Sir Ian Botham told BBC Sport it was high time the 29-year-old changed his bowling action to limit future ankle problems - but the player himself has been reluctant to do so. During the operation, the fragments of bone pressing on a tendon were removed from both the front and back of the left ankle and the ECB claimed the surgery was performed successfully, adding: "At this stage, the surgeon is optimistic that he has addressed the underlying root of the problem."
According to the ECB, Andrew flintoff is expected to play and to regain his full fitness ahead of England's domestic international programme in 2008 and he is expected to resume full training in early January.
Background information on Ankle Sprain which Andrew Flintoff is suffering from
Ankle sprain
A sprained ankle is one of the most common injuries caused by participation in sports. It refers to soft tissue damage (mainly ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards) or an eversion injury (where the ankle is twisted outwards).
Diagram obtained from:
http://www.physioroom.com/injuries/ankle_and_foot/ankle_sprain_full.php
Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle.
The most commonly injured ligament is the Anterior Talo Fibular (ATF) ligament which, as the name suggests, joins the fibular and talus bones together. If the force to the ankle is more severe, the Calcaneo Fibular ligament (between the Calcaneus and Fibula) is also damaged. The Posterior Talo Fibular (PTF) ligament is very rarely damaged in comparison to the other two ligaments.
Diagram obtained from:
http://www.physioroom.com/injuries/ankle_and_foot/ankle_sprain_full.php
Ankle sprains can be classified as follows:
- First degree, where only a few ligament fibres are damaged
- Second degree sprain refers to more extensive damage to the ligament with associated swelling
- Third degree sprain refers to a complete rupture of the ligament with swelling and a possible joint dislocation
In the more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture.
Techniques and Treatments for Ankle sprain
Techniques for Ankle sprain
Ankle arthroscopy refers to the technique used by orthopaedic surgeons whereby they insert a very small (2mm diameter) camera into the ankle joint. It is a minimally invasive surgical procedure, commonly known as keyhole surgery, and allows the surgeon to look directly inside the ankle joint to determine exactly what is wrong. Because the surgeon has a direct view, he can say with some certainty what is causing a problem that may not have shown up on an x-ray or a scan. As soon as the surgeon identifies the problem he can rectify it there and then with small tools that are attached to the camera.
When is this Technique Used?
An ankle arthroscopy is carried out when patients are suffering from the long term effects of repeated ankle sprains, and physiotherapy has failed to rectify the situation. There is often pain, stiffness or clicking; sometimes, due to over-use or trauma, there are small pieces of bone within the ankle joint space, and these can be removed very easily. In the case of patients who have suffered repeated ankle sprains there is a build-up of excessive scar tissue, which can cause pain and restrict the range of movement.
What does the Procedure Involve?
Most ankle arthroscopies are carried out as outpatient operations, and the patient is usually able to leave the same day, with a compression bandage on their ankle. The procedure is carried out under a light general anaesthetic. The small camera is introduced to the joint through small 'portals' on the inside and outside of the ankle and the whole operation usually takes about 45 minutes to perform. A course of physiotherapy is required after the surgery and the patient is usually given the all clear to resume normal activities after a check-up at 6 weeks.
Sprained Ankle Injury Treatment
In the first 48-72 hours following the injury it is important the follow the PRICE routine which is - protection, rest, ice, compression and elevation (never apply ice directly to the skin). Later in my report I will explained the PRICE routine in depth.
It is important not to put too much weight on the damaged ankle, so walking should be avoided if possible. Ankle injuries can be protected using a and these are regularly used by sport stars. However, it is important not to be on the crutches for longer than necessary and as soon as the pain allows the patient should begin to gently put weight through the ankle by walking. can be very helpful as they protect the injured area and help to resolve ankle swelling. In the early stages of the injury, ultrasound treatment is effective in encouraging the healing process and encouraging the formation of scar tissue to repair the ligament.
Andrew Flintoff has repeatedly sprained his left ankle, there was an inherent weakness which may required him to have a surgery on his left ankle. This surgery was done through can arthroscopically, where a camera was inserted into the ankle and flakes of bone and excess scar tissue can be removed.
Sprained Ankle Injury Prevention
Ankle instability is characterised by ankle weakness and giving way, even though the ankle ligaments are intact and the joint is ‘mechanically' stable. It is due to an impairment of proprioception, which leads to a lack of balance and ankle joint position sense. Proprioception is the mechanism by which nerve receptors in skin, muscle, ligament and joint tissue relay information to the brain about body position sense, where this information is quickly processed and movement strategies are formulated and executed using nerve signals to muscles. This mechanism can help you ‘catch yourself' when you are about to turn your ankle.
In the unstable ankle these receptors may have been damaged directly during an ankle sprain. This impaired proprioceptive ability may, therefore, lead to a delay in protective muscle activity and the resultant loss of postural awareness and stability around a joint. This may explain why recurrent ankle sprains are so common.
The can be use prevent sprain ankle injuries. are designed to assist the re-education of the proprioceptive system by improving sensory receptor function. Wobble board training improves single leg stance ability and balance; while other studies have suggested that patients with ankle instability who underwent wobble board training experienced significantly fewer recurrent sprains during a follow-up period than those who did not follow the training programme.
