Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury

The Use of Model Matching Video Analysis and Computational Simulation to Study the Ankle Sprain Injury Mechanism

Lateral ankle sprains continue to be the most common injury sustained by athletes and create an annual healthcare burden of over $4 billion in the U.S. alone. Foot inversion is suspected in these cases, but the mechanism of injury remains unclear. While kinematics and kinetics data are crucial in understanding the injury mechanisms, ligament behaviour measures - such as ligament strains - are viewed as the potential causal factors of ankle sprains. This review article demonstrates a novel methodology that integrates model matching video analyses with computational simulations in order to investigate injury-producing events for a better understanding of such injury mechanisms. In particular, ankle joint kinematics from actual injury incidents were deduced by model matching video analyses and then input into a generic computational model based on rigid bone surfaces and deformable ligaments of the ankle so as to investigate the ligament strains that accompany these sprain injuries. These techniques may have the potential for guiding ankle sprain prevention strategies and targeted rehabilitation therapies

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201 600 patients were included, with 32 509 ankle injuries. Ankle injury information was available from 14 098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports. © 2007 Adis Data Information BV. All rights reserved.link_to_subscribed_fulltex

In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review

Introduction: In-shoe pressure thresholds play an increasingly important role in the prevention of diabetes-related foot ulceration (DFU). The evidence of their effectiveness, methodological consistency and scope for refinement are the subject of this review. Methods: 1107 records were identified (after duplicate removal) based on a search of five databases for studies which applied a specific in-shoe pressure threshold to reduce the risk of ulceration. 37 full text studies were assessed for eligibility of which 21 were included. Results: Five in-shoe pressure thresholds were identified, which are employed to reduce the risk of diabetes-related foot ulceration: a mean peak pressure threshold of 200 kPa used in conjunction with a 25% baseline reduction target; a sustained pressure threshold of 35 mm Hg, a threshold matrix based on risk, shoe size and foot region, and a 40–80% baseline pressure reduction target. The effectiveness of the latter two thresholds have not been assessed yet and the evidence for the effectiveness of the other in-shoe pressure thresholds is limited, based only on two RCTs and two cohort studies. Conclusions: The heterogeneity of current measures precludes meta-analysis and further research and methodological standardisation is required to facilitate ready comparison and the further development of these pressure thresholds

Surf Lifesaving Injuries in New Zealand Between 2009 to 2018 Derived From the Surf Life Saving New Zealand Injury Reporting Database: Technical Report #2 to Surf Life Saving New Zealand (SLSNZ)

Background: Incident Report Forms (IRFs) are routinely completed by lifeguard patrols and include all incidents attended to by lifeguards in their supervision of beaches including rescue, search, and first aid activity. According to SLSNZ internal injury reports, increased use of IRBs in New Zealand may have resulted in an increase in injury incidences. However, the details surrounding these injuries were not provided in the internal reports. Purpose: To analyse the SLSNZ database from 2009 to 2018 to identify injury sites, types, and mechanisms of IRB‐related injuries occurring to surf life savers and reported to SLSNZ. Methods: A retrospective analysis of the SLSNZ injury database for 2009 to 2018 was conducted. Results: In total, there were 253 (female: 100/253, 39.5%; male: 153/253, 60.5%) IRB‐related injury cases reported to SLSNZ from 2009 to 2018. More reported surf lifesaving incidents occurred during patrol (155/253) than competition (12/253). Overall, most injuries to surf lifesavers were lower extremity injuries (131/253, 51.8%). The most reported injury types from 2009 to 2018 were “unclear” (86/253, 34.0%) followed by lacerations (65/253, 25.7%). Overall, the most reported injury mechanism from treatment note free text analysis was “landing” (females: 21/100, 21.0%; males: 25/153, 16.3%) defined by the authors as “landing inside the IRB after going airborne while the IRB was in the water”. Discussion: Injury prevention initiatives should be focused on areas of high injury frequency such as the landings after becoming airborne. The mechanisms for the lower extremity injuries needs to be clearly identified. As lacerations were most frequent the first aid kits will need adequate supplies such as steristrips. Staff first aid training should focus on lower limb fracture, ankle sprain, and laceration, first response treatment. SLSNZ would benefit from investigating the reporting rates of surf life savers and member mindset surrounding incident reporting, particularly in cases involving IRBs, as there was clear underreporting of injuries given feedback from SLSNZ staff on the results in this report. Conclusions: The SLSNZ injury database likely provides an underestimation of the number of injuries resulting from the use of IRBs during patrol and competition. Lower limb and back injuries were frequent. Landing after becoming airborne while the IRB was in the water was a common cause of injury.Surf Life Saving New Zealand (SLSNZ

The epidemiology and natural history of depressive disorders in primary care

Ref no. SMH-27Conference Theme: Improving Health and Recognising ExcellencePoster Presentation - Mental Health: no. Ab10BACKGROUND: Depressive disorders are commonly managed in primary care and primary care clinicians are ideally placed to serve as central providers to these patients. Around the world, the …link_to_OA_fulltex

Surf Life Saving Injuries in New Zealand Between 2013 to 2017 Derived From Accident Compensation Corporation Claims: Technical Report #4 to Surf Life Saving New Zealand (SLSNZ)

Background: Due to their speed and manoeuvrability, inflatable rescue boats (IRB) were thought to be associated with increased risk of injury by Surf Life Saving New Zealand (SLSNZ). Purpose: This study aimed to quantify the nature and extent of IRB‐related injury as reported to the Accident Compensation Corporation (ACC) in order to develop injury prevention strategies. Methods: A total of 956 moderate‐to‐serious injury (MSC) claims filed with the Accident Compensation Corporation (ACC) from 2013 to 2017 were retrospectively analysed to provide epidemiological data and related costs. The “sequence of injury prevention” approach proposed by van Mechelen, Hlobil [1] was utilised to identify risk factors, causes, and mechanisms in order to prescribe injury prevention strategies. Results: IRBs accounted for 605 (63.3%) MSC claims for surf lifesaving, costing ACC $875,585. The incidence of injury (IR) from 2013 to 2017 was 103 per 1,000 surf lifesavers; an average of 0.41 IRB‐related claims lodged per day. The most frequently injured body sites were the lower back (IR: 20/1000) and ankle (IR: 14/1000). Cause of injury was reported as landing in the IRB (IR: 23/1000). Utilisation of IRBs during surf lifesaving has a risk of injury to the lower extremities and back, particularly in younger females and to the right side of the body. Gender was statistically related to age of injury; incidence of injury for males over the age of 60 was 318 per 1,000 lifesavers. Discussion: The nature of the injury mechanisms may contribute to the development of chronic symptoms. Results are most likely an underestimate due to crude incidence rates. Future research should evaluate current techniques, as well as consider strength intervention strategies in preventing IRB‐related injuries. Conclusion: IRB‐related ACC claims lodged for surf lifesaving per‐day are high. Targeted injury prevention strategies must focus on lower back and ankle injuries.Surf Life Saving New Zealand (SLSNZ