A CASE STUDY An athlete presents with an acute inversion injury to the lateral (talo-fibular) liga- ment of the ankle. The injury occurred 15 minutes ago and is of mild to moder- ate severity (Fig. 4).

In the first aid stage, treat- ment would focus on con- trolling bleeding and swelling, probably involving application of

ice packs

every two hours. The patient is likely to be non-weight bearing. A stretchy adhesive or non-adhesive bandage could be applied which would control and accommo- date the swelling, yet could facilitate gentle active movements to encourage the muscle pump and reduce the risk of joint stiffness. An adhesive bandage (eg. EAB) may be the least attractive option as regular reapplications following ice treatment would make this a costly treatment. A non-adhesive bandage (eg. cohesive) may be a better choice as it

Figure 4: An acute inversion injury to the left ankle

Figure 6: Closed basketweave application to the left ankle

would be re-usable but is also relatively easy, quick and inexpensive to reapply. It may be possible to teach the athlete to reapply this support themselves, so reducing the dependence on the therapist. If additional support is required eg. if the athlete can be light/partial

weight-bearing, a heel lock could be applied over the cohesive bandage to further stiffen the application (Fig. 5).

Figure 5: Cohesive support reinforced with zinc oxide double heel locks

After a few days as the athlete begins to weight-bear more con- fidently and comfortably, and the oedema has also reduced, then the therapist may consider using an open (if still some oedema) or closed (no oedema) rigid tape application eg. a basketweave (Fig. 6). This type of application makes use of the non-stretchy property of this taping material to firmly support the injured lat- eral ligament while walking.

Once tissue healing has integrity and good muscle control has been re-established, the amount of support can be reduced for daily activities. This can provide some support to the healing lig- ament while controlling excessive loads to enable further rehabil- itation of structures and allows the athlete to build confidence.

References 1. Association of Chartered Physiotherapists in Sports Medicine and Smith and Nephew. Taping techniques for sport. Smith and Nephew 1998 2. Callaghan MJ. Role of ankle taping and bracing in the athlete. British Journal of Sports Medicine 1997;31:102-108 3. MacDonald R (ed). Taping techniques- principles and practice (2nd edi- tion). Butterworth Heinemann 2004. ISBN:0750641509 4. Laughman RK, Carr TA, Chao EY et al. Three dimensional kinematics of the taped ankle before and after exercise. American Journal of Sports Medicine 1980; 8(6):425-431 5. Garrick JG and Requa RK. Role of external support in the prevention of ankle sprains. Medicine and Science in Sports 1973;5(3):200-203 6. Callaghan MJ, Selfe J, Bagley P and Oldham JA. The effect of patellar taping on knee joint proprioception. Journal of Athletic Training 2002;37(1):19-24 7. Evans P. The healing process at cellular level: A review. Physiotherapy 1980;66(8):256-259 8. Association of Chartered Physiotherapists in Sports Medicine. PRICE guidelines published by the Chartered Society of Physiotherapy 1999. www.csp.org.uk/libraryandinformation/publications 9. Frankney JR, Jewett DL, Hanks GA and Sebastianelli WJ. A comparison of ankle tape methods. Clinical Journal of Sports Medicine 1993;3:20-25

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