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5/27/2019 0 Comments Ankle Sprain and Rehabilitation An ankle sprain occurs when the ligaments of the ankle are undergone a force that stretches them beyond their capabilities and tear. Ligaments of the ankle are tough bands of tissue that provide support to hold the ankle bones together and prevent excessive movement. The lateral (outer) part of the ankle is made up of three ligaments the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). The deltoid ligament supports the entire medial (inner) aspect of the ankle. There is an interosseous ligament, which is tissues that runs between the entire length of the tibia and fibula. Most ankle sprains occur on the lateral aspect of the ankle, affecting the ATFL ligament. Anyone can experience an ankle sprain at any age. There are three different types of ankle sprains:
There are 3 grades to a sprain:
 Phase 1 - Acute management of ankle sprain (within 24-72 hours of injury):
Phase 2 - Post-acute phase management (Recovery time will vary depending on severity):
Phase 3 – Return to play when all of the above is achieve:
Josh Hallinan Chiropractor Available for Appointment Tuesday & Thursday at Health Associates Vuurberg G, Hoorntje A, Wink LM, et al Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline British Journal of Sports Medicine 2018;52:956. Kerkhoffs GM, van den Bekerom M, Elders LAM, et al Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline British Journal of Sports Medicine 2012;46:854-860. Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8 Wolfe, Michael W. "Management of ankle sprains." American family physician 63.1 (2001). 
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 A great study titled "Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football" has recently been released discussing what type of football (soccer) shoes are best for reducing the risk of lower limb injuries such as the commonly experienced ACL damage. Football involves a high amount of acceleration, deceleration and changing direction. Both require an adequate amount of traction between shoes and surface in order for the movement to be executed quickly, safely and effectively. Previous studies have shown that compared to other team sports football requires the greatest amount of cutting movements. A player can perform up to 800 cuts per game! A players ability to accelerate, decelerate and change direction is influenced majorly by the tractional properties of boots and playing surface. The components of traction studied in this paper were translational and rotational. Translational relating to the player moving in a straight or side to side pattern. Previous studies have proven that increased translational movement is linked to improved performance whereas increase rotational movements are associated with an increased risk of lower limb injuries such as ACL damage. The study looked at the relationship between:- Shoe outsole purpose
This study was completed to shed some more light on which external factors are contributing to lower limb injury in football players. The external factor here being footwear and the way they interact with the playing surface. The study was done in Doha, Qatar at the Qatar national team outdoor training pitch. The study was carried out over a single season on the one natural grass football pitch. 6 Nike Shoes were included:- Artificial grass
All 6 shoes, one at a time, were attached to a portable traction testing device which is designed to mimic foot movements employed by football players. This allowed the researchers to pool data about all 6 shoes and their translational and rotational traction qualities. What were the results?! Soft ground outsoles showed to have the highest translational traction, however they also showed to have had the highest rotational traction! Shoe outsoles designed for artificial grass, so the Nike Tiempo (AG) had the lowest rotational traction and came out on top. So what does all this mean? Decreased rotational traction in a shoe is proven to decrease lower limb injuries WITHOUT causing any detriment to player performance. So YOU want increased translational traction, helping the player move forward and side to side more effectively and safely, and decreased rotational traction, meaning they can rotate and pivot without that increased chance of hurting themselves! This doesn't mean that if you put the Nike Tiempo on that you're invincible and you'll never hurt yourself. Many things come in to play when aiming to reduce the risk of injury. Adequately strengthening and stretching the correct muscle groups, building the appropriate skills and recruiting safe and effective movement patterns and strategies all compound together to make you a stronger, better player that will be able to stay in the game for longer. Moving forward towards purchasing footwear, artificial