A physiotherapy guide about
Returning to basketball following common ankle injuries
How to go from injured back to full action?
Background
Basketball is played in multi-directions with a lot of running, jumping and quick reaction. The ankle & foot are always the first point of contact to the ground for all these movements. For example, the defender moving their feet to chase the offensive player, or players jumping up to fight for a rebound yet not knowing where to land beforehand. Having the nature of a contact sport and the level of unpredictability, a high risk of ankle-related injuries are resulted. Statistics have shown that basketball has one of the highest incident rates of ankle injuries among other contact sports.
Different types of common ankle injuries in basketball:
Ankle sprains:
Lateral ankle sprain is one of the most common injury in basketball. They occur mostly when stepping awkwardly on someone’s foot. The grading of the ankle sprain is determined by the amount or coverage of ligament damage where grade 3 is the complete rupture of the ligament normally resulting from a severe sprain.
Ankle fractures:
Bone fracture can happen from a sprain, or it can be stress/load related. Some fractures may require surgical management depending on severity. Immobilisation under a plaster cast is normally required after surgery with certain weight-bearing status to achieve bone healing.
Achilles tendon injuries:
Jumping and sprinting are high-impact activities which may cause inflammation of the Achilles tendon when doing too much. Also, as tendon is important in producing and absorbing force, Achilles tendon tear/rupture may happen if the athlete is undertrained or fatigue in the worst case scenario.
Re-injury rate
Re-injury rate of ankle sprain injuries is high in basketball athletes. Up to 73% of recreational to elite level basketball players in Australia had a history of prior ankle injuries more than once. Also, players with previous ankle injury are nearly 5 times more likely to re-injury in the future if rehabilitation was not done well. Ankle instability, meaning less control in the ankle could become chronic after multiple ankle sprains. Therefore, this shows the importance of a proper rehabilitation after any ankle related injuries.
Reference list: Aksović, N., Bubanj, S., Bjelica, B., Kocić, M., Lilić, L., Zelenović, M., . . . Sufaru, C. (2024). Sports Injuries in Basketball Players: A Systematic Review. Life, 14(7), 898. doi:10.3390/life14070898 Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., . . . Bizzini, M. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853-864. doi:10.1136/bjsports-2016-096278 Blom, A., Warwick, D., & Whitehouse, M. (2017). Apley & solomon's system of orthopaedics and trauma: CRC press. Chmielewski, T. L., Myer, G. D., Kauffman, D., & Tillman, S. M. (2006). Plyometric Exercise in the Rehabilitation of Athletes: Physiological Responses and Clinical Application. Journal of Orthopaedic & Sports Physical Therapy, 36(5), 308-319. doi:10.2519/jospt.2006.2013 Davies, G., Riemann, B. L., & Manske, R. (2015). Current concepts of plyometric exercise. International journal of sports physical therapy, 10(6), 760. Dayakidis, M. K., & Boudolos, K. (2006). Ground reaction force data in functional ankle instability during two cutting movements. Clinical Biomechanics, 21(4), 405-411. doi:https://doi.org/10.1016/j.clinbiomech.2005.11.010 Del Buono, A., Smith, R., Coco, M., Woolley, L., Denaro, V., & Maffulli, N. (2013). Return to sports after ankle fractures: a systematic review. British medical bulletin, 106(1). Drakos, M. C., Domb, B., Starkey, C., Callahan, L., & Allen, A. A. (2010). Injury in the National Basketball Association:A 17-Year Overview. Sports Health, 2(4), 284-290. doi:10.1177/1941738109357303 Dubois, B., & Esculier, J.