Winter warm up advice 
It's time for some timely practical advice for all players and coaches. .With the temperature dropping as we go deeper into winder, some of our premier players are still playing at 10.00pm at night the other club girls are training outside after 8.00pm. This has seen a slight increase in muscle injuries related to a lack of warm up. It is important to increase the length of a warm up in cooler temperatures and include a mixture of running activity and dynamic stretches and ball skills. If a player has arrived late and not had time to warm up I would strongly recommend them not taking the court or the first quarter. Sideline players should keep warm with layer of clothing especially covering the legs and warm up every 5 minutes just in case they need to take the court for an injury. This is particularly important in the arena where the sideline players are sitting...consider a blanket for the legs as it can be removed quickly. The players’ lounge is available on Saturdays and at night to stay out of the weather and get a hot drink or some soup to keep up the liquids.

What is an ankle sprain?
Most people have twisted an ankle at some point in their life. But if your ankle gets swollen and painful after you twist it, you have most likely sprained it. This means you have stretched and possibly torn the ligaments in your ankle.

An inversion injury is the most common cause of an ankle sprain and occurs when the ankle rolls outward and the foot turns inward. It results in stretching and tearing of the ligaments on the outside of the ankle.

Less commonly, the ankle rolls inward and the foot outward in an eversion injury, damaging the ligaments at the inside of the ankle.

The high ankle sprain is the least common. It can happen when the foot is forced to rotate toward the outside (away from the other foot), or when the foot is planted so it can't move and the leg is rotated toward the inside

What causes ankle sprains?
Most ankle sprains happen when you make a rapid shifting movement with your foot planted, such as when you play soccer or get tackled in football. Often the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle. See the picture (right) of the different types of ankle sprains.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel "wobbly." You can't walk, because the ankle gives out and may be very painful. Often you will hear your Physio call it a grade 1 or grade 2. A grade 3 is a complete rupture of the ligament.

In all cases the best initial treatment is R.I.C.E (Rest, Ice, Compression and Elevation) remember to repeat the icing protocol for 20 minutes every 2 hours in the first 2 days.

Aims of Rehabilitation
Early Stage - first 2 days to 2 weeks depending on severity involves decreasing pain and swelling.
Protect the ankle with rest ice and bandaging or taping.

Rest - this is essential. Use crutches with partial weight bearing to get about with if necessary for the first few days. A healing ligament needs a certain amount of stress to heal properly but overdoing it early on in the rehabilitation process can prevent healing. Full weight bearing should be introduced as soon as pain allows.
Exercises of ankle pulling the foot upwards pointing the foot away can be performed early on so long as they are not too painful. Avoid turning the ankle though as this will stress the injured ligaments.

Ice - for 15-20 minutes every 2 hours initially for the first 2 days in the acute stage ice will constrict blood vessels and further bleeding. Longer term benefits include reduction of pain and muscle spasm.

Compression - use a tubi-grip bandage or taping

Elevation - put your feet up and read all about your injury! Elevating the leg will help swelling drain away from the site of the injury. Elevate the leg while icing and for 10 minutes after.

Rehabilitation Phase -2 days -4 weeks involves regaining movement, balance and returning to sportBegins when swelling starts to decrease and pain lessens. This means the ligaments have reached the point in the healing process where they are not in danger of being re-injured from mild stress.

Improve mobility and flexibility by moving it up and down then slowly adding writing of the alphabet with your foot.Attending a physio may involve mobilization of your foot and prescription of exercises using a band or wobble board or BOSU, stretching and taping for return to activity. Often Kinesio tape and acupuncture may be is used to reduce swelling and pain.

Proprioception exercises are thought to be important in avoiding recurrent ankle sprains. The neuromuscular control you have over your muscles will have been damaged when you injured the ankle as these small sensors are located in ligaments and tendons. Balance type exercises can be used to improve this function and help avoid future ankle injuries. WE recommend standing on one leg with your head tilted back for 30 seconds and eyes closed for 30 seconds.

Return to full fitness / functional trainingIn order to start the functional rehabilitation phase (activity and sports specific training) it is important the athlete has full range of motion and 80 to 90% of pre-injury strength. When you can comfortably do all of the above then you are ready to start phase 3 and begin your return to activity.

Cardiovascular exercise is important and should begin as soon as possible after injury. Stationary cycling, running in water and swimming are all possibilities depending on severity of injury and what pain will allow.
Running may begin as soon as walking is pain free and should begin on a clear flat surface such as a treadmill or footpath.  Grass or sand surfaces will increase the risk of re-injury.  Gradually increase speed over time to a sprint
Sports specific drills using cones can be introduced. Changing direction, running in a figure of 8 pattern and zig zagging between cones.


Achilles Tendon Injury
The Achilles tendon is the thickest strongest tendon in the human body and is the combined tendon of the gastrocnemius and soleus muscles.

Pain in the region of the Achilles tendon is an extremely frequent presenting symptom with the return to or increase in running based activities such as netball. It often presents as a gradual development of symptoms and complaints of stiffness on rising in the morning.  The pain diminishes with walking; similarly the pain diminishes during a training session only to reoccur several hours later.

Abnormal biomechanics of the lower limb are the main contributing factors to its onset, other factors that predispose a person to an Achilles tendinopathy include:
a/. years of running
b/. an increase in mileage, speed or gradient of a run
c/. a change in surface or terrain
d/. a decrease in recovery time between training sessions
e/. a change of footwear eg: running shoes to football boots
f/. excessive pronation of the foot
g/. calf muscle weakness or tightness
h/.  poor footwear or i/. stiff ankle joints

The key to successful rehabilitation of Achilles tendinopathy is early diagnosis, RICE to minimize additional collagen damage, an eccentric strengthening programme, correction of abnormal biomechanics and muscle imbalance along with appropriate progression of resumption of activity. Sometimes Kinesio taping and heel raise inserts help too. See our experienced team at the Sports injury Clinic (S.I.C) if you are suffering from this as many effective treatments are available.

Top Tips for Grading Day
Well here we go again ladies; time to trim the nails, remove the jewels, pad the feet and tie the bangs back… it's grading time!  Not to be taken lightly with two games up on the first day, here are some simple ideas of what to think about and what not to do this weekend.

Shoes - Don't test drive a brand new pair. Wear them in a little; make sure last years ones are in reasonable condition.

Ankles - if not sure get the trusty medical team to tape them up before you play. Check your braces for wear and tear, wear decent long socks with them and tie your shoes nice and tight.

Calves and Achilles - .always a lot more workload on this area in the game of netball compared to all the miles you may have run over summer. Warm up slowly for at least 15 minutes for each game, stretch down after and if Achilles are niggly consider rock tape and heel raises from the medical room.

Nutrition - have a good breakfast of cereal and yoghurt and fruit or wholemeal toast and egg two hours prior to warm up to ensure you have energy for the day. Top up with light snacks of fruit and muesli bars as needed on the day and watch for the signs of fatigue such as cramping or poor concentration....fuel the fire ladies!

Hydration - While playing sport stick with cool water even freeze your bottle the night before. Top up with an energy drink between games and stay out of the sun and off your legs in the break!

Don't forget your Physio and Docs are there an hour before the first game of the day so pop in if any queries but most of all enjoy the day.