Viva Dissert

8/8/2019 Viva Dissert

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INTRODUCTION

Lateral ankle sprains (LAS) occur when the

foot rolls excessively on its outside edge,

resulting in damage to ligaments on that side

ankle sprains induce long-term sequelae such

as persisting pain, swelling and instability --

interfere with the persons ability to carry out

his sporting and routine activities normally


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SPECIFIC AIMS & OBJECTIVES

Identify common steps by UOM students andstaff for management of LAS

Investigate into risk factors

To determine the level of residual symptoms interms of pain, swelling, weakness and giving-way sensation in this population

determine the impact of this condition on the

performance of usual sporting and daily activitiesin this population

explore new venues about treatment andprevention of LAS


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LITERATURE REVIEW

Epidemiology of LAS 1 sprain per 10 000 persons daily in the US

10-25% of all sports-related injury

10-30% of all musculoskeletal injury

14% of all attendance at the accident andemergency units of hospitals (stats from 1997-2009)

In mauritius, no epidemiological study aboutthe occurrence of LAS has been done


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ANATOMY

Main ligaments of lateralankle complex

-Anterior TaloFibular

ligament (ATFL)-CalcaneoFibular ligament

(CFL)

-Posterior TaloFibularLigament (PTFL)

Source:http://www.hawaii.edu/medicine/pediatrics/pemxray/v3c03.html


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MECHANISM OF ANKLE SPRAIN

77% to 85% of sprains are LAS

Out of these, 73% involve the isolated rupture

of the ATFL (most anterior and weakest tensilestrength)

LAS occur due to excessive supination

(invertion with adduction) of the rearfoot

coupled with plantar flexion at ground contact


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LAS can be contact related for e.g contact with

another player, objects or the playing surface

It can also be non-contact in instances of abrupt

change in direction or running on an uneven

surface


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Grading for severity of LASGRADE 1: Stretch of the ligament with minimalswelling, minimal loss of function and no instability.Full WB possible

Grade 2: stretch with partial tearing, moderateswelling and tenderness. Moderate loss offunctional ROM and unable to weight bear

Grade 3: complete rupture of ligament. Sever

swelling and ecchymosis, marked instability andunable to weight bear due to pain.


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Management and rehabilitation of LAS

Acute stage

Sub-acute stage

Rehabilitative stage

Functional stage

Prophylactic stage


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PHYSIOTHERAPY TECHNIQUES

Cryotherapy

Ultrasound

TENS

Taping techniques Braces and orthotics

Deep friction massage

Manual Lymphatic Drainage techniques

Passive joint mobilization

Therapeutic exercise regime


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Sequelae of LAS

Occurs in 55% to 72% of persons having had aprevious sprain

Some of the most frequent symptoms are:

Persistent synovitis

Ankle stiffness

Swellling

Pain Loss of sensation

Muscle weakness

Frequent giving way


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Ankle instability

Chronic ankle instability (CAI)-repeated

episodes of lateral ankle instability and is

characterized by the presence of residual

symptoms such as pain, swelling, giving way

and loss of motion.

Two components of CAI are Mechanical ankle

instability (MAI) and Functional ankleinstability (FAI)


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Mechanical ankle instability

MAI is defined as an increase in the accessory

movements of a joint.

Contributors to MAI are:1. Pathological laxity- can be assessed clinically

by the anterior drawer test and the talar tilt

test.

2. Arthrokinematics impairments

3. Synovial and degenerative changes


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Functional Ankle Instability (FAI)

FAI is the occurrence of recurrent ankle instabilityand giving way sensations due to contributions ofproprioceptive, sensory and neuromuscular

deficitsCauses of FAI are:

1. Impaired proprioception and sensation

2. Impaired neuromuscular firing patterns and nerve

conduction3. Impaired postural control

4. Strength deficits


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METHODOLOGY


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Inclusion criteria

- At least 1 ankle sprain sustained during the

last three years- Playing at least one sport

Exclusion criteria-Recent fracture of the foot or ankle


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The study instrument

An advertisement was posted on every sports

club groups of UOM on Facebook.

Students were approached individually in theUOM gymnasium to seek their informed

consent and choose them according the

criteria which have been set up

A six-paged questionaire was given to suitable

participants


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PILOT STUDY AND VALIDATION OF

QUESTIONNAIRE Conducted with 3 fourth year physiotherapy

student and 5 players in the gymnasium

selected at random.

Questionnaire was validated after consultation

with my supervisors


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ETHICS

Ethical clearance for the project was awarded

by the Research Ethics Committee of UOM

An information sheet and a consent form was

attached to the questionnaire to explain

clearly about the aims and objectives


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STATISTICAL ANALYSIS METHOD

Analysis of data was done by Microsoft Excel

2007 since it allows pictorial representation of

data to facilitate interpretation of results.


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Documents

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