ΕλληνικάProprioception algorithm of sports ankle injuries
Proprioceptionalgorithmofsports ankle injuries
Malliou P., Gioftsidou A.
Dept. of Physical Education and Sport Science
DemocritusUniversityofThrace
Proprioception is defined as the awareness of posture, movement and changes in equilibrium as well as the knowledge of position, weight, and resistance to objects in relation to the body (Davies, 1989).
During an ankle sprain, the nerve fibers of the mechanoreceptors located at the torn ligament could also be damaged. As a result, proprioceptive inputs from the ankle joint could be reduced (Freeman et al 1965). Thus, proprioception must be part of a complete rehabilitation program (Rozzi, Lephart, Sterner, Kuligowski 1999; Askling, Karlsson, Thorstensson, 2003). Balance exercises aimed at improving proprioception; train the brain to recognize the body's segment position every moment(Sammarco, 1995).
Balanceexercisesmustbeperformedwith progressive difficulty. In ordertoperform balance exercisesrehabilitation specialists proposed the use of specific equipment likebalance boards with air, hard balance boards, balance devices and mini-trampoline (Malliou et al. 2004; Gioftsidou et al 2006).
A rehabilitation training program for ankle sprain must include specific balance exercises. More specific, the first days after the injury, and when the athletes is in non-wait-bearing position, can perform proprioception exercises in a seated position. For example the athlete can perform toe exercises with a tower or can put the injured leg on a balance board and perform mildly motions without pain. Later athletes can perform exercises with the following order (Gioftsidou & Malliou 2006):
- Start from a two-leg stance position and advance to a one leg stance position. The degree of difficulty is increased with weight shifting and by switching to a soft surface (drills: lean forward, back, toe raises). As balance improves the athletes is switched to an unstable platform.
- Start performing the drills from the more stable surface to a less stable surface. For example, perform drills from a single –plane hard balance board to a multi – plane hard balance board, or by changing the surface on which the balance board is placed (from soft carpet to hard tile).
- Start performing static drills (try to maintain stable) and progressively perform dynamic drills (try to perform specific motions anterior-posterior, medial- lateral, to configure circle)
- Start performing the drills with open eyes and then with closed eyes (if that is possible).
- Try to increase the duration of each drill.
- Try to maintain the balance and perform drills related to injured athlete sport, progressing from the easier to the more difficult. The athletes standing on the balance board with the injured leg and try to perform headers, leg passing, or dribble. The exercises are more difficult and more interesting for the injured athlete.
Askling,C., J. Karlsson,and A. Thorstensson.Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports. 13(4):244-250. 2003.
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Freeman MA, Dean MR, Hanham IW. (1965). The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br., 47, 678–685
Gioftsidou A., Malliou P. (2006). Preventing lower limb injuries in soccer players. Strength and Conditioning Journal, 28(1), 10-13.
Gioftsidou A., Malliou P., Pafis G., Beneka A., Godolias G., Maganaris G. (2006) The effects of soccer training and timing of balance training on balance ability. European Journal of Applied Physiology, 96, 659-664.
Malliou P., Gioftsidou A., Pafis G.,Beneka A., Godolias G. (2004). Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. Journal of Back and Musculoskeletal Rehabilitation 17, 101-104.
Rozzi, S.L., Lephart, S.M., Sterner, R. and Kuligowski, L. (1999). Balance training for persons with functionally unstable ankles. Journal of Orthopaedic Sports Physical Therapy 29: 478-486.
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Recent Articles
Acute Lateral Ankle Sprains In Track & Field Athletes: A Proposal Of An Expanded Classification
We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track & field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally but there is a lack in international literature in predicting the time needed for full recovery.
Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes
Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.
Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.
Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.
Conclusion: We conclude that the instability repair using
a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.
ACL injuries. Diagnosis, treatment and rehabilitation
The ability to recognize the ACL deficient knee is lacking, even among orthopaedic surgeons. The history of an acute ACL tear is remarkably constant, because the injury is often non contact, and patients usually report a twist on the flexed knee, turning to the same side as the injured knee, although hyperextension or direct injury is the cause in some sports. Patients often remember a loud pop, but, because there are no nociceptors in the ACL, pain is not an immediate feature in the isolated lesion. Players may attempt to continue to play, but they usually stop because the knee feels insecure. Pain ensues in association with a hemarthrosis: 70% of acute hemarthroses of the knee are associated with a tear of the ACL. The diagnosis must be confirmed before treatment is offered.
