Synthesis Paper Final-Revised
Synthesis Paper Final-Revised
Synthesis Paper Final-Revised
Sasser
IR 1/Period 3/11 AP
03/07/2017
The Efficiency of a Proprioceptive Training Program for Sprained Ankles to Decrease Risk of
An average of 23,000 ankle sprains happen every single day (Hayman 32). When the
number is presented solitarily, it may be hard to believe. However, when compared to the fact
that only 4,000 more vehicular accidents occur each day (How Many 1), the importance of
ankle injuries becomes more striking. Teenage athletes who are recovering from ankle injuries
should recognize the impact of the injury, the importance of rehabilitation, and the risk of
ongoing conditions. One measure that is extremely important to ankle injury patients is the usage
of a physical therapy program for neuromuscular strength training. An ankle sprain is very
common for teenagersathletes and non-athletes alike. The most common cause of an ankle
sprain occurrence is extreme inversion and plantar flexion, usually affecting the lateral ankle
complex. The lateral ankle complex is composed of three ligaments: the anterior talofibular, the
Ankle sprains have a range of severity, and can be classified under Grade I, II, or III. The
severity of the sprain is determined by the amount of damage done to the ligaments and tendons
in the ankle joint. A first grade or first degree sprain is when the tendons and ligaments in the
ankle joint have been stretched to the point of uncomfort but not torn. Symptoms includes mild
pain, some swelling, mild joint stiffness, and some difficulty jogging or running (Choo). Second
degree sprains are the most common among not only teenage patients but adult patients as well.
In a second degree sprain, the ligaments are stretched and partially torn. There is significant
swelling on the ankle, as well as significant bruising. There is a moderate amount of pain when
pressure is applied to the affected foot, and the patient has trouble walking (Choo). A third
degree sprain is the most severe of the three degrees. In a third degree sprain, the ligament has
been severed completely. Common symptoms of this level of sprain include severe swelling,
severe pain, instability of the joint, extreme loss of motion, and walking can be very painful
(Choo).
The patient will receive an initial diagnosis by a doctor following the initial sprain, which
includes a general mobility test, and sometimes an x-ray or MRI, if the doctor has reason to
believe that a higher degree sprain has occurred. The patient will be prescribed a brace and a
physical therapy regimen. The grade, or degree, that the ankle sprain was classified under will
determine the intensity of the treatment program. If more damage was incurred, the intensity will
increase. While the intensity may fluctuate, it is important to note that the nature of the
rehabilitation program is not altered. The neuromuscular training program for the rehabilitation
of ankle sprains is used concurrently for the prevention of a recurring ankle sprain. This training
aim to prevent further health impairment of patients with acute lateral ankle injuries and meant
for all care providers who are involved in the treatment and guidance of patients with ankle
injuries (Mailuhu et al. 2). The effects of acute ankle injuries do not stop after the athlete returns
to play. If the ankle had not healed properly, there are a few repercussions that the athlete should
keep in mind. However, these repercussions may be prevented or at least lessened if the athlete
keeps up with their physical therapy as prescribed by their doctor, and the exercises they should
complete on their own. In a study conducted at the School of Public Health in Ireland by Doherty
et al., it was found that 40% of patients studied reported chronic ankle instability a year
following the study (Doherty 5). Furthermore, every subsequent ankle injury further increased
Figure 1.1
Ankle injuries are one of the leading injuries in all ages alike, including teenage athletes,
adult athletes, and non-athletes. Ankle injuries are the most common sports injury in high school
athletes, accounting for roughly 22.6% of all high school sports-related injuries (Nelson et al.
383). The patterns of sports-related injury vary slightly by sport, age, and type of athletic
exposure, but one fact remains consistent: Nearly 20,00,000 injuries occur yearly in organized
high school athletics, and the ankle is the most commonly reported site of injury (Nelson 381).
Figure 1.1 (Nelson) presents the breakdown of the occurrence of injury in 7 different sports and
two genders Overall, girls had an ankle injury rate that was similar to boys. It is already known
that ankle injuries are the leading type of injuries for the general population. This knowledge can
be applied to warn athletes and non-athletes to take special precaution when dealing with ankle
injuries. Before an injury even happens, the patient should be thinking of preventative measures.
