|Year : 2016 | Volume
| Issue : 1 | Page : 20-27
Common injuries in field hockey
Munazza Orooj1, Shibili Nuhmani2, Qassim I Muaidi2
1 Department of Rehabilitation Sciences, Jamia Hamdard, New Delhi, India
2 Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam, K. S. A
|Date of Web Publication||7-Jan-2016|
Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam
K. S. A
Source of Support: None, Conflict of Interest: None
Field hockey is considered as a popular sport worldwide next to soccer in popularity. According to National Collegiate Athlete Association overall injury rate is 6.3%/1000 athlete exposure. Mechanism of injury could be extrinsic injury that is, being struck by hockey stick or ball or intrinsic injury due to internal force acting on muscle or an overuse injury which includes tibial stress syndrome, shin soreness, illiotibial band pain, low back dysfunction, tendonitis, patello-femoral pain, planter fasciitis, and stress fracture of foot and leg. Initial approach to injured athlete includes airways, breathing, circulation, rest, ice, compression, elevation, referral protocol, normalize joint range of motion (ROM), restore strengthening, Improve proprioception, agility and balance, minimize chance of re injury by maintaining flexibility. Strengthening and therapeutic exercises that will vary accordingly to the injured part. Countermeasures include preparticipation screening, preseason conditioning, fitness program, adequate warm and pregame stretch, followed by cool down and postgame stretch, following rules and penalty and finally by wearing protective equipment. This article discusses the biomechanics and common injuries in field hockey. Patho-mechanics, diagnosis, and physiotherapy management of the common injures are outlined. This may help the health care practitioners who deals with different injuries related to hockey.
تعدّ لعبة الهوكي الرياضة الشعبية الثانية في جميع أنحاء العالم بعد كرة القدم. وحسب تقارير الجمعية الرياضية الوطنية فإن معدل الإصابة السنوية في لعبة الهوكي هو 6.3 بين 1000 لاعب . و يمكن أن تكون الإصابة خارجية وهذا يعني أن يصاب اللاعب بضربة من عصا الهوكي أو الكرة أو أن تكون الإصابة بسبب قوة داخلية على العضلات أوإصاية بسبب الاستخدام المفرط الذي يتضمن متلازمة الإجهاد في عظام الساق، ألم الساق، وألم الفرقة وانخفاض العجز الظهر، التهاب الأوتار، ألم الفخذ، وزارع اللفافة، وكسر الإجهاد في القدم والساق. وتشمل الرعاية ألأولية للرياضي المصاب الطرق الهوائية، والتنفس والدورة الدموية، والراحة، الثلج، الضغط، ورفع الجزء المصاب، وتطبيع مجموعة مشتركة من حركة (ROM)، واستعادة وتعزيز، وتحسين استقبال الحس العميق، وخفة الحركة والتوازن، وتقليل فرص تكرار الإصابة من خلال الحفاظ على المرونة. و تعزيز التمارين العلاجية التي سوف تختلف وفقا لذلك باختلاف الجزء المصاب.
وتتضمن هذه الإجراءات فحص قبل المشاركة، و التكييف قبل بداية الموسم، و برامج اللياقة البدنية،والإحماء الكافية، تليها التهدئة والإجهاد الذي يسبق البرنامج بالضاف الى التنويربقواعد اللعبة والجزاءات التى تفرض على المخالفات وأخيرا ارتداء المعدات الواقية. تتناول هذه المقالة تعنى بالميكانيكا الحيوية المصاحبة للإصابات الشائعة وسط ممارسى رياضة الهوكي. بالاضافة الى تشخيص، والعلاج الطبيعي لتلك الاصابات. وقد يساعد لك ممارسي الرعاية الصحية الذين يتعاملون مع مختلف الإصابات المصاحبة للعبة الهوكي.
