Effects of Weight Bearing Exercise Following Ankle Injury in Football Players - Essay Example

Effects of weight bearing exercise following ankle injury in Football players INTRODUCTION: Football is a popular sport played throughout the world with many participants, this is important to bear in mind as a background to discussions about the occurrence of football injuries in different situations. According to the Federation of International Football Associations (FIFA) there are around 200 million licensed players today in a total of 186 countries. Within the Union of European Football Associations (UEFA) there are 51 countries represented by over 22 million players (nearly 21 million men and over 1.3 million women) (Jennifer, 2001). Many studies have been carried out on the risk of injury in the game of football. These studies provide us with an idea of the more serious injuries and the pressure they represent on the resources of the community, but they only record the number of players injured, and not the number exposed to the risk of injury. In recent years, an injury has been defined as any injury a player has incurred in any football-related activity which has caused absence from training or from a match. These studies provide us with an idea of the risk of injury to the individual player and for the team, since they take into consideration the exposure to football and record injuries per 1000 hours of football activity which also provides valuable background information for preventive measures. AIM: To demonstrate an understanding of the injury and injury management including the process of enhancing the healing process in the early stages of rehabilitation in order to make the players optimally fit at an earlier stage. The aim of the project is to understand in detail the effects of weight bearing exercise following ankle injury in football players. LITERATURE REVIEW: In reviewing the literature, great differences in the incidence of football injuries have been reported. These differences might be partly caused by heterogeneous definitions, methods of data collection, observation periods, study designs and sample characteristics, but the magnitude of the influence of different methodologies on the reported incidences of sports injuries are difficult to estimate. The aim of the present study is to review the different methodologies applied in the evaluation of football injuries as well as to analyze the influence of different definitions and data collection methods on the influence of football injury. METHODS: The literature on football injury was reviewed and the methods applied were analyzed in details. Some of the methodological problems were investigated by analyzing data from my own prospective study on risk factors for football injury. As the literature review does not provide us with any major information or source of data about the detailed types and description of the injuries a small questionnaire was conducted whereby few football players were asked to answer a list of questions related to their injuries and complaints in the last twelve months. It was noted that ankle injury is one of the identical problem faced by many players. The mechanism of injury in football includes head-to-head contact as well as contact with relatively immovable objects such as the ground and the goalposts (Boden, Kirkendall, & Garrett, 1998). Controversy surrounds the notion of heading the ball as a mechanism of injury, and at the current time there are arguments for and against heading as a source of injury (McCroty, 2003). In any case, for a number of reasons, football players have been viewed as having a higher risk of concussion as compared to other players. Despite past perceptions of generally lower injury rates, soccer player's actual risk of concussive injury has only begun to be investigated. In recent times, investigators have studied soccer in a more systematic fashion. As an example, in a study focused on highly competitive college soccer players, injury incidence was estimated to range from 0.4 per 1,000 AEs for women to O.6 per 1,000 AEs for men (Boden et al., 1998). Parenthetically, in this study, no concussions were found to be caused by heading the ball. Ankle Injury: Ankle sprains usually occur when the foot is forcefully inverted when the ankle is plantar flexed; in this position the bony structure allows only minimal stability, the leverage is maximal, and the anterior talofibular ligament (ATFL), which is the weakest component of the lateral ligament of the ankle, is taut and exposed to injury. The degree of injury depends on the force exerted and on the range of abnormal motion that is enforced on the ankle. The force could be modified by timely muscle activation, external protection, and reasonable attention to the course or playing ground. Mechanism of injury: A certain lack of clarity surrounds the mechanics of ankle injury and staging. The load to failure of the lateral ligament of the ankle has been measured by various authorities. The ATFL has been shown to be the weakest component of the lateral ligament (Attarian et al. 1985; Siegler et al. 1990). The ATFL ligament has an approximate load to failure of 140 Newtons, the calcaneofibular ligament (CFL) of 350 Newtons, and the posterior talofibular ligament (PTFL) of 260 Newtons (Attarian et al. 1985). Others claim that PTFL is the strongest of the three (Anderson et al. 1954, 1962) and is rarely damaged (Brostrom, 1966), though when it is damaged, the talus dislocates out of the mortis (Anderson et al. 1954, 1962). A simple calculation will show that the combined force of the lateral ligament could not amount to more than 750 - 800 Newtons, which is far less than the force exerted by landing from a half meter jump, and far inferior to the strength of the anterior crucial ligament of the knee. This would probably at least partially explain the extremely high occurrence of this injury, which is repeated in half the population (Coutts & Woodward, 1965) and comprises 16 - 40% of sorts-related injuries. The extent of injury is directly related to the force exerted on the lateral ligament. The force would be reduced when injury occurs while walking on a level surface, and would be amplified by running, jumping, or when an opponent's weight and velocity are exerted on the medial side of the foot, as often occurs in football. Landing on a bump, a stone, or an opponents foot would further enhance both the force and the amount of ligament forced to elongate. The force would be reduced by both the personal muscle contracting and by preventive taping (Jennifer, et al. 2001), bracing (Leaderson & Wredmark, 1995) or a protective shoe (Shapiro et al. 1994). The effect of the brace or shoe would be most apparent as the injury commences and before extreme tilting occurs, as the torque has been shown to increase tenfold as