STASE FT SPORT
Disusun Oleh :
LAPORAN FT SPORT
Disusun Oleh:
Mengetahui,
ii
DAFTAR ISI
LEMBAR PERSETUJUAN..................................................................................ii
DAFTAR IS...........................................................................................................iii
BAB I ............................................................................................................................. 1
A. Latar Belakang .................................................................................................... 1
B. Rumusan Masalah ............................................................................................... 3
C. Tujuan Penulisan ................................................................................................. 3
BAB II ........................................................................................................................... 4
TINJAUAN PUSTAKA ................................................................................................ 4
A. Anatomi Dan Fisiologi Ankle .............................................................................. 4
B. Definisi Sprain Ankle .......................................................................................... 8
C. Tanda Dan Gejala Sprain Ankle........................................................................... 9
D. Etiologi Sprain Ankle ................................................................................ 9
E. Klasifikasi Sprain Ankle .................................................................................... 11
F. Patofisiologi Sprain Ankle ................................................................................. 12
G. Faktor Resiko Sprain Ankle ............................................................................... 13
H. Intervensi Sprain Ankle ..................................................................................... 15
BAB III ........................................................................................................................ 25
STATUS KLINIS ........................................................................................................ 25
BAB IV PENUTUP ..................................................................................................... 33
Kesimpulan................................................................................................................... 33
DAFTAR PUSTAKA .................................................................................................. 34
LAMPIRAN JURNAl ................................................................................................. 35
iii
BAB 1
PENDAHULUAN
A. Latar Belakang
Kaki adalah salah satu bagian anggota gerak tubuh yang sering
produktifitas seseorang. Salah satu kasus yang sering terjadi pada kaki
yaitu, terkilir. Terkilir dapat terjadi oleh beberapa faktor seperti, jatuh
tersandung atau gerakan yang terjadi secara tibatiba sehingga kaki belum
siap untuk menerima tumpuan. Dan salah satu gangguan maupun penyakit
pada kaki adalah Sprain Ankle. Sprain ankle adalah cedera pada ligamen
fleksi yang terjadi secara tiba-tiba saat kaki tidak menumpu dengan
yang disebabkan oleh gerak inversi dan plantar flexi ankle yang tiba-tiba.
menimbulkan nyeri.
1
2
seluruh dunia, satu kasus sprain ankle terjadi pada 10.000 orang per hari.
sprain ankle, sedangkan sepak bola dan lari juga merupakan kegiatan
atletik yang sering mengalami cedera sprain ankle. Gejala yang muncul
terdapat nyeri kronis, kelemahan otot dan tidak stabil (Gulano & Vega,
bentuk terapi latihan berupa karet (strip elastis) yang berfungsi untuk
Page and Todd S. Ellenbecker, 2003: 3). Metode ini sering digunakan
oleh para fisioterapis untuk memulihkan fungsi kerja otot, ligamen dan
sprain ankle antara lain infrared, TENS dan terapi latihan.Infra Red dapat
B. Rumusan Masalah
C. Tujuan penulisan
TINJAUAN PUSTAKA
1. Srtuktur tulang
Bagian distal dari tulang tibia dan fibula berartikulasi dengan tulang
2. Struktur otot
4
5
tanah dan harus dapat beradaptasi ketika berubah posisi. Fungsi otot
pronasi.
3. Struktur persendian
terdiri dari bagian distal dari tulang tibia, distal fibula dan bagian
superior tulang talus. Jenis dari ankle joint adalah hinge joint. Dengan
antara tulang tarsal (midtarsal joint), antar tarsal bagian depan (anterior
4. Struktur ligament
dibagian lateral yang tergabung dalam satu kapsul sendi. Jaringan pada
sendi ankle diikat oleh beberapa ligamen, antara lain adalah ligamen
antara tibia dengan fibula, ligamen deltoid yang mengikat tibia dengan
terletak pada otot betis sampai calcaneus yang membantu kaki untuk
5. Struktur vaskuler
anterior tibia dan arteri posterior tibia yang berfungsi untuk mensuplai
posterior tibia mensuplai 75% darah di kaki pada bagian posterior dan
darah pada bagian plantar dari kaki. Percabangan dari arteri posterior
6. Biomekanik
50˚, gerakan eversi adalah 20˚, dan gerakan inversi adalah 40˚.
plantarfleksi akan tertulis (S) 20-0-50 dan gerak inversi dan eversi
oleh adanya gaya inversi dan plantar fleksi secara tiba-tiba saat kaki
inversi dan plantar fleksi yang tiba - tiba, ketika sedang berolahraga,
aktivitas fisik, saat kaki tidak menumpu sempurna pada lantai/ tanah
yang tidak rata sehingga hal ini akan menyebabkan telapak kaki
kerusakan menetap
kekurangan darah
f) Peradangan sendi
posisi kaki
mengarah ke dalam
kaki.
11
cedera oleh karena sendi ankle menjadi bagian pertama dari rantai
dengan jaringan tubuh lainnya. Ligamen tidak dapat pulih dengan cepat
penyembuhan ligamen :
a) Fase I Hemoragik
b) Fase II Inflamasi
non kolagen.
13
a) Usia
b) Jenis Kelamin
terjadi.
c) Jenis Olahraga
atlit tenis atau bulu tangkis lebih sering terjadi sprain atau strain.
2. Faktor Gizi
protein serta zat gizi lainnya yang tepat akan sangat menjaga
cedera yang sering terjadi pada kegiatan olahraga antara lain adalah
a) TENS
nyeri.
kerja TENS, satu diantaranya adalah teori pain gates yang diajukan
cara ini, transmisi nyeri oleh serabut saraf terhambat dan aliran
elektroda tidak melekat dengan baik pada kulit dan sementara itu
1) Di sekitar lokasi nyeri : Cara ini paling mudah dan paling sering
nyeri.
b) US
energi akustik.
pada 3 MHz 7 mm
frekuensi 1 MHz.
19
4) Dosis
1) Frekuensi
2) Intensitas
3) Time
4) Aplikasi transducer
akan diterapi.
b. Indikasi
c. Kontraindikasi
c) Latihan
selama 5 detik
6 Ulangi 10 kali
6 Ulangi 10 kali
2. Terapi latihan
2) Towel Crunches
3) Picking Up Object
Latihan dengan cara berdiri dengan satu kaki diawali dengan mata
6)Thera Band
Latihan dengan cara dililitkan pada ankle dan kaki meja dilanjutkan
B. CATATAN KLINIS
(Medika mentosa, hasil lab, foto rontgen, MRI, CT-Scan, dll)
-
25
26
B. ANAMNESIS (AUTO/HETERO)
1.KELUHAN UTAMA
Px mengeluhkan nyeri pada bagian pergelangan kaki sebelah kiri dan bengkak
serta sulit untuk digerakkan
2.RIWAYAT PENYAKIT SEKARANG (Sejarah keluarga dan genetic, kehamilan, kelahiran dan
perinatal, tahap perkembangan, gambaran perkembangan, dll)
Pada 20 April 2022 lalu pasien melakukan marathon di track trill gunung rinjani,
saat turun dari summit pasien menumpu pada batu dan tergelincir sehingga
membuat pergerakan ankle yang tidak stabil dan mengarah ke inversi. Akibatnya
pasien langsung terjatuh dan merasakan kesakitan pada pergelangan kaki, pasien
mendapat pertolongan pertama berupa chlorethyl spray, namun hingga 2 hari
kemudian pasien masih merasakan nyeri dan kesulitan berjalan. Kemudian pasien
mengkonsultasikan nyeri yang dirasakan pada kaki sebelah kiri kepada fisioterapis.
5.RIWAYAT PENGOBATAN
Tidak ada riwayat pengobatan
6.ANAMNESIS SISTEM
a. Kepala dan Leher
Tidak ada keluhan
b. Kardiovaskular
Tidak ada keluhan
c. Respirasi
Tidak ada keluhan
d. Gastrointestinal
Tidak ada keluhan
e. Urogenital
Tidak ada keluhan
f. Musculoskeletal
1. Nyeri pada pergelangan kaki sebelah kiri
2. Oedema pada pergelangan kaki sebelah kiri
3. Spasme pada otot gastrocnemius
g. Nervorum
Tidak ada keluhan
C. PEMERIKSAAN
1.PEMERIKSAAN FISIK
a) TANDA-TANDA VITAL
27
c) PALPASI
(Nyeri, Spasme, Suhu lokal, tonus, bengkak, dll)
Nyeri gerak pada pergelangan kaki sebelah kiri
Oedema pada pergelangan kaki sebelah kiri
Spasme pada otot gastrocnemius
Suhu lokal terasa hangat
d) PERKUSI
Tidak dilakukan perkusi
e) AUSKULTASI
Tidak dilakukan auskultasi
f) GERAK DASAR
Gerak Aktif : px tidak mampu melakukan gerakan aktif pada ankle
sinistra secara full ROM.
Gerak Pasif : px mampu melakukan gerakan pasif pada ankle
sinistra dengan dibantu oleh terapis namun tidak full ROM.
Isometrik : px tidak mampu melakukan tahanan minimal dari terapis.
2.PEMERIKSAAN SPESIFIK
(Nyeri, MMT, LGS, Antropometri, Sensibilitas, Tes Khusus, dll)
a. Nyeri (NRS)
Diam :3
Tekan :5
Gerak :7
e. Tes khusus =
Anterior Drawer Test = (+)
Tallar Tilt Test = (+)
29
D. UNDERLYING PROCCES
E. DIAGNOSIS FISIOTERAPI
(International Clatification of Functonal and disability)
Hypomobility, pain and spasme e.c Sprain Ankle sinistra
1. Impairment
Nyeri pada pergelangan kaki sebelah kiri
Oedema pada pergelangan kaki sebelah kiri
Spasme pada otot gastrocnemius
Keterbatasan ROM
2. Functional Limitation
Px keterbatasan dalam gerakan dorso plantar fleksi
Px belum mampu berjalan normal dan naik turun tangga
3. Disability
Px belum mampu melakukan aktivitas pekerjaannya sebagai atlet marathon
ultra.
