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Lichte P, Weber C, Otto M, Bläsius F, Gutteck N, Hildebrand F, Arbab D. [Current diagnostics and treatment of ankle sprains in German]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:449-456. [PMID: 38634870 PMCID: PMC11133181 DOI: 10.1007/s00113-024-01428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany. MATERIAL AND METHODS All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy. RESULTS A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X‑ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively. DISCUSSION Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature.
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Affiliation(s)
- Philipp Lichte
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Christian Weber
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Michael Otto
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Felix Bläsius
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Natalia Gutteck
- Klinik für Orthopädie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Dariusch Arbab
- Klinik für Orthopädie/Unfallchirurgie, St. Elisabeth-Hospital Herten, Mitglied der Medizinischen Fakultät der Universität Witten/Herdecke, Herten, Deutschland
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Liu S, Tang J, Hu G, Xiong Y, Ji W, Xu D. Blood flow restriction training improves the efficacy of routine intervention in patients with chronic ankle instability. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:159-166. [PMID: 38708328 PMCID: PMC11067764 DOI: 10.1016/j.smhs.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 05/07/2024] Open
Abstract
As a new means of rehabilitation, blood flow restriction training (BFRT) is widely used in the field of musculoskeletal rehabilitation. To observe whether BFRT can improve the efficacy of routine rehabilitation intervention in patients with chronic ankle instability (CAI). Twenty-three patients with CAI were randomly divided into a routine rehabilitation group (RR Group) and a routine rehabilitation + blood flow restriction training group (RR + BFRT Group) according to the Cumberland Ankle Instability Tool (CAIT) score. The RR Group was treated with routine rehabilitation means for intervention, and the RR + BFRT Group was treated with a tourniquet to restrict lower limb blood flow for rehabilitation training based on routine training. Before and after the intervention, the CAIT score on the affected side, standing time on one leg with eyes closed, comprehensive scores of the Y-balance test, and surface electromyography data of tibialis anterior (TA) and peroneus longus (PL) were collected to evaluate the recovery of the subjects. Patients were followed up 1 year after the intervention. After 4 weeks of intervention, the RR + BFRT Group CAIT score was significantly higher than the RR Group (19.33 VS 16.73, p < 0.05), the time of standing on one leg with eyes closed and the comprehensive score of Y-balance were improved, but there was no statistical difference between groups (p > 0.05). RR + BFRT Group increased the muscle activation of the TA with maximum exertion of the ankle dorsal extensor (p < 0.05) and had no significant change in the muscle activation of the PL with maximum exertion of the ankle valgus (p > 0.05). There was no significant difference in the incidence of resprains within 1 year between the groups (36.36% VS 16.67%, p > 0.05). The incidence of ankle pain in the RR + BFRT Group was lower than that in the RR Group (63.64% VS 9.09%, p < 0.01). Therefore, four-weeks BFRT improves the effect of the routine intervention, and BFRT-related interventions are recommended for CAI patients with severe ankle muscle mass impairment or severe pain.
