FACULTY OF SPORT
AND PHYSICAL EDUCATION
Foundation Degree in Science
in
Sports Therapy
Student ID Number: 9900543251
Module Code: Introduction to Assessment and Treatment
EXCE1156
Module Leader: Tammy Emmins
Submission Date: 29/11/2024
Table of Contents
Table of Contents
i
List of Tables and Figures
ii
Abbreviations
iii
Introduction
1
Types, Common Sign and Symptoms of a Sport Injury
1
Lateral Ankle Sprain Injury
4
Ankle Sprain Grades, Signs and Symptoms
5
Cryotherapy, Thermotherapy and Its Applications
6
Common Risk Factors for a Range of Sport Injuries
7
The Relation between Common Risk factors and Mechanisms of an Injury
11
References
12
i
List of Tables and Figures
Figure 1, Classification of sporting injuries Brukner et al., (2017, pp. 14)
2
Figure 2, Classification of Contact as a Mechanism for Sudden-Onset Injuries (The
International Olympic Committee Injury and Illness Epidemiology Consensus Group et al.,
2020).
3
Figure 3, Signs and Symptoms of acute and chronic sports injuries (Babarinde et al., 2017)
3
Figure 4, A close-up of a foot and ankle (Cork, 2016)
4
Figure 5, Ankle Fundamental ROM (BMJ, 2021)
5
Figure 6, Ligaments injury grades of a lateral ankle sprain (Sportnova Team, 2019)
6
Figure 7, Intrinsic factors related to the risk of injury in athletes reported by the participants.
(Saragiotto et al., 2014)
9
Figure 8, Extrinsic factors related to the risk of injury in athletes reported by the participants.
(Saragiotto et al., 2014)
10
Figure 9. Comprehensive model for injury causation. (Bahr & Krosshaug, 2005)
11
ii
Abbreviations
ACL
Anterior Cruciate Ligament
ATFL
Anterior Talofibular Ligament
BMI
Body Mass Index
CFL
Calcaneofibular Ligament
Cm
Centimetre/s
COD
Change of Direction
DOMS
Delay Onset Muscle Soreness
MSK
Musculoskeletal
OA
Osteoarthritis
PTFL
Posterior Talofibular Ligament
ROM
Range of Movement
iii
Introduction
In sports medicine, sports injury and its definition has been discussed by Timpka et al., (2014),
regard the lack of common resources and records of health issues, developed by athletes in
sports participation. The authors suggest sports injury as a subdivision of sports impairment,
denoted as “the loss of bodily function or structure that would be observed in a clinical
examination” (Timpka et al., 2014). Micheo & Sanchez, (2018) defined sports injury as a
pathological process, in which an athlete may require time off from training or competition, in
order to seek medical attention due to trauma. Both the authors agreed, from different
perspective, that sports injury is related to the disfunction or impairment an athlete incur,
during sport participation, resulting in medical or therapy intervention. Through the years, there
has been an incremental impact of sport-related injuries due to the greater involvement in
recreational activity, which has resulted in substantial and almost inevitable incidents, in needs
of trustworthy preventive measure (Hopkins et al., 2016; Dreinhöfer et al., 2007). Despite the
acknowledgement of musculoskeletal injuries raise, specific statistic of sport-related injury, are
inadequate and difficult to compare; there are a range of many injuries that are common to a
variety of sports, however, the same injury can differ between individuals, by the mechanism
and activity performed while occurred, including factors related to the single or multiple
individuals pre and during the injury event (Werner et al., 2023; Dreinhöfer et al., 2007).
Types, Common Sign and Symptoms of a Sport Injury
Brukner et al., (2017, pp. 13-15, 29-34) defined the musculoskeletal sports injury of an athlete,
as the damaged occurred to tissues, while competing or training, of which may be categorised
as acute or overuse, based on the mechanism of injury and rapidity of the onset symptoms
(Fig.1). The International Olympic Committee Injury and Illness Epidemiology Consensus
Group et al., (2020) described, an acute episode, as a sudden injury derived from a specific,
identifiable event, due from a transfer of kinetic energy, for example, an unwanted inversion
of the foot, while performing a change of direction (COD) when walking or running, due to a
collision between players (Halabchi, F., & Hassabi, M., 2020); conversely, the overused
episode, is defined by the authors as a gradual onset injury that lack from a well-defined
traumatic event and is caused from a progressive accumulation of loading over time, for
example, a reoccurring ankle sprain from foot misplacement while jumping, due to laxity,
looseness at the joint with increased unstable ROM, of which, the patient may describe as the
ankle “giving way” (Mugno et al., 2023). It is worth mention that, in their article, the authors
1
consider a third onset injury, combining acute and overused mechanisms; an example would
be, an athlete who developed a tendinopathy due to their overtraining regime, resulting in
weakness, sustaining a tendon rapture, due to a collision or jump.
