A STUDY OF THE EFFECTS OF A FEE-SEASON ANKLE EXERCISE PROGRAM ON THE PREVENTION OF ANKLE INJURIES IN MICHIGAN HIGH SCHOOL BASKETBALL by EUGENE N. 13301323 AN ABSTRACT OF A THESIS Submitted to the College of Education of Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Education and Recreation 1956 Approved / /{ Zéé2E5/G¢LL,¢§€ZZ;;~x/6£Z::la_ / ABSTRACT T;TL§ A Study of the Effects of a Pro-Season Ankle EXercise Program on the Prevention of Ankle Injuries in Michigan High Sohool Basketball. STATEMENT 9:; To determine the effect of a pre-season ankle THE EQOBLEM exercise program.upon the incidence of ankle injuries among Michigan high school basketball players. METHODOLOGY Twenty high school basketball teams of central Michigan, acting as an experimental group, were given an.ankle exercise program.to be incorporated within their pre-season practice itineraries. Twenty other schools, comparable to those of the experimental group in size and locality, composed a control group. Records of all ankle injuries, games missed due to ankle injuries, and practices missed due to ankle injup ries were kept by each of the forty coaches. At the end of the season, these results were compared statistically by use of a "t" test. QQNQLUSIONfi The utilization of an ankle exercise program by the experimental group significantly decreased the number of ankle injuries, number of games missed due to ankle inju- ries, and number of practices missed due to ankle injuries. A STUDY OF THE EFFECTS OF A PRE-SEASON ANKLE EXERCISE PROGRAM ON THE PREVENTION OF ANKLE INJURIES IN MICHIGAN HIGH SCHOOL BASKETBALL by EUGENE N. RHODES A THESIS Submitted to the College of Education of Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Education and Recreation 1956. PREFACE This study is an investigation of the effects of a pre-season ankle exercise program on the incidence of ankle injuries in Michigan high school basketball. The data were collected from forty central Michigan high school varsity basketball teams during the 1955-56 season. Although the ankle injury is generally conceded the most frequent injury in basketball, little has been done in search for a definite means of prevention.. Authors, trainers, and coaches alike have all voiced their opinions; these theo- ries, however, tend to contradict one another. The writer believes this study will help the high school coach in his attempt to prevent ankle injuries among his basketball players. Grateful acknowledgment is extended to my advisor, Dr. Wayne D. van Huss, Associate Professor of Health, Physical Education and Recreation, for the professional guidance and patient counsel rendered in this study.. The writer extends gratitude to the twenty coaches who altered practice itineraries in order to take part in this study. Special thanks is likewise given to the twenty other coaches who recorded essential data. The author is deeply indebted to his wife, Ginger, for her valuable assistance in the final preparation of this study. Eugene H. Rhodes TABLE OF CONTENTS CHAPTER Io. INTRODUCTION OF THE PROBLEM . The-Problem. . . . . . . . Statement of the problem The need for this study . The source of data . . . Limitations of the study Definitions of Terms USed . Ankle injury . . . . . . Gamemissed....... Practice missed . . . . .- II. REVIEW OF LITERATURE . . . . Literature on Prevention of Literature on Strengthening III. METHODOLOGY . . . . . . . . . The Sample . . . . . . . . Orientation of Subjects ... Recording of Data . . . . . Statistical Procedure . . . IV.. ANALYSIS OF THE DATA . . . . Table and Chart Contents . Number of Ankle Injuries . Ankle Injuries the Ankle . . . PAGE \0 03 (D O\ \n 4' u: k» u: L» n: [U F4 %4 pa .4 II-‘il-‘fi'S'é' CHAPTER Number of Games Missed Due to Ankle Injuries ...... ,.,,,,.,,., Number of Practices. Missed Due to Ankle Injuries ................ General Discussion . . . . . . . . . . v... smmr, CONCLUSIONS AND RECOMIENDATIONS Summary................ Conclusions.............. Recommendations . . . . . . . . . . . . BIBLIOGRAPHY ................. APPENDIX A.. Ankle Exercise Program . . . . . . APPENDIXB. Letters ............. APPENDIX C. Record Sheet . . . . . . . . . . . APPENDIX D. Tabulation Sheet . . . . . . . . . PAGE 11 12 12 111- 11:- 11+ 15 16' 23 25 26 LIST OF CHARTS CHART PAGE I. Differences Between Groups . . . . . . . . . . . 