A SIGNIFICANTLY HIGHER RE- INJURY RATE, SOMETIMES UP TO 3 OR 4 TIMES HIGHER

basketball involve the inclusion of a simple progressive basketball-focused balance programme and an appropriate strength training programme. This minimises the effect of any mid-air contact by ensuring the body can quickly adapt to sudden impacts and changes in body position. The strongest effect comes from the body’s new ability to predict and, therefore adjust to, any situation or uneven surface, limiting the impact of what was previously considered unpreventable.

CRICKET In cricket, worldwide, ankle injures make up around 20% of all injuries; however, during the English first class cricket season of 2011 ankle injuries constituted only 7.6% of all injuries and 10.1% of missed playing time (8). The type of ankle injury within cricket depends on the participant’s age, with

THOSE SHOWING REDUCED FITNESS HAVE

the younger age group showing a higher likelihood of fractures, whereas the over 30s are more likely to sustain a lateral ankle sprain (9). A worrying trend within cricket is the fact that ankle re-injury rates appear to have doubled in the past 6 years, with the exact cause still unknown.

The most common injury around the ankle in cricket is ‘posterior ankle impingement’, which is defined as pain in the ankle due to impingement between the tibial articular surface and the calcaneus or any structures caught between. This occurs most often in fast bowlers with around 70% at first class level reporting some form of ankle injury within their career and at any one time 15% of all fast bowlers at this level will be carrying an injury (10). The significant risk factors relate to the range of motion at the ankle joint, specifically a lack of ankle dorsiflexion and ability to control this motion, which are shown to increase the risk of injury around the ankle joint.

ANKLE INJURIES WITHIN BASKETBALL RELATES TO LANDING

12

THE BIGGEST INFLUENCE IN

SOCCER Soccer is responsible for between one third and one half of all sporting injuries within Europe, with injuries to the foot and ankle making up around a quarter of these injuries. The most common type of ankle injury in soccer, accounting for around two thirds of incidents, involves the lateral ligaments of the ankle and, interestingly, less than 2% display a fracture (2). Detailed video analysis of the mechanism of acute foot and ankle injuries in soccer shows the two main situations where they occur are during player-to-player contact or during extreme joint ranges of motion. The player-to-player contact often occurred just above the ankle joint, and before or at foot-strike, which pushes the foot into high-speed inversion or eversion. When, during a shot or long pass, the high-velocity movement of plantarflexion at the ankle is followed by contact with an opponent’s foot, hyperflexion is created that stresses the tissues at the front and back of the ankle and results in injury (11). Despite this high involvement of

the lateral ligaments in acute injury the more complex and frequently reported longer term injury termed

the ‘footballers ankle’ (anterior ankle impingement) involves the compression of bony growth (osteophyte) formation around the anterior talotibial joint capsule (11). Currently three theories exists to explain the cause: 1) repetitive kicking of the ball could be causing direct damage to the anterior joint causing a cycle of inflammation with longer term scar tissue build up and finally leading to calcification formation; 2) repetitive forced dorsiflexion which is likely magnified by the over pronation and resultant external rotation of the talus caused within flat football boots results in micro trauma between the bone surfaces of the anterior portion of the talus and tibia; or 3) maximal plantarflexion either a one-off high- velocity movement or repetitive stretching of the joint capsule creating tracking spurs.

NETBALL

This is a sport described as including quick acceleration, deceleration, jumping in all directions both single and double footed, with and without twisting in the air, all while trying to avoid the defensive attention of an opponent or while trying to guide attacking movements (12,13). Ankle injuries within all aspects

and levels of netball make up around 31–42% of all injuries sustained (14) and this is reported to rise to a possible 84% during competitive games (15). Given the description above it should be of no surprise that the two key factors that have been shown to influence ankle injury rates in netball are landing technique and position played on court. On average a high level netball player will run 6–8km per game while completing around 40 vertical jumps, with centre-court players predominantly landing on one leg, whereas defensive players land on two (13). This is a reflection of the requirement of the position played, with centre court needing to maintain momentum and speed, and the defender has to secure possession of the ball followed by a complex process of decision making in determining where to initiate the attack. In simple terms a centre-court player will display a more horizontal jump with a flatter foot and is at a greater risk during a

sportEX dynamics 2012;34(October):10-14