It is important to care for the ankles because there are many facets of the additional benefits to
the remainder of the body and well-being of the athlete. One facet is improved balance. Since
balance and joint stability mutually depend on sensory input from peripheral receptors, balance
can be interpreted as a function of joint stability. Being a joint of the lower extremity in close
proximity to the body's base of support, the ankle plays an integral role in maintaining balance.
Thus, the stability of the ankle joint is paramount when considering regulation of balance
sprain patient. The completion of such a program can have many additional benefits to the
patient, aside from the standard goal of healing the ankle, so that he or she may return to normal
activity.
Foremost, a neuromuscular training program will allow the patient to train their ankle
back to normal abilities in a shorter period of time then if the patient were to simply wait out the
injury until it felt functional to them. Manual therapy, such as the exercises presented in a
neuromuscular training program, have been proven to have beneficial effects following acute and
subacute ankle injuries involving the complete gradient of sprain severity. A study by Lin et al.
proved that manual therapy also increased ankle function up to 1 month following the
treatment (Lin et al. 23). This study corroborates multiple others in that they all prove
neuromuscular training programs to hasten the recovery time of an acute ankle injury, much to
the athletes benefit. A neuromuscular training program, in addition to the immediate healing of
the ankle, has numerous short-term and long-term effects on the patients ankle and their general
health.
A short-term facet that a neuromuscular training program would remedy is the patients
balance. Balance and the stability of joints depends on the input created by peripheral receptors.
Thus, balance can be interpreted as a result of joint stability. As the ankle is a joint in the lower
extremity of the body and very proximal to the bodys base of support, it likely plays a pivotal
role in the ability of a patient to balance themselves (Blackburn et al. 316). Thus, the health of
the ankle may be directly correlational to the bodys overall ability to balance. In a study by
Karakaya et al., it was found that proprioceptive training for the ankle, including stretching,
strengthening, and balance board exercises during two weeks, causedsignificant improvements
than no intervention (3301). Evidently, the usage of a proprioceptive training program has more
benefits to the athlete than just the ankles health and wellbeing.
Furthermore, the usage of a neuromuscular training program has long term benefits on
the ankle sprain patient. The primary facet that patients want to avoid is chronic ankle instability.
It was found that 32-74 percent of individuals with a previous lateral ankle sprain history suffer
from chronic symptoms, such as chronic ankle instability (Evidence review 5). The majority of
patients with a lateral ankle sprain history will sustain at least one additional sprain, with many
developing physical and subjective functional limitations, with ongoing giving-way in the
affected ankle, resulting in the defined condition of chronic ankle instability (2016 consensus
1). It is crucial that the athlete takes certain preventative measures in an attempt to decrease their
risk of concurrent lateral ankle sprains, which will require a higher expenditure of time and
injured ankle. A training program will decrease the risk of re-injury by lessening chronic ankle
instability, and will maintain the athletes balance abilities post-sprain. Additionally, the training
program will allow the sprained ankle to heal more properly and faster than if the patient were to
heal the ankle on its own. While a training program should be properly implemented, it is up for
While examining the patterns and trends of society and teenage athletes, the means over
which the training program is presented would be most effective when presented as an
application. Applications are more readily available and more whole-heartedly embraced by the
Some may advocate for the old-fashioned method of implementing this training program,
However, this packet must be carried to the location of wherever the patient wishes to complete
their exercises. An application would be accessible on a mobile phone, a laptop, tablet, or any
other electronic device which are compatible with applications. Therefore, the training program
may be easily carried with the athlete wherever they find themselves at the time that they wish to
complete their training program. Furthermore, an application, such as the one used in a study by
papercopyincludedonlypicturesoftheexercisesthatneededtobeperformed(2).This
featurewouldbeahugebenefittothepatientifthepictureshappentobeconfusingornot
understandableatfirst.Inthatcase,thepatientmayquicklyaccessavideowithfurther
explanations.