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Affiliation(s)
- Shen Liu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiafu Tang
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Guangjun Hu
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Yinghong Xiong
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Weixiu Ji
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Daqi Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Liu N, Yang C, Song Q, Yang F, Chen Y. Patients with chronic ankle instability exhibit increased sensorimotor cortex activation and correlation with poorer lateral balance control ability during single-leg stance: a FNIRS study. Front Hum Neurosci 2024; 18:1366443. [PMID: 38736530 PMCID: PMC11082417 DOI: 10.3389/fnhum.2024.1366443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Chronic Ankle Instability (CAI) is a musculoskeletal condition that evolves from acute ankle sprains, and its underlying mechanisms have yet to reach a consensus. Mounting evidence suggests that neuroplastic changes in the brain following ankle injuries play a pivotal role in the development of CAI. Balance deficits are a significant risk factor associated with CAI, yet there is a scarcity of evidence regarding the sensorimotor cortical plasticity related to balance control in affected individuals. This study aims to evaluate the differences in cortical activity and balance abilities between patients with CAI and uninjured individuals during a single-leg stance, as well as the correlation between these factors, in order to elucidate the neurophysiological alterations in balance control among patients with CAI. Methods The study enrolled 24 patients with CAI and 24 uninjured participants. During single-leg stance, cortical activity was measured using a functional near-infrared spectroscopy (fNIRS) system, which included assessments of the pre-motor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), and primary somatosensory cortex (S1). Concurrently, balance parameters were tested utilizing a three-dimensional force platform. Results Independent sample t-tests revealed that, compared with the uninjured individuals, the patients with CAI exhibited a significant increase in the changes of oxyhemoglobin concentration (ΔHbO) during single-leg stance within the left S1 at Channel 5 (t = 2.101, p = 0.041, Cohen's d = 0.607), left M1 at Channel 6 (t = 2.363, p = 0.022, Cohen's d = 0.682), right M1 at Channel 15 (t = 2.273, p = 0.029, Cohen's d = 0.656), and right PMC/SMA at Channel 11 (t = 2.467, p = 0.018, Cohen's d = 0.712). Additionally, the center of pressure root mean square (COP-RMS) in the mediolateral (ML) direction was significantly greater (t = 2.630, p = 0.012, Cohen's d = 0.759) in the patients with CAI. Furthermore, a moderate positive correlation was found between ML direction COP-RMS and ΔHbO2 in the M1 (r = 0.436; p = 0.033) and PMC/SMA (r = 0.488, p = 0.016), as well as between anteroposterior (AP) direction COP-RMS and ΔHbO in the M1 (r = 0.483, p = 0.017). Conclusion Patients with CAI demonstrate increased cortical activation in the bilateral M1, ipsilateral PMC/SMA, and contralateral S1. This suggests that patients with CAI may require additional brain resources to maintain balance during single-leg stance, representing a compensatory mechanism to uphold task performance amidst diminished lateral balance ability in the ankle joint.
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Affiliation(s)
| | | | | | | | - Yan Chen
- College of Sport and Health, Shandong Sport University, Jinan, Shandong, China
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Ruzik K, Gonera B, Borowski A, Karauda P, Aragonés P, Olewnik Ł. Anatomic Variations of the Calcaneofibular Ligament. Foot Ankle Int 2024:10711007241241073. [PMID: 38590202 DOI: 10.1177/10711007241241073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology. METHODS The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed. RESULTS A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint. CONCLUSION The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction. CLINICAL RELEVANCE The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.
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Affiliation(s)
- Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Andrzej Borowski
- Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Menezes-Reis R, Beirigo EK, Maciel TDS, de Souza Borges NC, de Santiago HAR, Bezerra Leite W. Functional capacity and risk of injury in CrossFit practitioners measured through smartphone apps. J Bodyw Mov Ther 2024; 38:205-210. [PMID: 38763564 DOI: 10.1016/j.jbmt.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 05/21/2024]
Abstract
BACKGROUND CrossFit is a high intensity functional training that tends to challenge physical limits. The objectives of this study were to assess functional capacity, prevalence and risk of injury in CrossFit practitioners. METHODS This cross-sectional, observational and prospective study evaluate the rate of injuries that occurred in CrossFit practitioners in the last 12 months and their functional capacities. The sample was given for convenience, with a total of 22 participants. Functional capacities and risk of injury were measured by functional tests using PHAST and Clinometer applications. The prevalence of injuries was cataloged using the Nordic Musculoskeletal Questionnaire. RESULTS 5% of the injuries occurred in the neck; 9% in shoulder, hip, thighs, ankles and feet; 14% in the lumbar spine and knees. The worst functional results were for the shoulder medial rotation ROM test, where 86-95% of the athletes were classified as "Bad"; the dorsiflexion ROM test also performed poorly in 68% of athletes. CONCLUSION This study shows that the CrossFit practice suggests that the injury prevalence is relatively low, affecting mainly knees, lumbar spine, wrists and hands. However, the risk of injuries shown by the functional musculoskeletal assessment is higher, especially in the shoulder and ankle, and it is important for the practitioner to realize a specific functional assessment before starting training.
