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REHABILITATION OF AN ANTERIOR TALOFIBULAR LIGAMENT INJURY IN A PROFESSIONAL FOOTBALLER INCORPORATING THE USE OF THE EMPOWERBAND ANKLE SUPPORT FEATURE / DAVID FEVRE MSC, CHRIS WILDING MSC, RHYS DALY & CHASE HOMER Introduction Lateral ankle ligament injuries are common in most sports, particularly in football. The most recent studies put the incidence of such an injury in a range of 10-17% of all injuries (1,2,3) in elite soccer. The majority of these injuries are managed conservatively with a graduated rehabilitation programme before returning to play. This often involves the use of an immobilisation boot, brace or strapping with the progressive increase in load-bearing demanded throughout the specific rehabilitation stages. Recovery time for ankle sprains varies between 7 –34 days; post-surgery in more severe cases this figure is reported as 77-105 days (4) Case Report The subject is a 21-year-old professional footballer who is presently contracted to a professional English soccer team in EFL 2 for the 2020-2021 season. He primarily plays as a left-sided full-back or midfielder
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and has represented his country at U-18, U-19 and U-21 level. His injury occurred in a pre-season friendly match when he came on as a substitute. Two minutes after entering the field of play, his left foot was trapped in a collision with an opponent and his fixed foot ‘rolled’ over into a plantarflexed/ inverted position. He tried to play on but 5 minutes after the injury he was substituted to prevent further damage. On initial examination, he complained of moderate pain over the anterolateral aspect of the ankle, with an effusion over the anterior/ inferior lateral malleolus. He had tenderness on direct palpation of the anterior talofibular ligament (ATFL) with mild to moderate instability on stress testing. All other ankle structures appeared normal. He was treated with ice, compression and elevation using a Cryo-cuff with ankle attachment (Picture 1) and immobilised in an immobilisation walking boot (Picture 2).
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His injury was re-assessed daily but no further stress testing of the ATFL was performed until day 5 to allow the acute symptoms to subside and repair tissue to start to form. Each day his symptoms subsided and after re-examination on day 5, the medical team were happy that the player had an isolated Grade2 tear of the ATFL. An MR (Magnetic Resonance) scan was considered but after daily discussion with the player/medical team, this was decided to be unnecessary as physically and psychologically the player was improving daily without this additional intervention. Intervention and Outcome In order to assist his rehabilitation after coming out of the immobilisation boot, the player was offered the use of a semi-rigid Empowerband ankle support (Picture 3) which is worn over the boot unlike most other ankle braces or supports and which has been designed specifically for football.
