The Effect of Giving Cold Therapy to Decreased Pain Sprain Ankle Basketball Players

Sprain, is an injury to a joint that results in a torn ligament that functions as a binding between bones and as a sta-bilizer for the joint that occurs due to excessive pressure and sudden movements repeatedly. It is estimated that nearly 1.6 million injuries occur in connection with basketball in Indonesia. The epidemiology of injuries to male basketball players during training is 4.3 per 1000 while the competition is 9.9 per 1000. This study is an experimental study with a Two Group Pre-Test and Post-Test Design. The research subjects were 30 permanent members of the Bangau Basketball Club which were divided into 2 groups: O1 group was a group that was given cold therapy before training alone, O2 group was a group that was given cold therapy after exercise alone. The study was con-ducted in October-November 2018. There was a difference between pain intensity and the degree of ankle sprain O1 group before and after exercise with the pain intensity difference test value of 0,000 and the value of the ankle sprain degree difference test result of 0.029 (p <0.05). There was a difference between the intensity of pain and the degree of ankle sprain in the O2 group before and after exercise with the test value of the pain intensity difference of 0.024 and the value of the test result of the degree of ankle sprain difference of 0.047 (p <0.05). Wilcoxon test results showed that there was an effect of cold therapy to reduce ankle sprain pain with p <0.05.


INTRODUCTION
In United States there are more than 23.000 peoples per day, whether athlete or non athlete, that happen ankle injury. Th is incident is estimated 1 from 10.000 per day. Women athlete 25% has an incident rate more rather than men athlete. Th en in Indonesia, it estimate almost 1.6 million injury occurring related with basket ball sport. Epidemiology injury in men players while exercise is 4,3 per 1000 while in league is 9,9 per 1000 (Haddar, 2015).
is group that given cold therapy after exercise only. Intervention is given on fi xed schedule exercise basket is do. Before and after exercise assessed the intensity of pain using Pain Tools Scale (Visual Analog Scale) and Sprain Ankle degree. Th ere are the design table researches Two Group Pre-Test and Post-Test Design.
Th e subject research is divide into 2 groups there are: the O1 groups is the group that given cold therapy before exercise only, group O2 is group that given cold therapy after exercise only. Intervention is given to fi xed schedule basket exercise do. Exercise before and after is assessed the intensity of the pain by using Pain Tools Scale (Visual Analog Scale) and sprain ankle degree. Th ere are the research design tables Two Group Pre-Test and Post-Test Design.

DISCUSSION
Based on the result, it can explains that the pain that experienced by group O1 basket player before exercise (pretest) is 15 people with mild intensity pain (50%) and 15 people with moderate (50%).
Th e result is in line with research of (Nurjannah, 2016), where the pain can be understand with diff erent between individual, it depend on perception. Even though, any one diff erences about pain perception. In simple pain can be interpreted as a sensation that not fun whether sensory or emotional that related with any tissue damage or other factor.
Based on the research, it can get that pain experienced by group O1 basket ball player after exercise most of it is 27 people with mild pain intensity (90%). Th e result is in the line with research. (Nurjannah, 2016), the Pain happen if any mechanical stimulation, thermal or chemistry that past certain stimuli of excitement. Th ese stimuli are detected by nociceptors which are the occuring injury, physical contact that happen while in competency and exercise, it is called to men contact while competency more higher, around 52%, than while exercise, 44%, whereas on women, physical contact is occuring 46% while competing and 31% while exercise (Haddar, 2015).
Nowadays, high speed, physical contact and aggressiveness are a common thing that occurs to basket ball exercise, until causing the higher risk occurring injury. Th e injury that often happen to athlete is ankle sprain, which is injury to ligament that causing torn in ligament. Sprain happen because an excessive pressure and suddenly to joint or because excessive using that repeatedly. According to (American Collage of Emergency (AAOS), 2012) American College Health Association (ACHA) sprain is divided to Sprain mild (First Degree); usually accompanied with pain feeling, hematoma (infl ammation) and decreasing function, Sprain Moderate (Second Degree); occur the infusion fl uid that cause swollen and felt hot, then in Sprain Severe (Th ird Degree); all the entire ligament fi bers break up cannot be moved as usual with severe pain, swelling, and the presence of blood in the joints. Basket ball player occur a trauma because Inversion Injury, where the players landing a leg and ankle is rotating (Nurjannah, 2016).
Based on the previous study that happen to research, there are a lot of extracurricular groups and basketball clubs among teenagers throughout the city of Palembang, South Sumatra Province, one of which is the Bangau Basketball Club "Bangau Sport Center" that located in Mayor Ruslan Street No 207 B RT 029 Urban Village 9 ilir District East Ilir III Palembang City. Bangau Basket Club "Bangau Sport Center" is the longest-running club, managed independently by youth groups who love basketball, actively participating in various tournaments at the City and National level, often getting awards, supported also that the eff ect of cold therapy on reducing ankle sprain pain has never been done on members of this basketball club, based on this, researchers are interested in examining "the eff ect of giving cold therapy through decreased pain sprain ankle to basket ball players".