F. PROGNOSIS
Qua at Vitam : Bonam
Qua at Sanam : Bonam
Qua at Fungsionam : Dubia et Bonam
30
G. PROGRAM/RENCANA FISIOTERAPI
1.Tujuan treatment
a) Jangka Pendek
Menurunkan nyeri
Menurunkan oedema
Menurunkan spasme
Meningkatkan ROM
Meningkatkan keseimbangan dan berjalan
b) Jangka Panjang
Melanjutkan program jangka pendek
Meningkatkan ADL secara mandiri
Return to sport
2.Rencana tindakan
a. Teknologi Fisioterapi
a. TENS
- Mengurangi rasa nyeri
b. USD (Ultra Sound Dhiathermy)
- Merangsang jaringan tubuh yang mengalami kerusakan untuk
mempercepat proses penyembuhan jaringan, meningkatkan rileksasi
jaringan dan mengurangi nyeri
c. Terapi latihan
- Meningkatkan kekuatan otot / menstimulasi gerakan sendi kearah normal
H. PELAKSANAAN FISIOTERAPI
T0-T2
1. US (Ultra Sound Dhiathermy)
- F : 2 x/seminggu
- I : toleransi px
- T : Direct contact
- T : 5 menit
2. Electrical Stimulation
- F: 2 x seminggu
- I: toleransi pasien
- T: TENS
- T: 10 menit
3. Tapping
- F : 2 x/minggu
- I : 30-40%
- T:-
- T : Continues
31
4. Terapi Latihan
- F : 3 x/seminggu
- I : toleransi px
- T : Fase I : (isometrik )
` - ankle pumping
- AROM & PROM
- stretching gastrocnemius,
- ankle 4 gerakan
- quad set & ham set
T3-T4
Fase II : (isotonik)
- Ankle 4 gerakan + teraband
- Towel curl
- Calf rise, heel rise
- Step up & step down
- Wall squat, body weight squat
- Single leg stand (tanpa alat, handuk, bosu)
- Bridging
- Clam shell + miniband
- T : 10 x 3 set
- Spasme
T0 T1 T2 T3 T4
+ + + - -
- LGS
T0 T1 T2 T3 T4
S 15 -0-30o
o
15 -0-30o
o
20 -0-30o
o
20 -0-35o
o
20 -0-35o
o
L. CATATAN TAMBAHAN
(...............................................................)
33
BAB IV
PENUTUP
A. Kesimpulan
Sprain ankle merupakan cedera pada ligamen kompleks lateral karena overstretch
dengan posisi inversi dan plantar flexi yang tiba-tiba saat kaki tidak menumpu
yang tidak rata. Ligament-ligament yang terkena adalah anterior talofibular ligament,
Sprain ankle akan menimbulkan nyeri, nyeri yang diakibatkan karena inflamasi
akan meningkat dikarenakan adanya kelemahan pada ligament sebagai stabilitas pasif
aktif pada ankle, sehingga kemampuan untuk menyangga tubuh menurun, hal ini akan
kasus sprain ankle antara lain, IR dan USD yang berguna untuk mengurangi nyeri,
spasme, melancarkan sirkulasi darah dan memperbaiki sistem jaringan yang rusak dan
DAFTAR PUSTAKA
Aras Djohan dkk, 2016. “The New Concept Of Physical Therapist Test and
Aras Djohan dkk, 2014. “Tes Spesifik Muskuloskeletal Disorder (Edisi Revisi)”.
Martin R, Daven P, Stephen P, Wukich D, Josep. 2013. Ankle Stability and Movement
LAMPIRAN
JURNAL
International Journal of Research and Review
www.ijrrjournal.com E-ISSN: 2349-9788; P-ISSN: 2454-2237
ABSTRACT
Background: An ankle sprain is where one or more of the ligaments of the ankle are partially or
completely torn. An ankle sprain is a common injury. Inversion-type, lateral ligament injuries represent
approximately 85% of ankle sprain. The incident of ankle sprain is highest in sports population. Poor
rehabilitation after an initial sprain increases the chances of this injury recurrence.
Objective: To find out the effect of ultrasound and laser on functional performance in patients with acute
ankle sprain.
Materials and methodology: Total number of 38 both genders males and females participants between
the age18-35 years with ankle sprain patients were selected by customized sampling. Scoring scale for
subjective and functional follow-up evaluation after ankle injury was used to assess pain in ankle sprain
patients.
Results: After comparing pre and post intervention data using paired and unpaired t test results showed,
there was significant improvement in pain (p<0.0001) in Group A.
Conclusion: In this study we concluded that therapeutic ultrasound is more effective than LASER in ankle
sprain patients.
Keywords: Ankle sprain patients, Therapeutic ultrasound, LASER, functional performance scoring.
rotatory force along its vertical axis, consent was taken and subjects explained
Vertical compression: A force along long the aim and objectives of the study.
axis of the tibia. [2] Demographic data is obtained by using data
Many treatment options have been collection sheet. The subjects were
suggested like surgery, immobilization, instructed to fill out the scoring scale for
functional treatment with bandages tape or functional follow-up evaluation after ankle
different braces. [1] injury. Group A subjects received treatment
Ultrasound is commonly used in with therapeutic Ultrasound and Group B
association with other forms of treatment in received treatment with LASER.
the management of sprains of the lateral Assessment was done on 1 st and 7th day pre
ligament of the ankle. Despite its wide and post treatment.
spread use there is little scientific evidence
to supports its role in the management of Ultrasound: [6] Mode- Pulsed
ankle sprain. [3] Ultrasound is used in Frequency- 3 MHz
physical therapy to relief pain, reduced Intensity- 0.1 to 0.5 or 0.8 wcm-2
swelling and improved joint instability in Duration- 8 min
ankle sprain. [4] LASER: [6] Device- 904nm
Treatment of painful disorder with Peak power- 25 watt
LASER is still considered to be Frequency- 5000 or 500 Hz
experimental by main stream medicine. Energy density- 4-10J/cm2
LASER has three basic effects Pulse duration- 200nsec
(biostimulative-regenerative, analgesic and For 7 days.
anti-inflammatory effect). [4] Inclusion Criteria
1. Both males and females.
MATERIALS AND METHODS 2. Patients within 18-35 years of age.
Material 3. Medically diagnosed with ankle sprain.
Demographic data sheet, consent form, 4. Patients with grade I, II ankle inversion
therapeutic ultrasound, Laser. sprain.
Method Exclusion Criteria
A pre-post experimental study was 1. Any recent fracture to lower limbs in
conducted where in 38 ankle sprain patients past months.
were selected according to inclusion an 2. Patients not willing to participate.
exclusion criteria using customized Outcome Measures
sampling. The study duration was of 6 Scoring scale for subjective and functional
months and study setting was hospitals in follow-up evaluation after ankle injury. [7]
and around Pune. The target population was
ankle sprain patients. Synopsis was STATISTICAL ANALYSIS:
submitted to Institutional Ethical clearance Microsoft office excel 2007 was used and
to Tilak Maharashtra Vidyapeeth, statistical analysis was done by Instat.
Department of Physiotherapy. Patients with Paired and unpaired t test was used for
ankle sprain were approached and 38 normalised data with p<0.0001. Mean Age
samples were customized. Informed were was found to be 24.99.
RESULTS
Table 1: Comparison of Variables in Group A & Group B.
Outcome Measures Group A Group B
(Mean ± SD) (Mean ± SD)
Age 22.86±4.03 27.13±4.59
Gender M=6 F=9 M=5 F=10
Scoring scale for subjective and functional follow up Pre Post P value Pre Post P
evaluation after ankle injury value
28.53±4.67 60.8±6.92 <0.0001 31.2±5.83 32.26±7.12 0.067
DISCUSSION
The purpose of the study was to
compare effect of ultrasound versus laser in
ankle sprain. In this study 38 medially
Graph 1: Group A Intergroup comparison of subjective and diagnosed patients were approached out of
functional follow up evaluation after ankle injury
which 4 participants were excluded
Interpretation: This graph describes the pre and post according to the inclusion and exclusion
intervention mean values of Scoring Scale for criteria and 4 patients dropped out of the
subjective and Functional Follow up evaluation after study. Group A and group B were divided,
ankle Injury, for Group A (ULTRASOUND) and Group A was of Therapeutic ultrasound and
shows significant improvement.
Group B was of LASER. Assessment was
done on 1st and 7th day pre and post
treatment. Scoring Scale for Subjective and
Functional Follow-up Evaluation after ankle
injury was taken as outcome measure in
which there were nine components present.
Grading system was based on four
categories (excellent,85-100;good,70-80;
fair, 55-65; and poor,<50.) Pain, swelling,
stiffness, tenderness, or giving way during
activity (mild only one of these symptoms is
present; severe, four or more of these
Graph 2: Group B Intergroup comparison of subjective and
symptoms are present).
functional follow up evaluation after ankle injury It is generally agreed that majority of
acute grade 1 to 3 ankle sprains can be
Interpretation: This graph describes the pre and post treated by non- operative measures. During
intervention mean values of Scoring Scale for the proliferation phase, the tissue responds
subjective and Functional Follow up evaluation after
ankle Injury, for Group B (LASER) and shows with vascular ingrowth, fibroblast
significant improvement. proliferation and new collagen formation.
Protection of inversion is important during
this phase of healing to prevent excess
formation of weaker type III collagen
formation that can contribute to chronic
elongation of the ligament. Controlled stress
on the ligament will promote proper
collagen fibre orientation. In addition,
motion, stretching and strengthening will
avoid the harmful effects of immobilization
on the muscle, joint cartilage and bone. [1]
A study done by Daniele AWM Van
der Windt et al stated that application of
Graph 3: Interagroup comparison of subjective and functional
therapeutic ultrasound for ankle sprain
follow up evaluation after ankle injury
How to cite this article: Pawar P, Yeole U, Dhavale V et.al. Effect of therapeutic ultrasound v/s
laser on functional performance in patients with acute ankle sprain. International Journal of
Research and Review. 2018; 5(12):199-202.