-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72-73. doi:10.1136/bjsports-2019-101253 Fink, J., Schoenfeld, B. J., Sakamaki-Sunaga, M., & Nakazato, K. (2021). Physiological Responses to Agonist–Antagonist Superset Resistance Training. Journal of Science in Sport and Exercise, 3(4), 355-363. doi:https://doi.org/10.1007/s42978-020-00092-z Fuerst, P., Gollhofer, A., Lohrer, H., & Gehring, D. (2018). Ankle Joint Control in People with Chronic Ankle Instability During Run-and-cut Movements. International journal of sports medicine, 39(11), 853-859. doi:10.1055/s-0044-100792 Fukano, M., Mineta, S., & Hirose, N. (2020). Fear Avoidance Beliefs in College Athletes with a History of Ankle Sprain. International journal of sports medicine, 41(02), 128-133. doi:10.1055/a-1065-1940 Hagen, M., Lemke, M., & Lahner, M. (2018). Deficits in subtalar pronation and supination proprioception in subjects with chronic ankle instability. Human Movement Science, 57, 324-331. doi:https://doi.org/10.1016/j.humov.2017.09.010 Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train, 54(6), 603-610. doi:10.4085/1062-6050-447-17 Iversen, V. M., Eide, V. B., Unhjem, B. J., & Fimland, M. S. (2024). Efficacy of Supersets Versus Traditional Sets in Whole-Body Multiple-Joint Resistance Training: A Randomized Controlled Trial. Journal of Strength and Conditioning Research, 38(8), 1372-1378. doi:10.1519/JSC.0000000000004819 Janssen, K. W. (2018). Infographic: Ankle sprain treatment and prevention timeline. British Journal of Sports Medicine, 52(15), 953-954. doi:10.1136/bjsports-2016-097183 Krzysztofik, M., Wilk, M., Pisz, A., Kolinger, D., Tsoukos, A., Aschenbrenner, P., . . . Bogdanis, G. C. (2022). Effects of Unilateral Conditioning Activity on Acute Performance Enhancement: A Systematic Review. Journal of Sports Science & Medicine, 21(4), 625-639. doi:https://doi.org/10.52082/jssm.2022.625 Lin, C. W. C., Donkers, N. A. J., Refshauge, K. M., Beckenkamp, P. R., Khera, K., & Moseley, A. M. (2012). Rehabilitation for ankle fractures in adults. Cochrane Database of Systematic Reviews(11). doi:10.1002/14651858.CD005595.pub3 Lorenz, D., & Morrison, S. (2015). CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. Int J Sports Phys Ther, 10(6), 734-747. Magnussen, R. A., Dunn, W. R., & Thomson, A. B. (2009). Nonoperative Treatment of Midportion Achilles Tendinopathy: A Systematic Review. Clinical Journal of Sport Medicine, 19(1), 54-64. doi:10.1097/JSM.0b013e31818ef090 Markovic, G., Jukic, I., Milanovic, D., & Metikos, D. (2007). Effects of sprint and plyometric training on muscle function and athletic performance. The Journal of Strength & Conditioning Research, 21(2), 543-549. McKay, G. D., Goldie, P., Payne, W. R., & Oakes, B. (2001). Ankle injuries in basketball: injury rate and risk factors. British Journal of Sports Medicine, 35(2), 103-108. McKay, G. D., Goldie, P. A., Payne, W. R., & Oakes, B. W. (2001). Ankle injuries in basketball: injury rate and risk factors. British Journal of Sports Medicine, 35(2), 103-108. doi:10.1136/bjsm.35.2.103 Moore, M. L., Haglin, J. M., Hassebrock, J. D., Anastasi, M., & Chhabra, A. (2021). Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthopedic Reviews, 13(1). doi:10.4081/or.2021.9108 Moore, M. L., Haglin, J. M., Hassebrock, J. D., Anastasi, M. B., & Chhabra, A. (2021). Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthop Rev (Pavia), 13(1), 9108. doi:10.4081/or.2021.9108 Morrison, K. E., & Kaminski, T. W. (2007). Foot characteristics in association with inversion ankle injury. J Athl Train, 42(1), 135-142. Paavola, M., & Järvinen, T. A. H. (2005). Paratendinopathy. Foot and Ankle Clinics, 10(2), 279-292. doi:https://doi.org/10.1016/j.fcl.2005.01.008 Rohner-Spengler, M., Frotzler, A., Honigmann, P., & Babst, R. (2014). Effective Treatment of Posttraumatic and Postoperative Edema in Patients with Ankle and Hindfoot Fractures: A Randomized Controlled Trial Comparing Multilayer Compression Therapy and Intermittent Impulse Compression with the Standard Treatment with Ice. JBJS, 96(15), 1263-1271. doi:10.2106/jbjs.K.00939 Satyendra, L., & Byl, N. (2006). Effectiveness of physical therapy for Achilles tendinopathy: An evidence based review of eccentric exercises. Isokinetics and exercise science, 14(1), 71-80. doi:10.3233/ies-2006-0223 Silbernagel, K. G., Thomeé, R., Eriksson, B. I., & Karlsson, J. (2007). Continued Sports Activity, Using a Pain-Monitoring Model, during Rehabilitation in Patients with Achilles Tendinopathy:A Randomized Controlled Study. The American Journal of Sports Medicine, 35(6), 897-906. doi:10.1177/0363546506298279 Smith, M. D., Vicenzino, B., Bahr, R., Bandholm, T., Cooke, R., Mendonça, L. D. M., . . . Delahunt, E. (2021). Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus. British Journal of Sports Medicine, 55(22), 1270-1276. doi:10.1136/bjsports-2021-104087 Tassignon, B., Verschueren, J., Delahunt, E., Smith, M., Vicenzino, B., Verhagen, E., & Meeusen, R. (2019). Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Medicine, 49(4), 601-619. doi:10.1007/s40279-019-01071-3