mercoledì 11 settembre 2013

Ankle fractures: the most common injuries during sports activities

Fisiotek CPM devices for  athlete's ankle fractures

This abstract has been taken by an article from, where the authors have deepened the discourse of a correct rehabilitation program for athletes which have been involved in ankle fracture.
Ankle's factures are the most common injuries in sport activities; especially for skiing, snowboarding, cycling, motocross, ice skating and basketball, the ankle joint is frequently stimulated and in the 90% of cases they're due to strains or sprains.
The duration of the treatment of an ankle fracture is related to the associated soft tissue involvement, location and type of fracture. The main focus of rehabilitation should emphasize restoring full range of motion, strength, proprioception and endurance while maintaining independence in all activities of daily living. Resumption of pre-injury status is the goal with consideration of any residual deficit. Appropriate early mobilization of the ankle joint hastens recovery; however, protocols for initial rehabilitation must be based upon stability of the fracture and fracture management (operative, non-operative).

The goal of rehabilitation is to decrease pain and restore full function, with a painless mobile ankle. Local cold application may be beneficial for controlling pain and edema. Individuals should be encouraged to continue functional activities to prevent complications of inactivity and bed rest.  Individuals may progress from walker to crutches to cane based on ability and weight bearing status. If casted, range of motion exercises of the adjacent joints may be beneficial unless contraindicated based on fracture stability. After cast removal range of motion, proprioceptive and strengthening exercises should be started at the ankle. Exercise intensity and difficulty should be progressed until full function is evident. Edema is a common problem and may be controlled using modalities such as cold packs and compressive wrapping. If operatively managed, the rehabilitation protocol will be directed by the treating physician.

Bone healing may occur within 6 to 12 weeks; however, the bone strength and the ability of the bone to sustain a heavy load may take up to 1 year. Once healing has occurred, the individual may resume full activities of daily living. It is important to instruct the individual not to overload the fracture site until the bone has regained its full strength. The resumption of heavy work and sports should be guided by the treating physician.
Author(s): By Damieon Brown, DPM, Lawrence DiDomenico, DPM, FACFAS, and Michael VanPelt, DPM

"...A consideration with treating athletes is that if the athlete is inactive after his or her injury, the athlete loses training adaptation. This means the athlete will “detrain” as the individual’s physiological function reverts to the normal untrained state. It is most essential that the athlete remain active in some form of alternative exercise or maintenance program during the rehabilitative period in order to maintain his or her mental and physical strength. Alternative activities include water running and weight training of the upper extremity and the noninvolved lower extremity. Any form of maintaining aerobic capacity, neuromuscular coordination and muscle strength will help reduce injury.

      When it comes to ankle fractures in competitive athletes who require full function of their joints and motion, these individuals will need complete reduction with no malalignment. In previous studies, authors have shown that 1 to 2 mm of displacement of the fibula can cause an increase in tibiotalar contact up to 42 percent. This can lead to increased arthrosis and pain, which can reduce the longevity of playing careers.

      The trend is to perform open reduction and internal fixation of the fracture for early mobilization/rehabilitation, especially when it comes to early season injuries and reducing recovery time in order to facilitate a return to mid-season or end of the season play.

      If an injury occurs at the end of the season, the goal is getting an athlete fully rehabilitated for offseason training. If the podiatrist manages the athlete surgically with open reduction and internal fixation, one may have the patient begin early partial weightbearing in a walking boot with passive range of motion exercises at one to two weeks postoperatively. If you are treating professional athletes or high level college athletes, one may utilize bone stimulation in the postoperative management regimen to increase healing time.

      The athlete can begin physical therapy at two weeks postoperatively with phase one of rehabilitation exercises. The first phase of rehabilitation will include passive range of motion exercises and cryotherapy, which clinicians can initiate immediately after surgery by having the patient wear circulating cryotherapy boots at the hospital or surgery center.

      After the patient has met the goals of the first phase of rehabilitation, one may proceed to the second phase, which is usually initiated at three to four weeks postoperatively. One must remember to use pain as a guide in dealing with any type of rehabilitation procedure. In the second phase, patients may initiate strengthening with elastic bandages, range of motion exercises and proprioception exercises with a biomechanical ankle platform system (BAPS). Advise these patients that when they use elastic bandages, they should use the least resistant bands initially. Toward the end of the second phase, the athlete should begin using a wobble board to improve proprioception and begin closed kinetic chain activities such as walking and loading.

      In the sixth to eighth week post-op, the athlete should begin the third phase of rehabilitation, which involves improving power, increasing neuromuscular control and utilizing sport-specific training of the lower extremity for a full return to sport."

Passive rehabilitation is very important and useful for ankle's fractures, especially for a correct recovery of the physical conditons of an athlete:
1) using a CPM machine, the time of recovery can be reduced significantly;
2) the CPM methodology is strctly aimed to avoid consequents problems as future repercussions on the joints
Rimec has now performed the new Fisiotek 3000 TS:
As it as the last brother, Fisiotek 2000 TS, the new model has received excellent appreciation and recognitions, not only for its uniqueness on the market, but also due to new features set-up in the software, which allow to strenghten the recovery and the restoration of the joint mobility lost.


2 commenti:

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