Strengthening exercise and motor control among football players with ankle sprain: A scoping review.

INTRODUCTION: The ankles and feet of footballers are the most commonly affected areas by acute and chronic injuries, especially sprains. The durability of changes in motor control for the sprained injury strongly suggests that central motor commands have been reorganized and restructured involving the sensorimotor system. Indirectly, providing strength training improves muscular strength and benefits cardiometabolic health, coordination, sensorimotor, and motor performance. Thus, this study aimed to identify the effects of strengthening exercises on motor control among footballers with sprained ankles. MATERIALS AND METHODS: This scoping review selected studies published from January 2002 to November 2022. The articles were searched through PubMed Central, BMJ Journal, Science Direct, and Scopus using "motor control", "ankle sprain" and "strengthening exercise" as the keywords. After finding the articles, the information extracted included author, year of publication, country, objective, type of study, and motor control analysis summary. The literature search strategy used Preferred Reporting Items for Systematic Review and a meta-analysis (PRISMA) where studies that are related to strengthening exercise and motor control were selected. RESULTS: From the initial search, 50 articles were found. After processing, only ten articles were further reviewed. The findings demonstrated strengthening exercises provide changes in neurophysiological parameters with motor performance, improved motor control, strength, balance, pain, and functional movement in footballers with sprained ankles. CONCLUSION: This review suggests the application of strengthening exercise interventions not only improves motor control, but strength, balance, pain, and functional performance among footballers with sprained ankles.

Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of preventive interventions for lateral ankle sprain in the general population. DATA SOURCES: A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022. REVIEW METHODS: Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies. RESULTS: Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss. CONCLUSION: Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.

Extended Knee Control programme lowers weekly hamstring, knee and ankle injury prevalence compared with an adductor strength programme or self-selected injury prevention exercises in adolescent and adult amateur football players: a two-armed cluster-randomised trial with an additional comparison arm.

OBJECTIVE: To evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using a self-selected IPEP in amateur adolescent and adult male and female football players. METHODS: Two-armed cluster-randomised trial with an additional non-randomised arm. All 251 amateur teams (players 14-46 years) in one regional football district were approached. Teams meeting inclusion criteria were randomised to (1) extended Knee Control or (2) an adductor strength programme. Teams already using an IPEP were allocated to a comparison group and received no new intervention. Players responded to weekly questionnaires about football exposures and injuries during a 7-month season. RESULTS: Seventeen teams in the extended Knee Control, 12 in the adductor and 17 in the comparison group participated, with 502 players. For the primary outcomes, no difference in injury incidence in three lower-limb injury locations combined (hamstring, knee and ankle) was seen between extended Knee Control and the adductor group, whereas extended Knee Control had 29% lower incidence than the comparison group (incidence rate ratio 0.71, 95% CI 0.52 to 0.98). No between-group differences in groin injury incidence were seen. The weekly injury prevalence rates in the three lower limb locations combined (hamstring, knee and ankle) were 17% lower (prevalence rate ratio (PRR) 0.83, 95% CI 0.69 to 1.00) and 26% lower (PRR 0.74, 95% CI 0.63 to 0.87) in extended Knee Control compared with the adductor and comparison groups, respectively. CONCLUSION: No difference in injury incidence was seen between the extended Knee Control and the adductor programme whereas extended Knee Control reduced injury incidence by nearly one-third compared with a self-selected IPEP. Players in extended Knee Control had lower injury prevalence compared with an adductor or self-selected IPEP. TRIAL REGISTRATION NUMBER: NCT04272047; Clinical trials.

Most amateur football teams do not implement essential components of neuromuscular training to prevent anterior cruciate ligament injuries and lateral ankle sprains.

PURPOSE: Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT. METHODS: A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used. RESULTS: A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it. CONCLUSION: Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football. LEVEL OF EVIDENCE: II.

Does the Spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries.

BACKGROUND: Lateral ankle sprains are common in indoor sports. High shoe-surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes. METHODS: In this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or 'do-as-usual'. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented. RESULTS: 480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino. CONCLUSION: Compared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms. TRIAL REGISTRATION NUMBER: NCT03311490.

Isokinetic ankle eversion and inversion strength profiling of female ballet dancers.

