Prevention

1
Prevention

• of Ankle Injuries
• Presented by Kari Hiebert CAT(C)

2
Objectives

• To identify risk factors for ankle injuries.
• To review the current research on ankle injury
  prevention.
• To develop an ankle injury prevention program

3
Risk Factors

• Intrinsic
• Postural sway
• Proprioception
• Range of motion
• Muscle strength
• Foot variants
• Previous sprains
• Obesity

• Extrinsic
• Rules
• Player contact
• Officiating
• Coaching
• Player preparation
• Fields/ court
• Type of sport
• Level of competition
• Equipment
• Environment

4
Causation of Injury
Intrinsic Risk Factors
Exposure to extrinsic risk factors
Age
Flexibility
Predisposed athlete
Susceptible athlete
injury
Inciting event
Previous Injury
Mechanism of Injury (proximal to outcome)
Risk factors for injury (distance from outcome)
Somatotype
5
Levels of Prevention

• Primary prevention activities result in
  decreased occurrence of the injury.
• Secondary prevention activities promote early
  detection (ie risk factors) thereby allowing
  intervention.
• Tertiary prevention restoring function and
  reducing complications when an injury has already
  occurred.

6
Potential injuries

• Sprains
• Dislocation
• Fracture
• Avulsion
• Strain
• Instability

7
Prevention Strategies

• A literature review

8
Footwear

• High vs low top shoes
• Barret et al found no significant difference
  between hightop, hightop with inflatable cuffs
  and low top basketball sneakers related to ankle
  sprains.
• Cited studies found that Hightops taping for
  those with previous history was found to be
  beneficial.
• Hightops with the inflatable air chambers should
  be further studied.

9
Heel lifts/ Foot Supports

• Football boot insoles (textured vs smooth)
• Adams (2003) found that the use of a textured
  insole provides improved sensory feedback to the
  plantar sole.
• Heel lifts for limited dorsiflexion.
• Johanson et al (2006) found that the use of heel
  lifts for patients with limited dorsiflexion will
  increase their ankle DF excursion and time to
  heel off.

10
Taping bracing

• Provides proprioceptive protection.
• ? mechanical protection
• Reduces the incidence of sprains in those who
  have already sprained their ankle.
• Should be worn for 6-12 months post injury.

11
Balance/ Proprioception / Neuromuscular

• Traditionally used in rehabilitation but is now
  being researched a preventative strategy.
• Balance training has been investigated as a
  single strategy and as part of a multifactorial
  program.
• Risk factor detection
• Single leg test
• Flamingo test
• Economics overtime the cost of starting a
  balance training program would cost effective.

12

• Michell et al. (2006)
• Studied poor postural stability in relation to
  functional ankle instability.
• Concluded that functional balance training with
  or without exercise sandals improved postural
  stability.

13
http//www.orthopedictechreview.com/issues/marapr0
5/pg36.htm
14
http//www.nefitco.com/balance_disc_2.html
Balance exercise on a sissel disk.
15
Strength

• Imbalances
• Plantar flexors vs dorsiflexors
• Evertors vs invertors
• Strength ratio was found to be
• 0.8 uninjured subjects
• 1.0 injured subjects
• Peroneus tertius
• Witvrouw et al (2006) found that the absence of
  Peroneus tertius was not clinically important
  related to increased risk of ankle injuries.

16
Stretching

• Thacker et al. (2004)
• A systematic review of the literature
• Increases muscle and joint flexibility.
• Extremes of inflexibility and hyperflexibility
  increase the risk of injury.
• The importance of stretching for injury
  prevention, within the limits of normal
  flexibility, is not documented in the literature.

17
Skill Development

• Jumping take off
• Landing
• Falling
• Side to side movements
• Educational sessions on injuries

18
http//www.cartoonstock.com/directory/h/harrier_ju
mp_jet_gifts.asp
http//www.highlandimaging.com/page/2/
19
Conclusion

• Each preventative strategy can be effective on
  its own but a multifactorial approach will
  provide the best results.
• Incorporate balance training.
• Utilize ankle taping or bracing for 6 months to a
  year for post-ankle injury.
• Discuss skill technique with the athlete and
  coaching staff.
• Provide education on injury prevention.