Return-to-Sports after ankle injury The PAASS Framework
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Gastautor
Gepostet am 8.7.2022
Inversionstraumata are the most common in sport (1), as well as in football. Less than 50% are looking for a distorsion trauma for medical treatment and 70% return to sports within 3 days or less. This early return to sports is seen as an influence factor for the development of chronic ankle instability (CAI).
How did the result come about?
In this Delphi study a questionnaire was sent to 155 medical experts from the performance sports. For this purpose, sports physicians, physiotherapists and athletics trainers from various sports (e.g. football, tennis, basketball, handball etc.) were questioned. Several criteria were presented in three questionnaires, which should be taken into account in the RTS decision. Each criterion received a match of at least 70% within the respondents. The Consensus of Experts divided the results into 5 categories and named them in the Acronym PAASS (Pain Severity, Ankle Impairments, Ankle Perception, Sensorimotor Control, and Sport/Functional Performance).
Clinical relevance
This study supply some points of reference for which points should play a role to decide whether a footballer is capable of performance again. However, the results are based on expert opinions and must be validated in the future.
In a study, the reader gets very general information about which domains should be considered in the RTS decision. However, it is not described how these can be measured. Thus, it is practically the NRS for pain detection, the Calfraise Endurance Test, 1RM Test and/or a Goniometer for detecting the ankle restriction. The Y-Balance Test can be used to evaluate sensomotoric control. In order to be able to adequately assess the sport performance of a player, objective measuring instruments are also important in addition to completing an entire training unit.
Hop tests (frontal, lateral, multidirectional) as well as agility tests such as T-Test or 505 Test can be useful here. Psychometric questionnaires such as the Cumberland Ankle Instability Tool (CAIT) or the Foot and Ankle Disability Index Sport (FADI Sport) are useful to check the perception and self-received readiness.
The PAAS Framework are described points which important for RTS are. Preventive measures are not explicitly described here. In football you cannot avoid all ankle injuries, by factors such as opponent contact, change of direction etc. However, it may be useful to Risk factors (RF) Identification and these try to influence.
A preliminary injury is described as the largest RF for a recurrent occurrence. Most OSG traumas occur in the course of a game, less often in the beginning. This indicates that fatigue has an influence on the development. Also play Power deficits and delayed reaction times the ankle-inverters and the hip-abductors a role. Reduced mobility in the Dorsalextension as well as disturbed proprioception and postural control were also identified as RF (5).
However, the presence of a multiple RF does not in itself lead to an injury. In addition, a triggering event is required. The higher the presence of RF, the lower the player's tolerance to an event.
Of course, injuries without the presence of RF are also possible. Specifically addressing these risk factors can be very useful both in therapy and in ongoing seasonal operation. In addition, it has become very effective Preventive training protocols how to integrate the Fifa11+ program to prevent lateral ankle injuries (6). Because, the best treatment for an injury is to ensure that none arises.
The PAASS Framework provides a good basic design which providers of athletes can support in their RTS decision. However, such decisions should take into account other areas such as the importance of the game (e.g. Friendship Game vs. Cup Finals), the needs of the player or third party. However, to what extent the results obtained are valid, it is necessary to check them in more detail. A systematic risk factor analysis and the use of preventive training programs can provide added value for prevention.
Name: Fabian Haas
Current position: Sportphysiotherapeut bei Alemannia Aachen U19 und Sport-/Physiotherapeut bei Therapiezentrum GmbH NG
M.Sc. Sportphysiotherpie (NL) i.A.
Tasks: Planning and implementing rehabilitation of players, coordination and agreements in the multidisciplinary network for players of the U19, Side-Line Care on matchdays
LinkedIn: Fabian Haas
Literature
- Gribble PA, Bleakley CM, Caulfield BM, Abererty CL, Fourchet F, Fong DT, et al. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1493-5.
- Delahunt E, Gribble PA. Structured clinical assessment: a brake to stop the ankle joint ‘rolling’. British Journal of Sports Medicine. 2018;52(20):1294.
- Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 2013;43(6):385-93.
- Tassignon B, Scattered J, Delahunt E, Smith M, Vicenzino B, Verhagen E, et al. Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Medicine. 2019;49(4):601-19.
- Bloch H, Klein C, Luig P, Kühn N. Return-to-Competition - Testmanual for assessing the playability after acute lateral band injury at the ankle in cooperation with the2019.
- Nouni-Garcia R, Carratala-Munuera C, Orozco-Beltran D, Lopez-Pineda A, Asensio-Garcia MR, Gil-Guillen VF. Clinical benefit of the FIFA 11 programme for the prevention of hamstring and lateral ankle ligament injuries among amateur soccer players. Injury Prevention. 2018;24(2):149.