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Affiliation(s)
- Rafael Menezes-Reis
- Federal University of Amazonas, Institute of Health and Biotechnology, Coari-AM, Brazil
| | | | | | | | | | - William Bezerra Leite
- Federal University of Amazonas, Institute of Health and Biotechnology, Coari-AM, Brazil.
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Golmohammadi Qadikolai M, Sanjari MA, Mohsenifar H, Boozari S. Effect of non-elastic taping on vertical stiffness of healthy athletes during a basketball jump shot. J Bodyw Mov Ther 2024; 38:562-566. [PMID: 38763609 DOI: 10.1016/j.jbmt.2024.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Basketball is a high-risk team sport for lower extremity injuries, with ankle sprains being the most common injury. Non-elastic tape is widely used in injury prevention and quick return to play after ankle sprains, but its impact on stiffness, particularly global stiffness, has not been thoroughly investigated. OBJECTIVES The aim of this study was to investigate the effects of non-elastic ankle taping on vertical stiffness, among basketball players during the jump shot tasks; and to assess the reliability of accelerometers to evaluate vertical stiffness. DESIGN Single group, repeated measures study. PARTICIPANTS Thirty healthy semi-professional basketball players (15 males and 15 females) participated in the study. INTERVENTIONS Vertical stiffness was compared among three conditions: 1) without taping, 2) while the non-elastic tape was applied to their ankles, and 3) after running while taped. Vertical stiffness was calculated from acceleration data using a mass-spring model. RESULTS The result of a one-way repeated measures ANOVA showed that vertical stiffness was not significantly different between the three conditions (P = 0.162). Within-day and between-day reliability for average measurements were found to be high or very high. CONCLUSION The findings showed that the vertical stiffness is unaffected by non-elastic taping. Therefore, while non-elastic tape can limit ankle range of motion, it may not have an impact on vertical stiffness, a global parameter which reflects the musculoskeletal performance. On the other hand, the high reliability of the stiffness variable supports the use of an accelerometer as a small portable instrument for outdoor sports measurements.
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Affiliation(s)
- Maryam Golmohammadi Qadikolai
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Laboratory, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Holakoo Mohsenifar
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Boozari
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Justo-Cousiño LA, Da Cuña-Carrera I, Alonso-Calvete A, González-González Y. Effect of Kinesio taping on wrist proprioception in healthy subjects: A randomized clinical trial. J Hand Ther 2024; 37:184-191. [PMID: 38307737 DOI: 10.1016/j.jht.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception. PURPOSE The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects. METHODS Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT). RESULTS No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p=0.286), nor between pre and post-intervention (p=0.111). For wrist joint position sense, a statistically significant effect (p< 0.05) was found at 30º of extension between the control and experimental group in favor of the control group. CONCLUSIONS The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered.
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Affiliation(s)
- Lorenzo A Justo-Cousiño
- Universidade de Vigo, Departamento de Bioloxía Funcional e Ciencias da Saúde, Faculty of Physical Therapy, Pontevedra, Spain; Physiotherapy Group FS1, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Iria Da Cuña-Carrera
- Universidade de Vigo, Departamento de Bioloxía Funcional e Ciencias da Saúde, Faculty of Physical Therapy, Pontevedra, Spain; Physiotherapy Group FS1, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Alejandra Alonso-Calvete
- Universidade de Vigo, Departamento de Bioloxía Funcional e Ciencias da Saúde, Faculty of Physical Therapy, Pontevedra, Spain; REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain.
