Athletic Training Service Characteristics for Patients With Ankle Sprains Sustained During High School Athletics

Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain

CONTEXT

Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown.

OBJECTIVES

To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods.

SETTING

Online survey.

DESIGN

Cross-sectional study.

PATIENTS OR OTHER PARTICIPANTS

We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria.

MAIN OUTCOME MEASURE(S)

We distributed an online survey to ATs that asked about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return to activity. Descriptive statistics were used to characterize participant demographics and frequencies of the assessment measures used by ATs. Chi-square analysis was conducted to identify relationships between the demographics and assessment selection.

RESULTS

Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76.2% to 96.7% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25.3% to 35.1% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. Athletic trainers with higher degrees, completion of more advanced educational programs, employment in nontraditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs.

CONCLUSIONS

Before approving return to activity for patients with ankle sprains, ATs did not use some recommended outcomes and assessment methods. Practice in nontraditional settings, more advanced degrees, more clinical experience, and familiarity with expert consensus guidelines appeared to facilitate the use of ROASTs.

Incidence of injury and illness among paediatric Team USA athletes competing in the 2020 Tokyo and 2022 Beijing Olympic and Paralympic Games

Objective

To describe the incidence of injuries and illnesses among paediatric Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games, and the 2022 Beijing Olympic and Paralympic Games.

Methods

An electronic medical record system documented all injuries and illnesses that occurred while competing in the four Games periods. Incidence (IR) with 95% CI per 1000 athlete days were calculated for both injuries and illnesses. Incidence rate ratios (IRR) were calculated to compare injury and illness rates based on age (paediatric vs non-paediatric) sex, Games period and sport type.

Results

Two hundred paediatric athletes (age range, 15-21 years) competed across the four Games periods, representing 16.1% of all Team USA athletes. The overall injury IR (95% CI) was 13.4 (9.8 to 18.1), and the overall illness IR was 5.5 (3.3 to 8.7). There were no differences in incidence between paediatric and non-paediatric athletes for either injury (IRR (95% CI): 0.9 (0.6 to 1.2)) or illness (IRR (95% CI): 0.9 (0.5 to 1.5)). Female paediatric athletes were more likely to sustain an injury compared with male paediatric athletes (IRR (95% CI): 2.4 (1.1 to 5.3)). The most common mechanism of injury was gradual onset (IR, 4.3 (2.3 to 7.2)), and injuries most commonly occurred during practices (IR, 7.0 (4.5 to 10.5)).

Conclusion

Paediatric athletes account for a substantial proportion of Team USA athletes. It is essential that paediatric sports medicine experts are included in the medical team given that paediatric Team USA athletes are just as likely as their adult teammates to sustain an injury or illness.

Acute and Overuse, Time-Loss and Non-Time-Loss Lateral Ankle Sprains and Health Care Utilization in Collegiate Student-Athletes

CONTEXT

Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload.

DESIGN

Descriptive epidemiologic study.

METHODS

Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018-2019 through 2020-2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence.

RESULTS

A total of 1242 lateral ankle sprains were reported over the 3 years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved "ankle lateral ligaments" (45.6%), and very few were attributed to overuse mechanisms (2.4%).

CONCLUSIONS

Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization.

The Epidemiology of Ankle Sprains in US High School Sports, 2011-2012 to 2018-2019 Academic Years

CONTEXT

Continued monitoring of ankle sprain rates and distributions is needed to assess temporal patterns and gauge how changes in incidence may be associated with prevention efforts.

OBJECTIVE

To describe the epidemiology of ankle sprains in 16 US high school sports during the 2011-2012 to 2018-2019 school years.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from high school sports.

PATIENTS OR OTHER PARTICIPANTS

High school athletes who participated in practices and competitions during the 2011-2012 to 2018-2019 school years.

MAIN OUTCOME MEASURE(S)

A convenience sample of high school athletic trainers provided injury and athlete-exposure (AE) data to the National High School Sports-Related Injury Surveillance Study (data provided by High School Reporting Information Online [HS RIO]). Ankle sprain rates per 10 000 AEs with 95% CIs and distributions were calculated. Yearly rates were examined overall and by event type, injury mechanism, and recurrence.

RESULTS

Overall, 9320 ankle sprains were reported (overall rate = 2.95/10 000 AEs; 95% CI = 2.89, 3.01). The highest sport-specific rates were reported in girls' basketball (5.32/10 000 AEs), boys' basketball (5.13/10 000 AEs), girls' soccer (4.96/10 000 AEs), and boys' football (4.55/10 000 AEs). Most ankle sprains occurred during competition (54.3%) and were due to contact with another person (39.5%) or noncontact (35.0%). Also, 14.5% of injuries were recurrent. Across the included academic years, ankle sprain rates generally increased. Compared with the 2011-2012 academic year, rates in the 2018-2019 academic year overall were 22% higher; noncontact-related and recurrent ankle sprain rates also generally increased by 91% and 29%, respectively.