Keywords: Consultation, proprioception, protective devices, referral
|How to cite this article:|
Orooj M, Nuhmani S, Muaidi QI. Common injuries in field hockey. Saudi J Sports Med 2016;16:20-7
| Introduction|| |
Hockey is a team game played between two teams of eleven players each, using hooked sticks with which the player try to dive a small hard ball toward goals of opposite ends of a field. The hockey association was founded in 1886 and the international rules were founded in 1900. The governing body of hockey is known as International Hockey Federation (FIH) with men and women being represented internationally in competition including the Olympic Games, World Cup, World League, Champions Trophy and Junior World Cup, with many countries running extensive senior and masters club competition. The FIH is responsible for organizing the hockey rules board and developing the rules for the sport.
Substitution are permitted at any point in a game, apart from between the award and end of the penalty corner to exceptions to this rule is for injury or suspension of the defending goal keeper Other rules include no foot to ball contact, no use of hand, no obstructing other player, high back swing and no third party. Eleven players and will typically arrange themselves into forwards, mid fielders, and defensive, full back with the player moving between these lines with the flow of play. The goalkeeper who wears a full protective equipment comprising at least headgear, leg guard, and kicker. The game time is divided into two equal halves of 35 min each, with 5–10 min for half time the play is started with the pass from the center of the field, all players must start in their defensive position but the ball may be played in any direction along the floor. Free hits are awarded when offence are committed outside the scoring circle. Corners are played by attacking team and involve a free hit on the side line 5 m from the corner of the field closet to where the ball went out of play. Short corners begin with 5 defenders positioned behind the back line and at least 10 yards from the nearest goal post. Penalty stroke is awarded when a defender commits a foul in the circle that prevents a probable goal or commit a deliberate foul in the circle.
| Biomechanics|| |
The field hockey hit is a two handed swing motion which, due to the production of a high ball velocity, is generally used for long range passing and for shooting at goal and serves to give velocity to the game. Hitting the hockey ball, as opposed to sweeping or pushing the ball can give rise to increase the ball velocity. The player should adopt a side-on stance with the left shoulder facing in the direction of the target to increase weight transfer between the right foot and the left during the hit. The shoulder should turn to facilitates a great ROM and the wrists should cock while the stick proceeds through the whole backswing momentum should be transferred from the lower body, to upper limb and the stick during the downswing and that the hands pull the stick toward the ball as weight is shifted back onto the left foot and that this transfer of weight flattens the swing arc of the stick, helping to improve accuracy during the downswing. The acceleration of the stick in the late downswing comes from the straightening of the right arm and from uncocking of the wrist accompanied by the pronation of the forearm prior to impact. A ball impact the arm and hands lead the stick with the extension of the left elbow allowing the stick to act as an extension of the left arm. The field hockey hit progresses as a result of a combination and balance of muscular activity and segmental interactions. Muscular activation appears to initiate the downswing of the hit and causes the initial acceleration of the upper arms before being apparent to regulate the effects of segmental integrations, caused by the acceleration of the trunk, the arms and the hockey stick.
| Common Injuries|| |
According to National Collegiate Athlete Association injury rate in field hockey is 6.3/1000 athlete exposures. Training in natural grass demonstrated more injuries (64.87%) as compared to artificial turf (35.13%).
Extrinsic injuries are ranging from 60% to 80% of all injuries.,,, Most extrinsic injuries reportedly result from being struck by the hockey stick or ball. An early study, reported that ball and stick injuries make up 72.2% of all hockey injuries on grass. Extrinsic injuries can also occur to any part of the body and may result in laceration requiring suture, contusion, edema, inflammation with accompanying pain and acute or sustained incapacity. The most serious injuries in hockey include blows to head, throat, or genitals from a deflected ball or stick and collision with goalkeeper., The fall injuries on synthetic turf may be more frequent and severe than those on grass.,
Intrinsic are due to internal forces acting on muscles, tendon, ligament, or joint. Intrinsic injuries can result in tearing muscle fibers (strain); tearing ligament (sprain) tearing cartilage and localized bleeding and swelling. Intrinsic injuries are reported to account for 11–18.5% of all hockey injuries.