| | - Yoana González-González
- Universidade de Vigo, Departamento de Bioloxía Funcional e Ciencias da Saúde, Faculty of Physical Therapy, Pontevedra, Spain; Physiotherapy Group FS1, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
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Clark K, Trickett J, Donovan L, Dawson J, Goetschius J. Effects of Blood Flow Restriction on Balance Performance During Dynamic Balance Exercises in Individuals With Chronic Ankle Instability. J Sport Rehabil 2024; 33:181-188. [PMID: 38350443 DOI: 10.1123/jsr.2023-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Blood flow restriction (BFR) is a rehabilitation tool which may introduce a constraint, similar to muscle fatigue, that challenge patients' sensorimotor system during balance exercises. The purpose of our study was to examine whether adding BFR to dynamic balance exercises produced a decrease in balance performance and an increase in ratings of perceived exertion and instability in individuals with chronic ankle instability (CAI) compared with dynamic balance exercises without BFR. DESIGNS Crossover design. METHODS Our sample included N = 25 young adults with a history of CAI. Participants completed 2 laboratory visits. At each visit, participants completed 4 sets (30×-15×-15×-15×) of dynamic balance exercises, performed similar to the modified star excursion balance test (SEBT), once with BFR and once with control (no BFR) conditions. We measured composite SEBT scores at baseline and during the final repetitions of each set of balance exercise (sets 1-4). We also measured ratings of perceived exertion and instability following each balance exercise set. RESULTS We observed no difference in composite SEBT scores between conditions at baseline; however, composite SEBT scores were significantly lower during all balance exercises sets 1 to 4 with the BFR condition compared with control. During the BFR condition, composite SEBT scores were significantly lower during all balance exercise sets compared with baseline. During the control condition, composite SEBT scores did not significantly change between baseline and each balance exercise set. Ratings of perceived exertion and instability scores were significantly greater in the BFR group compared with the control group during all balance exercise sets. CONCLUSIONS Individuals with CAI demonstrated lower composite SEBT scores and greater perceived instability and exertion during dynamic balance exercise with BFR compared to without BFR. BFR introduced a novel muscle fatigue constraint during dynamic balance exercises in individuals with CAI. Additional research is needed to determine if adding BFR to balance training could improve clinical outcomes in CAI patients.
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Affiliation(s)
- Krista Clark
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Justin Trickett
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Luke Donovan
- Department of Applied Physiology, Health, & Clinical Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jordan Dawson
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - John Goetschius
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
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Liu X, He M, Hu R, Chen Z. Randomized controlled trial study of intelligent rehabilitation training system for functional ankle instability. Sci Rep 2024; 14:4996. [PMID: 38424225 PMCID: PMC10904850 DOI: 10.1038/s41598-024-55555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
To investigate the intervention effect of an intelligent rehabilitation training system on patients with functional ankle instability (FAI) and to advance the research to optimise the effect of FAI rehabilitation training. Thirty-four FAI patients who participated in this trial in Guilin City from April 2023 to June 2023 were recruited as research subjects, and all subjects were randomly divided into the control group (n = 17) and the observation group (n = 17). Both groups received the conventional rehabilitation training intervention for 6 weeks, and the observation group received the additional training using the intelligent rehabilitation training system training invented by our team. Visual analogue scale (VAS), ankle active mobility, ankle muscle strength and Y-balance test (YBT) were assessed before and after treatment. Two-way repeated measures ANOVA shows that the interaction effect between time and group of VAS scores was significant (F = 35.644, P < 0.05). The interaction effect between time and group of plantar flexion mobility was significant (F = 23.948, P < 0.05), the interaction effect between time and group of dorsiflexion mobility was significant (F = 6.570, P < 0.05), the interaction effect between time and group of inversion mobility was significant (F = 8.360, P < 0.05), the interaction effect between time and group of eversion mobility was significant (F = 10.113, P < 0.05). The interaction effect between time and group of inversion muscle strength was significant (F = 18.107, P < 0.05). The interaction effect between time and group of YBT scores was significant (F = 33.324, P < 0.05). The Intelligent Rehabilitation Training System can effectively reduce pain in FAI patients, improve joint range of motion, increase inversion strength, and improve dynamic balance of the affected limb.
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Affiliation(s)
- Xiaolong Liu
- School of Life and Environmental Science, Guilin University of Electronic Technology, Guilin, 541004, Guangxi, China
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, 541004, Guangxi, China
- Rehabilitation College, Guilin Life and Health Career Technical College, Guilin, 541001, Guangxi, China
| | - Mengxiao He
- School of Physical Education and Health, Guilin University, Guilin, 541006, Guangxi, China
| | - Rongbo Hu
- Credo Robotics GmbH, Bajuwarenstrasse 47, 94315, Straubing, Germany
- Department of System Design Engineering, Keio University, Yokohama, Kanagawa, 223-8522, Japan
| | - Zhencheng Chen
- School of Life and Environmental Science, Guilin University of Electronic Technology, Guilin, 541004, Guangxi, China.
