Sports Medicine: Unit 4 Assessment

Bones

Tibia, Fibula, Talus, Calcaneus, Medial and lateral malleoli

Joints

Talocrural joint, Subtalar joint, Superior tibiofibular joint, Distal tibiofibular joint

Ligaments

Deltoid ligament (medial), Anterior talofibular ligament , Calcaneofibular ligament , Posterior talofibular ligament, Anterior and posterior tibiofibular ligaments

Muscles and Tendons

Gastrocnemius

Functional Anatomy

• Ankle is a stable hinge joint

• Medial or lateral displacement is prevented by the malleoli (plural for malleolus)

• Ligament arrangement limits inversion and eversion at the subtalar joint

• Square shape of talus adds stability to the ankle

• Most stable position during dorsiflexion; least stable in plantar flexion

Why is functional anatomy critical to the kinetic chain?

Functional anatomy is important to the kinetic chain because it helps the body move in a smooth and coordinated way. Some joints, like the knees, provide stability, while others, like the hips, allow movement, and both must work together for efficient motion. If one part of the body is weak or not working correctly, other areas may have to compensate, which can lead to injuries. Understanding how muscles and joints work together helps people improve movement, fix imbalances, and prevent pain.

Injury Prevention: Achilles tendon stretching

• A tight heel cord may limit dorsiflexion

• Should routinely stretch before and after practice

• Stretching should be performed with knee extended and flexed 15-30 degrees

Injury Prevention: Strength training

• Static and dynamic joint stability is critical in preventing injury

• While maintaining normal range of motion (ROM), muscles and tendons surrounding the joint must be kept strong

Injury Prevention: Neuromuscular control training

Uneven surfaces, BAPS boards, or rocker boards can also be utilized to challenge the athlete

Injury Prevention: Proper footwear

• Can be an important factor in reducing injuries

• Shoes should not be used in activities for which they were not made for

Injury Prevention: Preventative taping and bracing

• Tape can prevent injury from spreading

• Improperly applied tape can disrupt normal biomechanical function and case injury

• Lace-up braces have even been found to be superior to taping relative to prevention

• Bracing can impact ankle and knee biomechanics

Assessment Techniques

Palpation: lateral and medial malleolus, talus bone, talocrural joint

Special Tests

• Thompson Test (Achilles tendon integrity)

• Homan's Sign (deep vein thrombosis)

• Anterior Drawer Test (ATFL integrity)

• Talar Tilt Test (lateral ligament complex)

• Ottawa Ankle Rules: Criteria for determining need for X-rays

Rehabilitation Principles: General body conditioning

• Must be maintained with non-weight bearing activities

Rehabilitation Principles: Weight bearing progression

• Non-weight bearing versus partial weight bearing

• Protection and foster healing

• Partial weight bearing helps to limit muscle atrophy (how big or small) proprioceptive (nervous system and neuromuscular system work together for your senses) loss, circulatory stasis and tendinitis

• Protected motion facilitates collagen alignment and stronger healing

Rehabilitation Principles: Joint mobilizations

• Movement of an injured joint can be improved with manual mobilization techniques

Rehabilitation Principles: Flexibility exercises

• During early stages inversion and eversion should be minimized

• Plantar flexion and dorsiflexion should be encouraged

• With decreased discomfort, inversion-eversion exercises should be initiated

Rehabilitation Principles: Neuromuscular control training

• BAPS board progression should be based on patients progress

• Non → Partial → Full- weight bearing

• Deficits can predispose individuals to injury

• Patients should engage in proprioception progression

Double and single leg stances

Eyes opened and closed

Single leg kicks

Alternating apparatuses and surfaces

Use a variety of closed kinetic chain exercises may be beneficial

Enhances overall proprioceptive return

Rehabilitation Principles: Strengthening exercises (isometric, isotonic, concentric, eccentric)

• Isotonic: muscles contract and relaxed

• Concentric: shortening

• Eccentric: lengthening

• Isometric: muscle does not shorten or lengthen but tension increases

With increased healing, aggressive nature of strengthening should increase (isotonic exercises)

Isometrics (four directions) early during rehabilitation phase

Pain should serve as the guideline for progression

Tubing exercises allows for concentric and eccentric exercises

PNE allows for isolation of specific motions

Biomechanics: Definition

The study of how the body moves and how forces impact athletic performance and injury prevention. It helps analyze movement patterns, improve technique, and reduce stress on muscles and joints.

Biomechanics: Importance in injury prevention and performance

It helps identify and correct inefficient movement patterns. By analyzing how forces interact with the body, biomechanics can reveal improper techniques or imbalances that increase the risk of injuries, such as joint strain or muscle overuse.

Biomechanics: Basic principles applied to ankle and lower leg

POLICE and RICE are both methods for treating injuries, but POLICE is a better way to help with healing. RICE stands for Rest, Ice, Compression, and Elevation, which helps reduce pain and swelling. However, POLICE stands for Protect, Optimal Loading, Ice, Compression, and Elevation, meaning instead of full rest, you should move the injured area gently to help it heal faster. The biggest difference is that POLICE encourages light movement instead of complete rest, which can help the injury heal stronger.

Homan’s Script

“Hi my name is Dr. Davis, I heard there’s a problem with your foot is that true?”

yes

“Okay I’m going to perform the Homan’s Test, please extend your foot and knee off the table.”

does it

“Okay I’m going to put this hand on your calf and push your foot into dorsiflexion. Let me know if it hurts okay?”

owww yes ouch

“Oh nooo, unfortunately a positive Homan’s test indicates you may be suffering from throm bow fluh bye tis. which is deep vein clotting.”

Anterior Drawer Test Script

“Okay now I’m going to perform the Anterior Drawer Test to determine if there’s damage to your anterior talofibular ligament”

“Okay I’m going to need you to extend your foot and knee off the table and put it into dorsiflexion just as before”

“Okay with this hand I’m going to put pressure on the base of your talus and compress, then Im going to put this hand on your Calcaneal and push up. I’m listening for a clunking sound.

Clumk

“Oh nooo, I hear a clunking sound, unfortunately that indicate you may have a tear to your anterior tapioca’s ligament.

Open - Ended

Neuromuscular control is important in rehab because it helps the body relearn how to move properly after an injury. When someone gets hurt, their muscles can become weak or stop working the right way. This can make it harder to balance, move smoothly, or react quickly. Rehab exercises focus on strengthening these muscles, improving balance, and teaching the body how to move safely again. This helps prevent future injuries and makes everyday activities or sports easier and less painful. Neuromuscular control helps people recover and get back to normal movement.