ECSS Paris 2023: OP-MH18
INTRODUCTION: The noncontact lateral ankle sprain is the most common injury in indoor and court sports. Here, it is predominantly described as occurring via a mechanism that typically incites from an initial “bad landing” – with the foot in inverted position. Descriptions of the actual foot landing posture prior to injury has, however, only been documented in few quantitative cases, or simply retrospectively reported by the incurring athletes during prospective trials. The aim was therefore to retrieve and systematically analyse a large number of video-recorded lateral ankle injuries from indoor and court sports to determine the initial foot landing posture. METHODS: In this explorative, observational, non-consecutive case-series study, two independent, blinded, analysists systematically retrieved and analysed 585 video-recorded lateral ankle sprain injuries. Injury mechanism was classified according to the IOC consensus guidelines, and both initial shoe-floor contact location and fulcrum (floor fixation point) around which the foot rotates was recorded. RESULTS: 445 injuries remained after 79 duplicates, and 61 videos with no clear view or non-lateral joint excursion, had been excluded. Of these, 113 (25%) were noncontact and 32 (7%) were indirect-contact injuries. Among the 113 noncontact injuries, 18 (16%) were characterised by initial contact on the lateral side, while 95 (84%) had a medial- or flat landing posture prior to injury. Among the 32 indirect-contact injuries, 9 (28%) injuries had initial contact on the lateral side, while 23 (72%) had a medial- or flat landing posture. Most noncontact injuries evolve around a lateral forefoot fulcrum (69%). CONCLUSION: Two out of three ankle sprains from online video platforms are direct contact injuries, with most involving landing on another player’s foot. Contrary to our expectations, most noncontact injuries were not caused by an initial “bad landing” with the foot in an initially inverted position. It is important to concede that the noncontact lateral ankle sprain can indeed occur and progress irrespective of initial foot landing posture. Active joint stiffness might be more important than initial joint position.
Read CV Filip Gertz LysdalECSS Paris 2023: OP-MH18
INTRODUCTION: About 10% of all medical complaints in military recruits are related to ankle injuries, with lateral ankle sprains being the most prevalent. The main concern is that recurrent ankle sprains could contribute to the development of chronic ankle instability, that may in turn lead to a range of related and persisting limitations, including increased risk of incurring additional musculoskeletal injuries during attrition. This study aimed at identifying the prevalence of ankle sprains during infantry training, and their associated risk factors. METHODS: A total of 365 infantry combat trainees (aged 18-21yrs) recruited in April 2022 were tracked individually for ankle sprains during basic infantry training and advanced infantry training by a physiotherapist. The trainees were assessed at the first week of each training period for anthropometrics, functional abilities (including proprioception ability, dynamic postural balance, ankle hopping agility and triceps surae muscle strength), Achilles tendon structure using the Ultrasound Tissue Characterization (UTC) and for ankle instability (pre-induction recurrent ankle sprains, perceived instability and mechanical instability). Pre-induction smoking-habits and pre-induction physical-preparation were also recorded. RESULTS: Ankle sprains were diagnosed in 109 trainees (29.9%) during the entire training period. Pre-induction recurrent ankle sprains were reported by 28.2% of the participants. The relative risk (RR) of a soldier with pre-induction ankle sprains to suffer a subsequent ankle sprain during training was 1.66 (p=0.001, 95% CI=1.21-2.26). Regression analysis indicated that reduced proprioception ability (OR=0.002, CI=0.00-0.14), higher BMI (OR=1.08, CI=1.00-1.16), recurrent sprains (OR=1.95, CI=1.13-3.39) and no pre-induction physical preparation (OR=3.12, 1.39-7.04) were related to ankle sprains during the full basic and advanced training sequence. Furthermore, pre-induction recurrent ankle sprains (OR=3.37, CI=1.18-9.67) and reduced Achilles tendon quality (OR=1.30, CI=1.17-1.44) were associated with ankle sprains during advanced training. CONCLUSION: The findings of this large-scale prospective study indicated that reduced proprioception ability, higher BMI, pre-induction recurrent sprains, and absence of pre-induction physical preparation were all associated with increased risk of ankle injury during training in the infantry. Moreover, reduced Achilles tendon quality and pre-induction recurrent sprains were also found to be significant factors in the second more advanced part of the training period. As such, this study emphasizes the multifactorial nature of military-related ankle sprains, that may include additional yet-to-be-identified parameters. These findings could greatly contribute to the development of preventive and interventive programs in the military in general, and in the infantry in particular.
Read CV Michal ShenharECSS Paris 2023: OP-MH18
INTRODUCTION: The objective of this trial was to observe the effect of uphill treadmill running and the combined effect of uphill running plus ankle joint mobilizations on subjective feeling of instability, dynamic postural control and ankle dorsiflexion range of motion in young adults with chronic ankle instability(CAI). METHODS: A randomized, four-arm, pretest-posttest design was implemented. After screening, a total of 76 CAI patients were randomly allocated among four groups: the combined uphill running and joint mobilization group(URJM), the uphill running alone group(UR), the joint mobilization alone group(JM), and the control group. Participants in the URJM group and UR group received 20 minutes per session, three treadmill training sessions per week throughout a 4-week program. Ankle joint mobilizations were provided three sessions a week for 4 weeks for the participants in the URJM group and JM group. The outcome measures included the Cumberland Ankle Instability Tool (CAIT) assessing subjective feeling of instability; the Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions assessing dynamic postural control; the weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree in half circle goniometer (NWBG) assessing ankle dorsiflexion range of motion. Linear mixed models were used to test differences between groups, with baseline outcome values serving as a covariate for adjustment. The effect size (Cohen’s d) will be calculated to evaluate the magnitude of difference among groups. RESULTS: There were statistically significant effects after isolated UR, JM or URJM on CAIT compared with the control group(p<0.01). All the mean difference and the lower 95% CI were greater than the minimal clinically significant difference of CAIT(3 scores), supporting the clinical efficacy. For the outcomes of dynamic postural control, there were statistically significant effects after isolated UR, JM or URJM on YBT-PM and YBT-PL compared with the control group(p<0.01). For ankle dorsiflexion range of motion, participants in URJM group had a significantly greater improvement in NWBG than those in UR(p=0.021), JM(p=0.028) and the control group(p=0.000). CONCLUSION: A 4-week uphill treadmill running program can improve the subjective feeling of instability and dynamic postural control in young adults with CAI. Compared to uphill running alone or joint mobilization alone, their combined application can better improve non-weight-bearing ankle dorsiflexion range of motion. This effect may help improve inadequate ankle dorsiflexion preceding heel strike, a known risk factor for ankle sprains in CAI individuals. Clinical implications: The uphill running program mentioned in this study is a form of exercise therapy that can be autonomously undertaken by CAI patients. Clinicians and physical therapists may consider incorporating uphill running into the rehabilitation protocols for CAI patients.
Read CV Yongjie LaoECSS Paris 2023: OP-MH18