Figure 1. Classification of sporting injuries Brukner et al., (2017, pp. 14)
The relation between the categorisation of an injury, as Bruce et al., (2015) suggested,
includes the mechanisms of an injury, which involve the transmission of force directly or
indirectly the injured body part. The International Olympic Committee Injury and Illness
Epidemiology Consensus Group et al., (2020) created and published a helpful table (Fig. 2),
classifying the mechanism of an acute injury.
2
Figure 2. Classification of Contact as a Mechanism for Sudden-Onset Injuries (The International Olympic Committee
Injury and Illness Epidemiology Consensus Group et al., 2020).
Different Injuries may be identified by common signs and symptoms, related to the stage the
injury is presented, the tissue affected and how far in time the event occurred; pain, swelling,
bruising, stiffness, instability as difficulty to bear weight, and limited range of motion (ROM)
are common in ankles, knees and shoulders injuries involving tissue strains and sprains
(Dalton & Schweinle, 2006; Hare et al., 2017; Caroline et al., 2005); headache, dizziness,
confusion, nausea, vomiting and sensitivity, might be seen in musculoskeletal (MSK) injuries,
however, these signs and symptoms are commonly related to sport-related concussion
(McCrory et al., 2016). ☓
Figure 3. Signs and Symptoms of acute and chronic sports injuries (Babarinde et al., 2017)
3
Lateral Ankle Sprain Injury
Fong et al., (2007) rates, the ankle injury across different sports, such as track and field,
basketball, tennis, hockey, football, volleyball, and gymnastic, the highest and most common
issue between athletes, with a 45% ratio, of all athletic injuries encountered. The 75% of the
injuries in sports, which involve the ankle, are lateral sprains from inversion and plantar flexion
of the foot, caused by a misplacement, while changing direction, walking, running, or jumping
(Ferran & Maffulli, 2006). In a more recent study, Van Middelkoop et al., (2012) retrieved
enough data, to affirm the requirement of more than one year for over 50% of the athletes in
the case study, to fully recover from long-term disability, and eventually regain optimal
performance, led from an ankle sprain; the author linked the injury, to an increased risk of
osteoarthritis (OA) and articular degeneration, underlying particular concerns.
Figure 4. A close-up of a foot and ankle (Cork, 2016)
Anatomically, the foot can be subdivided into three main areas, the hindfoot, also referred as
the rear foot including tibia, talus, and calcaneus bones, the midfoot, comprise of navicular,
cuboid, and cuneiforms), and the forefoot, toes and metatarsals (Dutton, 2016). The lateral
complex, situated in the hindfoot, are the predominant ligaments that suffer from an ankle
inversion sprain, formed by the anterior talofibular (ATFL), the posterior talofibular (PTFL), and
the calcaneofibular (CFL), respectively connecting fibula with talus and calcaneus (Dutton,
2016; Zulak et al., 2018). Despite the anatomical complexity of the ankle and foot, Halabchi,
F., & Hassabi, M., (2020), recognised and stated the ligaments involvement rate, as high as
4
85% of all ankle injuries, of which, 65% of the cases, isolate the ATFL, 20% includes both the
ATFL and CFL, and a smaller percentage involve the PTFL.