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, 541004, Guangxi, China.
- Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments, Guilin, 541004, Guangxi, China.
- Guangxi Engineering Technology Research Center of Human Physiological Information Noninvasive Detection, Guilin, 541004, Guangxi, China.
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McCann RS, Welch Bacon CE, Suttmiller AMB, Gribble PA, Cavallario JM. Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain. J Athl Train 2024; 59:182-200. [PMID: 35622952 PMCID: PMC10895399 DOI: 10.4085/1062-6050-0037.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown. OBJECTIVES To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods. SETTING Online survey. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria. MAIN OUTCOME MEASURE(S) We distributed an online survey to ATs that asked about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return to activity. Descriptive statistics were used to characterize participant demographics and frequencies of the assessment measures used by ATs. Chi-square analysis was conducted to identify relationships between the demographics and assessment selection. RESULTS Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76.2% to 96.7% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25.3% to 35.1% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. Athletic trainers with higher degrees, completion of more advanced educational programs, employment in nontraditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs. CONCLUSIONS Before approving return to activity for patients with ankle sprains, ATs did not use some recommended outcomes and assessment methods. Practice in nontraditional settings, more advanced degrees, more clinical experience, and familiarity with expert consensus guidelines appeared to facilitate the use of ROASTs.
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Affiliation(s)
- Ryan S. McCann
- Rehabilitation Sciences, Old Dominion University, Norfolk, VA
| | - Cailee E. Welch Bacon
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa
| | | | - Phillip A. Gribble
- Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
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Mailuhu AK, Verhagen EA, van Ochten J, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M. E-health intervention for preventing recurrent ankle sprains: a randomised controlled trial in general practice. Br J Gen Pract 2024; 74:e56-e62. [PMID: 38154933 PMCID: PMC10755994 DOI: 10.3399/bjgp.2022.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/10/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Ankle sprains are frequent injuries in general practice. However, no effective treatment is available yet. AIM To examine the effectiveness of an unsupervised e-health-supported neuromuscular training programme in combination with usual care compared with usual care alone in patients with acute lateral ankle sprains in general practice. DESIGN AND SETTING Randomised controlled trial with 1-year follow-up among patients (14-65 years) who visited the GP with an acute lateral ankle sprain within 3 weeks of injury. METHOD The intervention group received, in addition to usual care, an unsupervised e-health-supported neuromuscular training programme and the control group received usual care alone. The primary outcome was self-reported re-sprains during 52 weeks of follow-up. Secondary outcomes were ankle function, pain in rest and during activity, subjective recovery, and return to the same type and level of sport. RESULTS In total, 165 participants (mean age 38.3 years and 69 [41.8%] male) were included. No statistically significant difference in the occurrence of a re-sprain were found between the intervention 20.7% (17/82) and control group 24.1% (20/83) (hazard ratio 1.14, 95% confidence interval = 0.59 to 2.21). Also, no statistically significant differences in secondary outcomes were found between groups. The adherence rate to the programme was low (6.1%, 5/82). CONCLUSION The rate of re-sprains was relatively high and an unsupervised e-health-supported neuromuscular training programme does not yield meaningful effects and does not encourage adherence in preventing re-sprains in patients in general practice. More research is necessary to indicate the best treatment modality and way of delivery for these patients.
