Ankle sprain is most common GAA injury
September 18, 2009
Dr Pat O Neill and Dr Robert Patrella
Ankle sprain is the most common injury in Gaelic football and hurling with recurrence rate of up to 50% according to former Dublin player and manager Dr. Pat O'Neill.
Ankle sprains are frequently mistreated or not treated at all often resulting in recurring sprains, long term symptoms of discomfort and in extreme cases, chronic instability of the ankle joint and other joints in the body, according to Dr. Robert J Petrella of the University of Western Ontario, Canada speaking to Irish sports doctors at the Sixth Scientific Conference of the Faculty of Sports & Exercise Medicine at the Royal College of Surgeons, Dublin on 17th & 18th September.
Ankle injuries are one of the most common acute musculoskeletal injuries and account for 45% of such injuries in any given population. 85% of ankle injuries are sprains and they are especially common in the sporting population with more than 70% incidence. Ankle injury is particularly prevalent in sports involving a change of direction, running or jumping with high incidences in gaelic football and hurling as well as other sports including basketball, rugby, football, soccer, field hockey and racquetball. In such cases, the foot lands in an awkward position resulting in the stretching of the ankle ligaments, which are responsible for holding or hinging joints together.
Prompt diagnosis of ankle sprain by a sports physician is important and depending on the number of ligaments affected by the sprain, time taken to recovery is case dependent but can take up to six weeks. Approximately 85% of ankle injuries involve either tearing or complete rupture of the lateral ligaments which are those on the outside of the ankle. Ligaments attach bone to bone and when torn, pain, swelling & discomfort are the predominant symptoms. Recurrence of ankle sprain is very common with a recurrence rate of more than 40%, in basketball more than 60 to 80% have had multiple sprains. An estimated 50 to 60% of sports persons with ankle sprains do not seek professional treatment.
Former Senior All Ireland Football Championship medal winner and manager for Dublin, Dr. Pat O'Neill , who is also a Consultant in Orthopaedic and Sports Medicine and a member of the Faculty of Sports & Exercise Medicine believes that inadequate rehabilitation time is given to ankle injuries. Dr. O'Neill said "Ankle sprain is the most common injury in gaelic football and hurling and it has a very high recurrence rate - up to 50%. There is incredible pressure on players today to go back onto the pitch before such injuries have properly healed, particularly at peak or end of the competitive season. This, coupled with intense and frequent training schedule can lead to acute musculoskeletal problems including recurrent instability of the ankle joint and secondary bone damage.
"Of course, prevention is also very important and appropriate precautions should be taken to avoid injury, for example on artificial or semi-artificial surfaces such as we have today, footwear needs to be adequate to prevent injury and players with previous injuries should have adequate foot and ankle support," said Dr. O'Neill.
This view is echoed by Dr. Philip E Carolan, Sports & Exercise Medicine Physician, Dean of the Faculty of Sports & Exercise Medicine and is Team Doctor to the Cavan Senior and Under 21 Teams. Said Dr. Carolan, "Gaelic football, my own sport, is a high intensity, high fielding and multidirectional sport which contains all the risk factors for ankle sprain. It is my opinion that a lot of athletes who have had previous sprains and received no treatment, either prehabilitation or rehabilitation and progress onto a higher level of training experience recurring injury. Moving forward, we need to develop screening mechanisms, provide adequate examination and treatment and address the area of prehabilitation and rehabilitation for athletes. In the GAA, we are aware that the greatest risk of ankle injury is related to the mechanism of landing and therefore, we also need to look at footwear along with landing and body movement strategies to help prevent injuries."
RICE (Rest, Ice, Compression, Elevation) is the standard therapy as well as medication for pain relief and physiotherapy to help strengthen the ligaments and muscles. RICE can reduce pain and swelling but has no effect on recovery time and often drugs used for pain relief have unwanted side effects.
Dr. Petrella will present the findings of recently published research into the long-term efficacy of Hyaluronic Acid (HA) in acute ankle sprain. HA is a naturally occurring substance administered by injection which has been adapted and designed specifically to interact optimally with soft tissue such as ligaments. When injected into the injury site, HA reacts rapidly and efficiently with the torn ligament and acts as a support, binding the torn ligament fibres together. HA is now available in Ireland for the treatment of acute ankle sprain.
Petrella's research, recently published in The Physician & Sports Medicine shows that the use of HA in conjunction with RICE therapy helps accelerate recovery after ankle sprain with fewer days missing from sport and fewer recurrent ankle sprains (up to 50%) two years after initial injury. Previous short-term research with HA also reported less pain with weight bearing and walking.
Concluded Dr. Petrella, "In sports, coaches often tend to think 'its just another sprain', tape up the ankle, ice it and the player is back on the pitch in a matter of days. There is currently no consensus or optimal therapy for improving recovery from ankle sprain. The current standard treatment with pain killers and RICE does not reduce the recurrence of ankle sprain, has no impact on recovery time and over-use of NSAIDs for pain relief can have unwanted systemic side effects. However, the impact of ankle sprain is in fact of considerable concern to long term function and performance of athletes beyond the acute event and the current approach to the treatment of ankle sprain could now benefit from newer targeted interventions."
For further information on the treatment, go to
www.sportvis.ie
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