grass shoe outsoles are small round moulded studs vs the screw in metal studs used with soft ground outsole shoes. Also, making sure the fit of the shoe is correct is just as important as getting the appropriate outsole. Having a shoe that is wide enough, deep enough and long enough is crucial! Moving forward in the world of research they forecast studies looking further into the relationship between shoes and several different playing surfaces, soil types, and grass species to get a more complete understanding of shoe-surface traction. Stay tuned players! Access the whole research paper here, hot off the press! https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216364 References Taylor JB, Wright AA, Dischiavi SL, Townsend MA, Marmon AR. Activity demands during multi-directional team sports: a systematic review. Sports Medicine. 2017 Dec 1;47(12):2533–51. pmid:28801751  Anneliese Ball
Podiatrist Anneliese joins Health Associates as a podiatrist working Monday and Saturdays. She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years. As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience. Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.  Soccer is the most popular sport on the globe with over 270 million participants and it’s easy to see why. It is fast, dynamic, exciting and crazy, almost every emotion within 90 mins can be experienced. The performance of a soccer player is made up of many different variables such as tactile, mental, technical and physiological. During a game, elite level players run about 10km at an average intensity close to the anaerobic threshold (80-90% of maximal heart rate). Within this time there are a number of explosive movements including jumping, kicking, tackling, sprinting, turning and deceleration. Strength and power are equally as important as endurance in soccer. Now with this large number people playing and the high demands of the game there will be injuries. Let’s analyse to trends of injuries in soccer and how they can be managed and prevented, paying close attention to ankle sprains Most soccer injuries occur to the lower extremity at approximately 87% and the common injury types include strain, sprain and contusion. The UEFA injury study showed thigh strains makes up 17%, hamstring 12% and ankle sprain 7%. The incidence is higher during the game at 57% making injuries quite high during training at 43%. 16% accounted for more than 28 days away from training and game. 12% with season ending injuries. Another study among amateur soccer players in Spain showed there was an average of 0.11 injuries per player per year. A large number of injuries led to 1 competitive match being missed (87%). Midfielders had the highest injury rate at 34.3%. The knee and ankle making up 42.3% making them the most common injury location. Ligament sprains accounted for 32.1%. Risk factors:
As mentioned, ligament sprains are common within especially in the ankle. 80-90% of ankle injuries are on the outer aspect of the ankle (lateral) with 69% being on the dominant leg. Most of the time the sprains are uncomplicated, however, 60% suffer from a repeated sprain after the initial event. 63.3% occurs with player contact and most occur to defenders. The mechanism of injuring is due to landing, twisting, turning or running which leads to rolling the ankle. How to recognise an ankle sprain:
 Acute management of ankle sprain (within 24-72 hours of injury):
Once swelling and pain have decreased begin a rehabilitation program to be able to return to play and decrease the risk of re-occurrence. Prevention strategies for ankle sprains:
References:Lehnhart RA, Lehnhart HR, Young R, et al. Monitoring injuries on a college soccer team: the effect of strength training. J Strength Cond Res 1996; 10 (2): 115–9 Stølen, T., Chamari, K., Castagna, C. et al. Sports Med (2005) 35: 501. https://doi-org.simsrad.net.ocs.mq.edu.au/10.2165/00007256-200535060-00004 Am J Sports Med. 2014 Jan;42(1):78-85. doi: 10.1177/0363546513507767. Epub 2013 Oct 17. Injuries among Spanish male amateur soccer players: a retrospective population study. Ryynänen J, Dvorak J, Peterson L, et al Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups Br J Sports Med 2013;47:970-973. Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8 Med Sci Sports Exerc. 1999 Jul;31(7 Suppl):S470-86. Foot and ankle problems in the young athlete. Kofotolis, N. D., Kellis, E., & Vlachopoulos, S. P. (2007). Ankle Sprain Injuries and Risk Factors in Amateur Soccer Players during a 2-Year Period. The American Journal of Sports Medicine, 35(3), 458–466. https://doi.org/10.1177/0363546506294857 Safran MR , Benedetti RS , Bartolozzi AR 3rd , Mandelbaum BR Medicine and Science in Sports and Exercise [01 Jul 1999, 31(7 Suppl):S429-37] Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis.  |
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