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Affiliation(s)
- Adinda Ke Mailuhu
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Evert Alm Verhagen
- Department of Health Sciences & EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - John van Ochten
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Patrick Je Bindels
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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12
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Hong CC, Tan KJ, Calder J. Chronic lateral ankle ligament instability - Current evidence and recent management advances. J Clin Orthop Trauma 2024; 48:102328. [PMID: 38274643 PMCID: PMC10806209 DOI: 10.1016/j.jcot.2023.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Lateral ankle sprain is a common injury with a substantial negative impact on physical function, quality of life and health economic burden. Chronic lateral ankle instability (CLAI) as a sequela of lateral ankle sprain can lead to the development of posttraumatic ankle osteoarthritis in the long term. In this article, we explore the epidemiology, burden and definition of CLAI for the appropriate clinical assessment and imaging evaluation of patients with lateral ankle sprain and CLAI. Following that, recent advances and evidence on management of CLAI is critically distilled and summarized.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ken Jin Tan
- OrthoSports Clinic for Orthopedic Surgery and Sports Medicine, Mt Elizabeth Novena Specialist Centre, Singapore
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Xue X, Wang Y, Xu X, Li H, Li Q, Na Y, Tao W, Yu L, Jin Z, Li H, Wang R, Hua Y. Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Health 2024; 16:29-37. [PMID: 36872589 PMCID: PMC10732110 DOI: 10.1177/19417381231152490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
CONTEXT Postural control deficits arising from injured ankles are central to chronic ankle instability (CAI) and its persistent symptoms. This is usually measured by recording the center of pressure (CoP) trajectory during static single-leg stance using a stable force plate. However, existing studies have produced conflicting results on whether this mode of measurement adequately reveals the postural deficits in CAI. OBJECTIVE To determine whether postural control during static single-leg stance is impaired in CAI patients when compared with uninjured healthy controls. DATA SOURCES Literature databases, PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus, were searched from inception to April 1, 2022, using ankle-, injury-, and posture-related terms. STUDY SELECTION Two authors independently performed the step-by-step screening of article titles, abstracts, and full texts to select peer-reviewed studies investigating CoP trajectory during static single-leg stance using a stable force plate in CAI patients and healthy controls. A total of 13,637 studies were reviewed, and 38 studies (0.003%) met the selection criteria. STUDY DESIGN Meta-analyses of descriptive epidemiological study. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION CoP parameters, sway directions, visual condition, and numerical data (means and standard deviations) were extracted. RESULTS The injured ankles of CAI patients had higher standard deviations of sway amplitude in both anterior-posterior and medial-lateral directions (standardized mean difference [SMD] = 0.36 and 0.31, respectively) under conditions of open eyes than controls. Higher mean sway velocity in anterior-posterior, medial-lateral, and total directions (SMD = 0.41, 0.37, and 0.45, respectively) with closed eyes was also found. CONCLUSION CAI patients had deficits of postural control during static single-leg stance, and these deficits were identified by the CoP trajectory. Further methodological explorations of CoP parameters and corresponding test conditions are required to enhance the sensitivity and reliability of postural deficit assessments in CAI using force plates.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiran Wang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyun Xu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weichu Tao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Le Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, China
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14
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Xue X, Yu L, Zheng S, Gu X, Na Y, Xia T, Jue H, Chen T, Li H, Li H, Wang R, Hua Y. Insufficient recovery of proprioception in chronic ankle instability after surgical restabilization: A systematic review. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:48-58. [PMID: 38204486 PMCID: PMC10776890 DOI: 10.1016/j.asmart.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
Surgical repair or reconstruction of the lateral ligaments for patients with chronic ankle instability (CAI) could, logically, restore the proprioception of ankle through retensing receptors. To validate this hypothesis, seven databases were systematically searched, and thirteen studies comprising a total of 347 patients with CAI were included. Although five studies reported improved proprioceptive outcomes after surgeries, the other five studies with between-limb/group comparisons reported residual deficits at final follow-up, which does not consistently support proprioceptive recovery after existing surgical restabilization for CAI. More controlled studies are needed to provide evidence-based protocols to improve proprioceptive recovery after ankle restabilization for CAI.
