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4 Ways to Prevent Ankle Injuries in Volleyball Players

Roughly 20% of volleyball players will suffer an injury at some point in their career, with ankle sprains making up roughly 50% of all injuries experienced in volleyball athletes across all skill levels. Luckily, ankle sprains can be prevented with education and coaching on proper skill techniques/mechanics, as well as specific conditioning exercises such as balance and proprioceptive exercises. The therapists at Sheddon Physiotherapy and Sports Clinic have worked with numerous volleyball players from young athletes just learning the sport to higher-level rep players from clubs in Oakville/Mississauga such as Pakmen Volleyball. The team at SPSC can help identify athletes at risk for injury as well as quickly and efficiently rehabilitate volleyball athletes who have suffered an injury.

Causes/Risk Factors

Most ankle sprains (89%) occur around the net from landing after a block or an attack. They generally result from stepping on the foot of an opponent or a teammate. The greatest risk factor for an ankle sprain is a previous history of ankle injuries, especially if it occurred in the past 6-12 months and was not rehabilitated properly.

Prevention Strategies:

  1. One of the most effective prevention strategies is education and training regarding proper take off and landing technique during blocking and attacks. More specifically, players should be taught to jump straight up to hit the ball, instead of forward, so that they will not land on the centre line under the net. In addition, players need to practice take off and landing during 2 man blocks.
  2. Proprioceptive training to improve stability and balance. Proprioceptive exercises should be included in every warm up, and should only take 5 minutes to complete. They will generally involve the use of balance boards, bosu, trampolines, and ladders. For example: a. player standing on one leg and tosses a ball to another player or against wall 10/leg x 5 sets. B. Single leg stance on the balance board/bosu for 30 sec x 2 sets. C. Mini squats on balance board 10x 2 sets. D. Ladder drills to work on agility and coordination.
  3. Proper rehabilitation post ankle injury in order to prevent reoccurrence.
  4. The use of support (brace or tape) to protect the ankle. Research has shown that bracing/taping decreases the incidence of ankle sprains in previously sprained ankles, but not in previously uninjured ankles. The greatest risk of reinjury is during the first year post ankle sprain, due to weakness in the ligament and proprioceptive ability, as such athletes should brace/tape for the first year post injury.

Sheddon Physiotherapy and Sports Clinic has been treating athletes of all ages and skill levels for over 10 years in the Oakville and Mississauga area. If you’re currently injured, book an appointment with one of our physiotherapists, chiropractors, athletic therapists or massage therapists in order to help get you back on the court healthy and pain-free. If you’re not currently injured, the therapists at Sheddon can get you started on an injury prevention and strengthening program by working on your specific weaknesses and imbalances to help prevent any future injuries. If you’re looking for a sports medicine clinic in the Oakville and Mississauga area that has great therapists AND will get you results quickly, then contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.

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Prevention of Ankle Injuries in Soccer Players

Soccer requires a lot of sudden stops, cutting, jumping and landing movements, which have all been shown to increase the risk of lower extremity injuries, especially to the ankle. Roughly 35% of all soccer injuries occur in the ankle, with an average time lost from play of about 48 days. With the high prevalence and long recovery time associated with ankle injuries, identifying modifiable risk factors and prevention strategies is key to keeping athletes healthy on the field.

Mechanism of Injury

Roughly 50% of soccer related ankle injuries occur during contact with another player. Other common mechanisms include:

  • Overuse;
  • Tripping on grass;
  • Jumping, twisting and landing;
  • Tackling;
  • Shooting/kicking.

Common Ankle Injuries

The most common ankle injuries experienced by soccer athletes are ligament sprains (80%), followed by overuse impingement syndromes, tendonitis (achilles, peroneals, posterior tibial tendon), and though rarely, soccer players will experience fractures or osteochondral lesions.

Ligament Sprains

Ankle sprains account for 80% of all soccer athlete injuries, and these athletes are 5x more likely to sustain a recurrent ankle injury upon return to soccer. Initial treatment following a sprain will involve modalities, manual therapy and rest. However, functional treatment is key for long term success, focusing on strengthening, balance, and proprioception required for return to sport.

