Low compliance with self-training after overtraining: Opinion writer wants training incorporated into daily life. Illustration photo: Colourbox.com
Stimulation of musculature and joint sense after ankle sprain
Compliance with self-training after ankle sprains is very low and reduces the effect of rehabilitation. How to solve this dilemma?
Written by Per Morten Fredriksen, physiotherapist and professor, Inland Norway University of Applied Sciences and professor II, Østfold University College.
Conflict of interest: The author is involved in the development of an ankle training product and will receive income from the sale of the product.
Optimal effect of rehabilitation after ankle sprain involves more than 900 minutes with treatment. This is only achieved through self-training. Adherence to self-training after ankle sprains is very low and reduces the effectiveness of rehabilitation. How to solve this dilemma?
Incidence of ankle sprains
Ankle sprains are among the most common musculoskeletal injuries and emphasize the need for good prevention and treatment strategies to reduce the incidence of new sprains and reduce the risk of developing chronic ankle instability. The overall occurrences of ankle sprains in Norway is estimated at 400 per day and 150,000 - 200,000 per year. Studies indicate that up to 70% of the population has experienced at least one overdraft in their lifetime.
More people will experience at least a new ankle cover during the first 12 months after the initial injury. Thus, a previous ankle sprain is the most important risk factors for subsequent ankle sprains, and more people may develop chronic ankle instability if adequate rehabilitation is not provided. Ankle sprains are often considered a minor and self-limiting injury, which means that many does not seek treatment or do not receive adequate follow-up from healthcare professionals.
Mechanoreceptors
Joint sense refers to the body's ability to perceive the position and movement of the joints. This is made possible by mechanoreceptors in muscles, tendons and ligaments, which provide continuous feedback to the central nervous system about the body's position and movement. Mechanoreceptors are specialized neurons that transmit information about mechanical deformation into electrical signals. Stimulation of these receptors results in reflexive muscle contraction around the joint as a control of movement. In ankle sprains, the mechanoreceptors in the ligaments will be overstretched and thus have a higher threshold for firing. It is therefore crucial for optimal joint sense that other mechanoreceptors in tendons and muscles can perform the function of positioning the position of the joint until the receptors in the ligaments return to their normal state.
900 minutes of improvement with training
Training after an ankle sprain starts as soon as the acute treatment is over. A meta-analysis found that exercise intervention significantly reduces the likelihood of repeat ankle sprains, and that this effect is enhanced by long-term treatment. 900 minutes (OR=0.48, 95% CI 0.37 to 0.63). This corresponds to 15 hours of exercise, which can be difficult to achieve by only visiting a physiotherapist. Physiotherapists or other therapists are often seen once or twice a week, so it will take two months or more to reach 900 minutes of rehabilitation. In order to achieve the desired effect, volume training with the help of self-training is essential. The challenge with rehabilitation is to get patients to complete the self-training. Compliance with self-training has been shown to be very low. This is discussed by Sevild et al. in Fysioterapeuten January 2023, with a summary of previous research.
Foot positioning, muscle and joint stimulation
I think patients should exercise more in their daily lives. An assistive device that pulls the foot into an inversion position could be a solution. In this case, the patient would have to actively use the muscles on the outside of the foot to position the foot and ankle in a neutral position during walking. In this regard, EMG measurements have shown increased stimulation of muscles laterally on the foot with the aim of stimulating joint sensation.