Ankle injuries are highly prevalent in ballet, with strength highlighted as a primary risk factor. To profile ankle strength, fourteen female ballet dancers (age: 19.29 ± 1.59 years) completed an isokinetic testing protocol comprising concentric eversion (CONEV) and inversion (CONINV), and, eccentric inversion (ECCINV) trials at four angular velocities (30° · s-1, 60° · s-1, 90° · s-1, 120° · s-1) for both the dominant and non-dominant limb. In addition to Peak Torque (PT) and the corresponding Dynamic Control Ratios (DCRs), angle-specific derivatives of strength (AST) and Functional Range (FR) were calculated. There was no evidence of any significant bilateral strength asymmetry (p = 0.90) across all metrics, and no significant interactions with limb and contraction mode or velocity. A significant main effect for contraction mode (p = 0.001) highlighted greater ECCINV strength - which was maintained with increasing isokinetic velocity - in contrast to reductions in CONEV and CONINV strength. Specifically, dancers are ECCINV dominant at angular velocities greater than 60° · s-1, which is likely to be characteristic of most functional tasks. The lack of bilateral asymmetry may be attributed to dance training interventions that facilitate bilateral development, but ipsilateral mode and velocity-specific asymmetries have implications for injury risk and the training needs of female ballet dancers.

Delayed peroneal muscle reaction time in male amateur footballers during a simulated prolonged football protocol.

Peroneal muscle fatigue could result in ankle inversion sprain injuries. This study investigated the peroneal muscle reaction time during a simulated prolonged football protocol. Nine male footballers completed a 105-minute simulated prolonged football protocol. The peroneal muscle reaction time to an ankle inversion perturbation was measured every 15 minutes by a surface electromyography system sampling at 1000 Hz. One-way repeated ANOVA with post-hoc paired t-test showed a steady upward trend starting from 48.9 ms at baseline to 57.1 ms at the end of the first half, followed by a recovery back to 50.9 ms at the start of the second half and a further delay in the last 30 minutes to 60.2 ms at the end of the protocol. Delayed peroneal muscle reaction was found after 30 minutes of the first half and 15 minutes of the second half of a football match. The risk of ankle sprain could increase in the latter minutes in each half protocol. Thus, prevention injury training strategies should focus on these specific durations in football matches.

Shoe collar height and heel counter-stiffness for shoe cushioning and joint stability in landing.

This study examined the effects of shoe collar-height and counter-stiffness on ground reaction force (GRF), ankle and knee mechanics in landing. Eighteen university basketball players performed drop landing when wearing shoes in different collar height (high vs. low) and counter-stiffness (stiffer vs. less stiff). Biomechanical variables were measured with force platform and motion capturing systems. Two-way repeated measures ANOVA was performed with α = 0.05. Wearing high collar shoes exhibited smaller peak ankle dorsiflexion and total sagittal RoM, peak knee extension moment, but larger peak knee varus moment than the low collar shoes. Stiffer counter-stiffness shoes related to smaller ankle inversion at touchdown and total coronal RoM, but larger peak knee flexion and increased total ankle and knee sagittal RoM than the less stiff counter-stiffness. Furthermore, wearing stiffer counter-stiffness shoes increased forefoot GRF peak at high collar condition, while no significant differences between counter-stiffness at low collar condition. These results suggest that although higher collar height and/or stiffness heel counter used can reduce ankle motion in coronal plane, it would increase the motion and loading at knee joint, which is susceptible to knee injuries. These findings could be insightful for training and footwear development in basketball.

Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures.

BACKGROUND: Lateral ankle injuries are one of the most common musculoskeletal injuries sustained by pediatric and adolescent athletes. These injuries can result in significant time lost from competition, affect performance when returning to play, and represent a significant burden on the health care system as a whole. The purpose of this study was to systematically review the literature on the diagnosis, treatment, and prevention of acute lateral ankle injuries and their chronic effects in pediatric and adolescent athletes (younger than 19 y). METHODS: This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines between September and December 2018. PubMed and Google Scholar were systematically searched using the search terms: ("distal fibula fracture" OR "ankle sprain") AND ("youth" OR "pediatric" OR "adolescent"). All authors participated in article review (N=172) for relevance and age restrictions in which 30 met the inclusion criteria. RESULTS: Thirty articles met inclusion criteria [Levels of Evidence I to IV (I: n=4, II: n=16, III: n=9, and IV: n=1)] including distal fibula fracture diagnosis and treatment, and risk factors, prevention, and chronic sequela of lateral ankle injuries in pediatric and adolescent patients. CONCLUSIONS: Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and minimize the effect of acute lateral ankle injuries. LEVELS OF EVIDENCE: Level III-Systematic review.

Effectiveness of Novel Ankle Prophylactic Compared With Lace-Up Brace or Tape.

