PREVALENCE AND ASSOCIATED RISK FACTORS OF ANKLE SPRAIN AMONG BASKETBALL PLAYERS IN KADUNA STATE, NIGERIA

Mustapha B1*, Zakari MK2

1Ministry of Health and Human Services, General Hospital Rigasa, Kaduna State.

2Physiotherapy Department, Bayero University Kano. Kano State.

*Correspondence: Buhari Mustapha; +2347063917666; bukharimustapha@yahoo.com

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Abstract

Abstract

Background:  Ankle sprains have afflicted athletes and are recognized as a cause of absenteeism from training and tournaments and to some extent a cause of loss of sporting career. 

Objective: To investigate the prevalence of ankle sprain and associated risk factors among basketball players in Kaduna State. 

Materials and Methods: A retrospective observational study. A modified post-season injury questionnaire was adapted and administered to basketball players in Kaduna state. Data was summarized using mean, standard deviation, frequency and percentage. Chi-square was applied to test the relationship between demographic and basketball-related variables and ankle sprain at statistical significance level of p <0.05. Statistical analysis was performed using IBM SPSS version 20.0.

Results: Ninety-seven basketball players participated in the study. The prevalence of ankle sprain was 64.9%. Majority of the participants were males (79.1%). Most of them were in the age range of 20-29 years (49.5%). The mean Body Mass Index was 24.74 kg/m2. Participants in the 20-29 years age range, male, with right leg dominant and normal BMI had the highest prevalence of ankle sprain. The most common mechanism of ankle sprain was accidental twisting of the leg (33.3%) which mostly occurred during pre-match training (74.6%). Most of the participants treated their injury with self-medication (25.8%). Participants’ gender was the only demographic variable that showed significant association with ankle sprain (p = 0.007). Basketball-related variables did not also show significant association with ankle sprain.

Conclusions: There was high prevalence of ankle sprain among basketball players in Kaduna State and player gender was associated with ankle sprain in this study. 

Key words: Ankle sprain, Athletes, Basketball players, Prevalence, Risk factors.

Cite this article: Mustapha B, Zakari MK. Prevalence and associated risk factors of ankle sprain among basketball players in Kaduna State, Nigeria. Yen Med J. 2023;5(3):85–92.

INTRODUCTION

All around the world, a lot of people do participate in sport either for personal interest, relaxation, fitness or specific health benefits. Sport is one of the major causes of injuries, comparable to traffic accidents, home accidents, occupational accidents and violence.1 Severe injuries may lead to permanent cessation of sport participation which leads to psychological disturbance and perhaps death. For world and commercial teams, unexpected injury to one of the key players may result in defeat in major competition and huge financial loss. Ankle sprain varies depending on the mechanism of injury, position of the foot and rotational force on the joint and contractile structures. Low grade (grade I & II) injury result in micro tear or stretching of contractile structures, while high grade (grade III) sprain leads to disruption of structures.2 Numerous epidemiological studies reported that the ankle is one of the most injured body sites in sport accounting for 10-30% of sport injuries.3,4 Cumps et al5 suggested that sprains of lateral ankle ligament are the most common sport injuries in basketball. Although basketball is a non-contact sport, a high number of sprains have been reported as a result of landing on an opponent’s foot or caused by sudden change of direction.

Most common mechanism of ankle sprain is external rotation and/or ankle dorsiflexion.2 Assessment should be based on history of mechanism of injury, inspection, palpation and functional testing with Ottawa ankle rules, to predict which patient need x-ray to rule out fracture.6

Initial management involving conservative management with PRICE (Protection, Rest, Ice, Compress & Elevate) protocol is generally accepted. Resting the injured ankle for 72 hours followed by gradual resumption of activity as tolerated is a reasonable approach. Early weight bearing with support (use of braces) was shown to improve return to sport.7-9

Basketball is the most fast-paced and non-contact sport with evidence of injury similar to other full contact sport.10  Injuries such as ankle sprains result in temporary pain which can lead to long-term consequences such as decreased strength, delayed muscle reaction time and finally, loss of player carrier.11 In other to reduce the risk of such great loss, it is important to note the likely risk factors associated with such injury.12,13 This study aimed to investigate the prevalence and risk factors associated with ankle sprain among basketball players in Kaduna State, Nigeria.

MATERIALS AND METHODS

This study was a retrospective observational study, conducted in June 2018 among registered basketball players from all eight clubs that qualified for the 2017/2018 league competition within Kaduna State. Players below 18 years and up to 40 years were excluded from the study. A modified form of post-season injury questionnaire14 was adapted and self-administered to obtain information about basketball injuries and associated risk factors. The modified form of post-season injury questionnaire consists of two sections; demographic data and basketball-related data with information about treatment of injury.