13 CHAPTER I INTRODUCTION OF THE PROBLEM Attendance figures exceeding those of any other sport attest to the fact that basketball is one of the most popular sports in our country today. In nearly every high school in Michigan, this game is played on the varsity and/or intramural level. Participation being so great, the incidence of injury, especially those classified as "minor," is high. The most prevalent of all minor injuries is the ankle injury;1 there- fore, some method of preventing or minimizing ankle injuries is needed. I. THE PROBLEM Spatement g§.the problem. To determine the effect of a pre—season ankle exercise program on the incidence of ankle injuries among high school basketball players. The need for this study. To maintain the high level of participation that is enjoyed by basketball today, it is becoming necessary to decrease the number of injuries incurred. Regarding prevention of ankle injuries, several theories, many l J. Gallagher "Athletic Inggries Among Adolescents," Research arterl , 19:198-2lh, 19 . conflicting in nature, have been presented in literature throughout the years. The most popular argument is whether or not the wearing of ankle wraps and/or tape decreases the number of ankle injuries. Ochsenhirt2 has found that ado- lescents in basketball, baseball, and football have shown a reduction in ankle injuries by use of pre-season progressive resistance exercises. Equipment essential to the propagation of a progressive resistance exercise program, however, is foreign to most high school coaches due to the initial expense involved. Few athletic budgets are elastic enough to permit the coach to buy the material needed. For this reason, the author is attempting to evaluate the effects of an ankle exercise program given as part of the pre-season physical conditioning program utilized by the coach. The source g§_data. The first twelve members of forty central Michigan high school basketball teams in the general area of Grand Rapids to Flint and Leslie to Alma served as subjects. Limitations 9;,the study.. Although the results of this study are conclusive in nature, there are some limitations. 2 N. C. Ochsenhirt and others, "Prevention and Manage- ment of Athletic Disabilities," Archives gf_Physica; Medicine, 3H:158, March, 1953. In establishing the program with the experimental group, it was necessary for the author to accept the word of the coaches that they followed the program as outlined and that their injury reports were accurate. Any deviations by these coaches after the practice sessions were underway could not be controlled by the author. Drills utilized by coaches of the control group for other purposes could have overlapped on the experimental group's exercises and biased the data. II. DEFINITIONS OF TERIvIS USE Ankle injury. Any injury to the ankle, with the exneption of fracture, that is temporarily disabling, e.g., sprains, strains, torn ligaments and dislocations. Game missed. Any game in which the boy was unable to manipulate at top speed due to an ankle injury. Practice missed. Any practice in which the boy was unable to manipulate at top speed due to an ankle injury. CHAPTER II REVIEW OF LITERATURE Basketball, whether played on the varsity or intramural level, serves as an excellent avenue of escape for excessive physical energy stored up by high school children. Unfor- tunately, however, a marked increase in participation usually means an increase in the number of injuries. Regarding the susceptibility of the adolescent to injury, Stevens states: The adolescent years are fruitful yet dangerous for the athlete.w The structure of his body is developing, but has not reached physical maturity.. For example, long bones are more susceptible to fractures epiphyseal separations, dislocations, etc. The judgment of a qual— ified roentgenologist is necessary to discover defects not seen by those inexperienced in xeray evaluation. Frequently young tissues although fresh, virile, and flexible have neither matured nor been trained suffi-- ciently to develop tensile strength so necessary for the stresses they must withstand.l Gallagher,2 in a seven year study of athletic injuries among adolescents, found the ankle sprain to be the most common basketball injury. Of 28 basketball injuries, 3 were classified as major and 25 as minor, major injuries being l Harvin Alan Stevens and Winthrop Morgan Phelps, The Control of Footbal Injuries (New Yerk: A. S. Barnes and Company, 1933 , p. 10. 2.1. Gallagher and Thomas L- Delorme, "The Use and Techniques of Progressive Resistance Exercises in Adoles- cence," JOurnal of Bone and Joint Surgegz, 31-A:8#7, 1949. 