don’t just recover. conquer. r. kent kurfman, pt, dpt, ocs, mtc proaxis therapy greenville, south...
TRANSCRIPT
![Page 1: Don’t Just Recover. Conquer. R. Kent Kurfman, PT, DPT, OCS, MTC Proaxis Therapy Greenville, South Carolina](https://reader035.vdocuments.us/reader035/viewer/2022062421/56649c8b5503460f94945ebe/html5/thumbnails/1.jpg)
Don’t Just Recover. Conquer.
R. Kent Kurfman, PT, DPT, OCS, MTCProaxis Therapy
Greenville, South Carolina
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Most common athletic / sports injury Highest percentage (15%) of any regional
injuries in NCAA study (Hootman JM J Athl Train 2007)
Most common injury in several sports, such as soccer (Ekstrand/Tropp – Foot/Ankle – 1990)
10-15% of all football injuries (Garrick JG. J Sports Med 1977)
75% of all ankle injury = ligamentous sprain, 85% of these = lateral ligaments (Garrick JG Clin Sports Med 1988)
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
20-70% lead to chronic pain/instability - CAI (Barrett/Bilisko – Sports Med 1995, Gerber JP Foot Ankle Int 1998, McKay GD et al BR J Sports Med 2001, Verhagen RA et al Arch Orthop Trauma Surg 1995)
Reinjury rates = up to 70-80%
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Landings◦ Unexpected surface (on another athletes foot,
sloped surface).◦ Improper foot positioning prior to landing
(excessively inverted and plantarflexed) whether walking, running or landing from jumps
Sudden stops and cutting movements
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Greatest: history of previous sprain ◦ 4-5x more likely to re-injury
Distribution by gender: essentially the same (Beynnon)
Structural – limited information linking foot structural characteristics (Morrison, J Athl Train 2007)
◦ High medial longitudinal arch/pes cavus ◦ Greater than normal foot width◦ High 1st MTP dorsiflexion ROM
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Technical skill – Body mass – higher BMI = suspected
greater risk for ankle injury Footwear selection
◦ Inappropriate choices made , particularly during training – Running footwear use for court activities
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Proprioceptive deficits: Impairment in feedback◦ Aberrant ankle position sense is primary
problem in landing-related injuries – foot too inverted, due to diminished position sense
◦ Primary sensory input comes from cutaneous pressure receptors and muscle spindles – less from joint capsule receptors
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Long term disruption of sensory-motor control: Central changes in sensorimotor system function◦ Diminished motoneuron pool excitability◦ Mismatch of reaction time of peroneals,
compared to rapidity of ankle inversion stress/stretch during aberrant landing.
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Bottom line: deficits in those with CAI are not only peripheral but are also central – maladaptive changes to movement. ◦ We need to train global coordination to gain more
complete recovery (Hass CJ AJSM 2010).
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Differ, based on history of the athlete◦ Previously uninjured – no definitive approach!
No evidence that use of preventative bracing/taping/neuromuscular training will prevent an ankle sprain
Need to emphasize what we can encourage Appropriate footwear selection Proper practice /skill acquisition – role of coach
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Previously injured and CAI: a great deal of evidence that we can affect future injury occurrence!◦ Remainder of presentation will emphasize
preventative measures in those previously injured/CAI.
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Most commonly used supports.◦ Both are effective, shown via multiple studies.
Bracing:2010 study – preventative. Expense: bracing cheaper Taping:
◦ Support loss from taping:◦ Don’t underestimate proprioceptive effect.
Kinesiotaping
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Recommendation: Continue taping/bracing after LAS for at least 6 months
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Purposes : ◦ Traction, protect feet from abrasion/contact◦ Shock absorption – less certain
Shoes act as a filter to our proprioception We adjust the stiffness of our legs based
on cushioning (footwear and surface).◦ Hard surfaces: more hip/knees/ankle flexion. ◦ Softer surfaces – less hip/knee/ankle flexion
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Shoes can confound this - too much cushioning on a hard surface = increased lower leg stiffness, greater force transmission .◦ No midsole material available yet that
compensates /adjusts for this
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
High top vs. Low top◦ Mixed findings in the literature◦ In general, high tops can have a combined effect
with bracing /taping in prevention of re-injury
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Athlete should choose the shoe with the least amount of midsole that they are able to properly/comfortably train/compete in.