******
Oleh:
Siti Muawanah*, N. Adiputra**, Sugijanto***
*Program Studi Magister Fisiologi Olahraga, Universitas Udayana
**Program Studi Magister Fisiologi Olahraga, Universitas Udayana
***Universitas Esa Unggul
ABSTRAK
Sprain ankle kronis merupakan overstretch pada ligamen complex lateral terjadi pada
pergerakan plantar fleksi dan inversi. Kelemahan ligament sebagai stabilitas pasif
mengakibatkan keluhan nyeri, dan inflamasi kronis, hingga proprioceptive menurun,
kelemahan otot-otot foot and ankle serta ketidakstabilan dalam melakukan aktivitas normal.
kondisi-kondisi dari sprain ankle kronis menyebabkan ketidakmampuan dalam melakukan
aktivitas sehari-hari sehingga menyebabkan foot and ankle disability. Tujuan dari penelitian
ini adalah untuk menganalisa apakah pelatihan proprioceptive menggunakan wobble board
berbeda dengan pelatihan penguatan otot ankle menggunakan karet elastic resistance dalam
menurunkan foot and ankle disability pada kasus sprain ankle kronis. Metode penelitian ini
adalah Eksperimental murni dengan randomized pre-test and post- test group design. Dalam
penelitian ini 10 responden diberikan pelatihan proprioceptive dengan wobble board selama
6 minggu dengan frekuensi latihan 3 kali seminggu, dan 10 responden diberikan pelatihan
penguatan otot ankle dengan karet elastic resistance selama 6 minggu frekuensi latihan 3 kali
seminggu. Alat ukur yang digunakan adalah foot and ankle disability indeks (FADI). Hasil
analisis statistik parametrik dengan Paired sample t-test. Hasil uji hipotesis menunjukkan
kedua kelompok perlakuan secara signifikan dapat menurunkan foot and ankle disability,
sebelum Perlakuan pada Kelompok I dengan rerata 25,90 + 15,56 dan Sesudah Perlakuan
pada Kelompok I 6,60 +5,03 nilai p=0,001(p<0,05), dan Sebelum Perlakuan pada Kelompok
II rerata 44,90+ 18.80 dan Sesudah Perlakuan pada Kelompok II rerata 13,10 + 10,304 nilai
p=0,000 (p<0,05), sedangkan nilai sebelum Kelompok I 25,90±15,57 dan kelompok II
25,90±15,57 nilai p = 0,024 (p < 0,05) ada perbedaan bermakna maka memakai data selisih.
Uji beda dengan Independent sample t-test diantara ke dua Kelompok ada perbedaan yang
signifikan dengan nilai selisih Kelompok I 19,30±12,59 dan Kelompok II 31,10±12,19 dan p
= 0,047 (p < 0,005). Simpulan pada penelitian ini bahwa pelatihan proprioceptive
menggunakan wobble board dan pelatihan penguatan otot ankle menggunakan karet elastic
resistance ada perbedaan yang signifikan dalam menurunkan foot and ankle disability pada
kasus sprain ankle kronis.
Kata Kunci : foot and ankledisability, sprain ankle kronis, wobble board, karet elastic
resistance.
59
ISSN : 2302-688X Sport and Fitness Journal
Volume 4, No.1 : 59-71, April 2016
ABSTRACT
Chronic ankle sprained is the overstretched on complex lateral ankle ligament will
happens on that movement, especially on plantar flexion and inversion. The ligament
weakened as a passive stabilization will cause pain and chronic inflammation problem. So, it
will decreased proprioception, muscle weakness in foot and ankle and also unstable symptom
in normal activity. Chronic Ankle sprained coditions causing disability in daily activity so it
will lead to ankle and foot disability. The aim of this study is to analyze is the proprioception
exercise using a wobble board different with elastic resistance band to strengthened the ankle
muscle in decreasing foot and ankle disability in chronic ankle sprained condition. The
method rod this study is pure experimental with randomized pre and post test group design.
In this study there are 10 respondent given propioception exercise with wobble board for 6
weeks in 3 times frequent, and 10 respondent given given strengthening ankle muscle
exercise with elastic resistance band for 6 weeks in 3 times frequent. The measurement that
used is Foot And Ankle Disability Index (FADI). Result of parametric statistical analysis
with Paired sample-test. The hypothesis test shown that both group has significant result in
decreasing foot and ankle disability, pre group I result average 25,90 + 15,56 and post 6,60 +
5,03. And pre group II average 44,90+ 18,80 and post 13,10 + 10,304 with p value = 0,001
and p < 0,05. Group II and Group II After treatment at a mean 13.10 + 10.304 p = 0.000 (p
<0.05), while the value before the Group I 25.90 ± and group II 25.90 15.57 ± 15.57 p =
0.024 (p <0.05), significant differences then put the data difference. Different test with
independent sample t-test the result there is a significant difference from both group there are
differences group I 19,30±12,59 and group II 31,10 ± 12,19 and p = 0,047 ( p < 0,05). The
resume of this study is there are significant difference between proprioceptive exercise with
wobble board and ankle muscle strengthening exercise with elastic resistance band in
decreasing foot and ankle disability in chronic ankle sprained condition.
Key Word :foot and ankle disability, chronic ankle sprained, wobble board, elastic
resistance band.
60
ISSN : 2302-688X Sport and Fitness Journal
Volume 4, No.1 : 59-71, April 2016
63
ISSN : 2302-688X Sport and Fitness Journal
Volume 4, No.1 : 59-71, April 2016
Intensitas : 1 jenis latihan , 3 set. Time : tarik karet tersebut kearah dorsal fleksi.
1 menit , rest : 30 detik setiap 1 set latihan. Gerakan ankle ke plantar dan tahanan karet
Dalam latihan menggunakan wobble board elastic resistance ke dorsal fleksi, posisi
exercise dengan jenis pelatihan, yaitu : duduk dengan kaki lurus, tempatkan karet
Side-to-side Edge Taps, Front-to-back elastic resistance pada telapak kaki (dililit
Edge Taps, Edge Circles,Counter- 1 kali), tarik karet tersebut kearah plantar
Clockwise Edge Circles, Latihan Berdiri fleksi.
Statik, Latihan Partial Squat. Setelah Gerakan ankle inversi dan tahanan
selesai melakukan pelatiahan karet elastic resistanc eversi, posisi duduk
proprioceptive wobble board pada dengan kaki lurus, tempatkan karet elastic
Kelompok 1, maka peneliti mengevaluasi resistance pada telapak kaki (dililit 1
dan mencatat hasil dari perlakuan kali), tarik karet tersebut kearah inverse.
Kelompok 1 setiap 1 minggu 1 kali pada Gerakan ankle eversi dan tahanan
hari jumat, untuk mengetahui adanya karet elastic resistance inverse, posisi
penurunan foot and ankle disability, duduk dengan kaki lurus, tempatkan karet
kemudian pasien pulang. Prosedur di atas elastic resistance pada telapak kaki (dililit
di ulang sampai 3 x per minggu yaitu hari 1 kali), tarik karet tersebut kearah eversi.
senin, rabu, jumat hingga jumlah perlakuan Setelah selesai melakukan latihan
sebanyak 18 kali selama 6 minggu, pada penguatan otot ankle dengan karet elastic
saat ke 18 di lakukan assessment ulang dan resistance pada Kelompok II, maka
di data hasilnya sampai 18 kali (melakukan peneliti mengevaluasi dan mencatat hasil
rekapitulasi dan dokumentasi hasil test dari perlakuan Kelompok II setiap 1
pada form dan table data yang telah minggu 1 kali pada hari jumat, untuk
disiapkan). mengetahui adanya penurunan foot and
Kelompok II intervensi diberi ankle disability, kemudian pasien pulang.
latihan penguatan otot dengan karet elastic Prosedur di atas di ulang sampai 3 x per
resistance. Dengan prosedur sebagai minggu yaitu hari Senin, Rabu, Jumat
berikut : Latihan penguatan dengan karet hingga jumlah perlakuan sebanyak 18 kali
elastic resistance. Sebelum dilakukan selama 6 minggu, pada saat ke 18 di
latihan pasien terlebih dahulu diberikan lakukan assessment ulang dan di data
penjelasan tentang cara melakukan latihan hasilnya sampai 18 kali (melakukan
strengthening dengan karet elastic rekapitulasi dan dokumentasi hasil test
resistance.Selanjutnya posisikan pasien pada form dan table data yang telah
dalam posisi duduk rileks di bed dengan disiapkan).
posisi tungkai lurus. Kemudian terapis
berdiri di samping pasien. Lalu terapis F. Pengolahan dan Analisis Data
mengintruksikan pada pasien untuk
melawan tahanan karet elastic resisteanc Data yang diperoleh sejak
kearah atas-bawah (dorsal fleksi-plantar persiapan dan pelaksanaan (pre test dan
fleksi), medial-lateral (inverse-eversi) yang posttest) diproses dengan SPSS for
diikuti dengan rileksasi. windows. Data yang ada sebagai berikut :
Dosis latihan : Frekuensi : 3 x
Data yang diperoleh sejak
seminggu, Intensitas : 3 set latihan , Time
persiapan dan pelaksanaan (pre test dan
: 30 menit, Repetisi : 10 kali, Rest : 30
posttest) diproses dengan SPSS for
detik, 1 set latihan. Tehnik Latihan Latihan
windows. Data yang ada sebagai berikut :
dengan karet elastic resistance : Gerakan
ankle ke dorsal dan tahanan dengan karet 1. Mendeskripsikan rerata dan standard
elastic resistance ke plantar, posisi duduk deviasi terhadap umur, berat badan,
dengan kaki lurus, tempatkan karet elastic tinggi badan dan IMT. Uji normalitas
resistance pada telapak kaki (dililit 1 kali),
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akhir yang memiliki aktivitas yang tinggi Uji ini untuk mengetahui
secara fisik. penurunan nilai foot and ankle disability
sebelum dan sesuodah Perlakuan pada
Kelompok pelatihan proprioceptive
dengan wobble board dengan
2. Uji Normalitas dan Uji Homogenitas
menggunakan paired sample t-test yang
Tabel 2 disajikan pada Tabel 3 sebagai berikut :
Variable Rerata±SB p
(n=10)
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Tabel 5
Tabel 6 menunjukkan bahwa nilai
Rerata Nilai FADI Sebelum rerata sesudah Kelompok I sebesar 6,60 +
PerlakuanPada Kelompok 1 dan 5,03 sedangkan Kelompok II sebesar 13,80
Kelompok 2 + 10,304. Analisis uji kemaknaan
independent t-test menunjukkan nilai nilai
Vari Kelompok 1 Kelompok 2
P p = 0,063 (p > 0,05). Hal tersebut
able Rerata±SB Rerata±SB menjelaskan bahwa penurunan nilai foot
and ankle disability kedua kelompok
Sebe 25,90±15,57 44,90±18,78 0,024 menunjukkan tidak adanya perbedaan yang
lum signifikan pada kasus sprain ankle kronis.