5 defined as those causing an absence.of ten or more days from participation in athletics. Of the total 28 injuries, ankle sprains constituted 15. Many a coach has had the illusion of an undefeated season shattered when two nights before the first game, his star forward suffers a severely twisted ankle in practice. Thorndike3 believes that once an ankle is sprained it never fully regains its previous strength. The occurrence of every ankle injury in basketball is therefore accompanied by the fact that the recipient possibly will not be able to play at "full speed" for the remainder of the season. Consequently, it is necessary that some means of decreasing the number of ankle injuries in high school basketball be found. Literature gn,prevention g§_ankle injuries.. Several contradictory theories regarding the prevention of ankle injuries have been presented, the most common of these cone cerning the use of ankle wraps and tape. Meanwellu feels that ankle wraps should be worn both during practice and during games. Heppinstalls and other trainers and coaches seem to 1. 3Augustus Thorndike, At etic Injuries (second edition; Philadelphia: Lea and Febiger, 19 2 , p. 132. uwalter E. Meanwell and Knute K. Rockne, Training, Canditionipg and the Care inlnjuries (New York: Copyright by walter Meanwell, 19315, p. 121. 5John G. Heppinstall, Athletic Trainer, Michigan State university. 6 concur; however, many of their counterparts are of the opinion vthat continual use of wraps tends to weaken the ankle. Other writers believe that the use of tape is better than wraps.. Hanson6 states that taping the ankle will decrease the incidence of sprain; whereas Thorndike,7 one of those who does not agree, says that taping of normal joints is not desirable, provided certain definite joint tone exercises are carried out in the early training season. Whether or not to wrap the ankle remains largely a matter of individual choice, with the concansus of opinion being split fairly evenly in both directions. Literature gn strengthening the,agklg. Most authors believe the strength of the ankle can be increased by follow- ing a program of stretching exercises. Ochsenhirt8 has found that adolescents in basketball, baseball, and football have shown a reduction in ankle injuries by use of pre-season pro- gressive resistance exercises. Regarding stretching muscles in a strengthening program, Delorme, outstanding in the study 6W; A. Hanson and G. W. Hauser, "Common Injuries Associated with Fbotball at the Universit of Minnesota," khnnesota Medicine, 28:755, September, 19 5. 7 8N. C. Ochsenhirt and others, "Prevention and Manage- ment of Athletic Disabilities," Archives g£,Physical Medicine, 3N:158, March, 1953- Thorndike, loc. cit. of progressive resistance exercises, states: The loads to be overcome when performing progressive resistance exercises may stretch the muscles concerned beyond their normal resting length. This is advantageous. It has long been known that skeletal muscles develop greater force after being previously stretched. Their elasticity appears to be sufficiently high to resist tearing by loads capable of being lifted under the condi-- tions specified in the technique of application. Trauma of this type is never observed in properly administered progressive resistance exercises. Delorme also lists four ankle-strengthening exercises in a progressive resistance exercise program. These are: 1. Load resisting dorsiflexor exercise. 2. Load resisting plantar flexor exercise. 3. Load resisting evertor exercise. . Load resisting invertor exercise.lo 9Thomas L. Delorme and Arthur L. watkins, Progressive Resi§tance6Exercise (New Yor.: Appleton-Century-Crofts, Inc., l9l,p.- c 10 Delorme, 9p, cit., p..10. CHAPTER III METHODOLOGY The relative merits of a pro-season ankle exercise program in the prevention of ankle injuries in Michigan high school basketball is being determined in this study.