Ankle Sprain Grades, Signs and Symptoms
Brukner et al., (2017, pp. 19-27) graded the damage of the tissue by the severity, pain and
ROM the articulation possesses as grade one, two or three. Grade one is defined by mild
stretching of the tissue, with light tears and instability (<20% of full rupture), oedema and
ecchymosis might be present, influencing the ROM and function of the ankle joint, which could
partially impact the ability to bear weight, the patient might be restricted from activity for no
longer than one week, with full return to participation between two to three weeks (Glascoe,
Allen, Awtry, & Yack, 1999); grade 2 would show a tear or partial rupture of a tissue, with mild
oedema and ecchymosis (20% to 80% of full rupture), the patient can experience difficulties
to bear weight, and instability with mild functional loss at the articulation suggesting the stop
of activity for two to three weeks, with return to play between four to six weeks (Glascoe, Allen,
Awtry, & Yack, 1999); grade 3 appears as full disruption of the ligament or tendon (>80%),
with hard instability and impossibility to bear weight. It shows immediate oedema and
ecchymosis with great loss in functionality and stability of the joint (Mugno et al., 2023). The
recovery time can vary widely depending on the treatment provided, indicatively, from six
weeks to three or more months before the patient would be able to return to participation
(Konradsen, Holmer, & Sondergaard, 1991). x
Figure 5. Ankle Fundamental ROM (BMJ, 2021)
5
Figure 6, Ligaments injury grades of a lateral ankle sprain (Sportnova Team, 2019).
Cryotherapy, Thermotherapy and Its Applications
Nadler et al., (2004), define cryotherapy and thermotherapy as techniques used on acute and
chronic injuries in response to pain, reducing the action of its transmission, through signal sent
by nociceptors to the brain, which are specific sensory neurons that detect damaged tissues
and harmful stimuli all over the body. The author specify cryotherapy, “as the therapeutic
application of any substance to the body that removes heat from the body, resulting in
decreased tissue temperature.” The effects of cryotherapy on the body are pathophysiological,
and further than act as “psychological pain reduction”, it decreases blood flow, by causing
vasoconstriction to a depth of 2 to 4 centimetres (Cm), reduces tissue metabolism, oxygen
utilization, inflammation, and muscle spasm (Nadler, Weingand, & Kruse, 2004; Nadler,
6
Weingand, & Stitik, 2001). It is interesting how Nadler et al., (2004), in his article concluded
positively to continuous cold-water treatment, and intermitting compression, as extremely
effective technique related to post traumatic oedema, rather than cool packs. However, the
authors also referred to ice packs and ice message therapy as preferable, when a quick
recovery is needed, for example at side pitch. It is worth mention how in a most recent study,
Alharbi, (2020) agreed and reinforce the use of cold therapy treatment as injury approach, to
reduce the pain perceived from an individual.
Nadler et al., (2004) describes thermotherapy as “the therapeutic application of any substance
that adds heat to the body, resulting in increased tissue temperature”. Thermotherapy works
as analgesic over pain, however, the physiological effects are opposite; the increment in blood
flow, facilitates tissue healing by supplying fresh nutrients, oxygen, and proteins to the affected
body part, while the raised metabolism, given from the higher tissue’s temperature, aids the
waste and repair process, of the injury. Multiple studies have been conducted of the use of
thermotherapy and its application; demonstrating that continuous low-level heat therapy
applied directly on the skin, would be therapeutically effective in treating musculoskeletal
disorders like tendinopathy, joint contractures, muscle spasms and osteoarthritis, acute
muscular pain, menstrual pain, and DOMS (Nadler, Weingand, & Kruse, 2004).
In case of a lateral ankle sprain, following the studies provided by the authors, a first
application of intermittent cryotherapy, and compression, is indicated to reduce oedema and
ecchymosis in the affected area. The cold therapy should be applied as close as possible to
the traumatic event, cold packs, gels or ice are ideal at first, however, on the long term, lowlevel cold, for example a cold towel wrapped around the ankle, or a cold whirlpool, would be
beneficial to reduce pain and swelling. Thermotherapy also can be applied as soon the
inflammation ends; the vascularisation would help the damaged tissue to receive fresh blood
flow, carrying nutrients useful to the restoring process. It is indicated to use cryotherapy and
thermotherapy depending on the specificity and severity of the injury, and the condition and
sensitivity, of each individual, whether in needs of immediate action, post-surgery, or delay
onset muscle soreness (DOMS) varying the duration of the therapy case by case.
