Ankle Sprain has Higher
Occurrence During the Later Parts of Matches: Systematic Review with
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
An athlete is more
likely to develop an ankle sprain later in competition.
sprains are prevalent injuries in athletics, and although much is known about intrinsic risk factors (for example, decreased dorsiflexion range of motion, impaired
, 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
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.
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
By: Jeffrey Driban