Anapplication,throughtheimplementationonadevicesuchasasmartphone,ismore
widelyaccessibletothegeneralpublicthanahardcopybookletwouldbe.Thisbookletwould
primarilybedistributedbythephysicaltherapistoffice,sothepatientmustvisitthe
establishmentonsitetoreceiveacopy.Ontheotherhand,theapplicationwouldbeeasily
downloadedfromawebsiteorapplicationstore.Therefore,itmaybeaccessedatanytimethe
patientdeemsitnecessary,withouttheabsoluteneedofvisitingaphysicaltherapisteachtime
theyneedtheexercises.
Theapplicationwouldalsohavemanycostbenefitsovertheusageofapaperbooklet.
Asidefromtheindirectcostsofpurchasingandmaintainanelectronicdevice,thedirectcostsfor
theelectronicapplicationwouldbenoneforthepatient.Ontheotherhand,apapercopywould
beexpensivetoprintoutnumerouscopiesforeachindividualpatient.Furthermore,distributinga
papercopyrequirethepatienttovisitaphysicaltherapistoffice.AstudybytheUSConsumer
ProductsSafetyCommissionestimatedthatin2003alonethedirectmedicalcostoftreating
anklesprainsinhighschoolsoccerandbasketballplayers(ages1518years)was$70million,
andtheindirectcostswere$1.1billion(McGuineetal.1103).Thepriceforemergencyroom
andphysicianvisitsforsprainedanklesisseverelyhigh,whichisamajorfactorthatworksasa
deterrenttoyoungathleteswouldwanttohaveadoctorassesstheirsuspectedsprain.An
applicationwouldridthesecosts,andwouldbeaccessibletotheathletewithoutanactual
prescription.
However,ifanathleteweretovisitadoctorandrequireaprescribedneuromuscular
trainingprogram,anapplicationwouldbearevolutionarywayforthedoctortokeepthepatient
uptodate.Afeatureofanapplicationwouldbethatitmaybeupdatedinrealtime.Thisallows
thedoctortogetmessagesacrosstopatientsinstantaneously,andadoctorcouldalsotailorthe
generaltrainingprogramtofitapatientsspecificneeds.Physicianswouldwanttheirtreatment
toseemasuptodateastheypossiblycan,asthisisafactorthatpatientsconsiderwhenchoosing
theirdoctor.ThetechnologicaladvancementsinthemedicalfieldsuchaseHealth,definedby
Verhagenetal.asthepracticeofmedicineandpublichealthsupportedbyelectronicprocesses
andcommunication(1),couldleadtoanincreaseinpatientsforphysicians,conveyingthatthe
benefitofanapplicationwouldnotonlyapplytothepatientsbuttothephysicaltherapistsas
well.
Thecompiledresultsindicatethatthecompliancyratestoasupervisedphysicaltraining
programarerelativelylow.Thismisfortunetothemedicalfieldisaccompaniedwiththefalse
perceptionthatlateralankleinjuriesareminorinjuries,andmaybehealedwithouttheproper
usageofaneuromusculartrainingprogram.Thefalseperceptionmustbecounteredwiththe
knowledgethataneuromusculartrainingprogramhasmultiplefacetsofbenefitsforthepatient.
Includedamongthesefacetsareimprovedbalance,decreasedriskofreinjuryandchronicankle
instability,andahastenedrecoverytimeandreturntotraining.Theimplementationofatraining
programpresentedonanapplicationwouldsurelybethemostbeneficialmediumofwhichto
presenttheneuromusculartrainingprogram.Theapplicationwouldbetailorabletotheneedsof
theathleteandthephysician,asitmaybeupdatedbythephysicianinstantaneously.
Furthermore,thecostbenefitsoftheapplicationaretremendous;itcouldpossiblycutoutclose
to$70millionspentonthedirectcostsofvisitinganemergencyroomforalateralanklesprain.
Applications,whencomparedtoahardcopypaperbookletofexercises,ismuchmoreaccessible
tothegeneralpublic,asmanypeoplehaselectronicdevicesandarethereforeabletoparticipate
intherevolutionizingtechnologyofeHealth.
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