Common Risk Factors for a Range of Sport Injuries
Drawer & Fuller, (2002) stated the relation between sports injuries and osteoarthritis (OA) as
long-term result, an unacceptable burden for the healthcare settings and costs, in the early
2000s. Wiggins et al., (2017), reported an increment in sports incidence rate, between 15- and
7
25-years old athletes, noting that, major injuries and case studies referred to the lower limbs,
as part of the body majorly stress. Both the authors included in the research, the aim to
categorize and understand common risk factors that would influence the event of injury,
identifying high practice hours, absence or improper warm up routine, inadequate sports
facilities, and the younger age, especially 14 to 17 years old, as common risk factors. Recent
analysis by Al-Qahtani et al., (2023) reviewed, and confirmed the aforementioned risks factors,
including body mass index (BMI), physical activity patterns, age, gender, sport type, previous
injuries, and training practice. In an in-depth study, Saragiotto et.al (2014) interviewed 30
members of the medical and technical department who participated in the Pan American
Games of Guadalajara in 2011, questioning what could have been the main causes of injury
in the athletes who took part of the event, and what they would have done, in order to prevent
them. The conclusion generated from the study, again, reinforce as main risk factors the above
cited overtraining, athlete’s skills, fitness and behaviours, and incorrect sports technique and
facilities (Fig. 7; Fig. 8). It is interesting how all the authors in their studies, concluded
emphasizing the needs to target injury prevention strategies and detail of the mechanisms of
injuries, related to intrinsic and extrinsic risk factors.
8
An example list, with potential data related to intrinsic risk factors.
Figure 7. Intrinsic factors related to the risk of injury in athletes reported by the participants. (Saragiotto et al., 2014)
9
An example list, with potential data related to extrinsic risk factors.
Figure 8, Extrinsic factors related to the risk of injury in athletes reported by the participants. (Saragiotto et al., 2014)
10
The Relation between Common Risk factors and Mechanisms of an Injury
In their article, Bahr & Krosshaug, (2005), emphasise a comprehensive multifactorial model
approach to injury, based on Meeuwisse (1994) research, by deeply looking into the caused
of internal and external risk factors and inciting event as mechanisms of injury (Fig 9). This
models and study have been used since, in order to understand and perfection sports injury
prevention strategies. The authors accentuated the importance of the description of every
detail, in order to recreate the factorial line causing the inciting event. The model illustrated is
a concise confrontation of the traditional biomechanical approach of an injury event, to a more
targeted and descriptive mechanism, which involve the particular type of injury, in a specific
sport, considering all the key factors and, possible adaptations during the event itself (Bahr &
Krosshaug, 2005).
Figure 9. Comprehensive model for injury causation. (Bahr & Krosshaug, 2005)
11
References
Alharbi, S. A. (2020). The effectiveness of cryotherapy in the management of sports injuries.
Saudi Journal of Sports Medicine, 20(1), 1-5.
https://doi.org/10.4103/sjsm.sjsm_21_20
Al-Qahtani, M. A., Allajhar, M. A., Alzahrani, A. A., Asiri, M. A., Alsalem, A. F., Alshahrani, S.
A., & Alqahtani, N. M. (2023). Sports-Related Injuries in Adolescent Athletes: A
Systematic Review. Cureus, 15(11), e49392. https://doi.org/10.7759/cureus.49392
Babarinde, O., Ismail, H., & Schellack, N. (2017). An overview of the management of muscle
pain and injuries. South African Family Practice, 59(5), 11-19.
https://doi.org/10.4102/safp.v59i5.4745
Bahr, R., Krosshaug, T. (2005). Understanding injury mechanisms: a key component of
preventing injuries in sport. Br J Sports Med 2005: 39: 324-329. Understanding injury
mechanisms: a key component of preventing injuries in sport.
Bahr, R., Holme, I. (2003). Risk factors for sports injuries — a methodological approach,
British Journal of Sports Medicine 2003;37:384-392.
BMJ (2021, June 17). Ankle Pain, Physiotherapy. Bone, Muscles, Joints, Physiotherapy.
Retrieved November 29, 2024, from https://bmjtherapy.com/full-ankle-injury-recovery/
Bruce, H., Valle, X., Rodas, G., Til, L., Grive, R. P., Dr, Gutierrez Rincon, J. A., & Tol, J. L.