Overuse injuries are repetitive episodes of trauma can overwhelm the body's ability to repair itself. Typical example of this type include tibial stress syndrome shin soreness, illiotibial band pain, low back dysfunction, tendonitis, patello femoralpain, planterfascitis, and stress fracture of foot and leg. Females are more prone to overuse injuries (32%) than their male counterpart (18%).
| Body Sites|| |
Lower limb represent 12.7% of all hockey injuries. It has been suggested that women may be predisposed to a greater incidence of lower limb injuries than men because of anatomical differences when compared to men, women have a greater angle at knee, a higher rate of ankle pronation, and greater joint mobility., Ankle is particularly vulnerable part of the human anatomy and it has been estimated that ankle injuries account for up to 19% of all sporting injuries. Several studies report prevalence of ankle and foot, ranging from 4% to 27%.,,,,,,,, Most of the ankle injury in hockey is to the anterior section of the lateral ligament generally occurring when foot in inversion. Injuries to the knee are common (14%) among elite female player while knee pain was reported by 30% of players who survived. The prevalence of low back pain in elite hockey player is as high as 70–80%., Injuries to hand account for all 19.2% of all injuries. Head and eye injuries presenting to hospital emergency department accounted for 5.1% and 3.4% of all injuries respectively. Dental injury to the teeth, upper jaw, lower jaw, and alveolar arch  can occur when the ball rises abruptly in the air or a stick is swung carelessly.
| Mechanisim of Injury|| |
Most injuries (74.0%) requiring hospital emergency department treatment were as a result of the player being struck by or colliding with an object (e.g.,) ground ball, stick, or another player. Most common of these injuries were struck by hockey stick (40.8%) of all injuries followed by struck by a ball (23.3%) of all injuries.
| Head Injuries|| |
Concussion has been reported for the greatest proportion of all injury type in youth hockey concussion is defined as a complex pathophysiological process affecting the brain, induced by traumaticl forces. Neck pain, dizziness, and headache are commonly reported in youth secondary to a variety of neck pain is the third most commonly reported baseline symptoms in varsity athlete. Alteration of orientation in space and altered cervical spine control may lead to a reduced ability to control the head and neck. This may then change the way in which forces are transmitted to the head. Balance alteration have also been noted following a concussion.
The initial approach to an unconscious player is airways, breathing, circulation should be followed, for less severe injury neurological assessment should be followed it include assessment of speech, balance, and memory. Player should not return to play until the symptoms resolved both with rest and exertion.
In the initial days following a concussion, mental and physical rest has been strongly Exercise: The benefit of exercise have been reported include the facilitation of molecular marker of neuro plasticity and neurogenesis improved cognitive functioning,,, greater encouraged.,
Psychological treatment such as modified form of cognitive behavioral therapy with adults who have chronic symptoms and problem following traumatic brain injury (TBI).
In players with mild TBI, improvement in the symptoms after an 8 weeks period of vestibular physiotherapy. Vestibular rehabilitation included an individualized program of habituation, gaze stabilization, adaptation exercise, standing balance exercise, and repositioning maneuvers' based on assessment finding.
| Shoulder Injuries|| |
The acromioclavicular joint injury
Injury to the acromioclavicular (AC) joint most commonly occur as a result of direct force produced by the athlete falling on the point of the shoulder onto the ground or firm objects with the arm at the side in adducted position. The direct force of striking the point of the shoulder drives the acromion downward and the downward displacement of the clavicle is restricted by interlocking of the sternoclavicular ligaments. The clavicle remains in its normal anatomic position and the scapula and shoulder girdle are driven inferiorly. The result then of a downward force being applied to the superior aspect of the acromion is either give way of the AC or clavicular fracture. AC joint injuries consist of the continuum of ligament injuries beginning with the mild sprain of ac ligament followed by coracoclavicular ligament finally if the downward force continues tear of the deltoid and trapezius muscle attachment occur from the clavicle as well as rupture of the coracoclavicular ligament. When these structure tear, the upper extremity has lost its ligament support from the distal end of clavicle and its droops downward. With severe force the skin overlying the ac joint can also be disrupted.
