| Dear Sports Professional, We are always receiving requests from physios for advice on how to best treat ankles (it's the most common sports injury), so we have put together a case study analysis to fill this important gap in knowledge. Read the extracts below - I think you'll find them as revealing and useful as I did. To give you an idea of the content, read this extract from Olympic sports physiotherapist Mark Alexander's Masterclass on managing ankle sprain: "This regime has been used in elite sport for years but hasn't entered into mainstream injury management protocols. I have even had success with this technique on chronic swollen ankles that had been sprained four to six weeks previously. After one to two sessions the swelling was minimal and range of movement improved dramatically." Mark's Masterclass shows how to manage a nasty ankle sprain immediately after it happens. Apparently, the reason this technique hasn't entered into mainstream injury management protocols is simple: It's uncomfortable! (but it works): | "I have seen athletes on crutches after sustaining diagnosed Grade 2 2+ ankle sprains who were able to walk without crutches with only a minimal limp after their first session of this therapy, and who were back training after three to four days (obviously with a lot of tape support)." |
The ankle injury Masterclass is just one example from A Case Study Guide to Ankle Injuries. The report has just been published and is only available from Sports Injury Bulletin. Yours sincerely, 
Jonathan Pye
Editor, Sports Injury Bulletin Free: A Case Study Guide to Ankle Injuries Your free guide to ankle injuries is worth US $19.97 and contains case studies on: - An innocuous inversion sprain of the ankle that was taking too long to heal.
- Achilles tendon pain that was pointing therapists in the wrong direction.
- A series of inversion injuries stabilised by reconstruction.
- How to trick the brain and muscles to rapidly restore normal function.
- Chronic iliotibial band (ITB) problems with repeated ankle sprains on both legs.
Click on any link in this message to see the list of benefits you receive. Treating and rebuilding the ankle after injury Sports injury professionals will be familiar with what happens after an ankle sprain: internal bleeding, inflammatory processes, pain and swelling. The brain also gets involved, producing muscle inhibition and a reduction in proprioception, which usually forces the injured athlete to limp in an effort to reduce pain. Few athletes have not suffered from a hurt ankle at some time or another in their career – it's the most common sports injury. For athletes, physios and coaches, sprained ankles are double trouble. They can be extremely painful and often curtail training and competing at key times of the year. After recovery the ankle is weaker than normal and therefore at a higher risk of sustaining another sprain and even more serious ankle injury. The case studies show how, although devastating to the athlete, with expert investigation and treatment each can be resolved satisfactorily – and much faster than expected. You'll find A Case Study Guide to Ankle Injuries a constant resource you can refer to. 6 big benefits for sports professionals Click on any link in this message to see what you receive when you take out a free trial to Sports Injury Bulletin. With our special deal for sports professionals you receive: - Our latest report: A Case Study Guide to Ankle Injuries.
