankle brace to wear and cryotherapry to use after exercises. 1 Cryotherpary was used this treatment method 3-4 times a day for 15-20 minutes, this was done to help with pain and swelling and to reduce inflammation. 1 The use of isometric testing is used to help show how much inversion and eversion is affected.

1 The use of isometric training can be used to monitor the progress during treatment for ankle sprains and can also be used to help make programs for individualized for each athlete. 1 This study had patients completing a program where they completed different exercises at home and tests were also completed to check the progress of each person during their rehabilitation.

Several different outcomes were measured such as pain, ankle circumference, lower extremity functional scale, square hop test, and isometric ankle testing. 1 These test are helpful when people are trying to recover from an ankle injury. The use of isometric testing is a good way to track progress and could possibility help with the recovery process to go quickly. Physical therapy can be a tool used to help with the recovery process of an ankle injury.

The final study looked at physical therapy being a good way to help treat ankle injuries. Two groups were used in this study one group who received physical therapy and another group who did not. 5 The group who participation in the physical therapy program had improved results in pain reduction, dorsal and plantar flexion improved, and muscles were strengthen. 5 The use of physical therapy can be a beneficial way help someone who has suffered from an ankle injury recover more quickly.

After reading these three studies about different ways to help the recovery and monitor progress of ankle injuries, there were some beneficial ideas. The main one is that physical therapy or at home exercises can help with the healing process. Also, each athlete or patient should have an individualized program for recovery. This can help aid in the recovery of an athlete from their injury and return to play more quickly. There are a few limitations from these studies as well and more research should be conducted.

In the study with physical therapy used the sample size for each group was very small with only three patients in each group. 5 Facilities or equipment used should also be looked at. Isometric testing is a great way test patients and come up with individualized programs but could be very expensive or obtain this type of testing depending on what is available to each program. Prevention of injuries is important for keeping athletes playing and taking time away from their sports season.

In the article from the National Athletic Trainers' Association, three different ideas were given for the prevention of ankle injuries. The first suggestion is a prevention program for athletes for three months. 2 This type of program would include exercises that would help balance and neuromuscular control. 2 For athletes who have suffered an ankle injury previously might feel better if they train to help prevent their injury.

They might even feel a sense of security by training. Another prevention measure is increasing strength in the leg and hips. 2 Finally, dorsiflexion range of motion could also be trained, if it is limited. 2 Knowing if an athlete has suffered from an ankle injury and ways to help strengthen the ankle and leg could prevent another injury. An athlete should take any preventive measure decrease their chances of suffering from an injury.

Once an athlete has recovered from an injury, there is always a question of when they should return to play. There is a physical and mental part of returning to play. For an athlete, there is mental part of coming back from an injury. They might have feelings of nervousness to play because of risk of getting injured again. Before an athlete can return to play there should be a physical examination done by the athletic trainer.

The trainer could complete different tests to check for the readiness of a player to return to games or practices. According to the National Athletic Trainers' Association Position Statement, tests such as single-legged hop and Star Excursion Balance Test could be used to measure an athletes' injured leg.2 The athlete should be at 80% functional performance. 2 Athletes should also consider wearing ankle braces or taping for extra support during practices and games.

2 Each athlete should be looked at individually when returning to play and should be ready both physically and mentally to come back. One controversy that one mentioned for ankle sprains was the use of different types of shoes. According to one article,2 there have been studies conducted about low-top and high-top shoes. In basketball, players might wear high-top shoes but in sports like football low-top shoes could be worn.

There have been studies done with conflicting results if you wear low-top or high-top shoes with ankle stabilizers could help prevent ankle sprains.2 Some studies showed that high-top shoes and ankle taping was more helpful in preventing ankle injuries.2 While another study showed that wearing low-top shoes with ankle braces was more helpful in preventing ankle injuries.2 I found this interesting that shoes could make a difference if they were low-top or high-top.

Future research results on this topic would be interesting to see if there is a certain type of footwear that could help prevent ankle injuries and if there could be one consensus about this topic. Conclusion In conclusion, athletes in all sports see this injury too often. From conducting this research, I learned a lot about ankle injuries, which I have also seen during my time as a coach and player. I have learned about the different methods to treat this injury and the use of different techniques and exercises.

I hope to take away some ideas about prevention of this injury with the use of different exercises that can be used. Ankle taping and ankle braces could also be a good way to help support the ankle after an injury. It is important for coaches and players to learn about this injury and the different ways to prevent and recovery from this injury if it does occur.

References

1. Gediminas T, Aleksandras K, Lankaite D. Isometric eversion and inversion testing after acute ankle sprains. Annals of Physical and Rehabilitation Medicine. 2014;57. doi:10.1016/j.rehab.2014.03.978.
2. Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. Journal of Athletic Training. 2013;48(4):528-545. doi:10.4085/1062-6050-48.4.02.
3. Kernozek T, Durall CJ, Friske A, Mussallem M. Ankle Bracing, Plantar-Flexion Angle, and Ankle Muscle Latencies During Inversion Stress in Healthy Participants. Journal of Athletic Training. 2008;43(1):37-43. doi:10.4085/1062-6050-43.1.37.
4. Knight AC, Weimar WH. Effects of previous lateral ankle sprain and taping on the latency of the peroneus longus. Sports Biomechanics. 2012;11(1):48-56. doi:10.1080/14763141.2011.637121.
5. Popa C-E. The Effectiveness of Physical Therapy Methods and Techniques in Treating Post-Immobilization Ankle Sprains. Gymnasium. 2017;XVIII(2):19. doi:10.29081/gsjesh.2017.18.2.02.
6. Vries JSD, Kingma I, Blankevoort L, Dijk CNV. Difference in balance measures between patients with chronic ankle instability and patients after an acute ankle inversion trauma. Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(5):601-606. doi:10.1007/s00167-010-1097-1.

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