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Affiliation(s)
- Xiao'ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Le Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Shanshan Zheng
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xicheng Gu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tian Xia
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hao Jue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Xue X, Lu R, Li H, Chen Z, Sheng D, Jin Z, Liu S, Liu A, Yan X, Tang W, Chen S, Hua Y. In Vivo Characterization of Cerebellar Peduncles in Chronic Ankle Instability: A Single and Multishell Diffusion-Weighted Imaging Study. Sports Health 2024; 16:38-46. [PMID: 38112261 PMCID: PMC10732106 DOI: 10.1177/19417381231156544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ankle sprain causes proprioceptor injuries and prolonged joint deafferentation, which might lead to maladaptive neuroplasticity in patients with chronic ankle instability (CAI), especially in the cerebellum. Previous studies have indicated the impairment of superior cerebellar peduncle (SCP), but the inferior cerebellar peduncle (ICP) and middle cerebellar peduncle (MCP) have not been fully analyzed. HYPOTHESIS The cerebellar peduncles of participants with CAI would have altered fractional anisotropy (FA) and orientation dispersion index (ODI) in comparison with healthy controls without ankle injury history. In addition, FA and ODI would be correlated with the duration or severity of the sensorimotor deficits in CAI. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A group of 27 participants with CAI and 26 healthy controls underwent diffusion-weighted imaging scanning, with the cerebellar peduncles as the regions of interest. The measures obtained by single-shell diffusion tensor imaging and the multishell neurite orientation dispersion and density imaging were used. Correlation analyses were performed to examine the potential relationship between the FA/ODI and both the normalized Y-balance scores and the durations of ankle instability. RESULTS The ipsilateral ICP of the injured ankle in participants with CAI showed significantly lower FA (Cohen d 95% CI, -1.33 to -0.21; P = 0.04) and marginally significant higher ODI (Cohen d 95% CI, 0.10 to 1.20, P = 0.08) when compared with the same measures in the control group, with the ODI being positively correlated with the duration of ankle instability (r = 0.42, P = 0.03). CONCLUSION The ICP in participants with CAI exhibited impaired integrity and a trend of abnormally organized neurites in comparison with a healthy control group. CLINICAL RELEVANCE The impairments of ICP might be an ongoing part of the pathological process of CAI, having the potential to become a target for the diagnostic evaluation of this clinical entity.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyin Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ailin Liu
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Yan
- Scientific Marketing, Siemens Healthcare Ltd., Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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16
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Chen Y, Cao S, Chen W, Zhang C, Huang J, Wang X, Ma X. Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations. Clin Biomech (Bristol, Avon) 2024; 111:106165. [PMID: 38159328 DOI: 10.1016/j.clinbiomech.2023.106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND It is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments. METHODS A Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables. FINDINGS Pain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations. INTERPRETATION Individuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.
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Affiliation(s)
- Yungu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Wenming Chen
- Institute of Biomedical Engineering, Academy for Engineering & Technology, Fudan University, 220 Handan Road, Yangpu District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Jingan District, Shanghai, China; Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China.
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17
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An TW, Berke G, Beattie W, Chan JY. Orthotic Devices for the Foot and Ankle. J Am Acad Orthop Surg 2023:00124635-990000000-00849. [PMID: 38109744 DOI: 10.5435/jaaos-d-23-00832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Millions of Americans wear ankle-foot orthotic devices for protection, pain relief, and deformity correction. Inquiries about off-the-shelf and custom devices are a common reason for evaluation with a foot and ankle surgeon or general orthopaedic surgeon. Despite limited high-quality evidence for their use, these devices can have a notable clinical impact on physical function. An up-to-date understanding of orthotic device options and their appropriate use in managing musculoskeletal pathologies applies to all orthopaedic providers. This review aims to categorize orthosis types and provide specific device recommendations for common adult conditions such as flatfoot, cavovarus foot, and ankle instability. Collaboration with a certified orthotist can help patients achieve functional and recreational goals with the use of appropriately designed and applied orthoses.
