The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain

Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of preventive interventions for lateral ankle sprain in the general population.

DATA SOURCES

A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022.

REVIEW METHODS

Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies.

RESULTS

Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss.

CONCLUSION

Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.

Effects of eight week core stability training on stable- and unstable-surface on ankle muscular strength, proprioception, and dorsiflexion in athletes with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) is a common injury among athletes. Research has reported reduced dorsiflexion range of motion, impairment of proprioception, and decreased muscle strength of the ankle in people with CAI. The aim of this research was to examine the effects of 8-week core stability training on stable and unstable surfaces on ankle muscular strength, proprioception, and dorsiflexion range of motion (ROM) in athletes with CAI.

METHODS

Thirty-six athletes with CAI (age 22.42 ± 2.76 years; height 169.11 ± 3.52 cm; weight 68.46 ± 2.75 kg) participated in this study. They were divided into three groups: unstable-surface group (UG) (n = 12), stable-surface group (SG) (n = 12), and control group (CG) (n = 12). The UG and SG performed the core stability exercise protocol for 8 weeks, 3 sessions per week. The CG received their usual care and daily activities. Outcomes were measured pre-sessions and post-sessions.

RESULTS

The peak torque showed significant increases in the UG and SG compared with the CG during plantar flexion, dorsiflexion, inversion, and eversion (P < 0.05). There were also significant increases in UG compared with SG (P < 0.05). The proprioception showed significant decreases in UG compared with SG and CG (P < 0.05). The dorsiflexion ROM showed significant increases in UG and SG compared with CG. There were also significant increases in UG compared with SG (P < 0.05).

CONCLUSIONS

It seems that core stability exercises on trampoline surface helps improve the measured parameters in athletes with ankle instability. Therefore, this type of training is recommended as a therapeutic option for Individuals with CAI.

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

OBJECTIVES

1) determine the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients with an acute ankle sprain; 2) Determine whether prescribed exercises incorporate complex tasks associated with ankle sprain injury mechanisms?

METHODS

We searched databases CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar for RCT's including patients with acute ankle sprains, managed through exercise-based rehabilitation. Risk of bias was assessed by the Risk of Bias 2 tool. Exercises were analysed based on: the primary impairment(s) addressed; direction of movement; base of support; weightbearing status; flight phase. (PROSPERO: CRD42020210858) RESULTS: We included fourteen RCT's comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises incorporated a flight phase.

CONCLUSIONS

Rehabilitation after LAS comprises simple exercises in the sagittal plane that do not reflect mechanisms of re-injury. Future interventions should incorporate more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.

Evidence for Rehabilitation Interventions After Acute Lateral Ankle Sprains in Athletes: A Scoping Review

CONTEXT

Acute lateral ankle sprain (LAS) is a common injury in athletes and is often associated with decreased athletic performance and, if treated poorly, can result in chronic ankle issues, such as instability. Physical performance demands, such as cutting, hopping, and landing, involved with certain sport participation suggests that the rehabilitation needs of an athlete after LAS may differ from those of the general population.

OBJECTIVE

To review the literature to determine the most effective rehabilitation interventions reported for athletes returning to sport after acute LAS.

EVIDENCE ACQUISITION

Data Sources: Databases PubMed, Embase, CINAHL, SPORTDiscus, and PEDro were searched to July 2020.

STUDY SELECTION

A scoping review protocol was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines and registered (https://osf.io/bgek3/). Study selection included published articles on rehabilitation for ankle sprain in an athletic population.

DATA EXTRACTION

Parameters included athlete and sport type, age, sex, intervention investigated, outcome measures, measurement tool, and follow-up period.

DATA SYNTHESIS

A qualitative synthesis for all articles was undertaken, and a quantitative subanalysis of randomized controlled trials and critical methodological appraisal was also conducted.

EVIDENCE SYNTHESIS

A total of 37 articles were included in this review consisting of 5 systematic and 20 narrative reviews, 7 randomized controlled trials, a single-case series, case report, position statement, critically appraised topic, and descriptive study. Randomized controlled trial interventions included early dynamic training, electrotherapy, and hydrotherapy.

