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Managing the return to sport after ankle sprain

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The concept

Do not stop the sport! Propose to sports activities program of fitness and return to the field impose increasing constraints adapted to the evolution of ligament healing. Recommence the sport to its former level the day the tissue repair is completed!

The principles

Dissociate biomechanical constraints physiological stress through the use of strength training methods, targeted cardio and rehabilitation. Doser the first to participate in the conjunctiva mechanization and contribute to functional rehabilitation. Mix the seconds to maintain all the specific energy pathways of the sport.


In the 80s, the time of healing were considered a time of sporting rest. The most advanced ventured there prescribe some early rehabilitation. The custom was to say: "Once the healing achieved, we can reconnect gradually with the sport and wait at least 3 times the duration of rest before hoping to find his level."

The arrival of ankle braces and the advent of the concept of tissue mechanization allowed to endorse the remobilization of traumatized ankles. Thus, sports physicians sensitive exercise physiology and trained in trauma could try to optimize recovery times without compromising health. Their professionalism and their growing involvement in sports clubs senior stimulated this discussion. Formerly, only swimming and stationary cycling were available to the therapist. Now, gyms, physiotherapists and retail offer in leisure sports a wide variety of used fitness equipment to maintain fitness in case of ankle sprain.

The stationary bike mobilizes little ankle, it is used with a resin or at the first traumatic days. It is indicated to increase the intensity of training including using "split sessions". Later the dancer in work approaches the racing action.

The stepper imposes a constraint function of the body weight. The mobilization of the sector ankle may vary depending on the foot position on the pedals. It is well suited to reconnect with the energy systems of the sprint.

The elliptical motion generates close to running but bipodale charge and without impact. The simultaneous use of the upper extremities increases the peripheral oxygen demand and helps to intensify the cardiovascular work.

The treadmill allows a true "re-education to jogging." It is part of growing to the cardio session in which other devices are used for training more intense. Moreover, the running surface is steady and reassuring.

Swimming without sweater boy is not ideal because the propulsion imposes an equine foot. However, water aerobics is set to run in a landfill with a vest or "chips." Jumping into the water, it helps to reconnect with the plyometric work with the help of Archimedes.

During the 1980s, the discovery of the origin of DOMS eccentric or "aches" motivated the design of eccentric strength training sessions open chain. They do not seek the ankle and compensate by the party essentially concentric labor induced cardio machines.

The growing interest for muscular work with light loads was the origin of "fitness trail" involving general strengthening and cardiovascular stress. They are particularly suitable in the days following ankle sprain.

The degree of evaluation

The concept of fast detraining was validated for a long time. After 3-4 days of inactivity, mitochondria reduce their oxidative ability. The maximum heart rate decreases at the end of ten days without exercise. An athlete who stops the sport but continues his daily life finds a sedentary VO2 max of 3 months. Bedridden, he need only three weeks to disappear the benefit of many years of practice.

On the ground, the maintenance protocols fitness in athletes ankle sprain victim bring many satisfactions to coaches and athletes of all levels. 18 months ago in the center of Paris Saint Germain training, each player arrested over 3 weeks benefits at the end of the program, a "re-test". This control includes: a treadmill test with determination of maximum aerobic speed (MAS), a vertical jump plyometric monopodal right and left, a test Freeman left and right, a measure of body fat and a "Technical Evaluation field "denoted by the physical trainer. The analysis shows, most often:

- A conversation to see an improvement in the VMA probably because of the strong aerobic component of cardio
- A conservation sometimes a small decline in the vertical jump, still less than 3 cm, probably caused by the limitation of plyometric stress early protocol.
- Improved Freeman test favored by the specific work in physiotherapy.
- Stable or increased fat mass of less than 1.5%, in case of poor compliance with dietary recommendations.
- A "field assessment" noted in 4/5 despite the advice visualization and due to a lack of collective training.

Obviously no control group, not receiving maintenance program for the condition has been established, coaches wishing to optimize recovery times for each player. However, one can imagine that the performance degradation would be similar to that mentioned in studies on detraining.

Daily implications

6000 with ankle sprains in France every day, the application of this concept can start tomorrow for many practitioners. In practice, the physician can guide the patient towards a beneficial service for sport fitness and recovery. To save time, simple scalable advice may suffice. Within the top clubs, it is possible to design specific rehabilitation programs on biomechanical and physiological. In all cases, we also offer sessions back on the field. They are a real specific proprioceptive work.

The future

The future of the concept through its generalization. Indeed, it is the doctor's mission of sport. It meets the demand of the sports injury or its management. Indeed, it improves healing and functional recovery, he thus promotes healing without sequelae despite sporting solicitation. Most importantly, it reduces recovery times without harm to health!

Currently the cardio is done "in line". Also, sometimes we see a suffering adductor during the recovery side field trips. A new device has just appeared. It is called "lateral stepper". It reproduces the movement of the "skating" and should help to limit the inconvenience.

The strong point

Maintaining fitness after ankle sprain helps reduce time to return to sport without harm to health!

Doctor St├ęphane CASCUA. - 14 mai 2009.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.

When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.

Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.

When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.

You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!

That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.

The bone is strengthened or crack in contact sports

Doctor St├ęphane CASCUA.

Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.

Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.

Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.

Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.

Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!

In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.

After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.

If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.

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