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We have arranged this special offer so you can try out the 'Gold Membership' section of our website and download any or all of our injury treatment reports to check over. Click on any link in this message to see the list of benefits you receive. Meanwhile, here's more about your free ankle injury report. Ankle injury case studies from the online centre of sports medicine In this special report, we asked our experts to provide case studies showing investigations, diagnosis and techniques for resolving various ankle injuries. The overall objective is to minimise swelling and pain, maximise recovery speed and give protection for the future. Our expert contributors are: Mark Alexander: sports physiotherapist to the Olympic Australian triathlon team, coordinator of the Master of sports physiotherapy degree at Latrobe University Melbourne | David Joyce: sports physiotherapist for Premiership Rugby and Olympics, now with Galatasaray FC, teaching masters degree in sports physiotherapy at the University of Bath | Scott Smith: Australian physiotherapist at Albany Creek Sports Injury Clinic specialising in running and golf injuries, working with Australian Rules football teams | Sean Fyfe: strength and conditioning coach for the Tennis Australia National High Performance Academy, operates his own sports physiotherapy clinic | Lauren Young: is doing her foundation training as a physician at the Whittington Hospital and Watford General Hospital in the UK. Her main interests are emergency medicine and sports injuries. |
To give you a flavour of the articles contained in the case study report, I have summarised some of the problems and solutions below (you'll need to download the report for full diagnosis and treatment details): Case study one: an innocuous inversion sprain that was taking too long to heal Scott Smith writes: Fraser is a promising young Australian Rules football player who had sustained an innocuous inversion sprain of the ankle. I saw him quite soon after the incident and it looked as though the rehabilitation process would be short and straightforward. As it turned out, I got it completely wrong. He was sent to see a sports physician who thought that the young footballer should adopt a 'wait and see' approach. Six weeks later Fraser still could not hop on the leg pain-free. He still had swelling over the ATFL, but had full range of motion with no laxity in any of the supporting ligaments. My treatment? I tried a posterior glide of the fibula at the lateral malleolus. I also mobilised the head of the fibula, which was very stiff. I taped the fibula in a posterior direction, and Fraser was able to hop pain-free for the first time in 19 weeks. It was a miracle. Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. Case study two: Achilles tendon pain that was pointing therapists in the wrong direction Diana's foot pain was pointing her therapists in the wrong direction. David Joyce unravelled the mystery. This is a case of mistaken identity of a reasonably well known complication following ankle sprains. It took a bit of sleuthing and experimentation to get to the bottom of it and shows the tricky nature of some pathologies, stubbornly refusing to obey the text books! A couple of months ago, Diana, one of the world's best taekwondo athletes, was experiencing a sudden sharp pain at the back of her ankle that could seriously jeopardise her medal chances at the next Olympics. Diana's case was baffling: she experienced intense pain when she forced her ankle into the extreme of plantar flexion when kicking a pad or body armour. Other physios had assumed it was a tendinopathy and prescribed the standard heel drop programme, but these made it worse. Following our treatment, Diana is now back in full training with her ankles strapped to reduce the plantar flexion moment on the ankle, thereby reducing the posterior compression. Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. Case study three: a series of inversion injuries stabilised by reconstruction Lauren Young had inverted her left ankle, resulting in weeks of rehabilitation. While walking across a campsite in the dark one night she twisted her right ankle too. There was no fracture, but the ATFL was probably ruptured. Over the next three years Lauren sustained a series of further inversion injuries to her left ankle. With each incident she was taking longer to recover. Lauren's consultant opted to reconstruct her left lateral ankle ligaments, removing the inflamed soft tissue that was causing anterolateral impingement and also had loose cartilage removed to prevent further chondral damage. On the right ankle, she had arthroscopy to remove soft tissue causing anterior impingement and resection of Bassett's ligament. One week post-surgery, Lauren is recovering and is fully weight-bearing on her right side: | "I didn't know ankles could be stabilised by reconstruction, so I hadn't considered it a possibility and didn't push for MRI scans. If I knew chronic instability could be treated, surgical intervention could have been considered earlier, to prevent such extensive ligament damage." |
Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. Case study four: how to trick the brain and muscles to rapidly restore normal function This Masterclass by Mark Alexander explains how to manage a nasty ankle sprain immediately after it happens. The regime outlined below has been used in elite sport for years but hasn't entered into mainstream injury management protocols. The reason is simple: it is extremely uncomfortable! "But it works: I have seen athletes on crutches after sustaining diagnosed Grade 2 2+ ankle sprains who were able to walk without crutches with only a minimal limp after their first session of this therapy, and who were back training after three to four days (obviously with a lot of tape support)." By numbing the ankle and tricking the brain into allowing the ankle to move through a normal range of movement without pain, we can minimise the detrimental effects of ankle sprains. The 25-minute cryo-kinetic ice bath regime: by icing the ankle in an ice bath, strictly following the protocol we outline in the report, you will be able to: - Limit the bleeding by reducing the micro-circulation.
- Trick the brain and muscles into thinking that the ankle isn't that badly injured.