CONCLUSIONS

Early dynamic training after acute LAS in athletes results in a shorter time to return to sport, increased functional performance, and decreased self-reported reinjury. The results of this scoping review support an early functional and dynamic rehabilitation approach when compared to passive interventions for athletes returning to sport after LAS. Despite existing research on rehabilitation of LAS in the general population, a lack of evidence exists related to athletes seeking to return to sport.

Rehabilitation Strategies for the Neurologic Horse

Rehabilitation of the neurologic horse represents a unique challenge for the equine practitioner. Improving postural stability and balance control through improving the strength of the spinal stabilizer muscle multifidus remains one of the most promising rehabilitative targets. This muscle can be targeted through the use of physiotherapeutic exercises, various forms of perturbation, and even whole-body vibration. Neuroanatomic localization and diagnosis specificity enable the practitioner to determine suitability for such rehabilitative tasks, and with the advent of evolving strategies and commercially available equipment, the bandwidth for professionally guided programs is continuously being developed and is expected to improve traditional outcomes.

Influence of Chronic Lameness on Thoracolumbar Musculus Multifidus Structure in the Horse

The clinical relationship between equine limb lameness and secondary back dysfunction is largely unknown. Proper function of the spine is critical to maintain the integrity of the kinetic chain and attenuate forces from the appendicular skeleton. The musculus multifidus (m. multifidus) is the primary muscle providing spinal intersegmental stabilization and a functional relationship between m. multifidus hypertrophy and equine postural stability has been established. The relationship between equine thoracolumbar m. multifidus cross-sectional area (CSA) and limb lameness is unknown. The objective was to evaluate ultrasonographic changes in thoracolumbar m. multifidus CSA in horses with chronic single limb lameness, compared with sound horses. We hypothesized that the CSA of m. multifidus, ipsilateral to the lame limb would be smaller than the contralateral side, and within the sound group there would be no difference between sides. Thirty-six horses were enrolled, with twelve horses per group: sound, forelimb lame, and hindlimb lame. M. multifidus CSA was measured ultrasonographically at multiple spinal levels and compared between groups, spinal levels, and sides. M. multifidus CSA at the spinal level T18 was significantly larger than at all other measured levels, regardless of group (P≤.05). CSA at all levels was significantly larger in sound horses than the forelimb lame group, regardless of side (P= 0.002). This is the first study to evaluate the impact of chronic lameness on the axial skeleton and showed a decrease in m. multifidus CSA with forelimb lameness. These results support that axial skeletal adaptation occurs in response to naturally occurring chronic lameness.

In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report

We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.

Progress of Proprioceptive Training in the Treatment of Traumatic Shoulder Instability

In individuals with traumatic shoulder instability, there is a loss of proprioception. This paper reviews the academic literature on shoulder instability and functional impairment in recent years and combines it with clinical practice experience to summarize several techniques of proprioceptive regeneration following traumatic shoulder instability. Many issues were discovered, including a lack of literature on the role of sensory input, a lack of basic proprioceptive research, insufficient sample size in proprioceptive research, and a lack of systematic and standardized standards for the evaluation and training of proprioception in clinical practice, among others. In the future, we will need to better understand the mechanism of proprioception and conduct research on various groups of people, with a focus on discussing the optimal intensity, frequency, and duration of various training methods, as well as implementing proprioceptive training in stages throughout the rehabilitation process. The reestablishment of shoulder joint function, the restoration of proprioception, and the enhancement of daily activities are all critical.

Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis

Research questions

1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume?

Methods

This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed.

Results

Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up.

Conclusion

Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.

A novel movement system screen for primary care providers: a multisite, observational study

CONTEXT

Movement of the human body is essential for the interaction of an individual within their environment and contributes to both physical and emotional quality of life. Movement system disorders (MSDs) are kinesiopathologic conditions that result from either altered movement patterns, trauma, or pathology. A screening tool may facilitate earlier diagnosis and treatment of acute MSDs. This tool could prevent progression to chronic conditions, leading to better patient outcomes and quality of life.