(2015). Classification and grading of muscle injuries: A narrative review. British
Journal of Sports Medicine, 49(5). https://bjsm.bmj.com/content/49/5/306.info
Brukner, P., Clarsen, B., Cook, J., Cool, A., Crossley, K., Hutchinson, M., McCrory, P., Bahr,
R., & Khan, K. (2017). Brukner & Khan's clinical sports medicine: Injuries (5th ed.,
pp. 13-15, 29-34). McGraw-HIii Education (Australia).
https://doi.org/https://csm.mhmedical.com/content.aspx?bookid=1970&sectionid=168
688391
Calvert-Painter, B., Anthony, C., Caldwell, C., Zulak, D., Soman, D., Key, J., Bartsch, K. M.,
Nelson, K., Stuart, L., & Anderson, R. B. (2018). Clinical Assessment for Massage
Therapy: A Practical Guide. (1st ed., pp. 101-104). Handspring Publishing Limited.
Caroline, M., Adebajo, A., Hay, E., & Carr, A. (2005). Shoulder pain: Diagnosis and
management in primary care. British Medical Journal, 331(7525), 1124-1128.
https://doi.org/10.1136/bmj.331.7525.1124
Cork, D. (n.d.). News: Ankle Sprains – Help is only a click away! South Eastern Active
Health. Retrieved November 6, 2024, from https://activehealth.com.au/ankle-sprains/
12
Dalton, J. D., & Schweinle, J. E. (2006). Randomized Controlled Noninferiority Trial to
Compare Extended Release Acetaminophen and Ibuprofen for the Treatment of
Ankle Sprains. Annals of Emergency Medicine, 48(5), 615-623.
https://doi.org/10.1016/j.annemergmed.2006.05.015.
Drawer, S., Fuller, C.W. (2002). Evaluating the level of injury in English professional football
using a risk-based assessment process. Br J Sports Med 2002; 36:446–51.
Abstract/FREE Full TextHYPERLINK "https://bjsm.bmj.com/lookup/googlescholar?link_type=googlescholar&gs_type=article&q_txt=Drawer+S%2C+Fuller+CW.
+Evaluating+the+level+of+injury+in+English+professional+football+using+a+risk+bas
ed+assessment+process.+Br+J+Sports+Med2002%3B36%3A446%E2%80%9351."
Google Scholar
Dreinhöfer, K. E., MD, Reichel, H., MD, & Käfer, W., MD (2007). Lower limb pain. Best
Practice & Research Clinical Rheumatology, 21(1), 135-152.
https://doi.org/10.1016/j.berh.2006.10.007
Dutton, M. (2016). Dutton's orthopaedic examination, evaluation, and intervention (4th ed.,
pp. 1611-1613). McGrawHill Medical.
http://accessphysiotherapy.mhmedical.com/content.aspx?bookid=1821&sectionid=12
7518038
Ferran, N. A., & Maffulli, N. (2006). Epidemiology of Sprains of the Lateral Ankle Ligament
Complex, Foot and Ankle Clinics. Science Direct, Elsevier, 11(3), 659-662.
https://doi.org/10.1016/j.fcl.2006.07.002
Fong, D.T., Hong, Y., Chan, L.K., Yung, P.S., Chan, K.M. (2007). A systematic review on
ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94. Doi:
10.2165/00007256-200737010-00006. [DOI] [PubMed] [Google Scholar][Ref list]
Glascoe, W. M., Allen, M. K., Awtry, B.F., & Yack, H. J. (1999). Weight-bearing
immobilisation and early exercise treatment following a grade II lateral ankle sprain.
Journal of Orthopaedic and Sport Physical Therapy, 29, 394-399
Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and
algorithmic approach. World journal of orthopedics, 11(12), 534–558.
https://doi.org/10.5312/wjo.v11.i12.534
Hare, K. B., Stefan Lohmander, L., Kise, N. J., Risberg, M. A., & Roos, E. M. (2017). Middleaged patients with an MRI-verified medial meniscal tear report symptoms commonly
associated with knee osteoarthritis: A cross-sectional study of 199 patients. Acta
13
Orthopaedic, 88(6), 664–669. https://doiorg.plymouth.idm.oclc.org/10.1080/17453674.2017.1360985
Hertel, J. (2002). Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral
Ankle Instability. Journal of athletic training, 37(4), 364–375.