CONTEXT: Conventional ankle prophylactics restrict harmful ankle inversion motions that lead to injury. But these existing prophylactics also limit other ankle motions, potentially leading to detriments in functional joint capacity. The ankle roll guard (ARG) may alleviate the prevailing issues of existing ankle prophylactics and prevent harmful ankle inversion, while allowing other joint motions. OBJECTIVE: This technical report sought to compare the ARG's ability to prevent ankle inversion, but not restrict other ankle motions with existing prophylactics. DESIGN: Repeated-measures study. SETTING: Motion capture laboratory. PARTICIPANTS: Thirty participants. INTERVENTION: Each participant had dominant limb ankle kinematics recorded during 5 successful trials of a sudden inversion event and 30-cm drop landing task with each of 4 conditions (ARG, ASO ankle stabilizer [brace], closed-basket weave athletic tape [tape], and unbraced [control]). MAIN OUTCOME MEASURES: Peak ankle inversion angle, range of inversion motion (ROM), and time to peak inversion during the sudden inversion event, and ankle plantar- and dorsiflexion ROM during the drop landing were submitted to a 1-way repeated-measures analysis of variance to test the main effect of prophylaxis. RESULTS: Participants exhibited greater inversion ROM with control compared with tape (P = .001), and greater plantar- and dorsiflexion ROM with ARG and control compared with brace (P = .02, P = .001) and tape (P = .02, P < .001). It took significantly longer to reach peak ankle inversion with brace and tape compared with ARG (P < .001, P = .001) and control (P = .01, P = .01). No significant difference in peak ankle inversion was observed between any condition (P > .05). CONCLUSION: The ARG may prevent ankle inversion angles where injury is thought to occur (reportedly >41°), but is less restrictive than existing prophylactics. The less restrictive ARG may make its use ideal during rehabilitation as it allows ankle plantar- and dorsiflexion motions, while preventing inversion related to injury.

Acute Effects of Gastrocnemius/Soleus Self-Myofascial Release Versus Dynamic Stretching on Closed-Chain Dorsiflexion.

CONTEXT: Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy. OBJECTIVE: The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF. DESIGN: Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05. SETTING: A convenience sample study. PARTICIPANTS: A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate. INTERVENTIONS: Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques. MAIN OUTCOME MEASURES: Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96). RESULTS: Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7) cm, 0.700 (0.7) cm, and 0.907 (1.4) cm, respectively. CONCLUSION: Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.

Acute Effect of Ankle Kinesio and Athletic Taping on Ankle Range of Motion During Various Agility Tests in Athletes With Chronic Ankle Sprain.

BACKGROUND: Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility. AIM: To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions. METHODS: Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5-0-5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system. RESULTS: In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5-0-5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests. CONCLUSION: In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM.

Foot injuries, playing surface and shoe design: Should we be thinking more about injury prevention.

The increasing use of artificial pitches has occurred in a multitude of sports at both professional and amateur levels. Artificial turf has become an extremely attractive option as it is felt to encourage a faster, safer and more entertaining play. However these pitches are not without controversy among sporting professionals and in the media. Foot and ankle injury in sport remains incredibly common and a significant burden on health professionals, but what impact do the new artificial surfaces have on these injuries. This review article aims to establish whether artificial turf has an impact on injury rates in the foot and ankle.

Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis.

OBJECTIVES: To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION: Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS: Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS: Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.

The preventive effect of a soccer-specific ankle brace on acute lateral ankle sprains in girls amateur soccer players: study protocol of a cluster-randomised controlled trial.

BACKGROUND: Acute lateral ankle sprains are the single most often diagnosed injury in female soccer players and often result in an inability to play. This highlights the need for effective prevention strategies. Proprioceptive training and/or the use of an external support to decrease inversion of the ankle joint can prevent or reduce the number of acute lateral ankle sprains. The effectiveness of a soccer-specific ankle brace in reducing first-time and recurrent acute lateral ankle sprains has never been investigated in girl soccer players. If effective, ankle braces could be introduced into soccer. STUDY DESIGN: Cluster-randomised controlled trial. METHODS: Girl amateur soccer players (aged 14-18 years) will be allocated to an intervention or control group. The intervention group will be instructed to wear soccer-specific ankle braces on both ankles during soccer training and matches; the control group will continue playing soccer as usual. Primary outcomes are the incidence and severity of acute lateral ankle sprains. Secondary outcomes are the prognostic value of generalised joint hypermobility and functional stability on the risk of acute lateral ankle sprains and compliance with the intervention. DISCUSSION: The findings from this study may provide evidence to support the use of a soccer-specific ankle brace to prevent lateral ankle sprains during soccer. We hypothesise that this brace will reduce the incidence of ankle sprains among young amateur girl soccer players by 50%. The prevention of such injuries will be beneficial to players, clubs and society. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register (NTR): NTR6045; Pre-results.

Biomechanical evaluation of different ankle orthoses in a simulated lateral ankle sprain in two different modes.