OBJECTIVES

Our study evaluated whether a screening tool would be able to accurately screen individuals for MSDs, explore comorbidities that may predict the prevalence of MSDs, and identify why people do not discuss these problems with their primary care provider (PCP).

METHODS

A multisite, observational study in a primary care setting. Data were analyzed to determine the psychometric properties of the screening question. Logistic regression was performed to explore the relationship of comorbidities with MSDs. Thematic analysis was performed to explore why patients do not discuss these issues with their PCP.

RESULTS

The point prevalence of MSDs was determined to be 78%. The sensitivity of the screening question was determined to be good (70%). Arthritis, obesity, sleep disorders, and gastroesophageal reflux disease (GERD) were significant predictors for an MSD. Thematic analysis regarding why patients do not discuss the MSD with their physician revealed: (1) the perceived lack of importance of the problem; (2) the lack of access to healthcare, and (3) the acuity of the problem.

CONCLUSIONS

Screening for an MSD and associated comorbidities could prevent the transition of acute conditions to chronic conditions. If PCPs can identify predictors and factors associated with an MSD, they may be able to screen for MSDs more effectively. Earlier identification of MSDs may facilitate earlier treatment and prevent costs associated with resulting chronic disorders and persistent pain and disability.

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Background

Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability.

Objective

Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas.

Methods

Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement.

Results

Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26).

Strengths and limitations

This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group.

Conclusions

We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care.

Trial registration

NCT, NCT04092946. Registered 17/09/2019;

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04891-5.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective

The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work.

Methods

Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method.

Results

Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch.

Conclusions

Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01712-z.

Effects of proprioceptive training on ankle muscle strength in fencers: A clinical trial

BACKGROUND

Fencing is a combat sport, which depends of lower limbs muscular strength and neuromuscular function. Because of that, approximately half of all injuries occur in lower limbs, especially in ankle. Thus, the objective of this study was to verify the influence of a twelve-week proprioceptive training program on ankle muscular strength and muscular balance in fencers.

METHODS

The study was a clinical trial, with 19 fencing athletes from 14 to 35-year-old. The main outcome was ankle invertors, evertors, plantiflexors and dorsiflexors muscular strength and ankle muscle balance. The study was performed in six stages: familiarization of muscular strength test in isokinetic dynamometer; pre-intervention; intervention; post-intervention; three- and six-months follow-up. At pre-intervention stage, the muscular strength was evaluated. At intervention stage, the athletes performed 12-week proprioceptive training program, three times a week. At post-intervention, three- and the six-months follow-ups, same pre-intervention test was performed.

RESULTS

The proprioceptive training improved front leg ankle dorsiflexor strength at three- and six-months follow-ups compared to pre-intervention. Furthermore, training increased the front leg dorsiflexors/plantiflexors conventional ratio at three- and six-months follow-ups compared to pre-intervention; and evertors/invertors conventional ratio at three-months follow-up compared to pre-intervention; and evertors/invertors functional ratio at post-intervention and three- and six-months follow-ups compared to pre-intervention.

CONCLUSIONS

The improvement and/or maintenance of ankle muscle strength occurred in intervention group seems to be due to stimulus provided by proprioceptive training, with ankle dorsiflexors being the most stimulated group.