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kemudian diperolah nilai p = 0,001 dimana Hasil analisa data kedua kelompok
p < 0.05 yang berarti Ho ditolak dan Ha bermakna dipengaruhi oleh takaran.
diterima yang menunjukan bahwa pada Takaran dalam penelitian ini menunjukkan
Kelompok Perlakuan II adanya perbedaan adanya perbedaan intensitas latihan pada
antara sebelum dan sesudah perlakuan. Kelompok I dan Kelompok II. Pada
Penurunan foot and ankle disability Kelompok I diberikan initesitas, Minggu 1:
didapat adanya peningkatan kekuatan otot 1set: dilakukan selama 15 detik, Minggu 2-
dengan pelatihan selama 6 minggu dengan 3: 1 set: dilakukan 30 detik, Minggu 4: 1
frekuensi 3x/minggu. Peningkatan set: dilakukan 45 detik, Minggu 5- 6: 1 set:
kekuatan otot tonik dapat meningkatkan dilakukan selama 1 menit. Dosis Menit.
sirkulasi pembuluh darah kapiler hingga Pada Kelompok II diberikan intensitas dan
meningkatkan kekuatan otot phasik dosis latihan frekuensi 3x seminggu,
mengakibatkan terjadinnya penambahan intensitas 3 set latihan, time 30 menit,
recuitment motor unit pada otot yang akan repetisi 10 kali pada I set latihan.
mengaktifasi badan golgi sehingga otot
akan bekerja secara optimal. Dengan Dilihat berdasarkan intensitas pada
meningkatnya kekuatan otot ankle maka kedua kelompok maka pelatihan
fungsi ankle sebagai penyangga tubuh menggunakan wobble board tidak dalam
akan bekerja lebih efesien sehingga lebih jumlah yang jelas pengulangannya (dalam
stabil dan menurunkan foot and ankle satuan detik) maka progresifitas latihan
disability yaitu mampu melakukan yang di lakukan menggunakan wobble
kegiatan secara normal dalam aktivitas board tidak bisa di amati dengan baik.
sehari-hari.8 Oleh karena itu di asumsikan pelatihan
Pelatihan dengan karet elastic menggunakan wobble board tidak
resistance pada anke. selama 6 minggu mengalami progresifitas seperti pada
dengan dosis 3x perminggu, sebanyak 3 set pelatihan pengutan otot menggunakan
dengan 10 repetisi, dapat meningkatkan karet elastic resistance. Hal tersebut
kekuatan otot foot and ankle.11 menunjukkan bahwa pelatihan penguatan
otot menggunakan karet elastic resistance
Perbedaan Perlakuan Kelompok I dan lebih baik dari pada pelatihan
Perlakuan Kelompok II Terhadap Foot proprioceptive menggunakan wobble
and Ankle Disabiility pada Kasus Sprain board.
Ankle Kronis. Dari hal tersebut berarti sampel
Berdasarkan data yang diperoleh rata-rata termasuk kategori sprain ankle
dari Tabel 5 didapat nilai dengan derajat I dan II, yaitu adanya kelemahan
menggunakan Uji t-test Independent maka otot dan kelemahan ligamen, dengan usia
didapatkan hasil dengan nilai p= 0.047 terbanyak 16-25 tahun pada usia tersebut
dimana p < 0.05, ini berarti ada penurunan tingkat gangguan keseimbangannya sangat
nilai foot and ankle disability secara minim. Selain itu tingkat aktivitas ataupun
signifikan baik pada Kelompok I maupun pekerjaan yang kurang terkontrol pada
Kelompok II. Sedangkan pada uji hipotesis masing-masing individu juga dapat
III menunjukkan adanya perbedaan efek mempengaruhi terjadinya cedera berulang
antara Kelompok I dan Kelompok II yang memperlambat proses perbaikan dari
bahwa Perlakuan penguatan otot jaringan yang cedera.
menggunakan karet elastic resistance lebih
Pencegahan cedera sprain ankle
baik menurunkan foot and ankle disability
kronis diperlukan pelatihan khusus untuk
di bandingkan pelatihan proprioceptive
menghindari terjadinya cedera ulang
menggunakan wobble board pada kasus
karena secara umum cedera yang terjadi
sprain ankle kronis.
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ABSTRAK
Latar belakang: Sprain ankle kronis merupakan overstretch pada ligamen compleks lateral
ankle pada gerak inversi dan plantar fleksi. Kelemahan ligamen sebagai stabilitas pasif
mengakibatkan keluhan nyeri, inflamasi kronis, gangguan proprioceptive, hingga gangguan
aktivasi otot ankle, knee serta hip sehingga memicu terjadinya instabilitas ankle. Sprain ankle
kronis menyebabkan instabilitas ankle, yang disertai dengan reaksi penurunan kekuatan otot
gluteus karena perubahan aktivasi otot. Tujuan: Tujuan dari penelitian ini adalah untuk
membuktikan apakah penambahan glute exercise pada terapi latihan dasar lebih meningkatkan
stabilitas ankle pada kasus sprain ankle kronis. Metode: Penelitian ini adalah penelitian
experimental dengan rancangan pre test and post test control group design. Dalam penelitian ini
9 responden diberikan pelatihan terapi latihan dasarselama 8 minggu dengan frekuensi latihan 2
kali seminggu, dan 9 responden diberikan penambahan glute exercise pada terapi latihan dasar
selama 8 minggu frekuensi latihan 2 kali seminggu. Alat ukur yang digunakan adalah balance
error scoring system (BESS).Hasil analisis statistik parametrik dengan Paired sample t-test.
Hasil: Hasil uji hipotesis menunjukkan kedua kelompok perlakuan secara signifikan dapat
meningkatkan stabilitas ankle, sebelum Perlakuan pada Kelompok I dengan rerata
23,67±5,408dan sesudah perlakuan dengan rerata 13,11±3,887, dan Sebelum Perlakuan pada
Kelompok II 24,22±4,024 dan Sesudah Perlakuan dengan nilai 8,89±2,147dengan nilai p= 0,000
(p< 0,05). Uji beda dengan Independent sample t-test diantara ke dua Kelompok ada perbedaan
yang signifikan dengan nilai selisih Kelompok I 10,56±1,944 dan Kelompok II 15,22±2,635dan
p= 0,001 (p<0,005). Simpulan: Penambahan glute exercise pada terapi latihan dasar lebih
meningkatkan stabilitas ankle pada penderitasprain ankle kronis.
Kata Kunci: instabilitas ankle, sprain ankle kronis, glute exercise, terapi latihan dasar
ankle in case of chronic ankle sprain. Methods: The research method in this study is
experimental design with pretest and posttest control group design. In this study, nine
respondents were given basic training exercise therapy for 8 weeks with a frequency of exercise
two times a week, and 9 respondents were given additional glute exercise therapy for 8 weeks of
basic training exercise frequency 2 times a week. Measuring instrument used is the balance error
scoring system (BESS). Results: Results of parametric statistical analysis with Paired sample t-
test. Hypothesis test results show both treatment groups can significantly improve the stability of
the ankle, before treatment in Group I with a mean of 23.67±5.408 and after treatment with a
mean of 13.11 ± 3.887, and Prior Treatment in Group II 24.22 ± 4.024 and after treatment with a
value of 8.89 ± 2.147 with p = 0.000 (p < 0.05). Different test by Independent sample t-test
between the two groups was significant difference to the value of 10.56 ± 1.944 difference in
Group I and Group II 15.22 ± 2.635 with p = 0.001 (p < 0.005). Conclusion: The conclusions of
this research is the addition of glute exercise on the basis of exercise therapy further increase the
stability of the ankle in patients with chronic ankle sprain.
Keywords: ankle instability, chronic ankle sprain, glute exercise, therapy basic training.
melalui stabilitas postural dan lokal melalui penelitian dipilih berdasarkan kriteria
stabilisasi fungsional sendi.6 inklusi dan eklusi yang diambil secara
Pada penelitian ini peneliti ingin mengetahui consecutive sampling. Sampel yang dipilih
lebih lanjut tentang pengaruh penurunan dibagi menjadi dua kelompok dengan cara
stabilitas ankle dan penurunan kekuatan otot random alocation, masing-masing
gluteussetelah terjadi sprain ankle kronis. Untuk kelompok terdiri dari 9 sampel sesuai
membantu keluhan yang ditimbulkan dari dengan perhitungan rumus Pocock.
kasussprain ankle seperti adanya gangguan Kelompok I mendapatkan perlakuan terapi
stabilitas ankle, intervensi fisioterapi yang akan latihan dasar isometrik exercise dan
digunakan adalah pemberian terapi latihan dasar kelompok II mendapat pelatihanterapi
dan pemberian glute exercise. latihan dasar dengan penambahan
Penelitian ini bertujuan untuk membuktikan gluteexercise.
penambahan glute exercise pada terapi latihan
Kelompok I
dasar lebih meningkatkan stabilitas ankle Kelompok I mendapatkan pelatihan
penderita sprain anklekronis. terapi latihan dasar isometrik
Penelitian ini diharapkan dapat bermanfaat exercisedengan teknik latihan : muscle
sebagai penambah wawasan tentang peningkatan setting exercise, latihan stabilisasi dan
stabilitas anklepada kasus sprain ankle kronis multiple-angel isometric. Latihan
dengan memberikan latihan penguatan otot- dilaksanakan berdasarkan gerakan yang
ototankle dengan pemberian intervesi terapi terdapat pada ankle yaitu gerak inversi,
latihan dasar, serta pemberian glute exercise eversi, plantar fleksi dan dorsal fleksi,
dalam membantu meningkatkan stabilitas ankle.
beban latihan berasal dari tubuh sampel
sendiri. Latihan dilaksanakan selama 8
MATERI DAN METODE
minggu dengan frekuensi 2 kali seminggu.
