RELATING TO THE INDIVIDUAL’S SPORT, IS VITAL IN ORDER TO ACHIEVE THIS HIGHER UNCONSCIOUS LEARNING RESPONSE CONCLUSION

a detrimental effect on the ratio. Clearly more normative data on a large healthy population are needed before muscle imbalances can be used to maximum potential within a rehabilitation programme.

Using isokinetic dynamometry to measure strength deficits does have drawbacks. The use of a rehabilitation tool (41) within the research setting is difficult, as so many variables exist with the apparatus. Reproducibility and validity of strap tightness, verbal commands and axis positioning have all been shown to have an effect on measurement outcomes (42–44). Although isokinetic dynamometry is a good tool for gaining strength, especially eccentric, the speed needed to produce muscle reaction is limited on this piece of apparatus. Generally the strength speed used in testing is 30°/second (21,45). Is this relevant when the neuromuscular reaction time needed to prevent ankle inversion injury is 440°/second (12)?

Further use of isokinetics in the research setting of ankle injuries is needed, and more standardised data using large healthy non-injured groups need to be collected. A set methodology is required across the scientific community, including speeds, ratios, similar values and language, which will make comparisons across studies easier and more applicable than is currently possible. Neuromuscular testing using trapdoor

apparatus and electromyography to measure muscle reaction times, is becoming more prevalent. It has been shown that the muscle reaction time for peronei, tibialis anterior and gastrocnemius is too slow to prevent ankle inversion sprains (46,47). Interestingly, in Willems and colleagues’ study, tibialis anterior weakness, rather than peroneal weakness, was shown to be a risk factor to ankle injury (46). There does seem to be more functional relevance with this method of testing, but clearly more studies and comparisons between non-injured and injured ankles need to be undertaken to improve our understanding of the muscle firing sequence and speed in order to allow this to be applied in the rehabilitation setting. Reaction times and firing patterns play a key part in the later stages of rehabilitation, but no quantifiable information is currently available to assist the therapist in evaluating areas such as quantity, specific muscle groups and rest times between exercises.

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Lateral ligament injuries to the ankle can be a problematic issue to both the therapist and the athlete. There is a high rate of re- injury following this common sporting injury, and suggestions by Dvorak and colleagues (48) and Inklarr (49) give the two key risk factors as inadequate rehabilitation and incomplete healing. Studies have shown that a preventative programme incorporating the principles of strength and proprioception can reduce the rate of re-occurrence of injury to the lateral structures of the ankle (18,19). A planned programme must be designed around the athlete, the injury, and the type of sport that the athlete wishes to return to. An understanding of anatomy, proprioception and the principles behind the various methods of strength training needs to be applied in order to achieve a quick and effective programme. This article has considered somatosensory proprioception, although vestibular and visual proprioception also need to be applied to have the greatest effect. Physiological and accessory ranges of motion need to be gained before moving on to more testing functional activities. Strength gains and understanding of speed and its influence on load need to be planned carefully in order to achieve maximum results. The use of neuromuscular reaction must be applied in the later stages of the programme to develop the body’s preventative system from a conscious to an unconscious reaction. The demands and speed of any modern sport require these adaptations if re-occurrence of a lateral ankle injury is to be avoided.

References 1. Mack RP. Ankle injuries in athletics. Clinics in Sports Medicine 1982;1:71–84 2. Garrick JG, Requa RK. Epidemiology of foot and ankle injuries in sports. Clinics in Sports Medicine 1988;7:29–36 3. Staples OS. Result study of ruptures of lateral ligaments of the ankle. Clinical Orthopaedics and Related Research 1972;85:50–58 4. Grana WA. Chronic pain persistent after ankle sprain. Journal of Musculoskeletal Medicine 1990;7:35–49 5. Staples OS. Ruptures of the fibular collateral ligaments of the ankle: result study of immediate surgical treatment. Journal of Bone and Joint Surgery – American Volume. 1975;57:101–107 6. Balduini FC, Vegso JJ, Torg JS, Torg E. Management and rehabilitation of ligamentous injuries to the ankle. Sports Medicine 1987;4:364–380

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THE ABILITY TO INTRODUCE AND DUPLICATE SPEED WITH BALANCE,