Acute ankle sprain in athletes: Clinical aspects and algorithmic approach

Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

The Effect of Plantar Massage on Static Postural Control in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: Patients with chronic ankle instability (CAI) demonstrate deficits in both sensory and motor function, which can be objectively evaluated through static postural control testing. One intervention that has been suggested to improve somatosensation and, in turn, static postural control is plantar massage. Clinical Question: Does plantar massage improve static postural control during single-limb stance in patients with CAI relative to baseline? Summary of Key Findings: A search was performed for articles exploring the effect of plantar massage on static postural control in individuals with CAI. Three articles were included in this critically appraised topic including 1 randomized controlled trial and 2 crossover studies. All studies supported the use of plantar massage to improve static postural control in patients with CAI. Clinical Bottom Line: There is currently good-quality and consistent evidence that supports the use of plantar massage as an intervention that targets the somatosensory system to improve static postural control in patients with CAI. Future research should focus on incorporating plantar massage as a treatment intervention during long-term rehabilitation protocols for individuals with CAI. Strength of Recommendation: In agreement with the Center of Evidence-Based Medicine, the consistent results from 2 crossover studies and 1 randomized controlled trial designate that there is level B evidence due to consistent, moderate- to high-quality evidence.

Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes

Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.

Proprioceptive abilities improve in expert skiers and snowboarders from early-season to mid-season

OBJECTIVES

To determine whether the proprioceptive ability of advanced and expert snowsport participants increased with time on-snow, and whether gender, age, snowsport discipline and/or previous ankle injury were factors in proprioceptive ability at the start of the winter snow season (T1, n=80) compared to mid- season (T2, n=39).

DESIGN

Observational study METHOD: Participants completed a questionnaire at T1, and proprioception was measured at T1 and T2 by the Active Movement Extent Discrimination Apparatus (AMEDA), which tests lower limb proprioception.

RESULTS

At T1 there was no significant difference between the proprioception scores of the two cohorts of advanced and expert snowsport participants, between females and males, younger and older age groups, nor between alpine skiers and snowboarders. At T2, after a minimum of 5 weeks on-snow, the whole group had improved their proprioception by 0.04 (p<.0001) as measured by the AMEDA. Groups undertaking different snowsport disciplines achieved different gains across the season, with minimal change of 0.02 in skiers (p=.056), while snowboarders and mixed ski/snowboard participants gained 0.05 (p=.034) and 0.06 (p=.005) (η² 0.63 and 0.47 respectively). Males, females, instructors and elite youth participants all improved their proprioception by mid-season (η² 0.29-0.46).

CONCLUSIONS

Amongst an established group of snowsports participants, lower limb proprioception is a consistent skill that is equally well developed in all cohorts. Several weeks of regular snowsport exposure improves this proprioceptive acuity amongst snowboarders, and those who mix snowboarding with skiing. Exposure to a prolonged period of snowsport improves proprioception, with benefits to neuromuscular control mechanisms.

Relationship Between Postural Stability and Paraspinal Muscle Adaptation in Lame Horses Undergoing Rehabilitation

Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses after a rehabilitation strengthening exercise program; however, correlation with functional postural stability has not been shown. The objective of the present study is to evaluate the relationship of the thoracolumbar m. multifidus CSA and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the equine rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data were also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.

Sensory neuroprosthesis improves postural stability during Sensory Organization Test in lower-limb amputees

To maintain postural stability, unilateral lower-limb amputees (LLAs) heavily rely on visual and vestibular inputs, and somatosensory cues from their intact leg to compensate for missing somatosensory information from the amputated limb. When any of these resources are compromised, LLAs exhibit poor balance control compared to able-bodied individuals. We hypothesized that restoring somatosensation related to the missing limb via direct activation of the sensory nerves in the residuum would improve the standing stability of LLAs. We developed a closed-loop sensory neuroprosthesis utilizing non-penetrating multi-contact cuff electrodes implanted around the residual nerves to elicit perceptions of the location and intensity of plantar pressures under the prosthetic feet of two transtibial amputees. Effects of the sensory neuroprosthesis on balance were quantified with the Sensory Organization Test and other posturographic measures of sway. In both participants, the sensory neuroprosthesis improved equilibrium and sway when somatosensation from the intact leg and visual inputs were perturbed simultaneously. One participant also showed improvement with the sensory neuroprosthesis whenever somatosensation in the intact leg was compromised via perturbations of the platform. These observations suggest the sensory feedback elicited by neural stimulation can significantly improve the standing stability of LLAs, particularly when other sensory inputs are depleted or otherwise compromised.

