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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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