Sustained injuries can have a range of physical and psychological effects to both athletes and the general population. Subsequent re-injury as a bi-product of the initial sustained injury, however, can be much more debilitating. It is of such great importance to manage and overcome initial injuries using a specific, step-by-step approach that is INDIVIDUALISED to each person. Remember, each person is different, and therefore, applying a “one size fits all” approach to injury rehabilitation can be problematic, both short- and long-term.
Research on Elite Track and Field athletes who experienced acute lateral ankle sprains highlighted that almost 1 in 5 suffered a re-injury at least once in the future (Malliaropoulos et al, 2009). Denegar, Hertel & Fonseca (2002) also highlighted that joint and ligament laxity was significantly greater post-lateral sprain (in comparison to uninjured ankle), and that the re-injury rate in athletic populations may be as high as a whopping 80%. It is clear that rehabilitation, re-conditioning and a specific, individualised and structured return to play/performance (RTP) protocol is paramount in terms of minimizing risk of re-injury. As stated, however, each situation is relative to each individual’s progress, which is where the aforementioned “one size fits all” approach to rehabilitation, and the process of simply ticking off stages must be thrown out the window.
Let’s use the The Star Balance Excursion Test (SEBT), or its modified version, the Y-Balance Test (YBT) as an example. The SEBT/YBT is a test whereby individuals are asked to stand, balanced, on one leg, whilst reaching as far as possible with the other in several different directions. Extensive research on this test highlights a correlation between poor test performance and increased future injury/re-injury:
- 94 amateur female netballers were tested on the YBT pre-season. Results highlighted that a score of 77% leg length or less in the posterior-medial direction (backwards and outwards – away from body – direction) was associated with up to 4 times increased risk of future re-injury (Attenborough et al, 2015).
- After being tested on the YBT, it was found that, of 125 healthy college athletes, those that scored less than 80% leg length in the posterior-lateral (backwards and inwards – across the body – direction) had a 48% increased risk of sustaining a future lateral ankle sprain (de Noronha et al, 2013).
When you consider these findings, along with the fact that lateral ankle sprains vary in both severity and individual recovery/rehabilitation, it appears to be rather alarming to consider return to play/performance without sufficient, staged re-conditioning and future re-injury testing. The SEBT/YBT requires some tape on the floor and a measuring tape, along with the subject – nothing else. Now, I am by no means saying that by correctly performing such a test, future re-injury will not occur. I am, however (with the backing of research), underlining the higher possibility of subsequent re-injury without relevant testing and rehabilitation. That’s not to say that those who successfully perform an injury rehabilitation and prevention program, along with regular testing, will never again get injured. Implementation of an injury rehabilitation and prevention program with specific outcome-based focuses (increasing range of motion, neuromuscular control and strength) will increase the chances of successful return to play/performance and conversely decrease risk of re-injury. Additionally, the SEBT/YBT functions as a good guide to track rehabilitation/re-conditioning progress with direct comparison to the uninjured limb, providing relevant feedback on when RTP and injury prevention may be successfully achieved.
If you have suffered an ankle injury (and subsequent re-injury), then come on in to see the highly skilled team at Absolute Health & Performance. You too should experience the high quality service an elite athlete receives in injury treatment, rehabilitation, re-conditioning and prevention, managed using a holistic approach at Absolute. With collaborative efforts from the elite team of sports medicine professionals we provie an individualised approach to help you snap the injury cycle and ensure that return to performance is successfully achieved, whilst simultaneously preventing future injury recurrence.
By Performance Coach Jonathan Stahl
- Denegar, C.R., Hertel, J. & Fonseca, J. (2002). The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity. Journal of Orthopaedic & Sports Physical Therapy, 32(4), 166-173.
- Malliaropoulos, N., Ntessalen, M., Papacostas., Longo, U.G. & Maffulli, N. (2009). Reinjury After Acute Lateral Ankle Sprains in Elite Track and Field Athletes. The American Journal of Sports Medicine, 37(9), 1755-1761.
- Attenborough, A.S., Sinclair, P.J., Sharp, T., Greene, A., Stuelcken, M., Smith, R.M. & Hiller, E. (2015). The identification of risk factors for ankle sprains sustained during netball participation. Physical Therapy in Sport, 23, 31-36.
- De Noronha, M., Franca, L.C., Haupenthal, A. & Nunes, G.S. (2013). Intrinsic predictive factors for ankle sprain in active university students: a prospective study. Scandinavian journal of medicine & science in sports, 23(5), 541-547.
- Hughes, M. (2017). Ankle Sprains & Lower Limb Injury: Can We Identify Those At Risk? Retrieved from https://www.mickhughes.physio/single-post/2017/03/08/Ankle-Sprains-Lower-Limb-Injury-Can-We-Identify-Those-At-Risk