Functional Outcomes and Psychological Benefits of Active Video Games in the Rehabilitation of Lateral Ankle Sprains: A Case Report

CONTEXT

The use of active video games (AVG) as a treatment modality in the rehabilitation context is increasing. However, little is known about the functional outcomes and psychological benefits of such rehabilitation in college athletes with lateral ankle sprains (LASs).

OBJECTIVE

To examine functional outcomes and psychological benefits of AVG-aided rehabilitation program for LAS.

DESIGN

A mixed-methods, single-subject case series design.

SETTING

College athletic training clinic.

PATIENTS

Two female college soccer players who sustained LAS (grades I and II) during sport participation.

INTERVENTION

A 4-week balance training program. One patient completed balance exercises using AVG, whereas the other patient completed traditional balance exercises.

MAIN OUTCOME MEASURES

Several validated instruments were used to evaluate different functional outcomes and psychological factors: balance (Balance Error Scoring System, Star Excursion Balance Test), rehabilitation adherence (Rehabilitation Adherence Measure for Athletic Training), foot and ankle function (Foot and Ankle Ability Measure), perceptions of pain (Visual Analog Scale for pain), perceived readiness to return to sport (Injury-Psychological Readiness to Return to Sport Scale), and mood (Brunel Mood Scale).

RESULTS

It appears that the balance training protocols (AVG and traditional balance exercises) were equally effective in restoring patient's balance to functional levels. Despite very individualistic processes of rehabilitation, the participants' perceived pain, perceived readiness to return to sport, and mood states were closely linked with objective and subjective functional measures of progress.

CONCLUSIONS

Based on the results, AVG has the potential to provide more versatility into the static and dynamic postural control exercises typically used following acute LAS. Moreover, the current results support the existing psychological and biopsychosocial theoretical conceptualizations of athletes' responses to injuries and rehabilitation process.

Use of Functional Movement Screen Scores to Predict Dynamic Balance in Physically Active Men and Women

Scudamore, EM, Stevens, SL, Fuller, DK, Coons, JM, and Morgan, DW. Use of functional movement screen scores to predict dynamic balance in physically active men and women. J Strength Cond Res 33(7): 1848-1854, 2019-The primary focus of this study was to determine whether scores obtained from the Functional Movement Screen (FMS) can predict dynamic balance in young, healthy adults. Thirty-four physically active participants completed the FMS, and balance was assessed using measures of composite reach (CR) distance and overall stability indices (OSI) derived from Y Balance and Biodex Balance System testing, respectively. Results indicated that higher overall FMS scores were associated with better CR and OSI, and participants with FMS composite scores greater than 14 exhibited better CR compared to those with composite scores less than or equal to 14. In addition, lasso penalized regression demonstrated that (a) scores of 2 on the deep squat and 3 on the trunk stability push-up movements predicted a greater CR and (b) higher shoulder mobility scores and a rotary stability score of 3 predicted better OSI. We conclude that dynamic balance in young, active men and women can be predicted by specific FMS item scores.

Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review

Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.

What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review

BACKGROUND

Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults.

METHODS

Several medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers.

RESULTS

This study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence.

CONCLUSIONS

The overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation.

SYSTEMATIC REVIEW

Systematic review registered with PROSPERO ( CRD42015025478 ).

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Basketball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Women's Basketball (2004-2005 Through 2013-2014)

CONTEXT

The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of girls' and women's basketball injury data.

OBJECTIVE

To describe the epidemiology of injuries sustained in high school girls' basketball in the 2005-2006 through 2013-2014 academic years and collegiate women's basketball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from basketball teams in high school girls (annual average = 100) and collegiate women (annual average = 57).

PATIENTS OR OTHER PARTICIPANTS

Girls' and women's basketball players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college.

MAIN OUTCOME MEASURE(S)

Certified athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs) were calculated. Injury rate ratios (IRRs) with 95% confidence intervals (CIs) were used to compare injury rates by school size or division, time in season, event type, and competition level.

