Elsevier

Journal of Biomechanics

Volume 46, Issue 1, 4 January 2013, Pages 175-178
Journal of Biomechanics

Short communication
How to sprain your ankle – a biomechanical case report of an inversion trauma

https://doi.org/10.1016/j.jbiomech.2012.09.016Get rights and content

Abstract

In order to develop preventive measures against lateral ankle sprains, it is essential to have a detailed understanding of the injury mechanism. Under laboratory experimental conditions the examination of the joint load has to be restricted with clear margins of safety. However, in the present case one athlete sprained his ankle while performing a run-and-cut movement during a biomechanical research experiment. 3D kinematics, kinetics, and muscle activity of the lower limb were recorded and compared to 16 previously performed trials. Motion patterns of global pelvis orientation, hip flexion, and knee flexion in the sprain trail deviated from the reference trials already early in the preparatory phase before ground contact. During ground contact, the ankle was rapidly plantar flexed (up to 1240°/s), inverted (up to 1290°/s) and internally rotated (up to 580°/s) reaching its maximum displacement within the first 150 ms after heel strike. Rapid neuromuscular activation bursts of the m. tibialis anterior and the m. peroneus longus started 40–45 ms after ground contact and overshot the activation profile of the reference trials with peak activation at 62 ms and 74 ms respectively. Therefore, it may be suggested that neuromuscular reflexes played an important role in joint control during the critical phase of excessive ankle displacement.

The results of this case report clearly indicate that (a) upper leg mechanics, (b) pre-landing adjustments, and (c) neuromuscular contribution have to be considered in the mechanism of lateral ankle sprains.

Introduction

Lateral ankle sprains rank among the most frequent injuries in sports (Fong et al., 2007). For successful development of preventive measures, it is essential to have a sound understanding of the injury mechanism (Bahr and Krosshaug, 2005). While several methodological approaches are available to study etiological details about sprain occurrences (e.g., athlete interviews or simulation of non-injury situations), one valuable approach is the analysis of the undesired situation in which an athlete is injured during a biomechanical measurement (Krosshaug et al., 2005).

Few case reports of lateral ankle sprains are available containing biomechanical data about ankle joint kinematics and kinetics during the phase of ground contact (Kristianslund et al., 2011, Mok et al., 2011, Fong et al., 2009). The present case report enlarges this current information as additional measurement methods were applied. This report is able to describe the entire lower limb kinematics, the neuromuscular activation profile and the preparatory adjustments during an ankle sprain. Based on this additional knowledge the injury mechanism of lateral ankle sprains may be understood more comprehensively.

Section snippets

Experimental setup

One male soccer player (23 years; 1.83 m; 75 kg) participated in biomechanical measurements in a cross sectional study. He reported no orthopedic problems in the preceding six months; however he stated previous ankle sprains and self-reported functional deficits during sporting activities (FAAM-G sport subscale: 84%; Nauck and Lohrer, 2011). Before participation the subject gave written informed consent according to the local ethics committee. The protocol of the experimental setup required the

Ankle mechanics

The injury trial was characterized by a rapid increase in plantarflexion (up to 50°), in inversion (up to 45°), and in internal rotation (up to 13°) during the first 60 ms of ground contact (Phase 1; see Fig. 1). The peak angular velocities were: 1240°/s for plantarflexion, 1290°/s for inversion, and 580°/s for internal rotation. After a subsequent reduction of plantarflexion and inversion (Phase 2: 60–105 ms) the forefoot served as a pivot point and both the inversion and especially the internal

Preparatory adjustments

This case report adds the following information to current knowledge: the angular excursions of the pelvis, hip and knee joint had already deviated considerably from the non-injury trials before ground contact. First, this observation clearly points towards the hypothesis that etiological conditions of ankle sprains may not be related to the ankle joint complex alone. To fully understand sprain occurrences it seems important to focus research not only on ankle joint biomechanics (i.e., no

Conflict of interest statement

The cross sectional study was supported by the adidas AG (Herzogenaurach, Germany). The authors state that the sponsor had neither an influence on the decision to submit the manuscript nor on the content of the paper.

Acknowledgment

We thank Martin-Scott Löhrer for his help in writing the Bodybuilder script. The SPLINEFIT Matlab (Mathworks Inc., Natick, USA) script of Jonas Lundgren was used to calculate the angular velocities.

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