- An experimental group and a control group of twenty teams each have been established, the former being given an ankle exer- cise program; to be incorporated within their respective daily practice itineraries. Records of all ankle injuries, number of games missed, and number of practices missed were kept by the coaches of all forty teams. A "t" test correlating the tabulated data of both groups was run to check the validity of the program. Th§_§ampl§, The first twelve members of forty central Michigan high school varsity basketball teams constituted the source of data. These teams, twenty of which composed an experimental group, were picked from an area of Michigan from Grand Rapids to Flint and Leslie to Alma. The teams of the groups were matched as nearly as pos- sible as to school enrollments. For every school with an enrollment of 325 students or over placed in one group, a 1Ankle Exercise Program, Appendix A. 9 similar school was placed in the other. The same held true for schools with enrollments of fewer than 325 students. The teams were also matched as to locale. A.school, for example, from the Flint area placed in the experimental group was matched by a Flint area school placed in the control gI‘OUPo gaientation 9: subjects. A personal interview was held with each of the twenty coaches of the experimental group teams five weeks before the first scheduled basketball game. At this time, the program and study was thoroughly explained and any questions were answered. If a coach felt that he could not fully comply with the program, he was not included in the group. Hewever, not one of the coaches refused. Approximately three weeks after the start of practice, twenty more teams, comparable in size and locality to those of the first group, were chosen as the control group. Letters2 were sent to the coaches of these teams asking if they would record the ankle injuries incurred by their respective teams. A stamped self-addressed post card was included for their reply. No refusals were encountered, thereby eliminating the necessity of a substitute. 2Letter 1, Appendix B. lO Recording 9; data. Record sheets3 on which to record the injured boy’s name, number of practices missed, number of games missed, and type of injury were issued to the forty _coaches. These sheets were of such a nature that they could easily be posted and kept up-to-date. As each injury occurred it was immediately recorded so as to eliminate forgetting any injury. I, At the end of the season, a letter was sent to each of the forty coaches, requesting them to submit their report sheets and any questions regarding the data. Only one coach wrote that he had questionable information; he was visited by the author and the proper data was subsequently derived. After all data was collected, the author had a personal interview with ten coaches from each group. ‘The information obtained from each of these interviews substantiated the data recorded on the report sheets. Spatistical procedure. After the record sheets were obtained, the number of injuries, practices missed, and games missed were tabulated for each group.5 The results of these: two groups were then correlated by means of a "t" test. 3Record Sheet, Appendix C. 4 Letter 2, Appendix B. sTabulation Sheet, Appendix D. CHAPTER IV ANALYSIS OF THE DATA The preceding chapters have dealt with the statement and purpose of the problem, the need for the study, related literature, and the methods used in accumulating the data. This chapter will reveal the results of the study as indicated by the procedure described in Chapter III. EEDlé.§QQ.£E§£E contents. The tabulation of all data of each team in the study is shown in the Tabulation Sheet, Appendix D. A final compilation of the number of ankle inju- ries, number of games missed due to ankle injuries, and number of practices missed due to ankle injuries for each group is indicated in the table. In Chart 1,1 the significance of all three variables is demonstrated. Number Q£_ankle injuries. The number of ankle injuries suffered by the control group exceeded those of the experimen- tal group by 52 to NO. The "t" of 2.160 indicates this to be significant at the five per cent level. Number g§_games missed due §g_ank1e injuries.. The number of games missed by the control group exceeded those lChart I, page 13. 12 missed by the experimental group by 35 to 15. The "t" of 2.292 indicates significance at the five per cent level. Number 9_f_ practices missed _dpg _t9_ _a1_}_1_i_l_g injuries. Chart 12 indicates the control group missed 15% practices due to ankle injuries whereas the experimental group missed only 76. This is shown to be significant at the one per cent level by a "t" of 3.356. General discussion. The above data indicate that by deviating only slightly from his original practice itinerary, a basketball coach may utilize a pre-season.ank1e exercise program that will significantly decrease the number of ankle injuries suffered by his teams throughout the season. It is also demonstrated that a team using this prescribed program will miss significantly fewer games and practices than the team without the program. In essence, the utilization of this. ankle exercise program indicates the coach will have more boys available for full-time duty. 13 CHART I a.» o.» ......a 0:0m :~: 0d 0.. 