RESULTS

The High School Reporting Information Online system documented 2930 time-loss injuries during 1 609 733 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 3887 time-loss injuries during 783 600 AEs. The injury rate was higher in college than in high school (4.96 versus 1.82/1000 AEs; IRR = 2.73; 95% CI = 2.60, 2.86). The injury rate was higher in competitions than in practices for both high school (IRR = 3.03; 95% CI = 2.82, 3.26) and collegiate (IRR = 1.99; 95% CI = 1.86, 2.12) players. The most common injuries at both levels were ligament sprains, concussions, and muscle/tendon strains; the majority of injuries affected the ankle, knee, and head/face. These injuries were often caused by contact with another player or a noncontact mechanism.

CONCLUSIONS

Injury rates were higher in collegiate than in high school athletes and in competitions than in practices. Similarities in distributions of injuries by body parts, specific diagnoses, and mechanisms of injury suggest that both levels may benefit from similar injury-prevention strategies.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys' Basketball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Men's Basketball (2004-2005 Through 2013-2014)

CONTEXT

The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of boys' and men's basketball injury data.

OBJECTIVE

To describe the epidemiology of injuries sustained in high school boys' basketball in the 2005-2006 through 2013-2014 academic years and collegiate men's basketball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from basketball teams of high school boys (annual average = 100) and collegiate men (annual average = 55).

PATIENTS OR OTHER PARTICIPANTS

Boys' and men's basketball players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college.

MAIN OUTCOME MEASURES

Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs) were calculated. Injury rate ratios (IRRs) with 95% confidence intervals (CIs) compared injury rates by school size or division, time in season, event type, and competition level.

RESULTS

The High School Reporting Information Online system documented 3056 time-loss injuries during 1 977 480 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 4607 time-loss injuries during 868 631 AEs. The injury rate was higher for college than for high school (5.30 versus 1.55/1000 AE; IRR = 3.43; 95% CI = 3.28, 3.59). The injury rate was higher for competitions than for practices in both high school (IRR = 2.38; 95% CI = 2.22, 2.56) and college (IRR = 2.02; 95% CI = 1.90, 2.14). The most common injuries at both levels were ligament sprains, muscle/tendon strains, and concussions; most injuries affected the ankle, knee, and head/face. Injuries were most often caused by contact with another player or noncontact mechanisms.

CONCLUSIONS

Injury rates were greater among collegiate players compared with high school players and were greater during competitions than practices at both levels. Distributions of injuries by body part, diagnoses, and mechanisms of injury were similar, suggesting that athletes at both levels may benefit from similar injury-prevention strategies.

Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis

OBJECTIVES

To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume.

DATA SOURCES

The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro).

STUDY SELECTION

Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation).

DATA EXTRACTION

Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software.

DATA SYNTHESIS

Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training.

CONCLUSIONS

Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.

Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain

BACKGROUND

Following ankle sprain, residual symptoms are often apparent, and proprioceptive training is a treatment approach. Evidence, however, is limited and the optimal program has to be identified.

OBJECTIVE

To investigate the effects of two post-acute supervised proprioceptive training programs in individuals with ankle sprain.

METHODS

Participants were recruited from a physiotherapy center for ankle sprain rehabilitation. In a pre-post treatment, blinded-assessor design, 22 individuals were randomly allocated to a balance or a proprioceptive neuromuscular facilitation (PNF) group. Both groups received 10 rehabilitation sessions, within a six-week period. Dorsiflexion range of motion (ROM), pain, functional and balance performance were assessed at baseline, at the end of training and eight weeks after training.

RESULTS

Follow-up data were provided for 20 individuals. Eight weeks after training, statistically significant (p< 0.017) improvements were found in dorsiflexion ROM and most functional performance measures for both balance and PNF groups. Eight weeks after training, significant (p< 0.017) improvements in the frontal plane balance test and pain were observed for the balance group.