- Restore normal function more rapidly.
In elite sport, injured athletes ice late at night and early morning to minimise swelling and maximise recovery speed. | "I have even had success with this technique on chronic swollen ankles that had been sprained four to six weeks previously. After one to two sessions the swelling was minimal and range of movement improved dramatically." |
Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. Case study five: chronic iliotibial band (ITB) problems with repeated ankle sprains on both legs Some treatment outcomes make you feel you've made a massive difference to someone's life! Our patient, Mel, is a mountain runner and much of her week revolves around training, getting ready for the long run at the weekend, and ultimately the big competition. She was struggling with repeated ankle sprains on both legs and chronic iliotibial band (ITB) problems on both sides. Although these are clearly two different issues, they are not entirely separate, as we shall see. Mel had: - Chronic ATFL laxity
- ITB friction syndrome confirmed by MRI
- Poor proprioception
- Poor gluteus maximus and medius function
- Anterior and lateral tightness
The immediate aim was to stop her rolling her ankles, to prevent long-term joint damage and, importantly, to decrease the risk of a serious acute ankle injury. The solution was simple: we needed to retrain Mel's proprioception. As Mel didn't want to stop running we had to prioritise proprioception, to try and improve this before she suffered a serious ankle injury. We started with low-level balance exercises, and progressed this to increasing the time and height of the heel raises and single-leg balancing while throwing a ball. We further progressed to single-leg knee bends, hopping drills, hopping then holding balance on the ball of the foot. As Mel improved, we were able to introduce external devices to overload the proprioceptive system. Extra repetitions had the added benefit of helping her more rapidly hard-wire the beneficial motor patterns. She started running again, with the pain improving and still no rolling of the ankles. Gradually, as she got better the pain started to disappear and she began running pain-free – which she hadn't been able to do for 12 months. Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. Instantly accessible resource: worldwide research into prevention and treatment of sports injury Our latest report on ankle injuries is waiting for you to download - and it's just one example of what you receive in this huge bundle of reports. If you have ever wished for a world centre of excellence for sports injury treatment, here it is. Sports Injury Bulletin is the market-leading resource packed into one, instantly accessible website. The leading authority in this field, Sports Injury Bulletin provides a point-by-point summary of the latest advances in injury prevention and treatment, with practical systems to apply. These findings are not available to the general public, but are published and delivered to your inbox 10 times a year. You also receive regular new downloads at our exclusive 'Gold Membership' section of our web site. Information includes new and unorthodox treatments from top exercise physiologists covering the complete spectrum of rehabilitation. Note: you can access these training programmes and tips from anywhere – all you need is internet access to download to your computer or portable reading device. Here are more examples of the areas we cover: - Shoulder
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Click on any link in this message to see the list of benefits you receive with this special offer from Sports Injury Bulletin. How to keep ahead of important advances Sports Injury Bulletin was first launched because progressive new research revealed that many of the techniques and exercise used to treat injury are out of date. The latest advances, however, were not filtering through to athletes. We decided that tackling that dangerous knowledge divide was vital. There was another problem: by overlooking or ignoring old injury or weaknesses, athletes could never achieve maximal performances. We decided on a three part strategy for all advice we publish: diagnosis; treatment and prevention – rebuilding the weak points that hold athletes back. Our mission is simple: to show how, by replacing out-dated regimes, our members can: - Discover the different causes of injury and how to treat them
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How we keep costs low: it would prohibitively expensive for one person to subscribe to the hundreds of scientific journals in which sports research is reviewed and evaluated; to speak to the specialist therapists and coaches who put it into practice. But you'll find it all available here in Sports Injury Bulletin, translated into quickly digestible articles. It's all here today on special offer: With this special offer you receive Sports Injury Bulletin Gold Membership today for the nominal sum of just US $9.97 / GB £6.10. To take out your trial, click on the link below. Please note this special offer is only available when you apply via this message. You'll receive, by return, access to these downloads: - A Case Study Guide to Ankle Injuries
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