0.. no — .e _ _ C3832... _ _ : mnSOm 0 zwmgkwm mwozmmquo mmEDsz. mn_¥z< 0... mac omwm_s_ mung—Post mNEDsZ. m.._v_z< 0... mac ommmi mm2<0 mmEDpZ. m._v_Z< CHAPTER V SIH'«H~LARY, CONCLUSIONS AND RECO Ifl-EIIDATI ONS Summary. In this study, the author has attempted to determine the relative merits of a pre-season ankle exercise program in the prevention of ankle injuries in Michigan high school basketball. An experimental group and a control group of twenty high school basketball teams each were established. The experimental variable was the ankle exercise program incorporated within the experimental group's daily practice itineraries. Records of all ankle injuries, number of games missed due to ankle injuries, and number of practices missed due to ankle injuries were maintained. To test the effective- ness of the program, the data were statistically treated using the "t" test. Conclusions.. From the results, the following conclu- sions may be drawn within the limitations of the data: 1. The use of a pre-season ankle exercise program decreased the number of ankle injuries. The subjects of the control groupsuffered 52 ankle injuries whereas those of the experimental group had #0. ("t" 3 2.160; significant at the: five per cent level with 19 df) 2. The use of a pre-season ankle exercise program decreased the number of games missed due to ankle injuries. 15 35 games were missed by the control group; 15 were missed by the experimental group. ("t" = 2.292; significant at the five per cent level with 19 df) 3. The use of a pro-season ankle exercise program decreased the number of practices missed due to ankle injup~ ries. The control subjects missed INS practices; the experi- mental subjects missed 76. ("t' =’3.3§6; significant at the one per cent level with 19 df) ‘ Recommendatiggg. 1. It is recommended that this study be repeated for a period of three years. 2. It is recommended that the study be repeated on a~ larger number of subjects. 3. It is recommended that this study be repeated on subjects from a different, more diversified area. A. It is recommended that a study on the correlation of ankle strength and ankle injury incidence be run. BIBLIOGRAPHY BIBLIOGRAPHY A.. BOOKS Delorme, Thomas L- and Arthur L. Watkins- Progressive Resi nce Exercise. New York: Appleton-Century-Crofts, c., 9 . Heald, C.EB'.. quries _apg Sporp. London: Oxford Medical Publications, 1931. McMillan Mary... Massa e and gerapeutic Exercise. Second edit on. Phi adelp a: . B.. aun ers Company, 1925. Meanwell Walter E. and Knute K. Rockne. Trainin , Condi- tign ng §_n_d_ page Care 9;; Injgies. New YorE: UopyrIgEt by Walter Meanwell, 1931. Stevens Marvin Alan and Winthrop Morgan Phelps . e Contr i Ea r—Qlompany, 9; oot,b_al,;!I quri :5. New York: A. S. Barnes 1933. Thorndike Augustus. Atgletic Injuries. Second edition. Philadelphia: Lea an e iger, . Wiggers, Carl J. W 1p Hea t app; Dlsease. Fifth edition. Philadelphia: Lea and ebiger, 19 . B .. PERIODICALS Gallagher, J. Rosewall and Thomas I... Delorme... "The Use and Techn ques of Progressive Resistance Exercises in gigolesclegce," m 9; £9.22. gm}, innt ur er , 31-A: 7, 19 . . Hanson, W. A. and G. W. Hauser. "Common Injuries Associated with Football at the University of Minnesota," W Medicine, 28:755, September, 19’+5. Marshall M. 8. "Competition: For Better or Worse? " £92291. and épcigpz, 76:32.61}, November 22, 1952. ’ 18 Ochsenhirt N..C.. and others. "Prevention and Management of Athletic Disabilities," Archives g§,szsical medicine, 31:-:158, March, 1953. . Potthoff C. J. "Fracture of the Ankle," Todays Healt , 31: 23, January, 1953. "Preventing Disabilities of Our Nation's Athletes," Science News Letter, 60:297, November 10, 1951. . Tenenbaum, T. and D. Diamond. "How Safe Are Home and School: 1 It?“ cs?," Bgtter m and Mpg, 31:'Lrl‘-2, September, 9 3- . APPENDIIES APPENDIX A, ANKLE EXERCISE PROGRAM In the construction of an ankle exercise program, the following 1. 