CONCLUSIONS

Time trends suggested that ankle sprain rates have increased across the past decade, particularly among those with noncontact-related mechanisms, contrasting with previous research that indicated decreases in incidence. These findings may pinpoint specific etiologic factors that should direct prevention efforts, including considering both person-contact and noncontact mechanisms by mitigating illegal contact through rule changes and enforcement, as well as bracing and proprioceptive and balance-training programs.

Epidemiology of overuse injuries in U.S. secondary school athletics from 2014-2015 to 2018-2019 using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program

CONTEXT

With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports.

OBJECTIVE

To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from 211 high schools (345 individual years of high school data).

PATIENTS OR OTHER PARTICIPANTS

Athletes participating in secondary school-sponsored boys' and girls' sports.

MAIN OUTCOME MEASURES

Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014-2015 to 2018-2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

RESULTS

The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8).

CONCLUSIONS

Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers.

OBJECTIVE

To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries.

DESIGN

Descriptive study.

SETTING

Ninety-five athletic training facilities across 24 states.

PATIENTS OR OTHER PARTICIPANTS

A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1).

MAIN OUTCOME MEASURE(S)

Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care.

RESULTS

A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit.

CONCLUSIONS

Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

Characteristics of Injuries Occurring During Cross-Country: A Report from the Athletic Training Practice-Based Research Network

CONTEXT

Cross-country is a popular sport activity, particularly in adolescent populations. Although epidemiologic investigations have provided insight into patient and injury characteristics associated with running injuries, little is known about how these injuries are managed at the point of care.

OBJECTIVE

To describe injury and treatment characteristics of injuries sustained during cross-country.

DESIGN

Cross-sectional study.

SETTING

High school athletic training clinics within the Athletic Training Practice-Based Research Network.

PATIENTS OR OTHER PARTICIPANTS

Patient cases were included if the patient was diagnosed with an injury that occurred during interscholastic cross-country participation. All patients received usual care by an athletic trainer.

MAIN OUTCOME MEASURE(S)

We used summary statistics to describe injury (sex, age, participation level, time of injury, mechanism of injury, body part, injury type, diagnosis) and treatment (type, amount, duration, number of services) characteristics.

RESULTS

Most cross-country injuries occurred to the lower extremity and were musculotendinous or ligamentous in nature. The most common injury types were sprain/strain (43.8%), tendinopathy (18.5%), and general pain (9.5%). Injured body parts and diagnoses were typically similar between sexes. The most frequently used treatment was therapeutic exercises or activities (28.7%), and patients received an average of 7.4 ± 17.4 total athletic training services during 5.5 ± 15.1 episodes of care over 27.8 ± 87.5 days.

CONCLUSIONS

Adolescent cross-country student-athletes frequently sustained non-time-loss injuries that required up to 1 month of treatment and management. These findings will generate awareness surrounding the role of athletic trainers in providing care for cross-country athletes.

The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability

CONTEXT

Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control.

OBJECTIVE

To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain.

DESIGN

Retrospective cohort.

SETTING

Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation.

INTERVENTION(S)

Self-reported attendance or not of supervised rehabilitation at the time of initial injury.

MAIN OUTCOME MEASURES

Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral.

RESULTS

Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior-posterior direction (P = .030), and higher TTB anterior-posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation.

CONCLUSIONS

Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.

Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs

CONTEXT

Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear.

OBJECTIVE

To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques.

DATA COLLECTION AND ANALYSIS

Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness.

RESULTS

The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice.

CONCLUSIONS

Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.

Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence

CONTEXT

Health care leaders have recommended the use of health information technology to improve the quality of patient care. In athletic training, using informatics, such as electronic medical records (EMRs), would support practice-based decisions about patient care. However, athletic trainers (ATs) may lack the knowledge to effectively participate in point-of-care clinical research using EMRs.

OBJECTIVES

To discuss the role of EMRs in athletic training and identify methodologic approaches to conducting clinical research at the point of care.

DESCRIPTION

The 2020 Commission on Accreditation of Athletic Training Education curricular content standards included the use of an electronic patient record to document care, mitigate error, and support decision making through the collection and use of patient data (Standard 64). Patient data are collected by ATs at the point of care via routine documentation, and these data can be used to answer clinical questions about their practice. Observational or descriptive study designs are ideal for this type of data. Observational research (ie, case-control, cross-sectional, cohort studies) evaluates factors that influence patients' lives in the "real world," whereas descriptive research (ie, case study or series, descriptive epidemiology studies) identifies characteristics of individuals and groups. If ATs are comprehensively documenting patient care using an EMR, they have the means to participate in observational and descriptive research.

CLINICAL AND RESEARCH ADVANTAGES

Using an EMR to its full capacity allows ATs to collect meaningful data at the point of care, conduct practice-based research, and improve health care for the patient and clinician. However, to ensure data quality, these approaches must include routine and comprehensive documentation habits.

Sport-Specific Associations of Specialization and Sex With Overuse Injury in Youth Athletes

BACKGROUND

Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport.

HYPOTHESES

Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year.

RESULTS

A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes.

CONCLUSION

Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization.

CLINICAL RELEVANCE

Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.

Access to Athletic Trainer Services in California Secondary Schools

CONTEXT

California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies.

OBJECTIVE

To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Representatives of 1270 California high schools.