A. Ruang Lingkup Penelitian
Penelitian dilakukan di Poltekkes Dr. Rusdi Kelompok II
Kelompok II mendapatkan
Medan selama 8 minggu dari bulan Maret
penambahan glute exercise pada terapi
sampai dengan April 2016. Penelitian ini
latihan dasar isometrik exercise, teknik
melibatkan pemain tim futsalKarya Setia dan tim
latihan yang diberikan muscle setting
futsal Poltekkes Dr. Rusdi Medan yang
exercise, latihan stabilisasi dan multiple-
mengalami cedera sprain ankle kronis.
angel isometric dengan penambahan side
Penelitian ini menggunakan metode
plank with abduction leg down, side plank
experimental denganrancangan pre testandpost
with abduction leg up, front plank with hip
test control group design. Penelitian ini terbagi
extension dan single-limb squat.Latihan
menjadi 2 kelompok yaitu kelompok perlakuaan
dilaksanakan selama 8 minggu dengan
terapi latihan dasar latihan isometrik, dan
kelompok perlakuaan penambahan glute exercise frekuensi 2 kali seminggu.
pada terapi latihan dasar. Penelitian dilakukan C. Cara Pengumpulan Data
untuk membuktikan peningkatan stabilitas ankle Data sampel penelitian pada kedua
dengan pemberian kedua metode latihan. Nilai kelompok didapatkan dengan mengukur
stabilitas ankle diukur dengan menggunakan stabilitas ankle sebelum pelatihan dan
balance erorr scorring system (BESS). sesudah mendapatkan pelatihan. Stabilitas
ankle diukur dengan menggunakan balance
B. Populasi dan Sampel
erorr scoring system (BESS).
Populasi sampel pada penelitian ini adalah
pemain futsal berjenis kelamin laki-laki dengan Prosedur pengukuran stabilitas ankle
rentang usia 19-25 tahun yang mengalami sprain Pengukuran dengan balance erorr
ankle dari tim futsalpoltekkes Dr. Rusdi Medan scoring system (BESS), dilakukandengan 3
dan tim futsal Karya Setia yang dapat mengikuti kondisi sikap dan 2 kondisi permukaan, 3
program pelatihan ke poltekkes Dr. Rusdi kondisi sikap yaitu double leg, single leg
Medan selama waktu penelitian. Sampel dan tandem stances sedangkan 2 kondisi
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distribusi sampel antara kelompok I dengan Kekuatan otot sekitar pergelangan kaki
kelompok II. seperti peroneus longus, brevis, dan tertius
sangat penting dalam meredam tekanan dan
B. Uji Normalitas dan homogenitas
memberikan dukungan tambahan ke
Berdasarkan uji normalitas (shapiro wilk-
ligament lateral ankle kompleks.8
test) data stabilitas ankle sebelum, sesudah dan
Hasil penelitian ini sejalan dengan
selisih, pada kedua kelompok memiliki nilai
penelitian dilakukan oleh Jong Kim, et.al,9
p<0,05 berarti data berdistribusi normal.
ditemukan bahwa latihan strengthening
Tabel 4. Hasil Uji Normalitas Data dengan menggunakan isometrik exercise
dapat meningkatkan stabilitas fungsional
Nilai BESS p (Shapiro wilk test) ankle. Penelitian lain yang dilakukan oleh
Kel I Kel II Kaminski et.al,8 mengatakan bahwa terjadi
Sebelum 0,190 0,922 peningkatan kekuatan inversi dan dorsi
Sesudah 0,177 0,053 fleksi ankle setelah 6 minggu melakukan
Selisih 0,547 0,560 latihan penguatan secara progresif. 20
subjek dengan riwayat unilateral stabilitas
Tabel 5. Pengaruh Penambahan fungsional menunjukkan perbaikan dalam
glute Exercise pada Terapi pengaturan posisi ankle dalam melangkah
Latihan Dasar dan terjadinya peningkatan aktivitas
Kelom Stabilitas p*
pok
muscles-spindel.
Pre Test Post Test Selisih
Klp 1 23,67±5,40 13,11±3,88 10,56±1 0,000 Pada kelompok II di awal penelitian
8 7 ,944 nilai rerata stabilitas ankle adalah 24,22 ±
Klp 2 24,22±4,02 8,89±2,147 15,22±2 0,000 4,024 kesalahan (pre exercise). Setelah
4 ,635 mendapatkanpelatihan penambahan glute
p** 0,808 0,012 0,001 exercise pada terapi latihan dasar isometrik
Ket. : p* Paired Sample t test exercise nilai rerata kesalahan stabilitas
: p** Independent sample t test ankle dengan menggunakan BESS menurun
menjadi 8,89 ± 2,147 kesalahan. Dengan
C. Pengaruh penambahan glute exercise nilai p = 0,000 karena nilai p < 0,05 dapat
pada terapi latihan dasar terhadap disimpulkan bahwa ada perbedaan yang
peningkatan stabilitas ankle signifikan dalam hal rerata nilai stabilitas
Hasil uji statistik tertera pada Tabel 5, pada ankle sebelum perlakuan dengan setelah
kelompok I di awal penelitian rerata nilai setelah perlakuan.
stabilitas ankle adalah 23,67±5,408 kesalahan Kurangnya kekuatan pada abductor
(pre exercise). Setelah mendapatkan latihan pinggul tidak memungkinkan seseorang
terapi latihan dasar isometrik exercise nilai rerata untuk memulai hip strategy tepat pada
kesalahan stabilitas ankle dengan menggunakan waktunya untuk menahan gangguan
BESS menurun menjadi 13,11±3,887 kesalahan. /tekanan eksternal lateral yang tiba-tiba.
Dengan nilai p = 0,000 karena nilai p<0,05. Situasi ini dapat meningkatkan risiko
Disimpulkan bahwa ada perbedaan yang terjadinya cedera pergelangan kaki.10 Hal
signifikan dalam hal rerata nilai stabilitas ankle tersebut juga dapat terjadi secara
sebelum dan setelah perlakuan. Latihan berlawanan, adanya cedera pada
isometrik pada pergelangan kaki dilakukan pergelangan kaki (ankle sprain dan ankle
berdasarkan 4 arah gerakan ankle yaitu plantar isntability) dapat menimbulkan kelemahan
flexi, dorsal flexi, inversi dan eversi7. Latihan pada oto-otot gluteus. Hal ini terjadi karena
isometrik berpengaruh terhadap peningkatan perubahan aktivasi otot gluteus setelah
stabilitas ankle dengan cara membantu terjadi ankle sprain, perubahan kerja otot
meningkatkan kekuatan otot disekitar gluteus ini sebagai mekanisme pelindung
pergelangan kaki dan membantu terjadinya tubuh setelah terjadinya cedera.3
pengurangan nyeri ketika dilakukannnya latihan.
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Pemberian glute exercise pada abductor dan glute exercise pada terapi latihan dasar
ektensor hip yaitu pada otot gluteus madius dan isometrik exercise memberikan pengaruh
gluteus maximus akan membantu meningkatkan lebih besar terhadap peningkatan stabilitas
kekuatan otot gluteus sehingga memberikan ankle.
dampak terhadap perbaikan ketidakstabilan
Penambahan Glute Exercise pada Terapi
extremitas bawah.Latihan ini akan membantu
Latihan Dasar Lebih Meningkatkan
meningkatkan kontrol postural pada extremitas
Stabilitas Ankle Penderita Sprain Ankle
bawah dengan cara memperbaiki kekuatan otot
Kronis
yang ada.10 Rerata selisih penurunan kesalahan
Kombinasi glute exercise dan terapi latihan BESS pada kedua kelompok yaitu 10,56 ±
dasar isometrik exercise akan memberikan
1,944 kelompok I dan 15,22 ± 2,635
dampak pada dua titik permasalahan yaitu pada kelompok II dengan nilai p = 0,001 (p <
ankle yang mengalami sprain dan pada area hip 0,05) terlihat bahwa pada kelompok II
(gluteus) yang mengalami kelemahan. Dengan perbaikan stabilitas ankle jauh lebih baik
pemberian kedua metode ini perbaikan defisit dibandingkan dengan kelompok I.
posturalterutama yang berkenaan dengan Gangguan stabilitas ankle
gangguan stabilitas yang diakibatkan oleh ankle mengakibatkan aktivasi otot pergelangan
sprain akan lebih cepat diperbaiki. kaki, lutut, dan pinggul menjadi lebih
Uji beda pada penelitian ini dilakukan pada lambat jika dibandingkan dengan subjek
kedua kelompok untuk membandingkan data normal. Dalam keadaan normal kerja otot
penelitian, dengan menggunakan independent ektremitas bawah dimulai dengan adanya
sample t test pada rerata nilai kesalahan BESS
respos antisipasi untuk mengkompensasi
sebelum perlakuan kedua kelompok didapatkan penundaan kerja otot intrinsik hal ini akan
nilai p = 0,808 dimana p > 0,05 yang berarti berpengaruh dalam mencegah terjadinya
sebelum dilakukan pelatihan pada kedua gangguan keseimbangan pada ektremitas
kelompok tidak ada perbedaan nilai kesalahan bawah.11
BESS yang berarti data penelitian bersifat sama. Pasien dengan gangguan stabilitas
Independent sample t test pada kedua ankle telah memperlihatkan strategi inisiasi
kelompok setelah pelatihan didapatkan nilai p = cara berjalan yang berbeda dengan orang
0,012 di mana p < 0,05, hal ini menunjukkan normal, hal ini berkaitan dengan perubahan
bahwa pada kedua kelompok terdapat perbedaan mekanisme supraspinal dari kontrol
nilai kesalahan BESS setelah dilakukan program motorik. Mekanisme sistem saraf pusat
pelatihan.
memainkan peran dalam defisit fungsional
Analisis statistik independent sampel t- yang berhubungan dengan ankle instability,
testdata selisih pada masing- masing subjek sehingga pendekatan komprehensif dalam
menunjukkan nilai p = 0,001. Karena nilai melakukan rehabilitasiyang meliputi fungsi
p<0,05 maka terdapat perbedaan yang signifikan otot distal dan proksimal sangat
antara pemberian terapi latihan dasar isometrik 12
diperlukan.
exercisesaja dengan penambahan glute exercise Pernyataan diatas sejalan dengan
pada terapi latihan dasar isometrik exercise, penelitian ini karena perbaikan stabilitas
dalam meningkatkan stabilitas ankle pada kasus ankle tidak hanya difokuskan pada bagian
sprain ankle kronis. pergelangan kaki saja (distal) tetapi juga
Dengan membandingkan rerata selisih memberikan pelatihan pada otot proksimal
penurunan kesalahan BESS pada kedua dari ektremitas bawah yaitu group otot
kelompok yaitu 10,56 ± 1,944 kelompok I dan gluteal.
