AN INVESTIGATION INTO THE

MANAGEMENT OF LATERAL ANKLE

SPRAINS AMONG SPORTS PLAYERS
AT THE UNIVERSITY OF MAURITIUS
 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 person’s ability to carry
out his sporting and routine activities normally
 JUSTIFICATION OF THE PROJECT
• LAS are common sports injuries, prevalent mostly
in person below 35 years of age
• In Mauritius, unprecedented acheivements of
athletes such as Bruno Julie and Stephan
Buckland—encourage nurturing of new talents
• Growing endeavour among collegiate and
university students to engage in sports related
activities and competitions
• Parallel rise in incidence of LAS in this population
 SPECIFIC AIMS & OBJECTIVES
• Identify common steps by UOM students and
staff for management of LAS
• Investigate into risk factors
• To determine the level of residual symptoms in
terms 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 activities
in this population
• explore new venues about treatment and
prevention of LAS
 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 and
emergency units of hospitals (stats from 1997-
2009)
• In mauritius, no epidemiological study about
the occurrence of LAS has been done
ANATOMY
Main ligaments of lateral
ankle complex
-Anterior TaloFibular
ligament (ATFL)
-CalcaneoFibular ligament
(CFL)
-Posterior TaloFibular
Ligament (PTFL)

Source:
http://www.hawaii.edu/medicine/pediatri
cs/pemxray/v3c03.html
 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
tensile strength)
• LAS occur due to excessive supination
(invertion with adduction) of the rearfoot
coupled with plantar flexion at ground contact
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
 Risk factors for sustaining LAS
INTRINSIC EXTRINSIC
• Previous sprain • External support to the
• Sex ankle
• Height and weight • Shoe type
• Limb dominance • Duration and intensity of
• Anatomic foot type and size competition
• • Player position
Altered ROM of the ankle –
foot complex
• Muscle strength
• Sensory loss and postural
sway
 Grading for severity of LAS
GRADE 1: Stretch of the ligament with minimal
swelling, minimal loss of function and no instability.
Full WB possible

Grade 2: stretch with partial tearing, moderate

swelling and tenderness. Moderate loss of
functional ROM and unable to weight bear

Grade 3: complete rupture of ligament. Sever

swelling and ecchymosis, marked instability and
unable to weight bear due to pain.
Management and rehabilitation of LAS
• Acute stage
• Sub-acute stage
• Rehabilitative stage
• Functional stage
• Prophylactic stage
 PHYSIOTHERAPY TECHNIQUES
• Cryotherapy
• Ultrasound
• TENS
• Taping techniques
• Braces and orthotics
• Deep friction massage
• Manual Lymphatic Drainage techniques
• Passive joint mobilization
• Therapeutic exercise regime
 Sequelae of LAS
Occurs in 55% to 72% of persons having had a
previous sprain
Some of the most frequent symptoms are:
• Persistent synovitis
• Ankle stiffness
• Swellling
• Pain
• Loss of sensation
• Muscle weakness
• Frequent giving way
 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 ankle
instability (FAI)
 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
 Functional Ankle Instability (FAI)
• FAI is the occurrence of recurrent ankle instability
and ‘giving way’ sensations due to contributions of
proprioceptive, sensory and neuromuscular
deficits
Causes of FAI are:
1. Impaired proprioception and sensation
2. Impaired neuromuscular firing patterns and nerve
conduction
3. Impaired postural control
4. Strength deficits
METHODOLOGY
 SAMPLE POPULATION
• Male and Female University students and staff
• Members who practise sports such as
badminton, volleyball, basketball, football and
taekwondo, either within the university
setting or outside
• 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
 The study instrument
• An advertisement was posted on every sports
club groups of UOM on Facebook.
• Students were approached individually in the
UOM 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
 DESIGN OF THE QUESTIONAIRE
• Close-ended questions
• Different sections including questions about:
1.Personal history of the participant
2.History of the ankle sprain
3.Ankle ability
4.Management of ankle sprain
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
 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
 STATISTICAL ANALYSIS METHOD
• Analysis of data was done by Microsoft Excel
2007 since it allows pictorial representation of
data to facilitate interpretation of results.