Rückkehr zum Sport nach Kollateralbandläsion am Sprunggelenk

[Function-based tests to determine the return-to-activity state in patients with non-specific low back pain]

BACKGROUND

 Most people with back pain suffer from non-specific low back pain, for which no specific reasons can be found. Two out of three have recurrent pain episodes. To reduce the likelihood of recurrence and long-lasting pain, functional tests are increasingly used to determine the current functional status. This literature study evaluates evidence of functional tests in patients with non-specific low back pain and their validity related to the return-to-activity (RTA) status. The objective of this analysis is to give recommendations for specific activities and to assess the risk of chronification and recurrent pain.

METHODS

 PubMed-based literature search. Narrative review focusing on data from the past ten years.

RESULTS

 A total of twelve studies were included in the analysis. Overall, 33 different tests were identified for which positive statements regarding reliability, validity and relevance for the assessment of the RTA status in non-specific back pain could be made. The tests identified may be able to provide useful information when assessing the RTA status and to recognise yellow and blue flags in patients with non-specific low back pain. The ability to walk, the behaviour when lifting and carrying objects, motor control, muscle strength and mobility play a particular role.

CONCLUSION

 The determination of the RTA status in patients with non-specific low back pain should be patient-specific and based on biopsychosocial aspects rather than relying exclusively on movement-related tests. Exact statements regarding the point in time when patients can resume everyday activities and work without an increased risk of recurrence or chronicity do not seem possible with functional tests alone. The major influence of psychological and social factors on disease development, course and prognosis are limiting factors. Movement and strain-related tests can still be used to evaluate activities related to everyday life, to design therapy programs and to give patients confidence.

[Ligamentous ankle injury: an underestimated trauma?]

Ligamentous injuries of the ankle joint are among the most common injuries in sports, with landing on the opponent's foot or direct contact counting among the most common injury mechanisms. Initial measures most notably include a clinical examination, supplemented by X-rays, sonography or MRI as required. In most cases, conservative treatment is the treatment of choice. At the beginning, pain and swelling have to be reduced. Then function must be regained before patients may return to sports after a return-to-play test. Some injury patterns are more complex with concomitant injuries, and despite all the success of conservative treatment, certain cases remain the preserve of surgery. Not only the downtime of athletes, the severity of long-term damage and chronic functional limitations, but also the associated costs for treatment suggest the recommendation that ankle joint injuries should not be underestimated and adequate treatment should be selected.

Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

OBJECTIVE

The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury.

RESULTS

No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search.

CONCLUSION

There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.