Diagnosis Despite the high incidence of ankle sprains in athletes, syndesmotic injuries are rarely diagnosed. It is stressed through multiple reviews that the correct use of HIP/HOPS is initiated in order to prevent long term effects from the original injury. Diagnosis of the injury can be made easier by the associated pain on the medial aspect of the ankle, ballottable fibula, proximal fibular tenderness, swelling and crepitus that may be seen during inspection (7). If the patient is experiencing pain between the tibia and fibula, the distance, tenderness length, needs to be determined because it has been reported to be correlate with the degree of injury and time to return to play (2). There are many clinical tests that can be utilized for diagnosis of distal tibiofibular syndesmotic disruption, but research supports the use of four special tests. The Cotton Test, involves side-to-side movement of the talus on the involved leg compared with the contralateral side. In the External Rotation Test, there is …show more content…
The primary goals of this phase are to restore mobility, strength, and function in basic tasks. For example, ambulating with a normal gait pattern. Mobility can be facilitated through assistive devices, such as, towels or cords, or through activities, such as, cycling. Joint mobilization will be extremely helpful and effective in this stage. Strengthening can begin with basic resistance exercises using bands, cords or ankle weights. Once the athlete has gained strength they can perform closed-chain functional tasks, such as heel raises, or calf presses with weight machines. Strengthening should first be introduced with lower intensity, high repetition sets progressing into high intensity, low repetitions to promote muscle overload and thereby causing hypertrophy. Strength, endurance, and muscle control can be performed by having the athlete balance on unstable surfaces, such as, a bosu-ball, wobble board