The Ottawa Ankle and Knee Rules
Ankle and knee injuries are common across a wide variety of sports. Determining the severity of an ankle or knee injury can be challenging, especially immediately after injuries occur. The varying pain threshold levels from athlete to athlete can make it difficult to determine the injury severity based on subjective reporting of pain alone.
Sports Physiotherapists and other sports coverage practitioners around the world have utilized an immediate checklist screening system for determining if an athlete is suspected to have a fracture and needs to be sent for X-Ray imaging.[1,2] This screening system is known as the Ottawa Ankle rules and the Ottawa Knee rules. Both of these screenings can be conducted quickly and have been shown to be effective in accurately detecting fractures. [1,2]
Ottawa Ankle Rules
The Ottawa Ankle rules screening is used to determine if there are any fractures to bones that are commonly fractured at the ankle joint or foot.
Physiotherapists will palpate the medial and lateral malleolar zones, as well as the base of the 5th metatarsal and the navicular bones. Firm palpation on these areas will provoke a high level of pain if there is indeed a fracture.
After completing the palpations, physiotherapists will then have the athlete attempt to walk. If the athlete is also unable to perform more than 4 steps.
If they have pain at one of the indicated bone regions, then they must immediately be sent for imaging at the emergency department.
Ottawa Knee Rules
The Ottawa Knee rules screening is used to determine if there are any fractures at the patella or the head of the fibula.
Physiotherapists will first palpate these specific zones of the knee and then also see if the athlete is able to bend their knee to 90 degrees.
Similar to the Ankle rules above, the athlete will also attempt to perform 4 steps.
An additional criteria is if the athlete is 55 years or older, since bones become more frail with older age.
If the athlete meets any of these criteria they will need to be sent for imaging immediately.
If you have any concerns or questions regarding a potential fracture at the ankle or knee, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
References
Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa Ankle Rules. Journal of the American Medical Association 1994; 271:827-832.
Bachmann LM, Haberzeth S, Steurer J, ter Riet, G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004 Jan 20;140(2):121-4. Review.