MOST COMMON INJURY
GROSS AND
FUNCTIONAL
ANATOMY OF
THE ANKLE
JOINT
JOINT STABILITY
Shape of Bones
Ligaments
Strength of Muscles
BONY ANKLE JOINT
F
T
Ta
Achilles
Tendon
P. Longus
Flex. Hallucis
Longus
Flex. Digitorum
Longus
P. Brevis
Tib. Posterior
P. Tertius
Tib. Anterior
Ext. Digitorum
Longus
Ext. Hallucis
Longus
SYNOVIAL JOINTS
LATERAL LIGAMENTS
MEDIAL ANKLE
Tibia
Deltoid
Ligament
Calcaneus
Talus
Navicular
Sustentaculum Tali
ANKLE MOVEMENT AND
THE EFFECTS ON
LIGAMENTS
Plantar
Neutral
Dorsi
INVERSION
SPRAIN
BOTH INVERSIONS?
A
B
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 Brevis
Base 5th
Lateral Structures Ankle
Post.
Talofib.
Anterior Inf. Tib-fib.
Ant. Talofibular.
Calcaneofibular
P. Brevis
Base 5
MANDATE ON
PLAYING SURFACE
HOW SEVERE IS THE
INJURY.
HOW DO WE REMOVE
THEM FROM THE FIELD
ASSESSMENT
S. Subjective
O. Objective
A. Analysis
P.
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?
PALPATION
1
3
Anterior Inferior
Tibiofibular Ligament
2
Anterior Talofibular
Calcaneofibular Lig.
5th
Base of
Metatarsal
4
INVERSION SPRAINS
One 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.
3. Fracture
2. Ant. Inf.
Tib-fib.
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
Pain
FIGURE 8
SHUTTLE RUN
Figure 8 and Shuttle Run
FIGURE 8
SHUTTLE
½ Speed
¾ Speed
L
25 m
R
???