1. EPIDEMIOLOGY
Approx 14% of all sports injuries are Sprains to the ankle (6 per 100 per season)
In high risk sports (jumping/running) % is even higher at 25% of all lost time. (Mack,1975; Shneider & Sieber, 1987)
Ankle sprain has been shown to be 2.4 times more common in dominant leg and a high 73% recurrence. (Yeung et al; 1994)

2. ANATOMY Two joints? True ankle joint is composed of 3 bones.
TIBIA – medial part FIBULA – lateral part
TALUS – underneath D/P motion of foot
SUBTALAR JOINT – consists of TALUS on top of CALCANEUS IN/EV motion foot

3. LIGAMENTS Can be divided into LATER & MEDIAL
Lateral consists of 3 parts;
Anterior talofibular - Connects Fibula/Talus
Calcaneofibular- F/C gives lateral stability
Posterior talofibular – F/Talus
Medial or Deltoid consists 4 parts – strong fan shaped extending from medial malleolus to navicular and talus.

4. LATERAL

5. MEDIAL

6. STABILITY
In weight bearing position, the main stability is from the bony structures
Anterior talofibular ligament is the key ligamentous structure; Plantar Flexed most vulnerable however, its shared with Calcaneofibular ligament while neutral.
Peroneous Longus & Brevis are the major dynamic stabilisers.

7. CONTRIBUTING FACTORS Previous ankle injury Low profile boots
Narrow/long cleats or studs
Generalised ligamentous laxity
Weak Peroni muscles
Tight Achilles Tendon

8. CHRONIC SPRAINS Poor postural habits
Insufficient strength in musculature.
Gradual ballistic stretching e.g..Ballet
Team game players – 10years participation X-ray = evidence of degenerative changes.

9. INVERSION V EVERSION Majority of injuries = lateral side however;
Wrestlers have high incidence of Medial ligament strain probably due to wider stance
Soccer etc, produce eversion sprain via Hyperplantar flexion sprain (Pulled or Fallen on by player)

10. INVERSION ANKLE SPRAIN

11. TREATMENT
P.R.I.C.E.D
Remove the player from the surrounding area to prevent further trauma if safe to do so.
R – Take the player carefully and sit/lie in a comfortable position keep them warm and reassure at all times.

12. ICE
Apply ice to the injured area for at least 10 minutes. Every 2 waking hours.
This will have the following affect:
Minimise swelling and bruising and pain.
How local blood vessels constricted so blow flow to the area reduced.
Also helps to slow the release of chemicals that cause pain and inflammation.
Reduces the ability of the nerve endings to conduct impulses.

13. Skin Never apply ice directly – ice burn
Will pass through four stages;
cold
Burning
Aching
Numbness – as soon as the skin feels numb take ice off.

14. COMPRESSION Gentle pressure by surrounding area.
Check circulation by squeezing the nail beds (toes)
Compression bandage should be reapplied after 24 hours in order to maintain its function.
Above reduces blood flow, helps to control swelling by decreasing fluid that could seeo in from nearby tissue

15. ELEVATION Put leg in a raised position above the level of the heart.
This will help minimise swelling and bruising at the injury site.
How? By again reducing blood flow to the injured area.

16. SALTAPS See/Stop Ask Look Touch Active movements Passive movements
Strength
Stop the above at the appropriate section if your player has a serious injury.