15,22 ± 2,635 kelompok II terlihat bahwa Pada pengujian hipotesis satu arah
penurunan nilai kesalahan pada kelompok II jauh menunjukkan p < 0,05, hal tersebut
lebih besar jika dibandingkan dengan penurunan menunjukkan bahwa intervensi pada
nilai kesalahan pada kelompok I. Dari hal ini kelompok penambahan glute exercise pada
dapat diambil kesimpulan bahwa penambahan terapi latihan dasar isometrik exercise lebih
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Volume 5, No.2, Juli 2017: 51-57
baik secara signifikan dibandingkan dengan 8. Kaminski, TW., Heather, DH. 2002.
intervensi pada kelompok terapi latihan dasar Factors Contributing to Chronic Ankle
isometrik exercise dalam meningkatkan stabilitas Instability: A Strength Perspective.
anklekasus sprain ankle kronis. Journal of Athletic Training. Vol. 37.
Perbedaan rerata selisih yang cukup jauh No. 4: 394-405.
antara kedua kelompok penelitian disebabkan 9. Jong, KK., Young-Eok, K. 2014.
karena perbaikan tidak hanya mencakup area Which Treatment is More Effective For
ankle saja tetapi juga meliputi otot-otot gluteus. Fungtional Ankle Instability :
Perbaikan kontrol postural dengan meningkatkan Strengthening or Combined Muscle
kekuatan otot dan ligamen sekitar pergelangan Strengthening and Proprioceptive
kaki serta perbaikan aktivasi otot gluteus Exercise. Journal of Athletic Training
menjadi kunci utama pembeda antara kelompok Vol. 37. No. 4:394–405.
I dengan kelompok II. Kelompok I yang hanya 10. Presswood, L., John, C., Justin, WLK.
mendapatkan satu perlakuan yang hanya Chris, W. 2008. Gluteus Medius:
berfokus pada area pergelangan kaki, perbaikan Applied Anatomy, Dysfunction,
stabilitas tidak didapatkan secara menyeluruh Assessment, and Progressive
bila dibandingkan dengan kelompok II. Strengthening. Strength and
Conditioning Journal. Vol 3, No. 5.
SIMPULAN 11. Deun, SV., Filip, FS., Karel, HS. 2007.
Penambahan glute exercise pada terapi Relationship of Chronic Ankle
latihan dasar lebih meningkatkan stabilitas ankle Instability to Muscle Activation
pada penderita sprain ankle kronis. Patterns During the Transition From
Double-Leg to Single-Leg Stance. The
DAFTAR PUSTAKA American Journal of Sports Medicine,
1. Bahr, R., Holme, I. 2003. Risk Factor for Vol. 35. No. 2.
Sport Injuries- a Methodological Approach. 12. Feger, MA., Luke, D. 2014. Lower
Br J Sports Med. Vol. 37:384-392. Extremity Muscle Activation During
2. Sumartiningsih, S. 2012. Cedera Keseleo Functional Exercises in Patients With
pada Pergelangan Kaki (Ankle Sprains). and Without Chronic Ankle Instability.
Jurnal Media Ilmu Keolahragaan Indonesia American Academy of Physical
Vol 2. No. 1. Medicine and Rehabilitation. Vol. 6:
3. Hertel, J. 2008. Sensorimotor Deficits with 602-611.
Ankle Sprains and Chronic Ankle Instability,
Clinics in Sport Medicine. Virginia.
Elsevier.
4. Hertel, J. 2002. Functional Anatomy,
Pathomechanics, and Pathophysiology of
Lateral Ankle Instability. Journal of Athletic
Training. Vol. 37. No. 4:364–375.
5. Eric, E., Dieter, R. 2001. A Multi-Station
Proprioceptive Exercise Program in Patients
with Ankle Instability. Med. Sci. Sports
Exerc. Vol. 33. No. 12.
6. Page, P., Baton, R., Clare, CF. 2010.
Assessment and Treatment of Muscle
Imbalance The Janda Approach. Los
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57
PJAHS • Volume 3 Issue 2 2020 • (doi:10.36413/pjahs.0302.003)
Original Article
Biomechanical Taping and standard physical therapy were effective in the management of
acute ankle inversion sprain: a pre- and post- intervention study
Valentin Dones III,a,b Lyle Patrick Tangcuangcoa, Mark Angel Serraa, Angeleah Abada, Zacharie Fuentesa, Phyll Josh
Labada, Jannie Mauren Liboona, Judy April Emmanuelle Mianoa, Gian Karlo Reyesa, Marc Ryan Gerald Sabatina, Maria
Bianca Vergel de Diosa
aDepartment
of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines; bCenter for Health Research
and Movement Sciences, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
Abstract
Background: Ankle inversion sprain is a common musculoskeletal injury due to an inward foot twist. It results in pain, swelling, limited movement,
instability, and tenderness of the injured ankle. Standard physical therapy (PT) for acute ankle inversion sprain involves cryotherapy, range of
motion, balance, and strengthening exercises. Biomechanical Taping (BMT) is an adjunct to PT. Objectives: To identify the short-term effects of
BMT and PT on pain and function of individuals with acute ankle inversion sprains. Methods: Two licensed physiotherapists screened the
participants. Eligible participants were treated 3x/week with BMT and PT, with a day of home exercises in between treatments. Participants
answered the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). Friedman Test was used to determine differences in pre-
post measurements of VAS and FAAM. Results: 17 participants (10 males: 7 females) with unilateral acute ankle inversion sprains were included
in the study with a mean (95% CI) age of 21 (20-22) years. BMT and PT (a) decreased VAS mean rank scores at Treatments 3 and 5 (p<0.05); (b)
improved FAAM-ADL mean rank scores in Treatments 1 and 3 (p<0.05); (c) improved FAAM-Sports mean rank scores in all Treatments (p<0.05);
and (d) improved in VAS, FAAM ADL and Sports scores between Treatment 1, Treatment 2 and Treatment 3 (p<0.00001). Conclusion: BMT may
be an effective adjunct to PT in improving pain and function of participants with acute ankle inversion sprains. The increased stability created by
BMT may underpin the improved pain and function of participants.
Keywords: Biomechanical Taping, ankle injuries, fascia, physical therapy, lateral ligament ankle, pain
INTRODUCTION
Ankle inversion sprain is the most common the presence of severe ankle pain especially on
traumatic ankle injury associated with lateral the lateral portion with or without ankle motion,
ankle pain and difficulty in walking.1 It is localized heat, inability to severe difficulty
described as stretching, partial or complete bearing weight, and/or increased levels of
rupture of anterior talofibular ligament (ATFL), a localized swelling usually with ecchymosis.4 In
commonly injured lateral ankle ligament, after a the presence of equivocal evidence on the use of
sudden forceful inward movement of the foot Protection, Rest, Ice, Compression, and Elevation
due to miscalculated step.1,2 Ankle inversion (PRICE) protocol is widely used in clinics and
sprain has a prevalence rate of 93 per 1,000 research as standard physical therapy (PT) in
persons among athletes.3 managing acute ankle sprain.5 Ice combined with
exercise therapy reduced pain and swelling of
Typical clinical presentations of acute ankle
the ankle.6 Ice with compression combined with
inversion sprain (up to 4-6 days post-injury) are
elevation or rest is common treatment for acute
9
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ankle inversion sprain.6 Functional rehabilitation Study Design. This is a pre- and post-
consisting of ankle stabilization and progressive intervention experimental study.
weight-bearing and exercise is considered the
Sample Size. Using G*Power 3.1.9.2, a minimum
standard of care for acute ankle inversion
sample size of 30 was needed to determine the
sprains. Generally, early range of motion (ROM)
effectiveness of PT and BMT on acute ankle
exercises are followed by strengthening,
inversion sprains. This was computed using the
proprioception, and functional exercises. This
following information: mean (95% CI) VAS
early functional rehabilitation may aid in
values of 1.04 (0.20, 1.88), alpha value of 0.05
improving function and enabling a faster
and power of 0.20, as reported by Dones et al.9
recovery.7
Setting. This study was done at the Physical
Taping is an adjunct treatment tool used with PT
Therapy Skills Laboratory of the College of
in the management of acute ankle inversion
Rehabilitation Sciences of the University of Santo
sprains. Inelastic tapes improve neuromuscular
Tomas.
control, support and partially limit ankle joint
movement. It allows early weight-bearing by Biomechanical Tape. BMT fascia tape is
preventing excessive unnecessary movements of inelastic tape (Figure 1) with a height of 6 cm
the ankle joint area.8 The Biomechanical Taping and a length of 5.5 m. The BMT fascia tape is
Technique (BMT) is a taping technique that more stretchable than Leukoplast and Mueller
addresses pain secondary to acute ankle tapes.9
inversion sprains. BMT uses fascia tape, an Figure 1. The BMT fascia tape that was used in
inelastic tape, that pinches the skin and the study.