The descriptive statistics – mean, standard deviation, frequency, and percentage was used to summarize the data. Interferential chi-square statistics was applied to test the relationship between demographic and basketball-related variables and ankle sprain. All statistical analyses were performed with IBM SPSS version 20.0 at a statistical significance level of p <0.05.

 

 

Table 1. Demographic and basketball-related characteristics of participants (n=97)

Variable

N

%

Age

 

 

10-19

35

36.1

20-29

48

49.5

30-39

14

14.4

Gender

 

 

Male

68

70.1

Female

29

29.9

Dominant leg

 

 

Right leg

60

60.1

Left leg

30

30.9

Player position

 

 

Center player

8

8.2

Power position

14

14.4

Small forward

23

23.7

Shooting guard

27

27.8

Point guard

25

25.8

Frequency of training

 

 

Daily

65

67.0

Alternate day

24

24.7

Weekends

8

8.2

Pre-match training engaged in

 

 

Skill training                                   

13

13.4

Fitness training                                

16

16.5

Both                                                    

68

70.1

Stretching                                     

 

 

Yes                                    

96

99.0

No

1

1.0

Timing of stretching                    

 

 

Before training or match                  

89

91.8

After training or match                 

8

8.2

 

 

Prevalence and pattern of ankle sprain

As shown in Table 2, most of the participants had suffered ankle sprain (64.9%), 61.9% of them sustained the injury on their dominant leg and it occurred mostly during training (74.6%). Participants in the 20-29 years age range, male, with right leg dominant and normal BMI had the highest prevalence of ankle sprain. Moreover, ankle sprain was more prevalent among shooting guards and participants that did stretching exercise and combined both fitness and skill training. See Tables 3 and 4. Accidental twisting of the foot was the major mechanism of ankle sprain (33.3%) followed by rough tackle from an opponent (27.0%). See figure 1.

 

 

Table 2: Prevalence and pattern of ankle sprain

Variable

                      N

                   %

Sustained ankle sprain

 

 

Yes                                      

63

64.9

No

34

35.1

Leg sprained

 

 

Dominant                                                      

39

61.9

Non dominant                                               

24

38.1

Associated activity

 

 

During training                                                            

47

74.6

During a competition

16

25.4

 

 

Figure 1: Mechanism of ankle sprain injury

Association between participants’ demographic characteristics and ankle sprain

Table 3 shows association between age, gender, dominant leg, BMI and ankle sprain. There was no significant association between age and ankle sprain (p = 0.73). Gender showed significant association with ankle sprain (p = 0.007). There was no significant association between dominant leg and ankle sprain (p = 0.485). No significant association between BMI and ankle sprain (p = 0.332).

 

 

Table 3: Association between participants’ demographic characteristics and ankle sprain

Variable

          History of sprain

            Yes             no

              X2

       P-value

Age                                                                   

 

1.68                                                                       

.73

10-19                                   

              22             13

 

 

20-29                                               

              33              15

 

 

30-39                                            

                7               6

 

 

40-49                                       

                1               0

 

 

Gender                                                    

 

7.36

.007

Male

               50              18

 

 

Female

               13              16

 

 

Dominant leg                                                                      

 

.487

.485

Right

              42                25

 

 

Left

              21                 9

 

 

BMI

 

3.432

.332

<18 (underweight)         

              0                  2

 

 

18-25 (normal weight)            

              36               19

 

 

26-29 (overweight)      

              22               10

 

 

30-above (obese)        

               5                 3

 

 

 

 

Association between participants’ basketball-related characteristics and ankle sprain

Table 4 shows association between player position, stretching, pre-match training and ankle sprain. Position of player showed no significant association with ankle sprain (p = 0.053). Stretching showed no significant association with ankle sprain (p = 0.351). Pre-match training had no significant association with ankle sprain (p = 0.449).

 

 

 

Table 4: Association between participants’ basketball-related characteristics and ankle sprain

Variable

          History of sprain

            Yes             no

              X2

       P-value

Player Positions                                                                             

 

9.092

.053

Centre (pivot)

              4              4

 

 

Power forward

             12             2

 

 

Small forward

             17             6

 

 

Shooting guard

             19             8

 

 

Point guard

             11            14

 

 

Stretching                                            

 

1.872

.351

Yes

              63          33

 

 

No

              0             1

 

 

Pre-match training engaged in

 

1.755

.449

Skill training

            6              7

 

 

Fitness training

            9              7

 

 

Both 

            47           21

 

 

 

 

Treatment type

Figure 2 shows different forms of treatment received by the participant after sustaining ankle sprain. Majority of the participant (25.8%) had self-medication and 18.6% were treated using first aid. Only 2.1% were treated using physiotherapy.