Anterior Impingement Syndrome

Anterior impingement syndrome, better known as “Soccer Ankle”, has been shown to occur in roughly 60% of professional soccer players. Athletes generally feel pain in the front of the ankle, with feelings of giving way and catching, as well as pain with dorsiflexion movements (moving your foot up), squatting, sprinting and stair climbing. It has been proposed that recurrent ball impact results in microtrauma to the anterior joint, causing extra bony growth, which can become impinged with movement. Physical therapy treatment can be successful; however some athletes will require surgical intervention, which does have a high success rate.

Tendon and Muscle Strains

Tendon and muscle strains are another common overuse injury experienced in soccer players, with the achilles being the most common site of injury. To read a more comprehensive review on achilles tendon injuries and prevention strategies, click here.

Risk Factors

Several risk factors have been shown to predict who will sustain an ankle injury:

  • Previous injuries increased the risk for an ankle injury by up to 7x – especially if previous injuries were poorly rehabilitated. Symptoms that become chronic can be an indicator that the previous injury has not been properly rehabilitated, and overuse will eventually lead to future injury.
  • Muscle tightness or strength imbalance 
  • Slower reaction time 
  • Overuse
  • Joint instability (Mechanical instability due to ligament laxity or functional instability due to poor proprioception, coordination and weakness).
  • Poor balance and lower limb power (vertical jump)
  • Insufficient training
  • Inadequate warm up
  • Increased age:  Adolescent studies showed a high rate of injury in 12-15 year olds.
  • Playing on artificial turf has been associated with a greater risk for ankle sprains
  • Increased likelihood during competitions vs. training

Although there are several risk factors for ankle injuries, it is predicted that 30% of them are caused by a chance event that cannot be avoided.

Prevention Strategies

  • Warm up:
    • An improper or lack of warm-up is one of the easiest ways to injure yourself. Take 5-10 minutes before games to warm up properly. Check out the FIFA11 warm-up program here.
  • Stay in shape:
    • Preseason training should focus on muscle imbalances and weaknesses, with particular attention placed on proprioceptive exercises, especially in young adolescent soccer players.
  • Follow the rules of the sport:
    • Unfair player contact accounts for 25% of soccer related ankle injuries
  • Adequately rehab your injuries with sufficient rest time
  • Protective equipment:
    • Shin guards have been shown to reduce the impact forces to the leg, reducing the occurrence of soft tissue and fracture injuries to the lower extremity. In addition, ankle braces have been shown to provide mechanical stability to the ankle joint, as well as increase proprioception in previously injured ankle joints.
  • Focus on neuromuscular, balance and proprioceptive training:
    • Proprioceptive mechanoreceptors are found in the ligaments in the ankle. As such, injury to the ankle will likely damage these mechanoreceptors, resulting in a proprioceptive deficit and instability in the joint. If proper rehabilitation exercises are not completed prior to return to sport, then the athlete is at an increased risk for re-injury.
    • Proprioceptive exercises should include balance training in a static position progressing to dynamic movements, including equipment such as the bosu, wobble disc and balance boards. Furthermore, plyometric exercises that enhance joint stabilization and reaction time exercises should be part of the return to sport training program.

With cooler weather coming, this marks the start of the indoor soccer season. Ensure your current injuries are well rehabilitated and spend some time working on your weaknesses (strength, proprioception, balance, etc.). Research has shown that indoor soccer is associated with twice as many injuries than outdoor soccer. Possible factors include high-speed movements, smaller size field, and surface changes. Focus on yourself now and don’t get stuck on the bench resting your injuries this indoor season.

Henry et al., (2015). Risk factors for noncontact ankle injuries in amateur male soccer players: A prospective cohort study. Clinical journal of sport medicine. 26:251-258.

Nery et al., (2016). Foot and ankle injuries in professional soccer players. Diagnosis, treatment and expectations. Foot and ankle clinic N. Am. 391-403.

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Strong Feet = Less Injuries

You probably don’t see a whole lot of athletes spending time in the gym focusing on strengthening their feet. However, research has shown that exercises targeted at strengthening the feet can help prevent and treat a number of different foot conditions, such as plantar fasciitis, metatarsalgia, tibialis posterior tendinopathy and hallux valgus (bunions).

Why is a strong foot so important?

