Athletic Training Service
Characteristics for Patients with Ankle Sprains Sustained During High School
Athletics
Simon JE,
Wikstrom EA, Grooms DR, Docherty CL, Dompier TP, Kerr ZY. J Athl Train.
2018;53(1):000–000, doi:
10.4085/1062-6050-449-16.
Take
Home Message:
High school athletic trainers commonly
treat ankle sprains with therapeutic exercise and neuromuscular reeducation,
with an increased number of services for athletes with time-loss ankle sprains.
Ankle
sprains are prevalent among high school athletes and there is plentiful
information on incidence and common factors associated with ankle sprains.
However, less is known on how these athletes are treated by healthcare
professionals. Thus, the authors conducted an analysis of the National Athletic
Treatment, Injury, and Outcomes Network (
NATION)
data to determine what services were provided to high school athletes with
time-loss and non-time-loss ankle sprains during 3 school years (2011-2014). Time-loss
injuries were defined as injuries that prevented athletes from participating in
activities for longer than 24 hours, and non-time-loss injuries were less than
24 hours. These injuries occurred during school-related sporting activities and
were evaluated by a healthcare professional. Athletic trainers working at 147
high schools across 26 states and for 27 sports (13 boys’ sports, 14 girls’
sports) electronically recorded information about ankle injuries. They provided
information on injury specifics (site, mechanism, diagnosis, severity, sport,
event, playing surface) as well as the number of athletic training facility visits
and services provided for each case. The authors calculated the average number
of athletic training facility visits per ankle sprain and average number of
services per ankle sprain for time-loss and non-time-loss injuries. The high
school athletic trainers recorded 3213 ankle sprains and 19,925 athletic
training facility visits. Football players accounted for the most ankle sprains
(27%) and athletic training facility visits (35%). The highest incidence among female
sports was in soccer. Most (65%) ankle sprains were non-time-loss and comprised
most of the athletic training facility visits. On average, there were 6
athletic training facility visits per ankle sprain, with a higher rate for
time-loss injuries (10 vs 5 visits on average). The typical patient with an
ankle sprain received ~22 services per sprain (time-loss: 35, non-time-loss:
19). The most common services were therapeutic exercise (e.g., range of motion
and tubing strength, isotonic strength) and neuromuscular reeducation
(proprioception with devices) were the most common services provided, followed
by strapping (taping), modalities, and evaluation or reevaluation.
These
results provide insight into the allocation of resources and burden of high
school ankle sprain injuries on athletic trainers and other medical
professionals working with this population. Athletic trainers provide multiple
types and numbers of services for athletes with ankle sprains, regardless of
time lost due to injury. They often provided evidence-based treatments, like therapeutic
exercises and neuromuscular reeducation. However, the authors noted that
athletic trainers should consider using manual therapy and therapeutic exercise
since they are also supported by research. It is unknown how allocation of
resources differed based on the hired status of the athletic training staff at
different schools (assistantships, outreach, full-time, part-time) which would
be interesting to consider. The authors acknowledged that the database may be
limited if some injuries or injury details were missed (e.g. athlete never
reported a sprain). Additionally, total length of time lost from ankle sprain
injuries as well as injury recurrence were not taken into consideration. However,
this information is extremely important for better understanding how different
ankle sprains are handled and treated in this at-risk population. This also can
help identify what elements of care for ankle sprains in high school athletics
may be lacking, and inform future recommendations and planning for athletic
trainers in this setting. Furthermore, it would be interesting to see which
services would be reimbursed if insurance companies covered athletic trainers
and thus impact clinical practice. In all, both time-loss and non–time-loss
ankle sprains in high school athletes lead to a considerable number of athletic
training facility visits and healthcare services. It may be advantageous to encourage
greater use of therapeutic exercises and manual therapy.
Questions
for Discussion:
If you currently or have worked in a
high school setting, what other services do/did you incorporate into practice
that you would recommend to other healthcare professionals? How do you think
this information could be disseminated in a helpful way to inform patients and
coaches about ankle sprain injury burden?
Written by: Alexandra F. DeJong
Reviewed by:
Jeffrey Driban
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