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:

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?
Reviewed by: Jeffrey Driban
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