The intrinsic muscles of the feet help with stability, shock absorption, balance, arch support and foot mechanics. If there is a weakness in these deep muscles, then other structures will take the extra load, which subsequently lead to injuries not only in the feet, but also up the lower extremity, as biomechanics of the whole leg are altered. For example, weak intrinsic foot muscles can lead to over-pronation of the feet, which results in the leg rotating inwards, putting strain on structures of the hip and knee, potentially causing injuries to these areas.

Luckily, you don’t have to devote a whole training workout just to your feet. Research has evaluated EMG muscle activation of the intrinsic foot muscles during a number of different foot exercises in order  to determine which exercise is the most beneficial. The key exercise across a number of different studies is the “short-foot exercise.”This exercise has been widely studied and has been supported in the research for the following conditions:

  • Preventing foot/lower extremity injuries in runners;
  • Decreasing pain and disability due to bunions;
  • Prevention and treatment of plantar fasciitis;
  • Decreasing the risk of falls in the elderly

Instructions:

  • With even weight on both feet, place a business card under the first metatarsal head and slide the card back towards your heel as you lift the inside of the foot (in order to raise your arch)
  • Be sure to keep the weight on the metatarsal heads where the business card is placed – not through the toes; you should be able to lift the big toe up and down.
  • Hold the position for 10 seconds, relax and repeat for 10 repetitions and 2 sets.

Click here for a visual

The short-foot exercise is initially done in a seated position and can be progressed to more challenging positions, such as standing, balancing on 1 leg and eventually while doing functional activities such as squatting. Research has shown that doing this exercise daily for 4 weeks improves postural control of the foot, specifically preventing over-pronation, as well as improving balance and proprioception. 

If you have been suffering from foot pain that won’t go away, contact Sheddon Physiotherapy and Sports Clinic and a therapist can help get you back on your feet.

Fourchet and Gojanovic (2016). Foot core strengthening: relevance n injury prevention and rehabilitation for runners. Swiss Sports and Exercise Medicine. 64,26-30.

Jung et al., (2011). A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Physical Therapy in Sport. 30-35.

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Beat the Heat

With the hot and humid weather ramping up this weekend, many individuals will be wondering how to alter their training so that they can stay active. A review recently came out by Pryor et al., (2013) examing how to maximize athletic performance in the heat. The article discusses a variety of different elements from hydration to clothing with practical tips from which athletes of all levels could benefit.

Hydration

Sweating is the body’s main defense against overheating while exercising. Excessive sweating can lead to dehydration, if fluids are not replenished, which in turn will lead to an increase in body temperature, as the body can no longer effectively regulate its temperature. This increased strain on the body can have a negative impact on athletic performance in terms of strength, power and endurance. Unfortunately, thirst is not an adequate predictor of hydration. The best way to know if you are hydrating yourself properly is to weigh yourself before and after exercise in order to gauge how much water you are losing. Roughly 1 lb. of weight loss represents 450 ml of fluid loss. As your stomach can only handle so much water at a time without causing gastric issues, guzzling a tonne of water at once isn’t helpful. Be sure to consume 150-250 ml of water every 15 minutes during exercise in the heat to prevent dehydration and gastric issues.

Body Cooling

A variety of different body cooling methods have been examined in the research, such as cold water immersion, neck cooling collars, ice slurry drinks, facial spray and menthol mouth rinses. Research has shown that all of the above methods have their benefits, whether used prior to exercise or during; however, the exact mechanisms remain unclear. It is possible that these methods decrease one’s core temperature, allowing for a longer period of exercise without added physiological strain from the heat. Practical tips: plan ahead of time, have a cooler on the sideline with ice slurry drinks and ice towels. If you are running a race, pre-cooling (e.g., an ice cold bath) may be beneficial and/or have someone meet you halfway with an ice slurry drink.

Heat Acclimatization

Running in the August heat always feels a lot easier than your first hot run in June. Your body will naturally adapt to training in hot environments, and repeated bouts of exercise in the heat will improve ones tolerance and physiological capacity. Studies have shown that it takes roughly 10-14 days (longer for children) to acclimatize to exercising in the heat. The first several training days should be light and last only 20 minutes. The length of training and intensity can increase thereafter. Be aware that benefits of acclimatization will be lost after 6 -10 days of training at cooler temeratures.