CONCLUSIONS

Balance and PNF programs are recommended in clinical practice for improving ankle ROM and functional performance in individuals with sprain. Balance programs are also recommended for pain relief.

Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review

Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution.

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.

Active Ankle Circumduction to Identify Mobility Deficits in Subacute Ankle Sprain Patients

Assessment of ankle mobility is complex and of clinical relevance after an ankle sprain. This study develops and tests a biomechanical model to assess active ankle circumduction and its reliability. The model was then applied to compare individuals' ankle mobility between injured and noninjured ankles after a sprain episode. Twenty patients with subacute unilateral ankle sprain were assessed at 4 weeks and 10 weeks after the injury. They underwent a clinical exam and an ankle circumduction test during which the kinematics were recorded with an optoelectronic device. A biomechanical model was applied to explore ankle kinematics. Reliability of the ankle circumduction tests were good to excellent (ICC of 0.55-0.89). Comparison between noninjured and injured ankles showed a mobility deficit of the injured ankle (dorsiflexion = -27.4%, plantar flexion = -25.9%, eversion = -27.2%, and inversion = -11.6%). The model allows a graphical representation of these deficits in 4 quadrants. Active ankle circumduction movement can be reliably assessed with this model. In addition, the graphical representation allows an easy understanding of the mobility deficits which were present in all 4 quadrants in our cohort of patients with subacute ankle sprain.

Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction

Lateral ankle sprains (LAS) have been reported as one of the most common musculoskeletal injuries observed in sports and in individuals who are recreationally active. Approximately 40% of individuals who sustain a LAS develop a condition known as chronic ankle instability (CAI). Years of research has identified numerous impairments associated with CAI such as decreases in range of motion (ROM), strength, postural control, and altered movement patterns during functional activities when compared to individuals with no LAS history. As a result, an impairment-based rehabilitation model was developed to treat the common impairments associated with CAI. The impairment-based rehabilitation model has been shown to be an effective rehabilitation strategy at improving both clinical and patient-oriented outcomes in patients with CAI. To date, the efficacy of an impairment-based rehabilitation model has not been evaluated in patients with an acute LAS. Prior to implementing an impairment-based model for the treatment of an acute LAS, similarities between impairments associated with acute LAS and CAI across the spectrum of the healing process is warranted. Therefore, the purpose of this review paper is to compare and contrast impairments and treatment techniques in individuals with an acute LAS, sub-acute LAS, and CAI. A secondary purpose of this review is to provide clinical commentary on the management of acute LAS and speculate how the implementation of an impairment-based rehabilitation strategy for the treatment of acute LAS could minimize the development of CAI. The main findings of this review were that similar impairments (decreased ROM, strength, postural control, and functional activities) are observed in patients with acute LAS, sub-acute LAS, and CAI, suggesting that the impairments associated with CAI are a continuation from the original impairments developed during the initial LAS. Therefore, the use of an impairment-based model may be advantageous when treating patients with an acute LAS.

Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability

[Purpose] This study examined the effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability. [Subjects and Methods] Twenty eight adults with functional ankle instability, divided randomly into an experimental group, which performed visual feedback balance training for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Bio rescue was used for balance ability. It measured limit of stability at one minute. For ankle instability was measured using Cumberland ankle instability tool (CAIT). This measure was performed before and after the experiments in each group. [Results] The experimental group had significant increase in the Limit of Stability and CAIT score. The control group had significant increase in CAIT score. While the Limit of Stability increased without significance. [Conclusion] In conclusion, visual feedback balance training can be recommended as a treatment method for patients with functional ankle instability.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review

INTRODUCTION

Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for.

OBJECTIVE

The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention.

METHODS

An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included.

RESULTS

Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented.

CONCLUSIONS

Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

Extrinsic visual feedback and additional cognitive/physical demands affect single-limb balance control in individuals with ankle instability

AIM

To investigate the impact of extrinsic visual feedback and additional cognitive/physical demands on single-limb balance in individuals with ankle instability.