RESEARCH METHOD
Th is research is experimental research with Two Group Pre-Test and Post-Test Design plan. Th e subject is divided into 2 groups there are: the groups O1 is group that given cold therapy before exercise only, group O2 The illustration 2.13 Concept Framework while in exercise or competency, weak muscle, overuse or facility and pre-facility that not good. Th e exercise that is causing injury sports is exercise (30%), competency (35%), sport class (20%), and informal playing (15%).
Th e result is showing that part of sprain ankle degree that experienced by group O2 basket player before exercise is Degree II where Ligament is felt hot and swollen is 16 people (53.3%). According International Olympic Committee Medical Commission in Sport Medicine Manual that is quoted by (Hermawan, 2015). Based on the injury levels, the exercise is divided are 1). Higher risks sport, 2). Moderate risks sport, 3). Lower risks sport. Th e exercise that include moderate risks is; all the athletic exercise, including marathon running 30 km and walking 50 km, badminton, baseball, basket ball, biathlon, bobsled and luge, cross country skiing, canoeing, rowing, softball, tennis outdoor.
Th e result research is showing that part of sprain ankle degree that experienced by group O2 basket player after exercise is Degree II where ligament is felt hot and swollen is 23 people (76.7%). In line with the (Nurjannah, 2016) Research that Sprain is injury in joint that causing torn ligament that the function as binding between bones and as joint stability. Th is is happen because an excessive pressure and the moving is suddenly in repeatedly, where pain in swollen is usually mild into moderate and swelling that accompanies moderate to severe.. Th e injury is often experienced by basket players. Th is injury occurs when a player lands on the foot of another player or the ankle curls too out. While basket players playing, ankle injury is often happen while wrong landing jump shoot. Jump shoot that unstable will causing wrong landing position until the balance of the body while landing will causing ankle occur disposition. While this thing happen, the ligament can torn a half or entire.
Th e research is showing diff erent intensity pain test is 0.000 and result of diff erent ankle sprain degree test free nerve endings. Th e stimulation will be carried as nerve impulses through Delta A fi bers which myelinated, has fast delivery speed, and responsible to handle fast, sharp, and localized pain, and C fi bers that are not myelinated with slow nerve speed and are responsible for painful blunt and not localized pain. Th e factors that related with causing pain is the conditions that causing injury whether Biology, Chemistry, Physical, or Psychology.
Based on the research, it can get that the part of sprain ankle degree that experienced by group O1 basket player before exercise is Degree I where ligament feels pain, it occur hematoma (hematoma) mild is 21 people (70%). Th e result is in line with research of (Nurjannah, 2016), the injury can be happened because muscle coordination and not perfect joint, until causing the wrong moving and causing injury. Th is is can be happen because lack of warming up, lack of concentration or the condition of athlete in physical and mental is weak.
Based on the research, it is obtained that part of sprain ankle degree that experienced by group O2 basket player before exercise is 18 people with moderate pain intensity (60%). Based on the research that done by (Hermawan, 2015). Sprain is an injury that related injury to ligament (tissue that connects bone to other bone) or joint capsule. Th e Severe damage on this joint it will cause the joint is become not stable. Th e symptom is causing a pain feeling, swollen, bruised, infl ammation, instability and losing the ability to moving. But, the signs and symptom can be variation in intensity, it depends on the severity of the sprain.
Based on the research, it is obtained the pain that experienced by group O2 basket player after exercise as part of 23 people with mild pain intensity (76.7%). Based on the research (Hermawan, 2015), sport injury can cause by internal factor and from external, this is like referring by Arif Setyawan (Hermawan, 2015) that exercise Injury between them it can cause by collision

CONCLUSION Analysis u nivariate Group O1
1) Pain that experienced by group O1 basket players before exercise is 15 people with mild intensity pain (50%) and 15 people with moderate intensity pain (50%). 2) Th e pain that experienced by group O1 basket players after half of exercise is 27 people with mild intensity pain (90%). 3) Half of sprain ankle degree that experienced group O1 basket player before exercise is I degree where the ligament is feels sick, become infl ammation (hematoma) mild is 21 peoples (70%). 4) Half of sprain ankle that experienced by group O1 basket player after exercise is I degree where ligament is feels sick, occur infl ammation (hematoma) mild is 27 peoples (90%).

