1. Professional Assignment Project Treatment of acute ankle sprains of Turkish professional volleyball players: a comparison with the KNGF ankle guidelines. by Alpaslan Erdem Ruben Groenendijk Simon Train

2. Introduction into the subject Relevance Methods Results Conclusion Discussion Questions Overview

3. Introduction: Where does the interest come from? Volleyball background Turkey (personal/professional background) -Injury/ 16 years/ connections

4. Turkish league Physiotherapists role International success Popularity, broadcasting, budget Volleyball in Turkey

5. Number of universities Master and PhD programs Education in English Doctor of physiotherapy Education of physiotherapy in Turkey

6. Intensive training Types of injuries High risk of injuries Incidence 2.6 injuries per 1000 hours during playing time 4.1 injuries per 1000 hours during competition (Verhagen et al. 2003) Full time work and risks

7. Incidence of injuries

8. Attacking Blocking Jumping is crucial Mechanism of injury

9. In professional level About the ball..... Maximum explosive jumping Game Mechanics

10. http://www.youtube.com/watch?v=ht92OE9qv5Q&NR=1 http://www.youtube.com/watch?v=-3r-0t9jKtk

11. For physiotherapists in general In sports For us !! Relevance

12. Creation Translation Online (GoogleDOCs+Surveymonkey) Pilot (construct and content validity) Final adjustments Start of survey Reminder after 1 week Reminder after 2 weeks Results Procedure

13. What methods did we use?

14. Based on the KNGF ankle sprain guidelines (van der Wees J et al, 2006) Background Assessment Treatment (main outcome) Prevention The Questionnaire

15. Types of Questions Graded Questions (table 0-4) Phases of healing (KNGF table 1-5) Composition

16. KNGF phases of healing

17. KNGF phases/ goals/ interventions

18. Types of questions

19. Sample size/ target group Total teams in Turkish League (N=20) Teams interested in taking part in the survey (N=11) Completed the survey (N=9)

20. Results

21. Background: Main outcomes

22. Assessment: Main outcomes 88.8% of physiotherapists do an initial assessment (n=8) History: mechanism of injury + functional impairments (+ pain) Main tools are MRI and Talar tilt test Guidelines used= no!

23. When do they play again?

25. Phase 1: Inflammation 0-3 days Intervention RICE Taping Compression bandages EPM Goals Reduction of pain and swelling

26. Phase 2: Proliferation 4-10 days Intervention Main Active ROM exercises Taping Cold EPM Manual therapy Sub Exercise (3.0 SD1.22) Goals Main Functional recovery Increase of ROM Sub Pain+swelling (-) Increase of proprioception

27. Phase 3: early remodelling 11-21 days Intervention Main Exercise therapy Manual therapy Sub Active ROM Goals Increase proprioception Strength and stability Weight bearing ROM

28. Phase 4: Late remodelling 3-6 weeks Intervention Main Exercise Therapy Sub Taping Manual Therapy Goals Strength Proprioception Functional recovery Stability Weight bearing

29. Phase 5: Transfer stage 6-12 weeks Intervention Main Exercise Therapy Sub Active ROM exercises Goals Strength GBF Joint stability

30. Osteopathic manipulations (1-5) Heparin packs (1-2) Balance and proprioception exercises(1-2) Water exercises (2) Gait education (2) Isokinetic exercises (cybex norm) (4) Other reported interventions

31. 88.8% (n=8) perform prevention programs Proprioception + balance exercises (4.0 SD 0.0) Strength training Prevention: Main outcomes

32. Turkish physiotherapists roughly follow guidelines Except EPM and MLD in early stages Conclusion

33. KNGF followers? EPM MLD MRI and talar tilt test Prevention Combination of treatments Discussion

34. Time Reliability First time questionnaire Translation Low sample size? Seasonal factors Limitations

35. Looking into the effects of combinations of treatments More specific views on each phase KNGF is ok!...... key message......

36. First of all we want to thank our Coach Mel Major, for all her help who took the greatest part in this project with her feedback. Antonio Tomē del Olmo for being our client and giving us guidance for this project. To the participants in Turkey who were patient enough to complete the whole questionnaire. To Suna Gokturk who did all our translations from English to Turkish and to her work as external adviser. Dr. Özge Cinar and Dr. Tyra Inderwies who added many ideas that we could make it and motivated us with their great feedback. We personally thank Jose Hermans, Rob Oskam and Vasiliki Folia for taking the time to analyse our survey and giving us feedback as external advisers. Thank you....

37. Any Questions???