This reflection incorporates part 1 and 2 of the military series. In part one the presenter Pete Scott placed us in groups and assigned us with a case study which related to an injury which is common in the military. We then had to go away and design a programme for the end stage of rehab for the case study and present our findings in the next session (part 2).
The case study that my group got given was a royal marine assaulter who is at the end stage of an ankle inversion injury. Pete informed us that a royal marine assaulter would be someone who climbs ladders, changes direction at speed and moves short and fast distances, therefore will have limited body weight. It was important to learn about the job role of our case study so the rehab programme could include exercises that are specific to what they have to do within their job. We also needed to consider how we would test them to ensure they are safe to return to work.
In part 2 of the military series each group presented their finding based off of the research that they had conducted for the case study. It was interesting to hear the different clinical tests and exercises that were includes in other groups programmes as some of these could be used in future programmes that I produce which I may not of heard of before.
During our discussion we informed the rest of the group of the tests we would use for an end stage ankle inversion injury including the Cumberland ankle instability tool and balance error scoring system, which is very specific to our case study because when climbing ladders and changing directions at speed one foot is planted therefore stability in the ankle and strength of the muscles in the foot and leg are important to support these movements which are required in a royal marine assaulters job. We also used clinical reasoning to decide whether the star excursion balance test (SEBT) or YBT was more specific to our case study. We concluded that the YBT may be better as it can help us to identify the risk of reinjury.
In order to produce the programme, we considered the common risk factors for lateral ankle sprains so exercises for strength have been included as well as proprioception, stability, neuromuscular control and mobility.
Areas for further improvement
My first area for improvement would be to consider how each population who I work with differ. For example, within the military there clothing including footwear, body armour and helmet means they have a lot of functional differences. Therefore, in the later stages of rehab it would be vital to ensure they are completing the exercises with their equipment on so it is comparable to when they would get back to work. This will really help to see whether they are ready to return to work.
Also, in our rehab programme we needed to emphasise that at the end stage of not just an ankle inversion injury but any pathology they need to get back to doing the job roles that thy would usually do to show they are capable as this is the only way to find out.
Things to Remember:
Programme for case study and resources
Case study = A Royal Marine Assaulter who is at the end stage of an ankle inversion injury. Design a programme for the end stage of rehab (pain free).
A Royal Marine Assaulter:
Subjective Ax = Cumberland Ankle Instability Tool (CAIT)
Static balance = Balance Error Scoring System (BESS)
Example of BESS test = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445164/pdf/10.1177_1941738111403122.pdf
The BESS test, especially the single leg stance is specific to our case study. This is because when climbing ladders and changing directions at speed one foot is planted therefore stability in the ankle and strength of the muscles in the foot and leg are important to support these movements which are required in a royal marine assaulters job.
Dynamic balance = Star Excursion Balance Test (SEBT) or Y Balance Test (YBT)
SEBT = The stance requires adequate strength, proprioception and neuromuscular control (Mohammadi et al., 2017).
YBT = The reliability of the test is shown to be high where poor performance of the YBT is associated with an elevated risk of lower extremity injury (Mohammadi et al., 2017).
The YBT may be more suitable as the SEBT can be time consuming, however it also depends on the type of equipment available (Fullam, Caulfield, Coughlan & Delahunt, 2014). The YBT may be more specific to our case study as it can help us to identify the risk of reinjury. Both tests have strong clinical value (YBT – Plisky et al., (2009), SEBT – Gribble et al., (2013)).
Agility = The shorter Illinois Agility test
Example of the shorter Illinois Agility test = https://www.topendsports.com/testing/tests/illinois-shorter.htm
This test is specific for our case study as they need to change direction at speed and move short and fast distances – this can help to assess if they are ready to go back to work.
Week 4 Programme:
All exercises must be performed pain free for return to play/work.
The common risk factors for lateral ankle sprains include:
These risk factors have allowed us to produce a rehabilitation programme for a lateral ankle sprain. Exercises for strength have been included as well as proprioception, stability, neuromuscular control and mobility.
Bekerom, M. P. J. Van Den, Kerkhoffs, G. M. M. J., McCollum, G. A., Calder, J. D. F., & Didk, N. van. (2013). Management of acute lateral ankle ligament injury in the athlete. Knee Surgery, Sports Traumatology, Arthroscopy, 21(6), 1390–1395.
David, P., Halimi, M., Mora, I., Doutrellot, P., & Petitjean, M. (2013). Isokinetic testing of evertor and invertor muscles in patients with chronic ankle instability. Journal of Applied Biomechanics, 29(6), 696–704.
Fullam, K., Caulfield, B., Coughlan, G. F., & Delahunt, E. (2014). Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test. Journal of sport rehabilitation, 23(1), 27-35
Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater reliability of the star excursion balance test. J Athl Train. 2013;48(5):621-626. doi:10.4085/1062-6050-48.3.03
Mohammadi, V., Hilfiker, R., Jafarnezhadgero, A. A., Jamialahmadi, S., Karimizadeh Ardakani, M., & Granacher, U. (2017). Relationship between training-induced changes in the Star Excursion Balance Test and the Y balance test in young male athletes. Annals of Applied Sport Science, 5(3), 31-38.
Plisky, P. J., Gorman, P. P., Butler, R. J., Kiesel, K. B., Underwood, F. B., & Elkins, B. (2009). The reliability of an instrumented device for measuring components of the star excursion balance test. North American journal of sports physical therapy : NAJSPT, 4(2), 92–99.