They are minor injuries and are generally treated conservatively with a sling for 5–7 days to reduce the stress on the AC joint. Ice is applied for first 48–72 h and nonsteroidal anti-inflammatory medicine. Immediate isometric and gentle ROM exercises are encouraged. Strengthening program should be initiated as patient symptoms begin to resolve. Mostly players with type 1 injuries return to full activities within 1–2 weeks.
The time frame is prolonged due to greater trauma sustained sling is used for 1–2 weeks mostly players return to full activities within 2–3 weeks turn to full activities within 1–2 weeks.
They are commonly treated nonoperated treatment include ice nonsteroidal anti-inflammatory drugs and sling immobilization. Sling can be discontinued once major symptoms subside, within 1–4 weeks isometrics and gentle ROM exercises within 1st week.,
| Rotator Cuff Injuries|| |
The most common cause of a rotator cuff tear is repeated micro-trauma, which can occur over several weeks months or years. Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft-tissue resulting in bruising or swelling. Since there are only a few millimeters separating rotator cuff tendons from a bony hood (acromion), the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons tear is a reduction in shoulder function.
Stage I of the rehabilitation should focus on reducing inflammation and restraining the athlete from the activity that causes pain, ROM exercises and capsular stretching may be done. Begin with isometric exercises for the medial and lateral rotators of the join and progressing to isotonic exercises if the athlete does not experience pain. Aggressive pain-free strengthening of the peri scapular muscles should also be started.
If the pain continues to be absent, strengthening can be increasingly aggressive. lsokinetic exercises at speeds >200/s for shoulder medial and lateral rotation may begin. Aggressive neuromuscular control exercises and diagonal pattern can be started in this stage. Resistance exercise can be initiated with manual resistance from the sports therapist and advancing to resistance applied by surgical Thera-Band. The prone-on-elbows position is a good technique for self-mobilization. A body blade may also be used for rhythmic stabilization exercise program should now progress to free weights. Eccentric exercises of the rotator cuff should be emphasized to meet the demands of the shoulder in overhead activities. Strengthening of the deltoid and upper trapezius muscles can begin above 90° of elevation.
Should focus on sport specific activities, with throwing and overhead athletes. Total body conditioning, return of strength and increased endurance are the emphasis.
| Back Pain in Hockey Players|| |
A study done by Reilly and Seaton  revealed that 53% of field players have experienced back pain at some time. Most therapist seem to classify it as an overuse injury. Field hockey is a game with an inbuilt asymmetry. All sticks are handed and approximately 0.91 m long. The rules require that only one side of the stick be used during play. Therefore, most ball handling and defensive skills demand a combination of trunk flexion and rotation. This semi crouched position causes greater spinal loading than normal locomotion and is thought to be ergonomically unsound. Previous researched on back pain in field hockey players has focused on this semi crouched position as the underlying cause of injury and pain. Thirty percent of chronic mechanical back pain are reported to be due to thoraco lumbar muscle control dysfunction. Factors predisposing the young athlete to back injury include the growth spurt, abrupt increase intensity or frequency, improper technique, unsuitable sport equipment, leg length inequality, poor strength of back extensors, abdominal musculature inflexibility of the lumbar spine, hamstring, and hip flexors muscles may also contribute to chronic low back pain. Excessive twisting may produce sprain and strain, the most common cause of low back pain in adolescents. Blows to spine may create contusions or fracture. Fracture include compression fracture, comminuted fracture, fracture of the growth plate at vertebral end plate, lumbar transverse process, fracture and also fracture of the spinous process. Pain is usually confined to the low back. If the pain radiates, it does so to the buttocks or the back of the thigh and is more commonly from the hamstring tightness than from radiculopathy.
