MOST COMMON INJURY

GROSS AND FUNCTIONAL

ANATOMY OF THE

ANKLE JOINT

JOINT STABILITY

Shape of Bones

Ligaments

Strength of Muscles

TF

Ta

BONY ANKLE JOINT

P. Longus

P. Brevis

P. Tertius

Ext. Digitorum Longus

Ext. Hallucis Longus

Tib. Anterior

Tib. Posterior

Flex. Digitorum Longus

Flex. Hallucis LongusAchilles

Tendon

SYNOVIAL JOINTS

LATERAL LIGAMENTS

Calcaneus Sustentaculum Tali

Navicular

TalusTibia

Deltoid Ligament

MEDIAL ANKLE

ANKLE MOVEMENT AND THE EFFECTS ON

LIGAMENTS

Plantar Neutral Dorsi

INVERSIONSPRAIN

A B

BOTH INVERSIONS?

INVERSION SPRAIN

85% of all sprains

Happens during loading and unloading of the ankle.

What ligament is the first line of defence?

Depends on ankle position

Peroneus BrevisBase 5th

Anterior Inf. Tib-fib.

Ant. Talofibular.

Post. Talofib.

Calcaneofibular

P. Brevis

Base 5

Lateral Structures Ankle

MANDATE ON PLAYING SURFACE

HOW SEVERE IS THE INJURY.

HOW DO WE REMOVE THEM FROM THE FIELD

ASSESSMENT

S.

O.

A.

P.

Subjective

Objective

Analysis

Plan

Subjective: Information that is gathered from the athlete.

Objective: Observable or measurable findings.

WEIGHT BEARING

OR

NON-WEIGHT BEARING

PAIN RESPONSE OF DAMAGED TISSUE

1. Damaged muscle and ligaments are painful when stretched.

2. Damaged muscle is painful to contract.

PAIN RESPONSE .. Con’t

3. Both structures are painful if palpated at the site of tear.

FIELD ASSESSMENT

Ankle Sprains - General

Mechanism of Injury

Pain …… where?

Hear/feel anything?

Injured before?

Continue with activity?

1

23

4

PALPATIONAnterior Inferior Tibiofibular Ligament

Anterior Talofibular

Base of 5th Metatarsal

Calcaneofibular Lig.

INVERSION SPRAINSOne area of tenderness.

No sensation of tearing or feeling

unstable.

Full ROM with discomfort on active plantar flexion and inversion.

.. 2

.. 2

Stand athlete to check for pain in ankle or leg.

Walk to the sideline if athlete can walk

without a limp.

INVERSION SPRAIN

At least two areas of pain.

Hear/feel of tearing.

Painful ankle.

Limitation of pl. flexion and inversion.

2..

…2

Check to see if the athlete can stand.

Determine where the pain is located (leg pain

N.W.B.).

If they can walk, but limp, remove N.W.B.

EVERSION SPRAIN• Least common sprain.

• Most fractures happen in eversion.

• Stability of the medial ankle depends upon the Deltoid Ligament and the lateral malleolus.

EVERSION• Slight medial tenderness.

• Pain and slight limitation on active eversion.

• Stand to determine if there is leg pain.

• Walk off playing surface if not antalgic.

ANKLE SPRAIN SEVERE

Rigid, high footwear.

Unable to continue on with the activity.

Leg pain on standing.

Eversion and External Rotation of the ankle without Deltoid Ligament tear.

2. Ant. Inf. Tib-fib.

3. Fracture

1. Deltoid

Hockey Player

Inversion

Minimal Pain

Mild swelling

Mild bruising

Return in five days

Day 6

THE MINOR SPRAIN

Can this athlete return to play during this contest?

Definition… Discomfort versus pain?Pain changes the way you do things!

Dissect the sport into its’ components starting from the most simple on the ankle and progress to the most difficult. If they can perform the test without pain… then return. (Following taping?)

NON-RETURNING ATHLETE

C.I.C.E.R.

Crutches for proper gait.Referral for physio.

Prepare for return.

PREPARE FOR RETURN

Aside from the ‘formal’ rehabilitation, the athlete must work on maintaining conditioning and doing whatever sport skills they can.

WHEN DO I KNOW THAT I AM READY TO RETURN?????

WALK

JOG

FIGURE 8

SHUTTLE RUN

Pain

Figure 8 and Shuttle Run

25 m

½ Speed

RL

¾ Speed

FIGURE 8

SHUTTLE

???