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Rehabilitation of the common lateral ankle sprain

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(2)

Rehabilitation of

the common lateral ankle sprain

Aude AGUILANIU

(3)

TITRE

SOUSTITRE

(4)

REHABILITATION OF ANKLE SPRAIN

Plan

1. A complex injury

2. Rehab or No rehab in the literature ? 3. What is the first reflex ?

• Optimal Loading

4. Sensorimotor control • Variability of movement

5. Examples of rehab exercises • Range of motion

• Muscle strength

(5)

1

The Lateral Ankle Sprain (LAS)

is a complex injury

(6)

A COMPLEX INJURY

Lateral Ankle Sprain

A continuum of disabilities

(Wikstrom and al. 2013)

Re-injury

(Martin and al. 2013)

Persistant residual symptoms

(7)

REFERENCES

GUIDELINES

2018 - Evidence-based clinical Guideline in open access

(8)

2

Rehab or No rehab

in the literature ?

(9)

Rehab or No rehab?

[diagnosis and advice] [diagnosis and advice]

+

(10)

NOT UNINAMOUS

Studies

Low level of evidence High level of evidence

Rehab or No rehab

RCT

Expert opinion

(11)

9302 articles 7 articles PROCESS

Systematic Review

Rehab or No rehab ? High level of evidence

Bleakley C., Taylor J. and al. 2019

(12)

What we know

Rehabilitation exercises post ankle sprain

Decrease the risk of re-injury (10% at 7-10 month)

But

Which exercises ?

How many time they do exercises ?

(Bleakley C., Taylor J. and al. 2019)

(13)

3

(14)

RICE vs POLICE

The first reflex

R

ICE

vs.

P

OL

ICE

R : Rest I : Ice C : compression E : Elevation P : Protection OL : Optimal Loading I : Ice C : compression E : Elevation

(15)

OPTIMAL LOADING

Different view of care

R

ICE

vs.

P

OL

ICE

Load Binary progress Rest = Unload Load Unload Steady progress Optimal Loading Then Protection (Bleakley, Glasgow, McAuley, 2012) PRICE à POLICE

(16)

GOOD BALANCE

Optimal loading

TOO LONG

period of unload Gradually load

Immobilization

No more than 10 days

Functional support exercise therapy

!

(Vuurberg, Hoorntje, Wink and al. 2018)

(17)

4

(18)

3 MAIN INFLUENCES

Sensorimotor Control

(Wikstrom, Hubbard-turner, Mckeon, 2013) Organism Sensorimotor Control Environment Task

(19)

HOW TO IMPROVE IT ?

Sensorimotor control

GOAL-oriented rehabilitation

Ability to accomplish a movement goal in

VARIETY of ways

(Wikstrom, Hubbard-turner,

Mckeon, 2013)

(20)

5

Examples of

(21)

Variable ways to improve

Range of motion

Global mobility (alphabet exercise) Muscle stretch (calf stretch) Arthrokinematic (joint glide)

ABC

(22)

Optimal loading

Muscle strength

Increase load

Adapt intensity Adapt volume

(23)

Postural balance

INFINITE WAYS

Add progressively perturbations/difficulties

Learning with

constraints

(24)

Postural balance

(25)

Power and Agility

When we do

Rehabilitation exercises

Keep in mind what is going on the field

VARIATIONS and

(26)

Conclusion

Rehabilitation exercises for ankle sprain ? YES

with

Protection

Optimal loading

(27)

TITRE

SOUSTITRE Aude AGUILANIU Sport physiotherapist PhD student contact : aude.aguilaniu@uliege.be

Références

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