Virginia Tech Hokies

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Virginia Tech Hokies

• Post-Season Ankle Reconditioning
• A Case Study
• Roslynn Weise, ATC

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The Ankles Are Crucial

• Average contact force of 1025 N when the foot
  strikes the soccer ball. (Johannes 2002)
• Soccer players may run a total of 3-5 miles in a
  90 minute soccer game.

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The Injury Report

• 8/24 members had ankle pathology

• 3 acute sprains in season
• 1 high ankle sprain
• 3 cases of true ankle instability
• (2 of 3 impingement injury spurs)
• 2 with no documented injury but lack confidence
  in stability.

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Goals!!!

• 1. reduce the amount of time lost from
  participation

2. reduce the incidence of ankle re-injury
3. regain physical psychological confidence
in the body
4. reduce the dependence on bracing
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Program Design

• 6 weeks in length
• 3 days a week
• (On the opposite two days, the athletes
  completed agility training with the strength and
  conditioning coach.)
• 45 minutes per session.
• January - February

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Strength Agility
Lit Review

• Docherty et al (1998) 4 week band strengthening
  program improved dorsiflexion and eversion
  strength and inversion and plantar-flexion joint
  position sense.

• Hess et al - 4 weeks of agility training
  lead subjects to report feeling more stability.

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Proprioception Balance
Lit Review

• Tropp and Askling (1985) 10-wks of ankle disk
  training improved isokinetic pronator muscle
  strength postural control.
• Gauffin (1988) - ankle disk training decreased
  postural sway, restored pattern for postural
  corrections.
• Wester (1996) - wobble board training after
  partial sprains of the lateral ligaments of the
  ankle resulted in fewer recurrent sprains and
  chronic instability episodes.
• Soderman et al (2000) balance testing reduced
  incidence of re-injury

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ROM
Pre- Post- Testing

• Range of motion and balance were tested prior to,
  and 2 weeks following the end of the training.
• Goniometry
• Functional Screen
• - Squat Test

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Proprioception Balance
Pre- Post- Testing

• Balance tested bilaterally for 15 s. trials
• Ground
• Eyes open
• Eyes closed,
• BOSU
• Eyes open
• Eyes closed

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Range of Motion

• Slant Board
• Knee bent
• Straight
• Foot supinated (Gray)
• The Stepper Backwards
• Retro Walk in the Hydro-Track

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Wobble Board Routine

• progress from
• 2 feet to 1
• eyes open to closed
• moving the ankle in the frontal, and saggital
  planes.

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Speed Agility

• The ladder drills included frontal, saggital, and
  transverse (by incorporating spins and pivots)
  movement through the rungs.

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Multi-Planar Movement

• Jumping jack routine designed by Gray

• This concept worked to enhance the athletes body
  control while challenging the mind and body to
  work beyond routine patterns

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And the results are. . .

• improvements were noted in balance, as the number
  of attempts to regain balance, and step downs
  were reduced.

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Questionnaire

• 7/8 considered ankles stronger since the
  reconditioning program.

All 8 agreed that their ankles felt more stable.
3 felt quicker on their feet, while the others
stated no difference.
3/8 felt more confident playing since the
completion of the program.
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Average Compliance

• self-reported avg. 83.
• Those who tended to state no difference, also
  tended to self-report a lower percentage of
  compliance with the program.

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Happy Endings

• 0 documented ankle sprains for spring
• One individual states that she now feels
  confident and stable enough to play without ankle
  bracing
• The athlete with the high ankle sprain has
  returned to play (and very much a fan of the
  Ultra brace).

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Considerations

• Team is currently practicing on turf not grass
• Fewer Competitions
• less play at high intensity
• It was difficult to validate a loss of balance
  except with a touch down. (Study was not blind,
  and could be biased)

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Further Study

• analyze the difference in balance of soccer
  players that have not had ankle injuries to those
  with ankle instability
• f/u- determine length of effectiveness.

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Evolutionary Ideas

• Contra lateral ankle muscle latency time improves
  with wobble board training.(Osborrne et.al 2002)

• Tactile Stimulation increases speed of
• return to sport (Matsusaka et. Al 2001)

• Orthotics reduce postural sway for those
• with functional ankle instability
• (Hertel J, Gay R, Denegar 2002)

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The End

• Program appears successful
• I may modify, but will continue to use a
  reconditioning program in the future
• Any Questions?