Ankle injuries are more common than hamstring tears in footballers

Ankle injuries can be tackled by proprioception training

Contrary to popular belief, it’s not hamstring tears but ankle injuries that are the most common injury in footballers. And when footballers do sustain ankle injuries, there are three common treatment strategies employed to help prevent reoccurrence; strength training (to strengthen muscles and ligaments that stabilise the ankle), orthotic inserts (placed in the shoe to try and place the foot in a more ‘biomechanically neutral’ position and so prevent injury) and proprioception training (which mainly involves balance training and enhancing the ability of the ankle/foot structures to respond to and control external forces).

But which of these three single interventions is most effective at reducing the incidence of further ankle injury? That’s the question that Iranian researchers have been trying to address in a study on 80 male footballers in the first division of a men’s league who had all experienced previous ankle inversion sprains. The players were randomly assigned to one of four groups, each of which contained 20 subjects:

* Strength training;
* Orthotic use;
* Proprioception training;
* Control group (no intervention).

The players were then monitored for the rest of the season, during which data on the frequency of ankle sprain re-injury data were collected. There were no significant differences among the groups in the number of exposures (ie all the groups were exposed to the same degree of injury risk in terms of time, matches played etc), but the incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group. However, while the risk was also reduced in the strength and orthotic groups, the reduction was not large enough to be considered statistically significant and the researchers concluded that only the proprioception training group showed a significant reduction in rates of re-injury. Of course this is not to say that strength training and orthotics don’t have benefits; many rehab programmes use a combination of strength and proprioception training – something not assessed in this study. It does suggest however, that proprioception training is a crucial element in the prevention of ankle re-injury.
Am J Sports Med 2007; 22 [Epub ahead of print]

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