Cross sectional study to determine whether there are central nervous system changes in rugby players who have sustained recurrent ankle injuries

Master Thesis


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University of Cape Town

Background: Rugby is a popular game played around the world and has one of the highest recorded injury rates in sport. The literature exposes ankle injuries as one of the most common areas injured in sport and this trend carries through in rugby too, with lateral ankle sprains predominating. Recurrent ankle injuries are commonly reported in the literature and account for high economic and social burden. There are many intrinsic and extrinsic risk factors credited with causing lateral ankle injuries but to date the literature does not show conclusive evidence for management and prevention of recurrent injuries. A new area of research that has not previously been explored is the neurological influence on recurrent injury. Central processing is a recognised form of learning seen in adults and children during normal development and training and more recently acknowledged in injury settings. This phenomenon has also been seen in abnormal states of development such as neglect and chronic pain. Central Nervous System Changes In Recurrent Ankle Injuries In Rugby Player 2 Aim: The purpose of this study was to investigate whether there are changes in the central nervous system of rugby players with recurrent ankle injuries. Methods: An experimental and control group was used for this cross sectional study. Participants were recruited from the Golden Lions Rugby Union. Forty-six players in total were recruited. The control group consisted of 22 players, and the recurrent injury group consisted of 24 players. Medical and Sports History Questionnaire was administered as well as a battery of four physical test procedures. The questionnaire asked participants to provide information regarding demographics, playing position, training and playing history, current general health, current and previous injury history, and specifically ankle injury history. The four testing procedures were: body image testing, laterality testing, two point discrimination testing and pressure-pain threshold testing. Results: The results were collected and recorded. Between group and within group comparisons were made for the control and recurrent injury groups. From the Medical and Sports History Questionnaire the results indicated that the recurrent injury group participated in a significantly shorter preseason training period compared to the control group. The laterality testing within group analysis had a significant difference, the injured side had a slower recognition time [1.4(1.3-1.6)] compared to the uninjured side [1.3(1.15-1.5) Central Nervous System Changes In Recurrent Ankle Injuries In Rugby Player 3 p<0.01]. Pressure pain threshold testing produced a significant difference for the control group on the ATFL test site and the PTFL site. The PTFL site also demonstrated significant difference in the between group comparison analysis. The results from the two point discrimination testing and the body image testing produced interesting results. The two point discrimination tests performed on the both the recurrent injury group and the control group using within group comparison showed significant differences on the anterior talofibular ligament between the affected and nonaffected limbs. The between group test result were also significant for the injured vs control side at the ATFL site. The affected side showed a poorer ability to differentiate between one and two points, needing a bigger area before two points were distinguished from one. Similarly, body image testing showed significant differences in the within group comparison of total area drawn for the recurrent injury group only. In the recurrent injury group, the drawing of the affected foot was significantly larger than the drawing of the unaffected side. The control group showed no differences between sides. Conclusion: The study recommends that there is a relationship between central nervous system changes in recurrent ankle injuries in the sample group of professional rugby players. The data indicates that preseason length is a factor to be considered in recurrent ankle injuries. The clinical tests focussed specifically on central nervous system changes also produced some illuminating results. The recurrent injury group demonstrated significant difference between injured and uninjured sides in both two point discrimination testing of the ATFL ligaments and in the body image drawing of the foot and ankle. The control group in contrast didn't yield any differences between sides for these same tests. The pressure pain testing and laterality testing producing significant results also indicate the central nervous system involvement in recurrent injury.