Immediate treatment of an acute injury, such as sprain/strain, includes cryotherapy, electrogalvanic stimulation, anti-inflammatory, medication, and gentle exercises. Prolonged bed rest should be avoided since atrophy may occur rapidly. Early strengthening exercises include the Williams flexion exercises and Mckenzie extension exercises.
Stage I (early protection mobilization)
It consist of brief period of rest followed by various therapeutic modality (application of heat or cold), nonsteroidal anti-inflammatory medication, soft-tissue mobilization and epidural injection). Once pain is controlled the player begins an early exercise program to restore lumbar and lower extremity ROM.
Stage II (dynamic spinal stablization)
Focuses on co contraction exercises of the abdominal and lumbar extensors muscles to stabilize the injured motion segment. Isometric exercises help to retrain muscles to maintain a mechanically neutral position.
Focuses on strengthening.
The athlete returns to sport activity. Plyometric exercises are recommended in this stage.
Include warm up exercises.
| Groin Injuries|| |
The cumulative incidence rate was 20 groin or abdominal strain injuries per 100 players per year. Multiple causes, include strain of the abdominal muscles, hip flexors, or adductor. Referral of pain from internal organs, such as urethral colic, can represent as lower abdominal or groin pain. The adductor muscles are frequently involved especially in hockey players. Groin or medial thigh pain is the most common complaint particularly when the patient is asked to adduct the leg against resistance. Focal tenderness and swelling are detected; with more severe injuries, a defect may be palpable. Strains of the rectus femoris muscle result in palpable swelling and tenderness in the anterior thigh, 8–10 cm below the anterior superior iliac spine. These types of strains result from an explosive hip flexion maneuver, such as sprinting, kicking, or from eccentric overload as the hip is extended. Further examination reveals painful and possibly weak knee extension or hip flexion. Strain or rupture of the iliopsoas muscle can also occur during resisted hip flexion or passive hyperextension (eccentric overload). These injuries may be associated with significant swelling and are potentially a cause of femoral nerve palsy. The “sport hernia” “hockey hernia” has become common injury athlete participate in sport that require twisting turning at speed that is commonly seen in hockey players study of National Hockey League players showed a significantly increased incidence of groin injuries from 1991 to 1997.
It initially focuses on minimizing swelling and bleeding with compression and ice. The hip can be rested in a position of comfort and the patient should ambulate with crutches. Gradual stretching and strengthening of adjacent muscles should be performed before resuming premorbid activity. Exercises that are commonly done are, Aquatic deep water pool running, Stationary bicycling with no resistance, active ROM exercises of hip and isometric exercises, straight leg raises (SLR), quad set.
Intermediate phase consist of active ROM exercises for hip abduction, adduction, flexion, extension, SLR, proprioceptive exercises should be done. Initiate gentle groin stretching hamstring stretches passive rectus femoris stretches, and passive hip flexor stretches can also be given.
Advanced phase includes: Concentric and eccentric hip abduction and adduction with Thera-Band, function drills after warmed up and full stretches (slide boards) (jogging) (box drill) protective wrapping or commercial hip spica type protection.
Criteria for return to sports
Equal muscle strength of adductors, abductors, flexors, extensors on manual muscle testing, Full pain free ROM, ability to perform all sport specific functional drills at full speed without pain are the criteria to return to sport. Athlete must develop a rigorous pre- and post-sporting activity groin stretching program for the remainder of the season.
| Anterior Cruciate Ligament Injury|| |
The mechanism of injury is usually hyperextension, deceleration, or sudden rotation. Frequently, the anterior cruciate ligament (ACL) is injured in combination with other structures, such as the medial collateral ligament and medial meniscus (“terrible triad”). Reason for the increase in knee injuries to the ACL in field hockey is mainly due to the type of sudden rotation they do as athletes, and also the type of field played on. When athlete are cutting on turf they are normally at a greater risk for tearing a ligament since the friction on turf has a lower coefficient than it does on grass. There is less resistance on turf to keep the momentum of the player from sliding, even after they have tried to come to a complete stop but body stays in motion until acted upon. Turf shoes and cleats can cause the foot to get stuck in the turf too, thus leading knee to go in different direction then body.
