viva dissert
TRANSCRIPT
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INTRODUCTION
Lateral ankle sprains (LAS) occur when the
foot rolls excessively on its outside edge,
resulting in damage to ligaments on that side
ankle sprains induce long-term sequelae such
as persisting pain, swelling and instability --
interfere with the persons ability to carry out
his sporting and routine activities normally
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SPECIFIC AIMS & OBJECTIVES
Identify common steps by UOM students andstaff for management of LAS
Investigate into risk factors
To determine the level of residual symptoms interms of pain, swelling, weakness and giving-way sensation in this population
determine the impact of this condition on the
performance of usual sporting and daily activitiesin this population
explore new venues about treatment andprevention of LAS
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LITERATURE REVIEW
Epidemiology of LAS 1 sprain per 10 000 persons daily in the US
10-25% of all sports-related injury
10-30% of all musculoskeletal injury
14% of all attendance at the accident andemergency units of hospitals (stats from 1997-2009)
In mauritius, no epidemiological study aboutthe occurrence of LAS has been done
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ANATOMY
Main ligaments of lateralankle complex
-Anterior TaloFibular
ligament (ATFL)-CalcaneoFibular ligament
(CFL)
-Posterior TaloFibularLigament (PTFL)
Source:http://www.hawaii.edu/medicine/pediatrics/pemxray/v3c03.html
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MECHANISM OF ANKLE SPRAIN
77% to 85% of sprains are LAS
Out of these, 73% involve the isolated rupture
of the ATFL (most anterior and weakest tensilestrength)
LAS occur due to excessive supination
(invertion with adduction) of the rearfoot
coupled with plantar flexion at ground contact
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LAS can be contact related for e.g contact with
another player, objects or the playing surface
It can also be non-contact in instances of abrupt
change in direction or running on an uneven
surface
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Grading for severity of LASGRADE 1: Stretch of the ligament with minimalswelling, minimal loss of function and no instability.Full WB possible
Grade 2: stretch with partial tearing, moderateswelling and tenderness. Moderate loss offunctional ROM and unable to weight bear
Grade 3: complete rupture of ligament. Sever
swelling and ecchymosis, marked instability andunable to weight bear due to pain.
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Management and rehabilitation of LAS
Acute stage
Sub-acute stage
Rehabilitative stage
Functional stage
Prophylactic stage
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PHYSIOTHERAPY TECHNIQUES
Cryotherapy
Ultrasound
TENS
Taping techniques Braces and orthotics
Deep friction massage
Manual Lymphatic Drainage techniques
Passive joint mobilization
Therapeutic exercise regime
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Sequelae of LAS
Occurs in 55% to 72% of persons having had aprevious sprain
Some of the most frequent symptoms are:
Persistent synovitis
Ankle stiffness
Swellling
Pain Loss of sensation
Muscle weakness
Frequent giving way
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Ankle instability
Chronic ankle instability (CAI)-repeated
episodes of lateral ankle instability and is
characterized by the presence of residual
symptoms such as pain, swelling, giving way
and loss of motion.
Two components of CAI are Mechanical ankle
instability (MAI) and Functional ankleinstability (FAI)
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Mechanical ankle instability
MAI is defined as an increase in the accessory
movements of a joint.
Contributors to MAI are:1. Pathological laxity- can be assessed clinically
by the anterior drawer test and the talar tilt
test.
2. Arthrokinematics impairments
3. Synovial and degenerative changes
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Functional Ankle Instability (FAI)
FAI is the occurrence of recurrent ankle instabilityand giving way sensations due to contributions ofproprioceptive, sensory and neuromuscular
deficitsCauses of FAI are:
1. Impaired proprioception and sensation
2. Impaired neuromuscular firing patterns and nerve
conduction3. Impaired postural control
4. Strength deficits
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METHODOLOGY
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Inclusion criteria
- At least 1 ankle sprain sustained during the
last three years- Playing at least one sport
Exclusion criteria-Recent fracture of the foot or ankle
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The study instrument
An advertisement was posted on every sports
club groups of UOM on Facebook.
Students were approached individually in theUOM gymnasium to seek their informed
consent and choose them according the
criteria which have been set up
A six-paged questionaire was given to suitable
participants
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PILOT STUDY AND VALIDATION OF
QUESTIONNAIRE Conducted with 3 fourth year physiotherapy
student and 5 players in the gymnasium
selected at random.
Questionnaire was validated after consultation
with my supervisors
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ETHICS
Ethical clearance for the project was awarded
by the Research Ethics Committee of UOM
An information sheet and a consent form was
attached to the questionnaire to explain
clearly about the aims and objectives
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STATISTICAL ANALYSIS METHOD
Analysis of data was done by Microsoft Excel
2007 since it allows pictorial representation of
data to facilitate interpretation of results.
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