Hung, Y.J. (2015). Neuromuscular control and rehabilitation of the unstable ankle. World J
Ortho. 2015 Jun 18;6(5):434-8. [PMC free article] [PubMed] [Reference list]
International Olympic Committee Injury and Illness Epidemiology Consensus Group, Bahr,
R., Clarsen, B., Derman, W., Dvorak, J., Emery, C. A., Finch, C. F., Hägglund, M.,
Junge, A., Kemp, S., Khan, K. M., Marshall, S. W., Meeuwisse, W., Mountjoy, M.,
Orchard, J. W., Pluim, B., Quarrie, K. L., Reider, B., Schwellnus, M., Soligard, T., …
Chamari, K. (2020). International Olympic Committee Consensus Statement:
Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in
Sports 2020 (Including the STROBE Extension for Sports Injury and Illness
Surveillance (STROBE-SIIS)). Orthopaedic journal of sports medicine, 8(2),
2325967120902908. https://doi.org/10.1177/2325967120902908
Kondarsen, L., Holmer, P., & Sondergaard, L. (1991). Early mobilising treatment for grade III
ankle ligament injuries. Foot ankle, 12,69-73.
McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R. C.,
Cassidy, D., Echemendia, R. J., Castellani, R. J., Davis, G. A., Ellenbogen, R.,
Emery, C., Engebretsen, L., Feddermann-Demont, N., Giza, C. C., Guskiewicz, K.
M., Herring, S., Iverson, G. L., Johnston, K. M., … Vos, P. E. (2017). Consensus
statement on concussion in sport-the 5th international conference on concussion in
sport held in Berlin, October 2016. British journal of sports medicine, 51(11), 838–
847. https://doi.org/10.1136/bjsports-2017-097699
Meeuwisse, W.H., Tyreman, H., Hagel, B., Emery, C. (2007). A dynamic model of ethology
in sport injury: the recursive nature of risk and causation. Clin J Sport
Med. 2007;17(3):215–219. A dynamic model of ethology in sport injury: the recursive
nature of risk and causation.
Micheo, W., MD, & Sanchez, L. A., MD (2018). Geriatric Rehabilitation (-1st ed., pp. 161168). Elsevier. https://doi.org/10.1016/B978-0-323-54454-2.00012-1.
Mugno, A.T., Constant, D. Recurrent Ankle Sprain. (Updated 2023 Aug 8). In: Stat Pearls
[Internet]. Treasure Island (FL): Stat Pearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK560619/
14
Nadler, S. F., Weingand, K., & Kruse, R. J. (2004). The physiologic basis and clinical
applications of cryotherapy and thermotherapy for the pain practitioner. Pain
physician, 7(3), 395–399.
Nadler, S.F., Weingand, K.W., Stitik, T.P. et al. (2001). Pain relief runs hot and cold.
Biomechanics 2001; 8:1. (www.painphysicianjournal.com)
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;
Board on Health Care Services; Committee on Identifying Disabling Medical
Conditions Likely to Improve with Treatment (2020, April). Selected Health
Conditions and Likelihood of Improvement with Treatment. Washington (DC):
National Academies Press (US); 2020 Apr 21. 5, Musculoskeletal
Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559512/
National Institute of Health (2024, September). Sports Injuries. National Institute of Arthritis
and Musculoskeletal and Skin Diseases. Retrieved October 27, 2024, from
https://www.niams.nih.gov/health-topics/sports-injuries
Saragiotto, B. T., Di Pierro, C., & Lopes, A. D. (2014). Risk factors and injury prevention in
elite athletes: a descriptive study of the opinions of physical therapists, doctors and
trainers. Brazilian journal of physical therapy, 18(2), 137–143.
https://doi.org/10.1590/s1413-35552012005000147
Sportnova Team (2019, January 24). Sprained Ankle. Retrieved November 6, 2024, from
https://www.sportnova.co.uk/ankle-sprain
Van Middelkoop, M., van Rijn, R.M., Verhaar, J.A.N., Koes, B.W. and Bierma-Zeinstra,
S.M.A. (2012). Re-sprains during the first 3 months after initial ankle sprain are
related to incomplete recovery: An observational study. Journal of Physiotherapy. 58:
181–188
Werner, T., Michel-Kröhler, A., Berti, S., & Wessa, M. (2023). Not All Injuries Are the Same:
Different Patterns in Sports Injuries and Their Psychosocial Correlates. Sports
(Basel, Switzerland), 11(12), 237. https://doi.org/10.3390/sports11120237
Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D.
(2016). Risk of Secondary Injury in Younger Athletes After Anterior Cruciate
Ligament Reconstruction: A Systematic Review and Meta-analysis. The American
journal of sports medicine, 44(7), 1861–1876.
https://doi.org/10.1177/0363546515621554
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