METHODS

Sixteen subjects with ankle instability participated in the study. Ankle instability was identified using the Cumberland Ankle Instability Tool (CAIT). The subject’s unstable ankle was examined using the Athletic Single Leg Stability Test of the Biodex Balance System with 4 different protocols: (1) default setting with extrinsic visual feedback from the monitor; (2) no extrinsic visual feedback; (3) no extrinsic visual feedback with cognitive demands; and (4) no extrinsic visual feedback with physical demands. For the protocol with added cognitive demands, subjects were asked to continue subtracting 7 from a given number while performing the same test without extrinsic visual feedback. For the protocol with added physical demands, subjects were asked to pass and catch a basketball to and from the examiner while performing the same modified test.

RESULTS

The subject’s single-limb postural control varied significantly among different testing protocols (F = 103; P = 0.000). Subjects’ postural control was the worst with added physical demands and the best with the default condition with extrinsic visual feedback. Pairwise comparison shows subjects performed significantly worse in all modified protocols (P < 0.01 in all comparisons) compared to the default protocol. Results from all 4 protocols are significantly different from each other (P < 0.01) except for the comparison between the “no extrinsic visual feedback” and “no extrinsic visual feedback with cognitive demands” protocols. Comparing conditions without extrinsic visual feedback, adding a cognitive demand did not significantly compromise single-limb balance control but adding a physical demand did. Scores from the default protocol are significantly correlated with the results from all 3 modified protocols: No extrinsic visual feedback (r = 0.782; P = 0.000); no extrinsic visual feedback with cognitive demands (r = 0.569; P = 0.022); no extrinsic visual feedback with physical demands (r = 0.683; P = 0.004). However, the CAIT score is not significantly correlated with the single-limb balance control from any of the 4 protocols: Default with extrinsic visual feedback (r = -0.210; P = 0.434); no extrinsic visual feedback (r = -0.450; P = 0.081); no extrinsic visual feedback with cognitive demands (r = -0.406; P = 0.118); no extrinsic visual feedback with physical demands (r = -0.351; P = 0.182).

CONCLUSION

Single-limb balance control is worse without extrinsic visual feedback and/or with cognitive/physical demands. The balance test may not be a valid tool to examine ankle instability.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BACKGROUND

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports.

OBJECTIVE

To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI.

DESIGN

Overview of intervention systematic reviews.

PARTICIPANTS

Individuals with acute ankle sprain/CAI.

MAIN OUTCOME MEASUREMENTS

The primary outcomes were injury/reinjury incidence and function.

RESULTS

46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains.

CONCLUSIONS

For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.

Greater Reduction of Balance as a Result of Increased Plantar Fascia Elasticity at Ovulation during the Menstrual Cycle

One of the sexual hormones, estrogen, increases elasticity of human connective tissue such as the anterior cruciate ligament during the menstrual cycle in women. In the present investigation, the plantar fascia was investigated to see if there is a difference in elasticity with the menstrual cycle. Fifteen young healthy females in the age range of 18-35 years old with a regular menstrual cycle were tested twice throughout one full menstrual cycle; once during the early follicular phases and once at ovulation. Foot length, while standing on both feet and one foot were used to assess plantar fascia elasticity, ultrasound measured plantar fascia thickness while lying and standing, and posture sway and tremor using a balance platform during 8 different balance tests were assessed to see the impact of elasticity changes. Foot length increased significantly at ovulation compared to menstruation when standing on two feet (p = 0.03) and standing on one foot (p < 0.001). There was also a significant increase in plantar fascia in thinning per kilogram weight applied to the foot at ovulation compared to menstruation (p = 0.014). Associated with this increase in elasticity at ovulation, there was a reduction in balance in the most difficult balance tasks and an increase in tremor during ovulation (p < 0.05). Plantar fascia elasticity change during the menstrual cycle might have effects on posture sway and tremor, which could have a potential risk of falling. Therefore, healthy professionals working with young female adults should recognize these physiological effects.