2. two questions must be answered: Do the exercises sufficiently stretch the ankles in the manner intended? Are the exercises of such a nature that they can be incorporated within each coach's pre-season physical conditioning itinerary without requiring additional time for administration? In order to answer "Yes" to these questions the author used the following two exercises as the constituents of his program: 1. Defensive gpppp exercise. The defensive drill is designed to improve footwork and to condition the arms, feet, forelegs, and ankles. In this drill, a designated person (usually the coach) calls out, "Forward, rear, right, left," in any sequence he desires. The players, alined three deep and ten feet apart, are in a defensive position (hands up, feet spread, knees flexed), sliding in the direc- tion called out by the coach. At the end of five minutes, the drill is momentarily interrupted as the player "changes hands"; for example, if he has used his right hand as the lead hand (up in the air), 2. 21 he changes to his left for the remaining five min- utes. This is done mostly to prevent excessive tiring of the arms. To make this drill a little more realistic, a boy sometimes dribbles a ball in front of the group. As the boy, facing the group, dribbles to his right, the group slides to its left, much as if they were actually playing defense against the dribbler. (This will also give the coach an added opportunity to correct defensive mistakes, such as crossing the feet.) Apklg egepcise. The second part of the program has the group responding to the coach once more as he calls out "Up, back, out, in." This time the group is in a stationary position, going up on its toes‘ on the command of "Up," back on.its heels on "Back," bending outward as far as possible on "Out," and bending inward on the command "In." It was suggested to the experimental group coaches that the above exercises be given out-of-doors the first couple of weeks of the training season, using a cinder track or school-o yard on which to run. This is preferred due to the "give" in the surface, permitting a gradual conditioning of the legs. "Shinpsplints" result quite often from.working on a hard 22 surface too early in the season. Administration p§,ppg,program. One week before the beginning of practice each coach of the experimental group was thoroughly oriented in the adninistration of the program. In turn, the coaches were entrusted to incorporate the exer- cises into their daily practice sessions.» The duration of the ankle exercise program was daily for the first four weeks of the training season. 23 APPEl-IDIX B, LELTER 1 Michigan State University East Lansing, Michigan November 20, 1955 Mr. Ted Bauer Everett High School 3426 8. Cedar Lansing, Michigan Dear Coach: This fall I have been doing research work on the occur- rence of ankle injuries in Michigan high school basketball. To make this study complete, it is necessary to obtain from several high schools throughout the state a report of the hump ber of injuries, type of injuries games missed and practice sessions missed by members of their basketball eams. I hope you will consent to keep the included reports up to date during the season. At the conclusion of the basket- ball year, I will send for or pick up these reports personally. The injury report sheet is self-explanatory with an example given.. Any time a member of your varsity squad (first twelve men) cannot go full speed due to some ankle injury, it is to be regarded as time lost and should be recorded. Enclosed, also, is a post card which I would like to have returned as soon as possible. Please feel free to jot down any questions you may have along with the information already on the card. Thank you very much for your cooperation and good luck throughout the basketball year. Sincerely, Gene Rhodes 2 Encl. 21+ APPENDIX B, LETTER 2 Michigan State University East Lansing Michigan l-«Larch 15, 1956 Mr. John Richard Durand High School Durand, Michigan Dear Coach: A.few'months ago when I first contacted you in regard to recording the ankle injuries of your basketball team, I had anticipated picking up the data personally at the end of the season. However, I find it impossible to do this and consequently must ask you to mail me the information as soon as possible. Included with this letter will be a stamped self-addressed envelope within which I‘d like you to enclose the blue report sheet I sent earlier. Please include any questions you may have regarding the data. A cepy of the final tabulation of my results will be forwarded to you in approximately six weeks. Heping you had a successful season I once again want to thank you very much for taking part in this project. Sincerely, Gene Rhodes, 1 anl. 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