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Tuesday, June 27, 2017

Can We Prevent Ankle Injuries?

If you've played basketball, then you've probably had an ankle injury. The "big 3" foot and ankle injuries I think of first are sprains, Achilles tendon injury, and fifth metatarsal fracture (e.g. Kevin Durant)...the outside transitional bone between heel and toes. In this article, I'll share some recent science (studies) examining ankle injury and injury prevention. 

Outside view of the ankle. 

Focus above the foot on the fibrous band of tissue called the "anterior talofibular ligament"...between the tibia (the big shin bone) and the fibula (the bone on the side of the shin). When you "roll" your ankle, it can be injured. 

Significance. "Ankle and foot injuries are the most common injuries in basketball at any level. A recent study found that ankle and foot injuries accounted for 40% of high school basketball injuries, followed by the knee (15%), head/face/neck (14%), arm/hand (10%), and hip/thigh/upper leg (8%)."

What is a sprained ankle? A sprained ankle occurs with ligament injury...resulting in pain, swelling, heat, and loss of function. 

What is a "high ankle sprain"? A high ankle sprain involves more extensive injury to the tissue connecting the tibia and fibula. It usually has a longer recovery period and may have more associated injuries (including fracture). 

Initial treatment. PRICE (Protection, rest, icing, compression, elevation). 

"It must be the shoes." Do shoes matter? This is an elegant article comparing high-top and low shoes and measuring muscle stabilizing activation with electrodiagnostic tools. The article suggested that high top shoes produced a detrimental effect on ankle stability. High top shoes don't prevent ankle injury

Braces. In 2011, a controlled study showed a reduction of ankle injury using ankle braces. From the American Journal of Sports Medicine, "The rate of acute ankle injury (per 1000 exposures) was 0.47 in the braced group and 1.41 in the control group (Cox hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.20, 0.52; P <.001)."

Taping. Does ankle taping work? A study in European soccer professionals was stunning, "ankle inversion ROM in a taped ankle increased after 45 minutes of soccer from 7 degrees to 12.6 degrees, a figure which reflects 90.3% of the inversion ROM in an untaped ankle.  In other words, after 45 minutes of soccer match play, the ‘residual mechanical effectiveness’ of a professionally applied ankle taping job is minimal."

Exercises. Can ankle exercises prevent injury?  A Netherlands study showed that a home-based training program using a one-legged stance program and a "balance board" reduced ankle sprain recurrence. The training improves proprioception, our unconscious awareness of spatial orientation. 

The takeaways are that some common beliefs about footwear and taping fail under scrutiny and that some exercise programs and braces have modest value in preventing injury or recurrent ankle injury. 

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