Ankle orthoses are commonly used for prevention of recurrent ankle sprains. While there are some data on their functional performance or restriction of range of motion, there is little knowledge on the quantifiable passive mechanical effectiveness of various devices. This study aimed to determine the prophylactic stabilization effect for commonly prescribed ankle orthoses in a simulated recurrent ankle sprain. Eleven anatomic lower leg specimens were tested in plantar flexion and hindfoot inversion in a simulated ankle sprain in a quasi-static and dynamic test mode at 0.5°/s and 50°/s internal rotation, respectively. Tests included intact specimens, same specimens with the ruptured anterior talofibular ligament (ATFL), followed by stabilization with five different semi-rigid orthoses: AirGo Ankle Brace, Air Stirrup Ankle Brace, Dyna Ankle 50S1, MalleoLoc, and Aequi. Compared to the injured and unprotected state, two orthoses (AirGo and Air Stirrup) significantly reinforced the ankle. The Aequi ankle brace restored stability comparable to an intact joint. Dyna Ankle 50S1 and MalleoLoc provided insufficient resistance to applied internal rotation compared to the ankle with ruptured ATFL. Ankle orthoses varied significantly in their ability to stabilize the unstable ankle during an ankle sprain in both testing modes. Presented objective data on passive stabilization reveal a lack of supporting evidence for clinical application of ankle orthoses.

Vitamin D intake, calcium intake and physical activity among children with wrist and ankle injuries and the association with fracture risk.

BACKGROUND: Several studies have revealed a substantial increase in the incidence of fractures in children in the past few decades. AIM: To assess the strength of the association between suggested risk factors and fracture prevalence in children. METHOD: A cross sectional observational study. Children aged 6-15 years and their guardians presenting to the Emergency Department of a single tertiary paediatric hospital were recruited. Self-reported data on vitamin D intake, calcium intake and physical activity were collected. All participants had a radiograph of their injured limb reported by a consultant radiologist, on the basis of which they were classified into fracture or no fracture groups. Statistical analysis included descriptive statistics and binary logistic regression. RESULTS: Of the 130 patients recruited, 53 (41%) had sustained a fracture. The overwhelming majority of children (98%) did not consume the recommended daily dietary amount of vitamin D (400 IU/day). Low calcium intake and low levels of physical activity were also ascertained. However, there were no significant differences between fracture and no fracture groups for vitamin D intake, calcium intake or physical activity. Both site of injury (wrist) and sex (male) were associated with increased fracture risk ( p = 0.001 and p = 0.05, respectively). Logistic regression showed a statistically significant relationship between calcium intake and fracture risk (every additional unit of calcium consumption (mg/day) decreased the likelihood of fracture by 0.002, 95% confidence interval, 0.001-0.003). CONCLUSIONS: Low dietary intake of calcium and vitamin D and low levels of physical activity were evident. Fracture risk was significantly associated with reduced calcium intake but showed no association with vitamin D intake or physical activity.

Effectiveness of Warm-Up Routine on the Ankle Injuries Prevention in Young Female Basketball Players: A Randomized Controlled Trial.

Background and Objectives: Ankle joint is the most common site of injury for basketball athletes. An effective warm-up (WU) is a period of preparatory exercise to improve training performance and reduce sports injuries. Continuous examination of effective WU routines in basketball players is a necessity. The aim of this study was to investigate the effects of general and combined warm up on ankle injury range of motion (ROM) and balance in young female basketball players. Materials and Methods: A sample of 28 young female basketball players were randomly allocated to either global warm up control group (GWU) (n = 11) or combined warm up experimental group (CWU) (n = 17). All participants performed 7-min of run. The CWU group performed a single leg stance barefoot with eyes closed, plank forearm position and triceps sural stretching. Participants in GWU performed walking ball handling and core stability using a Swiss ball. Both WU routines were conducted 3 times per week for 10 weeks. Outcome measurements were the Stabilometric platform and dorsiflexion lunge test. Results: Twenty-eight young female basketball players completed the study. Participants in the experimental group improved significantly in the range of motion (ROM) in right and left ankle and the center of pressure displacement (CoP). The control group did not show any changes in ankle dorsiflexion and a significant reduction in all body balance parameters. Conclusions: An 8-min combined warm-up routine for 10 weeks improves the ankle dorsiflexion ROM and CoP displacement that plays a key role in ankle injuries prevention in basketball players. Further studies are strongly needed to verify our findings.

Are Landing Biomechanics Altered in Elite Athletes with Chronic Ankle Instability.

This study analyzed landing strategies used by athletes with chronic ankle instability (CAI) and copers compared to uninjured controls. Thirty participants were asked to perform a single-leg forward jump followed by a single-leg landing. Compared to uninjured controls, those with CAI athletes had significantly greater hip flexion and ankle eversion angles at initial landing, suggesting preference for using hip movements and extra ankle eversion angles to avoid ankle inversion when landing. CAI athletes were also found to have significantly decreased peroneus longus activation and higher ankle inversion velocity were both found during descending phase. And these were potential contributors to cause ankle inversion injury as there were likely many others. Based on these findings, CAI athletes may need to utilize more multi-joint or multi-muscle strategies during landing to maintain stability and prevent re-injury.

Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT.

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.