Less stack height = less chance of injury ◦ More plantarflexion (heel height) = more chance
of injury. ◦ High tops = matter of preference.
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Effective in prevention of future injury – Balance training alone = 36% reduction in
ankle sprain Multiple-intervention training (balance,
weight, plyometric, agility/sport specific training)= 50% reduction in ankle sprain injuries
Consideration of study problems
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Retraining guidelines:◦ Dosage: Typical = 6 weeks, 3-5 sessions/week◦ Wobble boards – common denominator◦ 4 constructs: static balance, joint position sense,
dynamic balance, motoneuron pool excitability (via agility and plyo work).
◦ Strength - only a component◦ Bottom line: Since balance control is
multifactorial, work on all factors during a session
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Program components:◦ Static single leg balance – easiest to retrain,
acts as a base for all other activities. Goal: 60” eyes open, 30” eyes closed.
◦ Position sense retraining –essential for landing control Technique accuracy is essential
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
◦ Dynamic balance and neuromuscular control. A progression of balance board / soft surface
training. Emphasize speed of control, range of control . Add distractions – throwing/catching Balance with reaching
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Agility: progression back to “real activity” – hopping, cutting activities.◦ Concentrate on doing these activities on very
firm surfaces.◦ Proprioceptive/kinesthetic confusion issues on
soft surfaces.
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Typical tools used: ◦ Simple tools work well
Wobble board Half-rolls AIREX BOSU
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6Posturalstability
Single legstance onAirex® cushion:(3 minutes)
Single legstance on tiltboard: (3minutes)
Single leg stanceon BOSU® ball:(3 minutes)
Single leg stance onBOSU® ball withrebounding ballcatches: (3 minutes)
Anterior jump lands fromReebox® step: (2 sets × 10reps with 10 secondstabilization)
Lateral jump lands fromReebox® step(2 sets × 10reps with 10 secondstabilization)
Strength Double legheel raises: (3sets × 12 reps)Double legbridge: (2 sets× 10 reps)Clam-shellgluteus medius:(2 sets × 10reps - each side)
Double legheel raises:(3 sets × 12reps)Double legbridge: (2 sets× 10 reps)Clam-shellgluteusmedius:(2 sets × 10reps - eachside)
Single leg heelraises: (2 sets ×10 reps - eachside)Single leg bridge:(3 sets × 12 repseachside)Figure-4 gluteusmedius: (2 sets ×10 reps - eachside)
Single leg heel raises:(2 sets × 10 reps - eachside)Single leg bridge:(3 sets × 12 repseachside)Figure-4 gluteusmedius: (2 sets × 10 reps- each side)
Single leg heel raises withweight (15 kg): (3 sets × 12reps - each side)Double leg squats: (3 sets ×12 reps)Resisted lateral side-steps:(3 sets × 12 reps/step - eachsides)
Single leg heel raises withweight (20 kg): (3 sets × 12reps - each side)Single leg squats: (3 sets ×10 reps - each side)Resisted lateral side-steps:(3 sets × 12 reps/step -each sides)
Plyometics Tuck jump: (3sets × 10 reps)
Broad jumps:(3 sets × 10reps)
180° tuck jumps:(3 sets × 5 reps ineach direction)
90° hop turns:(10 reps - clockwise andanti-clockwse)
Double leg lateral jumpsover mini-hurdle: (3 sets ×10 reps)
Single leg lateral jumpsover mini-hurdle: (3 sets ×10 reps)
Speed/Agility
Figure of 8runs: (10 mcourse,5 reps in eachdirection)
Ladder:forward runthrough:(10 reps)
Ladder: lateralrun through: (10reps - each way)
Ladder: lateral hopthrough: (10 reps - eachway)
Ladder: hopping slalomdrill: (10 reps)
Lateral shuttle runs: (10 mcourse, 2 sets × 10 reps)
O’Driscoll et al. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2011, 3:13. http://www.smarttjournal.com/content/3/1/13
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Lateral ankle sprain = high injury rate Highest risk = previous ankle sprain Important to address deficits aggressively to
prevent CAI Multifaceted approach is best
◦ Bracing/taping◦ Shoe selection◦ Aggressive neuromuscular retraining with
attention to quality of movement
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Don’t Just Recover. Conquer.
Don’t Just Recover. Conquer.
Thank you