Analysis univariate Group O2
1) Most of the pain that experienced by group O2 basket player before exercise is 18 peoples with moderate pain intensity is (60%). 2) Th e pain that experienced by Group O2 basket players after exercise most of it is 23 peoples with mild pain intensity (76.7%). 3) Most of it is sprain ankle degree experienced by group O2 basket player before exercise is Degree II where Ligament it felt hot and swollen is 16 people (53.3%). 4) Most of it sprain ankle degree that experienced by group O2 basket player after exercise is Degree II where the Ligament is felt hot and swollen is 23 peoples (76.7%).

Analysis bivariate
1) Pain intensity diff erent test is 0.000 and the result of sprain ankle degree diff erent test is 0.29 so this thing showing that those both values <0.05, can conclude H0 is rejected and H1 is accepted are a diff erent between pain intensity and sprain ankle degree group O1 before and after exercise.
is 0.029 so this thing can be showed that both those value is <0.05, can be conclude that H0 is reject and H1 is accept are a diff erences between pain intensity or sprain ankle degree group O1 before and after exercise. Based on research (Atmojo, 2017), Ankle sprain occur because excessive pain (overstretching and hypermobility) or sudden inversion and plantar fl exion trauma, while exercising, physical activity, while leg is not resting perfectly to the fl oor/ground until causing ligament structures to stretch beyond normal physiological and functional lengths. Elongation causes tearing of the lateral complex ligaments, this will cause pain when contracting. Th e pain causes immobility resulting in decreased muscle strength and limited mobility. Th en based in (Hermawan, 2015) Research ankle injury is caused by the pressure to make a sudden turning motion. Ankle injury can aff ect not only the side of the ankle but usually can also damage the outer (lateral) ligaments. With the support of a lot of nutrients and oxygen, metabolism at the site of injury will increase with the rest of the metabolism in the form of heat. Th at condition causes the location of the injured ankle area to be hotter (hot) compared to other locations that did not experience injury. Stacks of metabolic waste and other chemicals will stimulate nerve endings in the injured ankle and causing pain (dolor). Th is pain feeling is triggered by depressed nerve endings. Th ose infl ammation signs symptoms will decrease the organ function or dislocation joint injury that called with the term joint decrease or functiolaesa.
Th e result is showing pain intensity diff erence test is 0.024 and sprain ankle degree diff erent test is 0.47 so this thing is showing that those both values <0.05, can concluded H0 accepted and H1 rejected are a diff erences between pain intensity and sprain ankle degree group O2 before and after exercise.
Based on (Atmojo, 2017) research, ankle injury can be happen when sprained at suddenly continue with any response from body with infl ammation signs that include from rubor (red), kalor (hot), tumor (swollen), dolor (pain), and functiolaesa (function decrease).
Th en according to (Setiawan, 2011) research, causing exercise injury is usually from traumatic/collision in direct or exercise that repeatedly in a long time. Th is causing is divided into 1) external factor, is: (a) football, basket, boxing, karate; (b) exercise tools: stick hockey, racket, ball; (c) Field conditions: slippery, uneven, muddy; 2) internal factor, are: (a) anatomy factor. Unequal leg length, fl at foot arch, tiptoe, so that when running it will interfere with movement; (b) Wrong any eff ect giving cold therapy through sprain ankle pain decreased.
Compliance with ethics requirements: Th e authors declare no confl ict of interest regarding this article. Th e authors declare that all the procedures and experiments of this study respect the ethical standards in the Helsinki Declaration of 1975, as revised in 2008(5), as well as the national law. Informed consent was obtained from all the patients included in the study.
2) Pain intensity diff erent test is 0.024 and sprain ankle degree diff erent test is 0,047 so this thing is showing that those both value <0.05, can be conclude H0 is accepted and H1 is rejected are a diff erent between pain intensity and sprain ankle group O2 before and after exercise. 3) Based on the result of wilcoxon test to know is there any eff ect of giving cold therapy through sprain ankle pain decreased, it show that all the values is showing each variable comparison <0.05 is 0.008, 0.000, 0.000, 0.000 that means