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- Ankle sprains are common in sports, particularly in lower body-dominant activities like football and basketball. Key factors contributing to these injuries include functional strength imbalances, joint hypermobility, increased BMI, and body weight. Prevention strategies focus on reducing the chances of re-injury rather than guaranteeing complete injury prevention.
- The ankle complex consists of three joints: the talocrural, subtalar, and inferior tibiofibular joints. The talocrural joint allows for dorsiflexion and plantarflexion, while the subtalar joint facilitates inversion and eversion. The inferior tibiofibular joint, connected by the interosseous membrane, is susceptible to high ankle sprains. Ligaments, especially the lateral collateral ligaments like the anterior talofibular ligament (ATFL), are frequently injured during ankle inversion.
- Ankle sprains are categorized as low or high. Low ankle sprains, mostly lateral, involve the ATFL. High ankle sprains affect the syndesmosis, leading to longer recovery times. Statistical data indicates that ankle injuries are common in sports like soccer, American football, and volleyball.
- Common mechanisms of ankle injury in football include landing after jumping, twisting, turning, and running. Defenders are most susceptible, followed by midfielders and forwards. Injuries often occur towards the end of each half, suggesting fatigue as a contributing factor.
- Ankle sprains are graded by severity. Grade 1 involves minimal pain and swelling, while Grade 3 presents complete ligament tears with severe pain and inability to bear weight. Diagnosis includes physical examination, palpation, and special tests like the anterior drawer and talar tilt tests. The Ottawa ankle rule guides the need for X-rays or MRIs.
- Treatment protocols involve PRICE (protection, rest, ice, compression, elevation), taping, strengthening, mobilization, and balance training. POP casts are discouraged unless there's a bone fracture, as they can lead to muscle atrophy and instability. Icing and compression are effective for pain relief and reducing swelling, ideally with modalities like Game Ready. Elevation above heart level is crucial for controlling edema.
- Rehabilitation progresses from partial to full weight-bearing as tolerated. Proprioception exercises are vital to regain balance and neuromuscular control. Functional progression includes running, agility drills, and sport-specific activities. Psychological readiness and functional tests such as the dorsiflexion lunge test, star excursion balance test, agility tests, and vertical jump tests determine the athlete's fitness for return to play.
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