Figure 2: Treatment forms after ankle injury

DISCUSSION

The aim of this study was to investigate prevalence of ankle sprain and its associated risk factors among basketball players in Kaduna state. The study found out that there was high prevalence of ankle sprain among basketball players in Kaduna State and player gender was associated with ankle sprain.

This 64.9% prevalence in this study was seen in other studies with similarly high prevalence of 67.3%15 and 92.7%.16 However, the result of this study was higher compared to other studies having 41.0% 17 and between 40.0% to 50.0% prevalence.18

This research revealed that participants between 20-29 years had the highest ankle sprain prevalence rate but there was no significant association between age and prevalence of ankle sprain. Similarly, the study of Layan et al16 shows that young basketball players (18-25 years) were more likely to sustain sprain than older player. This was also as shown by authors of other studies – Doherty et al,18   Stevenson et al,19 McKay et al11 and Ramirez et al.20 Younger athletes with average age of 25.2 years tend to have impair neuromuscular control caused by physiological changes, these changes can cause loss of stability while landing, muscular strength imbalance and postural instability.21,22 However, Turbeville et al23 noted that older and more experienced players have a higher risk of injury.

This study showed that male basketball players had higher prevalence rate of ankle sprain than females, it also showed significant association between gender and ankle sprain. These findings concur with Beynnon et al’s study.24 Contrary to our study, it was reported in other studies that prevalence rate of ankle sprain was higher in females than in males25,26 but another study shows prevalence of ankle sprain to be the same in both gender.27

The Chi-squared test showed no significant association between dominant limb and BMI. Participants tended to sustain injury with their dominant limb more in this study, as also reported similar with studies.16,28 More participants had normal body weight. However, no significant association was found between prevalence of ankle sprain and body weight status, but in another study, it was shown that people with normal body mass had lower prevalence rate of injury than overweight.29

Player position showed shooting guard had the highest rate of ankle sprain in this study. A study30 revealed lower risk of ankle sprain for forwards and highest for Centre players. Layan et al’s16 and More-Pacheco et al’s31 studies also reported higher incidence rate among center player with a significant association between player position and ankle sprain, which is contrary to this study that shows no association between player position and ankle sprain. There was no significant association between prevalence of ankle sprain and stretching activities in this study. Almalki et al reported similar findings.32 Regarding the sports stage, this study reported that the occurrence of ankle sprain was higher in training stage than competition stage. The result was consistent with the study that reported ankle sprains were the most common injury during training.33 However, other study shows that higher prevalence occurred during competition than during practice,34 also another study shows that higher level of competition was a risk factor for ankle sprain.35

The main mechanism of ankle injuries in this study were accidental twisting of the foot followed by rough tackle from an opponent. Other study supported our findings that sudden change of direction of the foot contributed to the incidence rate of ankle sprains.36 

Various means of treatment was applied by the participants in this study, with self-medication leading and involved use of over-the-counter drugs to relieve pain and visitation of traditional bone setters. First aid approach involved icing, massaging with balm and compressing the affected joint with bandage. The least utilized was physiotherapy. This is similar to the study of Emery and Tyreman27 in which 17.5 % reported to have combination of both self and first aid treatment and lastly physiotherapy treatment. The low utilization of physiotherapy in this study suggests a low level of awareness of physiotherapy treatment in managing sport injuries.

This study has some limitations. Firstly, the study design is retrospective observational which is prone to recall bias. Secondly, the male: female ratio of the study population is a strong bias which may affect the validity of the association found between gender and ankle sprain. Finally, the sample size is small and may have limited the power of the study; perhaps a larger study may find associations between some participants’ characteristics and ankle sprain. Larger cross-sectional studies of gender-matched basketball players should be considered.

CONCLUSION

There was high prevalence of ankle sprain among basketball players in Kaduna State and player gender was associated with ankle sprain in this study.

It is important to note that there is need to educate players, coaches as well as team managers on proper prevention program and use of protective braces in other to reduce the rate of injury and withdrawal from play due to injury.

AUTHOR’S CONTRIBUTION

Author BM conceived the idea, collect, analyze data and write the drafted manuscript. Author MKZ supervise and review the manuscript.

ACKNOWLEDGEMENT

The authors would like to thank all consented subjects for their cooperation and willingness to be part of the study.

CONFLICT OF INTEREST

The authors declare no conflict of interest

FUNDING

Not funded.

ETHICAL APPROVAL

Ethic committee of Kaduna State Ministry of youth and Sport Kaduna, Nigeria granted ethical approval before the commencement of the study.

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