Tips and tricks - Ankle sprains and what to do about them.

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:

• Previous injury
• Age (older players tend have a greater number of injuries)
• Play intensity
• Poor rehabilitation to injured area
• Lack of strength and stability
• Increased risk towards end of the game – fatigue
• Inadequate preseason preparation (see more overuse injuries)

 A change in score also has a strong correlation with an increase in injury incidence, this is because it changes:

• Team strategy
• Player precautions
• Players attitudes
• Intensity of the match
• Competitiveness

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:

• Pain or discomfort around ankle post rolling it
• Swelling
• Discoloration
• Limited ROM
• Non-load bearing pain
• Instability
• Weakness
•  

There are 3 grades to a sprain:

1. Grade one;
   - No bruising, mild swelling and tenderness
   - Mild to no limp, can raise up on toes
   - No joint laxity, pain at end range of motion
   - 1-2 weeks recovery
2. Grade 2;
   - Bruising on one side of foot, more extensive swelling
   - Less localised tenderness, i.e. both sides of ankle
   - Visible limp and unable to raise up on toes
   - Slight laxity and pain with most movements
   - 4-8 weeks recovery
3. Grade 3;
   - Bruising and swelling both sides of foot.
   - Tenderness on both sides
   - Unable to weight bear
   - Large amount of laxity
   - 2-6 month recovery

Acute management of ankle sprain (within 24-72 hours of injury):

• RICE protocol – rest, ice (20 min on, 1 hour off), compression, elevation
• Move ankle through pain free active range of motion as soon as possible
• Watch for significant swelling or changes to ankle which means major damage has occurred
• Weight bear when tolerable, use crutches if it is too painful to load the ankle

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:

• Bracing
• Tape
• Strength, flexibility and balance training
• Good warm ups
• Hydration
• Conditioning
• Good pre-season preparation

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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