Acute care should include splinting, icing, and compressive wrapping. The following exercises for hyperextension are towel stretches, heel props, prone hangs, wall slides.
| Meniscal Injuries|| |
Medial meniscal injuries usually occur when an athlete is attempting to sudden rotation with a fixed foot. Damage results when rotational forces are applied to the knee while it is partially flexed with the foot on the ground. Lateral meniscal injuries are seen with less frequency than medial meniscal injuries. The lateral meniscus permits greater anatomic mobility and is thus less susceptible to tears. Damage to the lateral meniscus can occur when both rotational and compressive forces are applied to the knee while it is fully flexed with the foot fixed on the ground. A combination of torsional and axial loading appears to underlie many meniscal injuries. If intrinsic degeneration of the meniscus is present, minimal trauma may cause tearing. Patients who have meniscal degeneration are probably predisposed to meniscal tears. Meniscal injuries are common in the ACL – Deficient knee, as a result of abnormal tibial translation. Lateral meniscal injury is usually associated with an acute ACL tear, whereas medial meniscal tears occur more often in persons with chronic ACL insufficiency.,
Reduce pain and inflammation, normalize joint ROM, strengthen knee: Especially quadriceps (vastus mediallis obliquus) and hamstrings, strengthen lower limb: Calf, hip and pelvis muscles, improve patello-femoral (knee cap) alignment, normalize muscle lengths improve proprioception and balance improve technique and function example walking, running, squatting, hopping and landing, and minimize chance of re-injury.
| Hamstring Injuries|| |
There are many potential contributing factors to hamstring injuries:
- Lack of flexibility, particularly in the hamstring, hip flexors, quadriceps, and spine
- Lack of strength particularly in the gluteals, hamstring, quadriceps, and lower back
- Muscle imbalance, especially between the hamstring and quadriceps or between the hamstring and gluteals
- Fatigue injuries often occur late in the game
- Lack of warm up cold muscles will be vulnerable early in the game
- Back injuries: The sciatic nerve passes deep through the hamstring the flexibility of the nerve can be affected by spinal and muscle disorder and this makes the hamstring and the nerve itself vulnerable to injury
- Past injury: Scar tissue can make the muscle more vulnerable and affect the strength and flexibility. Past injuries to the knee and other leg muscles are also at the risk factors for hamstring strain
- Age: It has been found that there is a significant increase in injury incidence between the age of 21 and 24 in one study, 23-year-old athlete were at twice risk to younger players
- Poor control of the lumbo pelvic and trunk muscles
- Posture extreme of posture: Resulting in pelvic forward or backward tilt, can affect the hamstring tightness, tension and strength
- Race: Black athlete is at greater risk.
Treatment of hamstring injuries is directed toward restoration of strength and flexibility of the muscle group. Isometricexercisesare initiated with improvement in motion and pain, the isometric exercises are replaced by isotonic exercise with light weights. When the athlete is pain-free throughout the prone hamstring exercise program, a high-speed, low-resistanceisokinetic exerciseprogramis begun pool walking and stationary bicycle with no resistance are also used in the early stages. Hamstring curls in the water are also beneficial in the early postinjury phase. Wall-leg exercise and upper body exercises are also used throughout for aerobic conditioning.
| Shin Splints|| |
Shin splints are a nonspecific term typically used to describe exertional leg pain. Hockey players are particularly at risk of developing shin splint. This is most likely due to the hard and unyielding nature of the artificial turf. A study in USA found 39% female college field hockey players suffered from sport related lower leg pain. It is among the most common chronic complain in hockey player with incidence between 10% and 20%. A connective tissue, known as fascia, attaches along the edge of tibia. Tension through muscles behind the leg may indirectly causes injury or inflammation along this attachment. Bone stress may result from repetitive bending and compression force the bone itself become painful. Poor foot biomechanics: Being excessively “flat – footed” has long been considered one of the major contributing factor to shin splint. This is known as over pronation.