hypothesized to lift the deep fascia. The lift
creates light skin fold potentially allowing
movement between deep fascia and underlying
muscles. Unlike inelastic tape, it does not limit
ankle joint movement.9
Considering that BMT is an emerging taping
technique, no study reports on the effectiveness
of BMT on ankle inversion sprain. The
effectiveness of BMT, however, was reported by
Dones et al. in the management of lateral elbow
pain, which reported significantly decreased
lateral elbow pain (p<0.05), increased handgrip
strength (p<0.05) and improved function
(p<0.0001) of 23 patients with lateral
epicondylalgia. Improvements in clinical
symptoms and functions were reported after
three applications of BMT (on Days 1, 3 and 5).9
This study aimed to determine the effectiveness
of BMT and PT on pain and function of patients
with acute ankle inversion sprains.
pain at all” and “pain as bad as it could be” or Elevation. Ice and elevation above heart-level
“worst imaginable pain”. The participants were were done for ten (10) minutes. Participants
asked to draw a line perpendicular to the VAS received the following based on their ability to
line corresponding to their pain. The score was perform the exercises:
determined by measuring the distance (mm)
• Ankle dorsiflexion, plantarflexion, eversion,
between the “no pain” anchor to the patient’s
and inversion for 10 repetitions within the
mark using a ruler. A longer distance suggested
pain-free range;
greater pain intensity. The minimal clinically
• Ankle isometric exercises towards
significant difference was 1.1 points on an 11-
dorsiflexion, plantarflexion, eversion, and
point scale (or 11 points on a 110-point scale).
inversion for 10 repetitions with a 6-second
The minimum clinically important difference
hold for each repetition;
was 1.37 cm. VAS was highly correlated with a 5-
point verbal descriptive scale and a numeric • Balance exercises in the following sequence:
rating scale graded from no pain with worst pain o Single leg stance with eyes open for
with correlations ranging from 0.71–0.78 and 30 seconds,
0.62–0.91, respectively).10 VAS was sensitive o Single leg stance on unaffected limb
(sensitivity = 0.70) and reliable (between groups swinging for 30 seconds, and
r = 0.97) in measuring the intensity of pain.11-15 o Single leg squats for 30 seconds.
FAAM a self -report measure, assesses the The progression of the balance exercises was
physical function of individuals who had lower from eyes opened to eyes closed.7,20
leg, ankle, and foot musculoskeletal disorders. It Recruitment and Eligibility Criteria of
is a 29-item questionnaire that has two Participants. Potential participants were
subscales: ADLs subscale (21 items) and sports recruited through purposive sampling from
subscale (8 items). Subscale scores are based on November 2017 to March 2019 in clinics, sports
a Likert scale (4-no difficulty; 3- slight difficulty; clubs, and barangays. Information dissemination
2-moderate difficulty; 1- extreme difficulty; 0- was done using social media, posters, brochures,
unable to do). The participants answer N/A for flyers, and personal invitations. Participants
the activities limited by other factors other than were screened by either one of the two licensed
the foot and ankle. Participants assess their physiotherapists using the Initial Screening
current functional level as “normal”, “nearly Checklist (Appendix C).
normal”, “abnormal” and “severely abnormal”.
The inclusion criteria used were as follows:
N/As are not counted. The score is determined
by the sum of the points divided by the total • Male or female aged 18-35 years old;
possible score. A higher score reflects a higher • Has an ankle sprain with at least Grade 1
level of physical function. The minimal tenderness suggesting inflammation 1 day to
detectable changes for the activities of daily 3 weeks before being seen by the group; and
living and sports subscales are 5.7 and 12.3 • Diagnosed with Grade 1 or 2 ankle sprain
respectively.16-18 The ADL and Sport subscales using the West Point Ankle Grading System
demonstrated the following associations:
The exclusion criteria used were as follows:
• strong with SF-36 physical function
subscale (r = 0.84, 0.78) • (+) fracture on the ankle/foot for < 6 weeks
• strong with physical component • (+) neurologic deficits in the lower
summary score (r = 0.78, 0.80) extremities
• weak with SF-36 mental function • (+) for Squeeze Test, External Rotation Stress
subscale (r = 0.18, 0.11) and test, and syndesmosis ligament palpation.
These potential participants would have
• weak with mental component summary
suffered a syndesmotic ankle injury
score (r = 0.05, -0.02).19
• (+) chronic ankle instability as reported by
PT Management for Acute Ankle Inversion participants
Sprain. Participants received the PRICE protocol • infected skin
namely; Protection, Rest, Ice, Compression, and
11
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Figure 4. Third BMT fascia strip. The third BMT scheduling difficulties. Seventeen (17) patients
fascia strip was anchored on the participant’s (10 male: 7 females) with unilateral ankle
skin overlapping the previous BMT fascia strips. inversion sprains (11 left: 6 right) were included
The tape was pushed towards the posterior in the study with mean (95% CI) age of 21 (20-
aspect of the ankle by the investigator creating a 22) years. At baseline, patients reported mean
skin lift over the painful area. The distal end of (95% CI) VAS scores of 3.40 (2.11 to 4.69). Two
the BMT fascia strip was attached to the medial participants did not return on Treatment 5. The
aspect of the Achilles tendon. mean (95% CI) FAAM ADL and Sports Subscale
Scores were 72.56 (67.90 to 77.22) and 62.87
(54.50 to 71.23).
The following number of participants received
the three treatments (Treatments 1, 2, and 3) on
the following days:
• 13 participants on Days 1, 3 and 5;
• 2 participants on Days 1, 3 and 7;
• 1 participant on Days 1, 4 and 7;
• 1 participant on Days 1, 4 and 6.
15 of 17 participants performed the home
exercise program with two (2) participants
resting the injured ankle.
Shapiro-Wilk Test reported non-normal
Statistical Analyses Used. Descriptive statistics distribution of VAS scores, FAAM ADL and FAAM
(median, range) were used to describe baseline Sports Subscale Scores (p<0.01). Using Friedman
demographics of participants. Using MedCalc Test, a difference in VAS, FAAM ADL and Sports
version 15.2.2. Friedman Test was used to scores was found between Treatment 1,
determine differences in pre-post measurements Treatment 2 and Treatment 3 (p<0.00001).
of VAS and FAAM. Friedman Test is the non- Conover post-hoc test found improved
parametric equivalent of repeated measures differences in VAS, FAAM ADL and Sports Scores
one-way ANOVA). Alpha value at p<0.05 with a (p<0.05) between:
calculated 25th-7th percentile range will be • Treatment 1 Pre vs Treatment 2 Post
determined.21 Imputation method was used • Treatment 2 Pre vs Treatment 3 Post
during intention-to-treat-analysis. The last VAS, • Treatment 1 Pre vs Treatment 3 Post
and FAAM scores of non-compliant participants
at Treatment 3 were carried forward and used in Except on Day 1, the pre- and post-VAS Scores
data analysis. were different in Treatment 3 and Treatment 5
(p<0.05). Table 1 reports the mean ranks
between pre- and post-VAS scores.
RESULTS Except in Treatment 3, the pre- and post-FAAM
During this 2-year study, a total of 17 out of 30 ADL Subscale Scores were different in Treatment
patients were investigated. Using post hoc 1 and Treatment 3 (p<0.05). Table 2 reports the
analysis by G*Power 3.1.9.2, the power was mean ranks between pre- and post-FAAM ADL
calculated at 61% with an effect size of 0.50, and Subscale Scores.
an alpha value of 0.05.22 The pre- and post-FAAM Sports Subscale Scores
A total of 30 participants were recruited for the were different in Treatments 1, 2 and 3 (p<0.05)
study. 11 were excluded due to pain experienced Table 3 reports the mean ranks between pre and
on the posterior aspect of the ankle and negative post FAAM Sports Subscale Scores.
anterior drawer test. Two (2) potential
participants did not participate due to
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PJAHS • Volume 3 Issue 2 2020 • (doi:10.36413/pjahs.0302.003)
Table 1. Pre and Post VAS Mean Rank for each treatment
Post 4.44
Post 3.38
Post 1.53
*p<0.05 significant value
Legend: VAS, Visual Analogue Scale
Table 2. Pre and Post FAAM ADL Subscale Mean Rank for every treatment
Post 3.06
Post 3.82
Post 5.47
*p<0.05 significant value
Legend: ADL, Activities of Daily Living; FAAM, Foot and Ankle Ability Measure
14
PJAHS • Volume 3 Issue 2 2020 • (doi:10.36413/pjahs.0302.003)
Post 2.50
Post 3.79
Post 5.59
*p<0.05 significant value
Legend: FAAM, Foot and Ankle Ability Measure
treatment sessions, the effectiveness of BMT as Audrely Nicole Boiser, Regine Paola Galanga,
an adjunct to PT may be evident more so, not Angela Beatriz Imperio, Mary Helen Kagaoan,
causing additional pain or limitation in function Marcus Ian Lizardo, Sheree Mae Silvia, Mary Jude
on the injured ankles of participants. Karla Soller, Guineviere Tubay and Patricia Mae
Yumol.
Implications to practice. BMT with PT may be
used in the treatment of acute ankle inversions
sprains. The increased stability provided by a
Individual author’s contributions
possibly compact superficial fascia secondary to
the skin-lift created by BMT fascia tape may The following are the authors’ contributions to
underpin the improved pain and function of the paper:
participants. BMT fascia tape allows the mobility Valentin C. Dones III – writing of research
of ankle while maintaining a certain level of proposal, research implementation, writing of
stability. drafts, writing of final manuscript;
Albeit no adverse skin reactions were reported Lyle Patrick Tangcuangco Mark Angel Serra,
in the study, the application of BMT fascia tape Angeleah Abada, Zacharie Fuentesa, Phyll Josh
may potentially cause skin reactions to the Labada, Jannie Mauren Liboona, Judy April
involved area such as redness, itching, and Emmanuelle Mianoa, Gian Karlo Reyesa, Marc
blisters. Regular monitoring of the skin condition Ryan Gerald Sabatina, Maria Bianca Vergel de
throughout the treatment period is Diosa– writing of research proposal, research
recommended. Patients should be instructed to implementation, writing of drafts.
keep the tape for a maximum of three (3) hours
from the time of application to minimize skin
reactions. Disclosure statement
Implications to research. A large-scale This paper did not receive any funding.
randomized controlled trial is needed to increase
the external generalizability of the reported
effectiveness of BMT on pain and function of Conflicts of interest
individuals with acute inversion ankle sprains.
