Sports Medicine Research: In the Lab & In the Field: Ankle Sprains Come into Play Late in the Game (Sports Med Res)

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Tuesday, July 3, 2018

Ankle Sprains Come into Play Late in the Game

Ankle Sprain has Higher Occurrence During the Later Parts of Matches: Systematic Review with Meta-Analysis

De Noronha M, Lay EK, McPhee MR, Mnatzaganian G, Nunes GS. J Sport Rehabil. 2018 May 29:1-25. doi: 10.1123/jsr.2017-0279. [Epub ahead of print]

Take Home Message: An athlete is more likely to develop an ankle sprain later in competition.

Ankle sprains are prevalent injuries in athletics, and although much is known about intrinsic risk factors (for example, decreased dorsiflexion range of motion, impaired balance), there is some debate about which external factors may contribute to ankle sprain injuries. One perspective is that fatigue may increase the risk of injury later in a game, and conversely that an improper warm-up prior to activity may make an athlete more prone to injury earlier during an athletic event. To explore this issue, the authors studied the timing of ankle sprains during athletic competitions by synthesizing current study information through a systematic review of the literature and meta-analysis. The authors searched multiple databases using key words pertaining to ankle sprains, injury incidence, and sports matches. After reviewing 1,142 potential studies, the authors were able to pool information from 8 studies that explored ankle sprain timing during soccer, rugby, futsal, and American and Gaelic football. Game timing was broken up into halves and quarters, and individual sports where multiple studies were available were explored separately. Overall, the authors found that ankle sprains were more likely to occur in the second half of games compared to the first half. Additionally, ankle sprains were more likely to occur in the 2nd, 3rd, or 4th quarters of competition compared to the first quarter, with no difference in risk among the last 3 quarters. These results were consistent among soccer and rugby.

In all, this study solidified that ankle sprains are more likely to occur later in competitions as compared to earlier timepoints. This supports the notion that fatigue plays a role in getting an ankle sprain in athletics. However, it is important to note that fatigue was not directly measured and is not the only component that leads to ankle sprain injuries and that individual characteristics should be considered as well. Additionally, there were only 8 studies that truly evaluated timing of ankle sprains, which is important to consider. However, clinically understanding that fatigue may be a factor is meaningful because those that have other pre-disposing factors related to ankle sprain risk should be monitored more closely as they participate longer in intense activity. Additionally, fatigue may be considered during rehabilitation to target balance and stability in a more taxed state to help prepare for future exposures. In all, ankle sprains have been identified across multiple studies to occur later in competition that may be related to strenuous activity, supporting a role of fatigue as an external risk factor to consider.

Questions for Discussion: How does understanding that fatigue plays a role in ankle sprain risk shape your clinical approach to ankle sprain management? Have you incorporated fatiguing exercises into your rehabilitation plans for athletes with ankle sprains?

Written By: Alexandra F. DeJong
Reviewed By: Jeffrey Driban

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