Ankle injuries: what can we learn from other sports?

GD McKay* & PA Goldie School of Physiotherapy, La Trobe University, Melbourne

Objective: Review literature regarding the risk factors, physical deficits and preventive measures associated with anlde injuries.

Methods: Selected journal articles from Medline and Sport Discus, along with own research results.

Results: Risk factors - Intrinsic: A history of previous injury (basketball, soccer and army); leg dominance (collegiate athletes); and weight x height 2 (army). Extrinsic: Recent field- based studies (basketball) show no relationship between high cut shoes and decreased incidence of ankle injuries. However, an earlier basketball study reported the converse and laboratory studies also argue for the effectiveness of high cut shoes. One basketball study cll also linked the type/cost of the shoe worn with the incidence of ankle injuries. In field-based studies, a lower rate (basketballl21, soccer 131) and severity (soccer I~l) of ankle injury was found in players wearing an ankle brace. Relatively few field-based studies have assessed the relationship of ankle tape and ankle injuries. However, one basketball study reported an association suggesting tape may decrease the risk of ankle injury in players with a history of ankle injury Ill.

Physical deficits - Well-known physical deficits include anatomical laxity, functional instability, increased postural sway and altered joint sense. However, debate exists whether muscle strength is decreased or whether decreased muscle reaction time is responsible for the deficit. It w a s s u g g e s t e d 141 the ankle is naturally protected by preplanned evertor activity when landing and fully activated and strong evertor muscles are the best protection. It was postulated when the evertor muscles were not recruited in time the passive devices (tape/brace) may increase the resistance to further inversion. Further, a recent controlled clinical trial has shown balance training to decrease the recurrence of ankle injuries 151.

Conclusions and significance: The use of ankle tape and braces, particularly for athletes with recurrent ankle injuries, appears to be sound practice. The role of balance training and re-training of strong and fully activated evertor muscles should not be underestimated.

References: 1. McKay GD, Goldie PA, et al., (1996b) A prospective study of ankle injuries in basketball. Aust

Physio Assoc Conf, Brisbane, Australia 2. Sitler M, Ryan J, et al. (1994) The efficacy of a semirigid ankle stabilizer to reduce acute ankle

injuries in basketball. Am J Sports Med 22(4): 454-461 3. Surve I, Schwellnus MP, et al. (1994) A fivefold reduction in the incidence of recurrent ankle

sprains in soccer players using the sport-stirrup orthoses. Am J Sports Med 22(5): 601-606 4. Ashton-Miller JA, Ottaviani RA, et al. (1996) What best protects the inverted weightbearing

ankle against further inversion? Evertor muscle strength compares favourably with shoe height, athletic tape, and three orthoses. Am J Sports Med 24(6): 800-809

5. Wester JU, Jespersen SM, et al. (1996) Wobble board training after partial sprains of the lateral ligaments of the ankle: A prospective randomised study. JOSPT 23(5):332-336

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