VCD was the originator of Biomechanical Taping.
Albeit he trained the researcher who applied the
CONCLUSION BMT on participants, he took no part in the
actual taping of participants and collection of
Biomechanical Taping may be an effective outcome measures. Other authors had no conflict
adjunct to PT in managing pain and improving of interest.
the function of patients with an acute inversion
ankle sprain. The stability the BMT is assumed to
create in the ankle joint decreased pain Supplementary files
promoting functional improvement, such as
experienced when walking. The basic science Appendix A. Visual Analogue Scale
underpinning the mechanism on pain Appendix B. Foot and Ankle Ability Measure
improvement experienced by patients with ankle
inversion sprain during BMT application has yet Appendix C. Screening Checklist
to be investigated. Appendix D. Participant’s Diary
Acknowledgments References:
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17
“Innovation of Physiotherapy Community on Increasing Physical
Activity during Pandemic Covid-19”
Jl. A. Yani, Pabelan, Kec. Kartasura, Kabupaten Sukoharjo, Jawa Tengah 57169
O-10
PHYSIOTHERAPY MANAGEMENT OF ANKLE SPRAIN IN THE
ACUTE PHASE: A CASE STUDY
ABSTRACT
Introduction: Ankle sprain is a condition in which the ligaments in the ankle are injured due to
sprains. According to research, injuries to the ankle are less than 10% due to PTFL and CFL, and
injuries in an inversion state or to the lateral ligaments of the foot occur in 85% of cases. The
meta-analysis found that 13.6 occurred in female athletes and 6.94 occurred in male athletes per
1000 exposures to soccer, basketball, hockey, tennis, and other sports. In the problem of acute
ankle sprains will cause symptoms of pain and swelling.
Case Presentation: a case study of three databases (PubMed, Pedro, Science Direct) with the aim
of knowing the effect of ultra sound, ice packs, exercise therapy and kinesio tape in The purpose
of this paper is to influence the effect of giving ice, ultrasound, exercise, and kinesio tape in the
acute phase of the right lateral ankle sprain patients.. The keyword used in the search was ankle
sprain related to "acute phase exercise". Inclusion criteria were athletes who had a grade 1 ankle
sprain and had no fractures.
Management and Results: The use of ultrasound and ice packs can reduce pain intensity and can
reduce edema, as well as the implementation of exercise therapy prescriptions and the use of
kinesio taping can increase functional activity.
Discussion: the study showed a decrease in silent pain from 5 to 3, tenderness from 8 to 6, and
motion pain from 8 to 6. a decrease in edema from a difference of 3cm to 2cm, an increase in the
functional activity of the FADI index, a decrease in the level of limitation after physiotherapy
actions from 41.3% to 36.3%.
Conclusion: physiotherapy management in the acute phase of ankle sprain cases uses a
therapeutic program twice. Ultrasound, ice packs, exercise therapy, and kinesio tape are used to
treat pain and swelling in ankle sprains.
Keywords: Sprain Ankle, Ultra Sound, Ice Compress, Exercise, Kinesio Tape.
562
“Innovation of Physiotherapy Community on Increasing Physical
Activity during Pandemic Covid-19”
Jl. A. Yani, Mendungan, Pabelan, Kec. Kartasura, Kabupaten Sukoharjo, Jawa Tengah 57169
Introduction
Every sport activity will be faced with the risk of injury. This injury will affect physical
activity, psychological, and achievement. The ankle is one of the most frequently injured limbs.
Injury to the ankle due to a sudden sprain can occur both medially and laterally which can result in
tearing of ligament fibers in the joint (Sumartiningsih, 2012). Ankle sprains can cause local joint
disturbances that affect the entire musculoskeletal and sensory system. This is what causes
disability, repetitive injuries, and a decrease in a person's quality of life (Abdelmonem et al., 2018).
The ankle joint is formed by the ends of the distal bones of the tibia malleolli, fibula, and dome of
the talus. There are supporting ligaments such as the medial collateral ligament and the lateral
collateral ligament which consist of the Anterior Talofibular Ligament (ATFL), Posterior
Talofibular Ligament (PTFL) and Calcane Fibular Ligament (CFL). AFTL stretches towards
inversion and plantar, CFL is injured when resisting excessive inversion, and PTFL is the strongest
and is rarely injured. PTFL itself serves to limit excessive external rotation (A. Attia et al., 2018).
According to research, injuries to the ankle are less than 10% due to PTFL and CFL, and
injuries in an inversion state or to the lateral ligaments of the foot occur in 85% of cases. From the
meta-analysis, it was found that 13.6 occurred in female athletes and 6.94 occurred in male athletes
per 1000 exposures to soccer, basketball, hockey, tennis, and other sports (Haque, 2019). In the
problem of acute ankle sprains will cause symptoms of pain and swelling. The standard treatment
commonly used is RICE which consists of Rest, Ice, Compression, and Elevation. One of the
physiotherapy modalities used to relieve pain, reduce edema, and increase joint space is ultrasound
(Bekerom et al., 2012). The kinesio tape modality in ankle sprain cases can provide injury
protection and rehabilitation (Yuliawan & Setiawan, 2019). Exercise therapy is also given to
reduce the prevalence of repetitive injuries and ankle instability (Halabchi & Hassabi, 2020). Based
on the background of the problem, the purpose of this paper is to influence the effect of giving ice,
ultrasound, exercise, and kinesio tape in the acute phase of ankle sprain.
Case Presentation
The author takes a sample of the basketball player Mr. H, a 19-year-old basketball athlete at the
Sport Injury Life Clinic in Surakarta, came after an injury while playing basketball. The main
complaint felt by the patient was pain in the right ankle when walking and lifting the leg, and the
presence of edema because it was still in the acute phase. The patient complained of pain in the
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ankle due to an injury while playing basketball. This is the first time the patient has had a sprain.
Pain increases with inversion and dorsal flexion and then swelling is present, limiting ROM. The
patient received positive scores for the application of the specific talar tilt test, and negative results
for the anterior drawer test and heel tap test. Limited range of motion is seen in dorso and plantar
flexion of the ankle. The ankle inversion is also seen to be limited. The patient has not been able to
carry out his activities as a basketball player.
Result
This research was conducted in May 2020 at the Sport Injury Life Clinic, Surakarta. The
results for the examination of pain using the Numerical Rating Scale (NRS). Examination
of this ankle sprain uses the NRS with a value of 0 (no pain), 5 (moderate pain), and 10
(very severe pain). Then the results are obtained as shown in Figure 1. In Figure 1 there is
a decrease in silent pain, motion and pressure in the right ankle area. The use of
ultrasound, ice compresses, exercise therapy and kinesio taping can reduce silent pain from
5 to 3, tenderness from 8 to 6, and motion pain from 8 to 6.
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Figure 1. Pain Examination Using NRS
In edema using a meterline and a decrease from 3cm to 2cm after physiotherapy
intervention. For functional ability checks using FADI (Foot and Ankle Disability Index)
get in Figure 2:
From the graph above, it can be seen that the patient experienced a decrease in the level of
activity limitation after physiotherapy actions from the level of limitation of 41.3%,
showing improvement to 36.3%.
Discussion
The use of ultra sound according to the results of research that has been carried out, there
is a decrease in pain described in Figure 1, namely reduced silent pain from 5 to 3,
tenderness from 8 to 6, and motion pain from 8 to 6. In addition, there was a decrease in
edema from a difference of 3 cm to 2 cm. Decreased pain due to the effects of using
ultrasound. According to research, exposure to 1MHz at 50 joules/cm2 can increase tissue
temperature which is considered a mediator in tissue repair mechanisms, increase
extensibility in soft tissues, relax muscles, augment blood flow, and reduce inflammation
in tissues. soft. With this research, it can be used as therapy in relieving pain, reducing
edema, and increasing the range of motion of joints in musculoskeletal disorders including
ankle sprains (M. P.J. Bekero et al., 2012). The decrease in pain pain to 3, tenderness to 6,
and motion pain to 6, as well as a decrease in edema from a difference of 3 cm to 2 cm
also because cold therapy was given in the first week of injury can help reduce pain in the
short term and reduce the presence of edema. This is due to the occurrence of
vasoconstriction (especially applied in the first hours. Cold therapy can also be used before
exercise therapy without disturbing sensory perception (Michel P.J. et al., 2012). At the
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beginning of the treatment the limitation of the patient was 41.3% but after the second
treatment there was a decrease in limitations to 36.3% as described in Figure 2. The
provision of exercise therapy is expected to increase activity and functional ability. One of
the recommended exercise therapies in this phase is proprioceptive exercise.
Proprioceptive exercise can improve functional instability, gait abnormalities, and prevent
re-injury. In the first week of injury there is pain. Proprioception has a role in providing
feedback to the nervous system. This is known as the ability to recognize the position of
our joints. So proprioceptive exercises are expected to increase joint stability and affect
balance dynamically (Yong & Lee, 2017). The increase in limitations as measured by the
FADI index of 41.3% to 36.3% is also due to the installation of kinesio tape. The use of
kinesio tape is done to prevent injury during injury rehabilitation, this is because the
installation of kinesio tape will limit or slow down the inversion motion. In addition to
preventing movement towards inversion to minimize repeated injury, kinesio tape has also
been shown to have a placebo effect. The elastic properties of the kinesio tape will also
increase the functional stability of the ankle joint (Mohamed et al., 2016).
Conclusion
After carrying out a physiotherapy program in the case of right lateral ankle sprain 2 times
using ultrasound, ice packs, exercise therapy, and kynesio tape on a patient named Mr. H
gets the following results:
1. Physiotherapy treatment with ultrasound, ice packs, exercise therapy, and kynesio tape
can reduce pain in the right lateral ankle sprain.
2. Physiotherapy treatment with ultrasound, ice packs, exercise therapy, and kynesio tape
can reduce edema in the right lateral ankle sprain.
3. Physiotherapy treatment with ultrasound, ice packs, exercise therapy, and kynesio tape
can improve the functional ability of the right lateral ankle sprain.
Acknowledgments
Acknowledgments
We thank the ankle sprain patients and thank everyone who has provided input and
suggestions for the author
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