APPLIED REHABILITATION

PART 2: APPLYING THE PRINCIPLES OF REHABILITATION

Successful application of rehabilitation principles in the clinical environment depends upon the ability of the physiotherapist to accurately determine the best possible combination of a range of interventions in order to restore or enhance athletic function following injury. Rehabilitation involves the seamless integration of the five broad subcategories of sensorimotor training, motor control stability training, strength training, range of motion enhancement and endurance training. At any given stage of the rehabilitation process the particular combination of interventions used should be guided by the physiotherapist's understanding of the functional anatomy, biomechanics, clinical presentation and functional deficits associated with the injury. The current paper will consider the management of the injured ankle and highlight the clinical reasoning process involved in the functional rehabilitation of athletes from two different sports (athletics: high jumper and rugby union: outside-half).

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IN THE CLINICAL ENVIRONMENT

By Dr Philip Glasgow PhD, MTh, MRes, BSc (Hons), MCSP

LATERAL LIGAMENT INJURY Injuries to the lateral ligament complex of the ankle are one of the most common athletic injuries (1) and frequently result in prolonged functional deficits, increased risk of injury and chronic instability (2, 3). As a result, it is essential that rehabilitation of lateral ankle injuries focus on minimising functional deficits and reducing the likelihood of recurrence. Injury is usually sustained as a result of forced plantarflexion and inversion of the ankle and most commonly affects the anterior talofibular ligament (ATFL). The ATFL, which has been described as the primary lateral stabiliser of the ankle, arises from the anterior border of the lateral malleolus and passes anteriorly to insert on the lateral pole of the talus. It runs almost parallel to the axis of the neutral foot, however when the ankle is placed in plantarflexion its course runs almost parallel to the axis of the lower leg (4) (figure 1). Louwerens & Snijders (5) have suggested that rather than acting as a lateral stabiliser, the primary role of the ATFL is to tune the coupling of longitudinal rota- tion from the leg to the talus. The authors have highlighted that the talus internally rotates during plantarflexion and that in this position the ATFL cannot resist high forces and is unable to withstand weight bearing or stabilise the foot.

Figure 1: Anatomical image of the lateral aspect of the ankle showing the ATFL sportEX medicine 2007;32(Apr):17-22

Injuries to the ATFL generally result in localised swelling, pain, reduced ankle ROM and significant sensorimotor impairment. During the early stages of management, focus should be directed towards the reduction of pain and swelling and the restoration of ROM (6). In light of the potential adverse effects of swelling on muscle

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