foot inversion proceeds from 7 to 48 degrees. (Ottaviani et al, 1995). Injury management: The majority of the injuries sustained through participation in football do not require hospital attention. Most injuries are to the lower extremities and involve damage to the soft tissue. Any approach to injury rehabilitation must attempt to restore normal function to the extremity in question. The major considerations in the treatment of injuries must be to regain proper range of motion, endurance, and strength. Initial management is aimed at controlling the swelling and pain associated with acute injuries. Ice should be applied to the injured area as soon as possible. Frequent application of the ice throughout the next several days will reduce swelling and allow earlier mobilization of the body part. Compression and elevation during the initial stages of the injury will also reduce the associated swelling. Prevention of injuries in sport has been difficult to carry out, mainly because there has been very little research on the efficacy of preventive measures. Even if there are well substantial studies, the athletic community has not enforced protective rules and the utilization of protective equipment. Tradition, inefficiency and cost seem to be common obstacles fro the implementation of preventive measures. Improving and implementing rules in, for example, international football, may take years. Relative rest should be instituted as an integral part of the rehabilitation program. Relative rest implies refraining from the offending activity while starting an exercise program that will allow strengthening of the musculature surrounding the injured area. As flexibility of the affected are begins to normal, strengthening exercises needs to be initiated. The initial approach emphasizes endurance through low-resistance high-repetition exercises. Non-weight-bearing-exercises (open kinetic chain) may need to be utilized at the onset but, as improvement is seen, weight-bearing exercises (closed kinetic chain) should be added to simulate functional movement. As improvement continues, advancement to sports specific activity is in order. Jogging with slow changes in direction can be started with a progression to sharp turns. Individual work with a ball can then be instituted. As fluidity and ease of movement return, advancement to drill and then to play can be accomplished. The rehabilitation program should be continued beyond the complete return to play to reduce the chance of recurrence. Application of Isokinetics in Rehabilitation process: In most people's minds, an ankle sprain often appears to be trivial because it is quite a common sports injury. However, athletes with sprains often report related residual symptoms. Few surveys conducted in the past reveals that pain and immobility which resulted from an ankle sprain would lead to secondary muscle atrophy, thus muscle weakness is reported by the patients in such type of injuries. This muscle weakness, especially the ankle averter, causes a decrease in dynamic support of the ankle mortise and thus places an ankle joint at risk of recurrent injuries. Injuries are often specific to anatomical location and tissues. These factors also determine the type of clinical care and rehabilitation. The ankle usually heals with conservative treatment. The rehabilitation after ankle ligament injuries is based on both strength training and proprioceptive exercises. An isokinetic velocity training protocol is designed for exercising the injured ankles. The protocol includes a spectrum of velocities for training different types of muscle fibres for enhancing neurological and motor responses. It has been working effectively and successfully in reducing the time of healing in an ankle injury. CONCLUSION: The number of people participating in sports is ever increasing. The physical demands of different sports is also increasing and, thereby, the risk of injury. It will be necessary for the sports world to focus more on prevention and correct clinical care. By understanding the injury mechanisms and the risk for injury, prevention can be made effective. This requires, however, much more support from scientific studies, and for more education in injury prevention and clinical care in sports. Foot and ankle injuries, because they are so common and potentially disabling, are of the utmost importance to those concerned with sports medicine. Understanding the role of certain muscles should encourage preventive strengthening programs. Early and aggressive rehabilitation, stressing functional activities, full restoration of strength, range of motion, perception and endurance, and gradual return to playing field, will serve to minimize disability. Maintaining good physical condition during the rehabilitation process cannot be overemphasized. Finally, appreciating that inadequate treatment often leads to recurrence of injury should cause us to give these injuries our full attention. REFERENCES: Anderson, Clary - The Young Sportsman's Guide to Football - Thomas Nelson & Sons, 1962, reissued 1963 as "Football". Attarian, D.E., McCrackin, H.J., DeVito, D.P., McElhaney, J.H, and Garrett, W.E., Jr., 1985: Biomechanical Characteristics of the Human Ankle Ligaments. The American Orthopedic Foot and Ankle Society, Inc., Foot & Ankle, Vol. 6, No. 2. Boden BP. Kirkendall DT. Garrett WE Jr. Concussion incidence in elite college soccer players. American Journal of Sports Medicine. 26(2):238-41, 1998 Mar-Apr. Brostrom L: Sprained ankles: VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 1966; 132:551-65. Garrett, WE. Sports Medicine in Orthopedic Surgery. American College of Sports Medicine Annual Meeting 2000. Jennifer Shamus & Eric Shamus, 2001: Sports Injury: Prevention & Rehabilitation. McGraw-Hill Professional. Robert A. Ottaviani et al., Basketball Shoe Height and the Maximal Muscular Resistance to Applied Ankle Inversion and Eversion Moments, The American Journal of Sports Medicine, vol. 23, No. 4, (1995), pp. 418-423. Robbins, S. And Waked, E. 1998. Factors associated with ankle injuries: preventative measures. Sports Medicine, 25, (1), 63-70. Siegler, S., Chen, J., and Schneck, C.D., 1990: The Effect of Damage to the Lateral Collateral Ligaments on the Mechanical Characteristics of the Ankle Joint - An In-Vitro Study. Journal of Biomechanical Engineering, Vol. 112, pp. 129-137. Shapiro, M.S., Kabo, J.M., Mitchell, P.W. and Loren, G. 1994. Ankle sprain prophylaxis: an analysis of the stabilizing effect of braces and tape. The American Journal of Sports Medicine, 22, (1), pp. 78-82. Stephen H. Liu et al., Lateral Ankle Sprains and Instability Problems, Clinics in Sports Medicine, vol. 13, No. 4, Oct. 1994, pp. 793-809. Stephen B. Thacker et al., The Prevention of Ankle Sprains in Sports, The American Journal of Sports Medicine, vol. 27, No. 6, (1999), pp. 753-760. Read More