obstaclemudrunner.co.uk ForEliteAtheletes toFunRunners 34 References 1 Diagnosis Foundation http://dxfoundation.org / what-percentage-of-all-ankle-sprains-are-on-the- lateral-side/ • 2 NICE guidelines - https://cks . nice.org.uk/sprains-and-strains#!scenario • 3 Anandacoomarasamy, A., & Barnsley, L. (2005). Long term outcomes of inversion ankle injuries. Br J Sports Med, 39. https://doi.org/10.1136 / bjsm.2004.011676 • 4 B, T. S., F, S. D., M, B. C., A, G. R., & A, W. E. (n.d.). The prevention of ankle sprains in sports: a systematic review of the literature. Retrieved https://www.readbyqxmd.com / read/10569362/the-prevention-of-ankle-sprains-in- sports-a-systematic-review-of-the-literature • 5 Bahr, R., Lian, Ø., & Bahr, I. A. (2007). A twofold reduc- tion in the incidence of acute ankle sprains in vol- leyball after the introduction of an injury prevention program: a prospective cohort study. Scandinavian Journal of Medicine & Science in Sports, 7(3), 172– 177. https://doi.org/10.1111/j.1600-0838.1997. tb00135.x • 6 Egger, M., Davey Smith, G., Schnei- der, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research Ed.), 315(7109), 629–34. https://doi . org/10.1136/BMJ.315.7109.629 • 7 Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the An- kle After Acute Sprain or Chronic Instability. Journal of Athletic Training, 37(4), 413–429. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12937563 OCR – it’s a war zone. We accept the challenge but sometimes we forget that preparation is the best way to avoid an injury. With the surroundings that we are confronted with at the events (rabbit holes, uneven ground) it is inevitable that at some point we will twist our ankle. Researchers from WebMD have shown that ankle sprains account for up to 1.5 million visits to A&E in the UK every year. And ankle sprains are the most common type of sports injury. Achieving 50 % of all athletic injuries, with 80% of these being lateral ankle sprains 1 . In addition, you can fracture lower leg bones (fibula and/or tibia), damage the joint, tendons, ligaments or muscles. There are generally 3 types: 1 A mild sprain with some swelling and stretching of the ligament causing minimal pain, bruising, swelling with no joint instability. 2 A moderate sprain with 1-99% of the ligament ruptured causing pain, bruising and swelling. 3 A severe sprain with complete rupture of the ligaments causing severe pain, swelling, bruising and the patient is unable to put weight over the joint. The most common ankle twist is to the lateral side. The reason behind it is because our ankle contains 3 relatively small strands of ligaments, which unfortunately are weak. Thereby, when rolling the ankle, the most common one to get injured is the anterior one, anterior talofibular ligament. The most beneficial immediate treatment is P.R.I.C.E. Protection, Rest, Ice, Compression and Elevation. Some researches 3 have concluded that most patients that sustain an inversion ankle injury, had persistent symptoms for at least two years after their injury. This highlights why prevention is so important. Prevention If you have had previous injuries on your ankles and you have not gone through rehab exercises for strengthening, you are more likely to damage your ankles again and probably looking at a longer time scale for recovery. Strengthening your feet, legs, thigh and core are essential. Researches 4,5,6,7 have shown several methods how to prevent injuries. Taping, clothing (compression socks), orthotic devices, specific shoes, and prescribed exercises for strengthening 6 and proprioception 5 . “Strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved.” 6 I have seen this on myself and some of my patients. My faith relies on minimal trainers or barefoot for those that enjoy it. The theory behind it is that with no support, yes I said it, no support, you actually get your feet stronger to utilize all the muscles of the foot. Is that not going to make you pronate the foot? Yes, it is. We need to pronate our foot so there is an exchange of forces (absolving and expelling forces) and movement from the foot towards the leg and the rest of the body, thereby activating the windlass mechanism at its fullest. How to get stronger? Barefoot walking as much as you can, proprioceptive training 5 , eccentric, isometric and concentric exercises 7 . I do not recommend anybody to start running barefoot or with a minimal shoe without going through specific training. If you jump the basic steps of strengthening and progression you are most likely to get injured and then blame it on the shoes. A combination between strength training and coordination training exercises will produce a significant improvement of your strength and proprioception. If you are coming from an injury perspective you should start by gentle articulation, by performing the ABCs movements with your feet and walking on your toes. This will help you regain your normal range of motion and some strength. Once you can weight bare and there is no pain you can start proprioceptive training (balance board) and strengthening. The exercises should be followed in a progressive manner starting by, isometric, then concentric and eccentric training. They can be as simple as, just standing on your toes at an edge of a step (isometric), doing calf raises (concentric) and doing heal drops on a step (eccentric). Obviously there are many other ways of doing these exercises. Be creative. Don’t forget n Warm up increase activity gradually. n Strengthen your muscles in all planes of movements. n Foam rolling after exercise. n Stretching only after the exercise. n Good nutrition n Listen to your body, if you are experiencing pain, see your therapist. Remember... Be strong HEALTH : INJURY ask the expert Ankle injury prevention & rehab “Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.” Thomas A. Edison Dan Fernandes, (DO, M. Ost) Sports Care Revolution
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