MAIN OUTCOME MEASURE(S)

Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch.

RESULTS

More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values < .001).

CONCLUSIONS

With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.

Medications Used in U.S. Emergency Departments for an Ankle Sprain: An Analysis of the National Hospital Ambulatory Medical Care Survey

BACKGROUND

An ankle sprain is a common musculoskeletal injury treated in the emergency department. Rest, ice, compression, and elevation is the preferred method for managing the symptoms after an ankle sprain. However, many patients receive a medication, such as a nonsteroidal anti-inflammatory drug (NSAID) or an opioid.

OBJECTIVES

We sought to quantify the type of medication(s) used for an ankle sprain and to examine those across age and sex.

METHODS

This was a retrospective review of the publicly available data collected through the National Hospital Ambulatory Medical Care Survey from 2006-2015. All cases with an isolated diagnosis of an ankle sprain were identified. Medication listed for each case was classified based on its detailed category and further explored across all 10 years, age, and sex.

RESULTS

An estimated 9,052,678 ankle sprain visits occurred in emergency departments from 2006-2015. NSAIDs (56.1%) and opioid analgesic combination (28.4%) were the 2 most common medications. Regardless of the type, most medications were prescribed at discharge. The use of NSAIDs appears to have increased while opioid analgesic combinations decreased in 2010. NSAIDs were the most common medication identified with each age cohort; however, there was no apparent trend in medication for sex.

CONCLUSIONS

NSAIDs are the most common medication used for ankle sprain visits to the ED. Nevertheless, an opioid is also used at a relatively high rate for this injury. These findings provide awareness and opportunity to focus on strategies for reduction of opioid use.

A 14-Day Recovery and Physical Activity Levels After an Ankle Sprain in Mice

CONTEXT

Research is needed to find ways of improving physical activity after a lateral ankle sprain.

OBJECTIVE

To investigate the effects of a prolonged rest period on lifelong activity after a surgically induced ankle sprain.

DESIGN

Controlled laboratory study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 male CBA/J mice (age at surgery = 7 weeks).

MAIN OUTCOME MEASURE(S)

We transected the anterior talofibular ligament and calcaneofibular ligament of the right hindlimb. Each mouse was placed in a separate cage and randomized into 1 of 3 groups of 6 mice each. A running wheel was placed in each cage at 3 days, 7 days, or 14 days after surgery. Physical activity was measured daily. Daily duration (ie, time spent on the wheel), distance, and running speed were examined using analysis of variance (group × age) with repeated measures at 15-week periods to approximate the first 3 quartiles of the lifespan.

RESULTS

From weeks 3 to 15 after surgery, we observed no differences in duration, distance, or running speed among groups (P > .05). From weeks 16 to 30, distance (F_2,14 = 0.57, P = .041) and running speed (F_2,14 = 0.93, P = .01) were greater in the 14-day group than in the 3- and 7-day groups. From weeks 31 to 45, duration (F_2,14 = 0.74, P = .02), distance (F_2,14 = 0.95, P = .009), and running speed (F_2,14 = 1.05, P = .007) were greater in the 14-day group than in the 3- and 7-day groups.

CONCLUSIONS

Our findings suggest that the longer recovery period of 14 days can increase activity levels throughout the lifespan after a severe ankle sprain. Rest after an ankle injury is critical to restoring physical activity levels across the lifespan. Rest and time away from exercise after an ankle sprain may be necessary to restore physical activity to normal, uninjured levels.

Functional performance tests identify lateral ankle sprain risk: A prospective pilot study in adolescent soccer players

Determining the clinical utility of functional performance tests (FPTs) and establishing cutoff scores could be useful in identifying those athletes who could benefit from effective injury prevention interventions. Our purpose was to determine the accuracy of FPTs in identifying adolescent athletes who go on to experience lateral ankle sprain(s) and establish specific cutoff scores capable of identifying those who sustain a lateral ankle sprain in the near future. Sixty-four participants (age = 15.5 ± 1.3 years; height = 161.7 ± 7.7 cm; mass = 57.1 ± 8.4 kg) were recruited from a junior soccer club and tracked for 10 months. Participants performed the anterior (AN), posterior-medial (PM), and posterior-lateral (PL) reach directions of the Star Excursion Balance Test (SEBT) and the Single-Leg Hop Test (SLHT) in pre-season, and then were followed for the 10-month competitive season (12 injured, 52 uninjured). Significant Area Under the Curve (AUC) values and cutoff scores were found for the PM (AUC = 0.78; 95% CI 0.61-0.95; P = 0.003; Sn = 0.83; Sp = 0.77; cutoff = 76%) and the PL (AUC = 0.82; 95% CI 0.71-0.94; P = 0.001; Sn = 0.92; Sp = 0.65; cutoff = 70%) reach directions of the SEBT and the SLHT (AUC = 0.77; 95% CI 0.60-0.95; P = 0.003; Sn = 0.67; Sp = 0.94; cutoff = 15.4 seconds). The PM and PL reach directions of the SEBT and the SLHT may be useful as pre-season screening measures to help clinicians identify adolescents who will go on to experience a lateral ankle sprain.