Wearing Sports Ankle Braces is another method of sprain ankle injury prevention. Ankle braces reduce the incidence of ankle injury, Sports ankle braces, provide stabilisation and support for athletes who have suffered a sprained ankle.
Overall, these techniques and methods would prevent Andrew Flintoff from getting sprain ankle injuries. These techniques will be useful for him to use and also be able to prevent him from getting further injuries in the future. He will also be able to play more games for his country and be able to achieve more things in his carrier.
HOW TO PREVENT INJURY DURING SPORTING
There are two types of sports injury and they are acute and chronic or overuse injury.
Acute Injuries: These are the result of a sudden stress on the body for example a dislocated finger joint caused by a basketball striking the finger.
Chronic or Overuse injury: These are caused over training, insufficient recovery time, poor techniques and badly designed foot wear or equipment. Example: tennis elbow.
HOW TO AVOID ACUTE INJURY
The first thing to do to avoid acute injuries is to consider your body before anything else.
- Make sure you have practised the skill needed for the sport before doing it.
- Know how to look after yourself during the play so that you avoid unnecessary risks.
- Make sure you are fit for the activity. Do not take part if you are ill or injured.
- Warm up correctly to reduce the risk of muscle and joint injuries.
- Cool down correctly to prevent stiffness and soreness to be prepared for the next event.
Secondly, consider the kit and the equipment, event itself and the environment.
KIT AND EQUIPMENT
- Make sure you are wearing the right kit. The right footwear is very important.
- Do not forget things like mouth or shin guards if the sport required.
- Do not wear jewellery or watches that could catch in clothing or equipment. Tie back long hair for sports like basketball, netball, fingers should be kept short.
- Make sure the equipment is in good repair for example no loose studs on rugby boots.
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Lift large or heavy equipment with care. Poor lifting techniques cause injury.
EVENT ITSELF
- Make sure you play at the level that suits you. It can be dangerous to play against people who are bigger, stronger or more skilful.
- Know the rules of the sport and obey them. The rules were developed to protect you and test your skill.
- Pay attention to advice or warning given by coaches, referees and other officials.
THE ENVIRONMENT
- Watch out for hazards in the play area like broken glass pitches, wet patches of the floor and rakes left in long jump pits.
- Take special care on hazardous weather. For example frost can make the ground too hard and slippery that can make one slide.
High winds and fog are dangerous for canoeists. An event should be postponed if conditions are too hazardous.
HOW TO AVOID CHRONIC INJURIES
- Make sure you develop the right techniques. For example a poor throwing technique of shot-put leads to arm injury.
- Choose kit and equipment carefully especially foot wear.
- Follow heavy training days with light days.
- During hard training days, train for days and rest for a week.
- Allow enough time for full recover between training sessions and or events.
PE and the Law
Schools have a duty to ensure safe practice in PE and sport, under the Health and safety at Work Act of 1974. They must make sure that:
● Safety equipment is available and working.
● First aid is available and emergency procedures are planned and followed.
● Events and training sessions are properly planned and supervised.
● The group size suits the activity and the space available.
● The ability of the group matches the event.
BONE AND JOINT INJURIES
Fractured Bones
A fracture is a break or crack in a bone. There are two types of fractures and they include;
Simple fracture: In a simple or closed fracture, the bone may crack or break but the skin is not damaged or torn at all.
An open or compound fracture: the skin is damaged too.
Bones contains nerves and blood vessels, so a fracture means pain and bleeding. This leads to swelling and bruising when the blood leaks into surrounding tissue.
Signs and symptoms
● The casualty may have heard or felt a snap.
● Pain and tenderness around the injury.
● The casualty can’t move the part normally.
● Swelling and bruising occur.
● The limb may look deformed and twisted.
Treatment
● Dial 999 for an ambulance.
● Do not remove the casualty and do not try to straighten the fractured limb.
● Support the limb at each side of the fracture using cushions or clothing.
● A sling made from a towel or bandage can be used to support a fractured arm bone.
● Don’t try using a sling or splint unless you have taken a First Aid course.
If a leg bone is fractured, the leg can be tied gently to a splint to stop movement.
Joint injuries
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Dislocation: a bone is pulled out of position at a joint, usually by violent twisting. It happens most often at the shoulder, elbow, finger and thumb joints.
Signs and symptoms
● Severe pain at or near the joint.
● The joint appears deformed and the casualty can’t move it.
● Swelling around the joint, followed by the bruising.
Treatment
● Dial 999 for an ambulance.
● Support the injured part using clothing or towels. Use slings or bandages for elbow and finger joints.
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Sprain: a ligament at a joint gets stretched and torn. For example, twisting your foot when running can cause a sprained ankle. In a severe sprain the ligament is badly torn and the injury looks like a fracture.
Signs and symptoms
● Pain and tenderness around the joint. Movement makes it worse.
● Swelling occurs, followed by bruising.
Treatment
● If in doubt, treat as a fracture.
