Thursday, October 29, 2009

Training around the injury

Much thanks to Dr. Phillip Gribble, PHD-ATC from U. Toledo for sharing some of his unpublished manuscript that was presented at the International ankle symposium in Australia this past summer.


He compared a "traditional" ankle rehab program (that focused in on the ankle) with one that focused on the hip & knee. The hip/knee program contained half functional (SLS variations) & half open chain supine (SLR's et al). His conclusion was:

"Proximal joint rehabilitation may be as effective, or more effective
than traditional ankle rehabilitation, for improving dynamic postural
control in subjects with CAI."

Along the same lines, some researchers from Ireland (Coughlan et al) in their study came to the conclusion,

"that a 4-week dynamic lower limb training program resulted in no significant changes in the ankle position or velocity during treadmill walking, jogging, and running. This study raises issues regarding the methods of ankle sprain rehabilitation and the measurement of their effectiveness in improving functional activities. "

Kind of sounds like when I say "rehab the athlete, not the injury", no?

Now I need you opinion. In other research, Dr. Gribble found that CAI subjects had less glute max activity in a same side rotational SLS at the point of maximal excursion than the control group. Any ideas why?


JH said...

Yes, same myotome.

When at Camp Lejeune working wioth the Marines (here he goes again) we had a female marine with CAI and was on her way out the door. We used total body functional exercises to teach her how to avoid ankle sprains even when her ankle was in the process of inverting. Normally she would take her center of mass (COM) away from the direction of the ankle sprain. We were able to effectively teach her to take her COM toward the direction of the inverting ankle. She came back months later and told us how she successfully has avoided ankle sprains due to her knew skill.

Garrett said...

Hi Joe - thanks for giving my article a plug - my academic career just went up a few notches amongst my colleagues here in Ireland that I made it onto Joes!!!

We wanted to measure the effects of training on a functional weight bearing activity i.e. gait - many studies have reported improvements in static balance, proprioception and isokinetic strength in non - functional positions which are not applicable to a clinical situation - if we cannot restore or improve strength, coordination and control of the functional pattern which led to the initial injury it is unlikely to improve, hence why we see initial ankle sprains develop chronic ankle instability (CAI) in 30-70% of cases depending on the sport. Mc Keon et al (2009) have reported similar findings following a 4 week SLS balance training program in CAI subjects. We are obviously still missing the vital cog in the wheel for rehabilitating ankle sprains. My guess would be that as highlighted by Dr. Gribble, we need to focus not only on the ankle but also huge emphasis on the proximal musculature/joints and the coordination of movement between the shank and rearfoot.

One of the other major findings which emerged at the IAS4 conference is the responses to initial injury i.e. those that develop CAI and those who don't - following the conference I would imagine that CAI studies will attempt to sub classify their subjects in order to assess why some reinjure or not which may give us all a clearer explanation as to why it all happens.