Protective Equipment and Clothing

Research has shown that the first few days of football training camps experience the most heat related injuries. This is partially related to the athletes not being acclimatized to the heat, with the added strain of having to wear football equipment, which in turn prevents cooling and increases heat production. The first few days of practice in hot weather for sports such as football should be without equipment and gradually adding equipment for part of the practice after the first 5 days.

Clothing in the heat should be lightweight, light-coloured and loose. Although you may be tempted to switch to a dry shirt during halftime, it is pointless, as dry clothes will prolong sweating and cooling.

Signs of Heat Exhaustion

  • Thirst;
  • Fatigue;
  • Grogginess;
  • Nausea and vomiting;
  • Headache;
  • Dizziness;
  • General Weakness

If any of these symptoms are felt during exercising in the heat, you should stop, hydrate yourself and move to a cooler environment. Heat exhaustion should be taken seriously, as it can lead to heat stroke. If you’re not used to training in the heat, move your workout indoors.

Pryor et al., (2013). Maximizing Athletic Performance in the Heat. Strength and Conditioning Journal. 35, 24-33.

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Soccer Players and Sports Hernias

Groin injuries affect roughly 20% of soccer players due to the nature of the sport, which involves lots of kicking, cutting, sprinting and explosive movements. Research has shown that 50% of soccer players suffering from groin pain lasting longer than 8 weeks may be due to an injury called a sports hernia (Kopelman et al., 2014, Munegato et al., 2016). Unlike a traditional hernia, a sports hernia does not involve the protrusion of an organ through the muscular wall. Instead, it is characterized by weakness in the deep abdominal wall, and only occasionally will a bulge be felt during abdominal straining, as the organs push up against the abdominal wall (without pushing through). A sports hernia can also involve weakness, stretching or tearing of the abdominal muscles, fascia and/or the adductor (inner thigh) muscles on the pubic bone.

What causes a Sports Hernia?

The majority of sports hernias occur as a result of repetitive overload to the area, as opposed to a single traumatic event. Hockey, soccer and football athletes are most at risk, due to the sudden changes in direction, kicking, and sprinting seen during these sports. Other risk factors include:

  • Athletes with muscle imbalances around the hip/pelvis/core;
  • Individuals with a significant leg length difference;
  • Athletes with decreased hip range of motion (especially internal/external rotation);
  • Athletes with other underlying hip pathologies, such as labral tears and femoroacetabular impingement;

Symptoms of a Sports Hernia

  • There is usually pain with activity/sports, which improves with rest;
  • Pain is localized in the lower abdominal/inner thigh and groin area;
  • Generally there is pain with certain movements, such as abdominal curls and resisted hip adduction;
  • There is tenderness over the pubic bone and abdominal muscle insertions.

Treatment

Most sports hernias can be treated conservatively with physiotherapy and rest. Physiotherapy will generally consist of manual therapy and exercise in order to address muscle imbalances, as well as core stabilization exercises. A sports hernia may lead to an inguinal hernia, and if conservative treatment is not successful, surgical repair may be necessary. Surgical repair has a high success rate; most athletes will return to sport pain-free.

What can you do to prevent a sports hernia and groin injuries?

  • CORE, CORE, CORE – core and pelvic stability cannot be overlooked;
  • Get your minor injuries addressed ASAP!! Soccer players tend to overwork their hip flexors and adductors, which gradually lead to minor groin strains. If left untreated, they can eventually lead to a sports hernia. Don’t let that nagging pain develop into something much bigger;
  • Make sure your hip/pelvis muscles are well balanced in terms of flexibility and strength. For example, just stretching the groin muscles and letting everything else stay tight will lead to more injuries than if you didn’t stretch at all. You want to be symmetrical in all directions.

If you have been suffering from groin pain for longer than 8 weeks and think you may have a sports hernia, contact us and one of our therapists at Sheddon Physiotherapy and Sports Clinic will assess and treat your injury and get you back on the field pain-free.

Kopelman et al., (2014). The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia.

Munegato et al., (2016). Sports hernia and femoroacetabular impingement in athletes: A systematic review. World Journal of Clinical Cases. 3(9) 823-830.

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