● For minor sprains follow the PRICE routine.
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Torn Knee cartilage: there are two curved pads of cartilage at the knee joint. These may tear if the knee is twisted violently.
Signs and symptoms
● Pain o one side of the joint.
● The joint may ‘lock’ and not straighten fully for a time.
● It may swell later.
Treatment
● Use an ice pack for swelling.
● Get the casualty to the doctor. This injury may need surgery.
WAYS TO PREVENT INJURY DURING SPORTING THAT APPLY TO MY CLIENT
Some of the ways to prevent injury during a sport that apply to my client include the ones below. Bearing the fact that Andrew Flintoff is a professional Cricketer playing for a club and country, some of the ways to prevent injury during sporting do not apply to him.
HOW TO AVOID ACUTE INJURY: make sure you have practised the skill needed for the sport before doing it. Andrew Flintoff is playing for a club and country that competes with other clubs and countries; therefore he will make sure that he practices enough for any game to be played.
Make sure you are fit for the activity. Do not take part if you are ill or injured. Andrew Flintoff had his left ankle injury for quite long time; he had a few operations on his ankle in order to boost his ankle injury and fitness to play for England. When he came back from his ankle injury, he was still having problems with the left ankle, he reduced his bowling in order to get his left ankle sorted but that still didn’t worked. So he went under another operations and he is hoping that this operation hopefully works for him.
KIT AND EQUIPMENT: make sure you are wearing the right kit. The right footwear is very important. The equipment is mainly provided by the club and country but if Andrew Flintoff is not comfortable playing in any of the equipment most especially the foot wear then he should inform the coach about it.
EVENT ITSELF: make sure you play at the level that suits you. Do not play too many games that may harm your body or your fitness level. Andrew played too many games for England; this might have an effect on his left ankle because he didn’t rest enough in order to recover from an ankle injury.
HOW TO AVOID CHRONIC INJURIES
Make sure you develop the right techniques. For example a poor throwing to a fielder leads to arm injury. This does apply to Andrew Flintoff in away that he has to develop his bowling techniques in order to ankle injuries. Choose kit and equipment carefully especially foot wear. This is a big aspect in Cricket that all players have to pay a lot of attention to because the surface of the ground.
FIRST AID FOR THE INJURY
When an injury happens, the first thing to do is to offer the causality first aid which is the immediate treatment that is given to an injured person to reduce pain and to prevent further injury before being taken to hospital.
Following most injuries the method of immediate treatment is the PRICE routine, which is Protection, Rest, Ice Compression and Elevation. The purpose of PRICE is to reduce pain, swelling and bruising around and injury which is the actual reason for first aid.
The diagram of pain, swelling and bruising
When bones, joints, ligaments, muscles or tendons get damaged, the blood vessels around them get damaged too. The blood leaks into the surrounding tissues, causing pain, swelling and bruising. The leaked blood also slows down healing.
The injured tissues should be protected from further damage. A removable plastic cast is ideal for foot injuries and ankle injuries. It provides the same protection as a plaster cast but it is lightweight and can be removed by the patient. All English Premier League football players use removable plastic casts when they suffer significant ankle and foot injuries. In the case of more severe injuries crutches should also be used.
Rest from sports is essential, but even walking on a sports injury may cause further damage and should be avoided if it is painful. Movement keeps the blood leaking. So stay still. Pain relieving medication prescribed by a doctor may also be necessary.
Place an icepack around the injured part for 20-30 minutes. The ice packs relieve pain and are thought to reduce bleeding in the damaged tissue. The Aircast Cryocuffis the most effective method of providing ice therapy and is the professional’s choice for foot and ankle injuries. It can provide continuous ice cold water and compression for 6 hours and it significantly reduces pain and swelling.
Bandage the injured part firmly (but not tightly) using a crepe bandage. This also reduces internal bleeding. A swollen ankle is a sign of a significant sports injury. The swelling may be caused by bleeding in the joint or inflammation of the joint. If this swelling is allowed to consolidate it can produce excessive scar tissue which seriously lengthens the rehab period. Compression during the early stages helps to resolve swelling and is essential for a good outcome. Compression is provided for the ankle by the use of a removable plastic cast which has inflatable air cells to massage out swelling; together with intermittent use of an Aircast Ankle Cryocuff to provide ice and compression.
Support the limb in an elevated (raised) position. This reduces blood flow to the limb because the blood has to flow against the gravity.
If the injury is not elevated then excessive swelling can accumulate and cause a delay with rehabilitation. This is particularly true with ankle injuries. If the ankle is not elevated then the effect of gravity causes the tissue fluid to accumulate around the ankle and foot. This can cause increased tissue pressure which is extremely painful. To relieve ankle and prevent excessive ankle swelling, the ankle is kept elevated above waist height for as much time as it is practical.
When to use (or not to use) PRICE routine
- Minor strains and sprains.
- Bruising from a collision or fall.
● Do not use PRICE routine for: fractures or dislocations. These should be moved as little as possible.
For fractures, dislocations, and serious strains and sprains call an ambulance or see your doctor.