ANKLE INJURY

SPORTING CONTEXT 1 - HIGH JUMPER REHABILITATION OF AN ATFL INJURY

The key stresses placed upon the ankle during a high jump are experienced during the run-up and at the point of take-off. Clearly, greater challenges will exist if the ankle of the take-off foot has been injured. It is suggested that, once able, gentle straight line running should be introduced; care should be taken to ensure that there are no visible differences between the injured and non- injured side. During the rehabilitation of running, focus should be directed towards perfect form, especially maintenance of correct foot and ankle alignment during the weight bearing phases of gait. Speed of running may then be increased in concert with ability. As soon as the athlete is able to run in a straight line without diffi- culty, slow, gently curved running may be introduced. It may also be beneficial during this phase to include a number of curved runs in the opposite direction to the athlete's usual approach. Curved running may then be progressed by increasing speed and reducing the size of the arc.

It is also important that at the same time as progressing running ability, focus is directed towards the reintroduction of plyometric type activities. Gentle hopping exercises are indicated in the early stages, which may be progressed by increasing the height of the hop and the introduction of multi-directional hopping. Drills to

progress hopping include moving to different positions around a cross marked on the floor, moving around an imaginary clock face, lateral hopping across a line and hopping for distance. Specific challenges such as time to complete a task and responding to ver- bal instruction can be used to increase the difficulty of the senso- rimotor challenge. Once simple hopping drills can be performed without difficulty, plyometric exercises may be introduced.

It is important to remember that plyometrics should be performed in small amounts and that they should remain painfree at all times.

Once running and bounding can be performed without difficulty, simple high jump training drills should be introduced and gradual- ly progressed. Bar clearance from a static standing position can be progressed to jumps from a three and then five step approach; full approach may then be completed with a scissor kick clearance and when able, a return to full high jump. Throughout rehabilitation it is important that appropriate weight training is completed to min- imise strength loss. Athletics training drills that provide a senso- rimotor and technical challenge should also be performed as able. Examples of drills that are particularly effective in this regard include hurdle walkovers, ankle hops and marching drills.

BOX 1: FLOW CHART OF A 10-STAGE PROGRESSION FOR THE SAFE AND EFFECTIVE PROGRESSION OF PLYOMETRICS IN THE REHABILITATION OF AN ANKLE INJURY

1

Bilateral limb bounding, hold landing position

Bound from one foot onto another and hold landing position

2

Bound from and land on same foot and hold landing position

3

Single leg bound onto box

6

Single leg bound onto box, step

7

off box into double leg landing position

Single leg bound onto box, step off

8

box into single leg landing position

Single leg bound onto box, step off box into double leg

9

landing position and immediate vertical bound

Single leg 4

bound, stabilise landing position and then hop vertically

Single leg bound, land and

5

immediately bound again

Single leg bound onto box, step off box into single leg and immediate single leg vertical bound

10

20

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