In acute phase
Ultrasound therapy is considered, nonimpact activities are begun, gastrocnemius and soleus stretching, isometrics are begun.
It emphasis on improving flexibility, isometrics are progressed to Thera-Band exercises, towel scrunches are progressed from a seated to a standing position. Balance activities are begun with progression of difficulty to include the biomechanical ankle platform system (BAPS).
Return to sport phase
Warm-up and stretching are emphasized, running is allowed to progress within the limits of a pain-free schedule avoid running on uneven surfaces.
| Ankle Sprain|| |
If there is a severe in turning or out turning of the foot relative to the ankle, the forces cause the ligaments to stretch beyond their normal length. If the force is too strong the ligament can tear. Player may lose the balance when foot is placed on some unstable ground. Player may fall and be unstable to stand on the foot. When excessive force is applied to the ankle soft-tissue structures, patient may hear a “pop.” Pain and swelling. The amount of force determines the grade of the sprain a mild sprain is grade 1 (slight stretching and some damage to the fibers), a moderate sprain is grade 2 (partial tearing of the ligament), a severe sprain is grade 3 (complete tear of the ligament).
Aim is to decrease swelling, decrease pain, protect from reinjury, and maintain appropriate weight-bearing status. Protection options are: Taping, functional bracing, removable cast boot (some grade 2 and most grade 3 sprains) is given, rest, ice with other modalities (interferential, high-voltage galvanic stimulation, ultrasound), light compression, elevation above the heart (combined with ankle pumps) are generally given.
This focuses on increasing pain-free ROM, begin strengthening, begin nonweight-bearing proprioceptive training, provide protective support as needed. Progress weight-bearing as symptoms permit. Partial weight-bearing to full weight-bearing if no signs of antalgic gait are present. Therapeutic exercises include active ROM exercises, dorsiflexion, inversion, foot circles, plantar flexion, eversion, use of aqua ankle in cold water for gentle strengthening and ROM, strength exercises. Patients can perform balancing exercises on an isometric in pain-free range. Circular tilt board to improve proprioception, sitting or toe curls with towel (place weight on towel to in standing. Pick up objects with toes (tissue, marbles). Proprioceptive training seated BAPS board wobble board. Ankle disc, stretching passive ROM-only dorsiflexion, and plantar flexion achilles stretch (gentle). Joint mobilizations (grades 1-2 for dorsiflexion/plantar flexion,) can be given.
Increase pain-free ROM, progress strengthening, progress proprioceptive training, increase pain-free activities of daily living, pain-free full weight-bearing and uncompensated gait. Stretching gastrocnemius and soleus with increased intensity joint mobilization (grade 1, 2, 3, for dorsi flexion, eversion, hold inversion) strengthening, weight bearing exercises, heel raises, toe raises, stair steps, quarter squats, eccentric/concentric and isotonics, peroneal strengthening, isokinetics, proprioceptive training, single leg balance activity supportive tapping, bracing, and orthotic used as needed.
| Playing Rules and Safety|| |
Goal keeper is required to wear appropriate protective head gear. Player may not wear anything that may be dangerous to other player referees will suspend the game and stop the clock because of player injury. If a player incurs a wound that cause bleeding, the umpires must stop the game at the earliest possible time the wound must be evaluated by medical personnel. Play will be stopped and field cleared based on the lightning safety standards.
The injury may be catastrophic, causing lifelong disability. Injuries may have long-term effects, because there is evidence that knee and ankle injuries may result in an increased risk for osteoarthritis later in life. Although it is impossible to eliminate all injuries, attempts to reduce them are obviously warranted by coaching and expertise of coaches. Preparticipation screening, preseason conditioning and fitness program, adequate nutrition and hydration, adequate warm up and pregame stretch, officiating and expertise of officials, prophylactic taping and bracing can decrease the chance and impact of injuries.
We express our sincere thanks to Dr. Mohammed Showki for helping in the review process.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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