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Affiliation(s)
- Tonya W An
- From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (An, Berke, and Chan) and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, IL (Beattie)
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18
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Dolan P, Kenny I, Glynn L, Campbell M, Warrington GD, Cahalan R, Harrison A, Lyons M, Comyns T. Risk factors for acute ankle sprains in field-based, team contact sports: a systematic review of prospective etiological studies. PHYSICIAN SPORTSMED 2023; 51:517-530. [PMID: 35757862 DOI: 10.1080/00913847.2022.2093618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospectively measured ankle sprain risk factors in field-based team contact sports. METHODS Eight databases including SPORTDiscus, CINAHL Complete, MEDLINE (EBSCO), Education Source, Web of Science, Scopus, Embase, and Pubmed were searched using specific Boolean terms. A modified-CASP diagnostic test assessed the quality of the included studies. Extensive data extraction included but was not limited to injury definition, protocols for injury diagnosis and recording, and outcomes associated with ankle sprain. RESULTS 4012 records were returned from the online search and 17 studies met the inclusion criteria for this review. Twelve different risk factors including anatomic alignment of the foot and ankle, joint laxity, height, mass, BMI (body mass index), age, ankle strength, hip strength, single leg landing performance (ground reaction force, pelvic internal rotation, and knee varus), and single leg reach were all found to be associated with ankle sprain incidence. Injury definitions and methods of diagnosis and recording varied across the 17 studies. CONCLUSION This review updates the literature on prospective risk factors for ankle sprain in a specific population rather than heterogeneous cohorts previously studied. From more than 20 categories of risk factors investigated for ankle sprain association across 17 studies in field-based team contact sports, 12 variables were found to be associated with increased incidence of ankle sprain. In order to reduce the risk of ankle sprain, BMI, ankle plantar and dorsiflexion strength, hip strength, and single leg landing performance should be factored in to athlete assessment and subsequent program design. More studies utilizing standardized definitions and methods of recording and reporting are needed. Future prospective etiological studies will allow strength and conditioning coaches, physiotherapists, and physicians to apply specific training principles to reduce the risk and occurrence of ankle sprain injuries.
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Affiliation(s)
- Patrick Dolan
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ian Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Ireland
| | - Mark Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Lero, The Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Giles D Warrington
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, University of Limerick, Limerick, Ireland
| | - Andrew Harrison
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Mark Lyons
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Thomas Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
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Bleakley CM, Wagemans J, Schurz AP, Smoliga JM. How robust are clinical trials in primary and secondary ankle sprain prevention? Phys Ther Sport 2023; 64:85-90. [PMID: 37801794 DOI: 10.1016/j.ptsp.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Determine the statistical stability of RCTs examining primary and secondary prevention of ankle sprains. METHODS Databases were searched to August 2023. We included parallel design RCTs, using conservative interventions for preventing ankle sprain, reporting dichotomous injury event outcomes. Statistical stability was quantified using Fragility Index (FI) and Fragility Quotient (FQ). Subgroup analyses were undertaken to test if FI varied based on by study objective, original approach to analysis (frequency vs time to event), follow-up duration, and pre-registration. RESULTS 3559 studies were screened with 45 RCTs included. The median number of events required to change the statistical significance (FI) was 4 (IQR 1-6). FI was similar regardless of study objective, original analysis, follow-up duration, and pre-registration status. Median (IQR) FQ was 0.015 (0.005-0.046), therefore reversing events <2 patients/100 would alter significance. In 80% of studies the number of patients lost to follow-up was greater than the FI. CONCLUSION RCTs informing primary and secondary prevention of ankle sprain are fragile. Only a small percentage of outcome event reversals would reverse study significance, and this is often exceeded by the number of drop outs. Robust reporting of dichotomous outcomes requires the use P values and key metrics such as FI or FQ.
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Affiliation(s)
- C M Bleakley
- Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom.
| | - J Wagemans
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - A P Schurz
- Department of Health Professions, Bern University of Applied Sciences, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Belgium
| | - J M Smoliga
- Department of Physical Therapy, High Point University, United States; School of Medicine, Tufts University, United States
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20
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Fakontis C, Iakovidis P, Kasimis K, Lytras D, Koutras G, Fetlis A, Algiounidis I. Efficacy of resistance training with elastic bands compared to proprioceptive training on balance and self-report measures in patients with chronic ankle instability: A systematic review and meta-analysis. Phys Ther Sport 2023; 64:74-84. [PMID: 37801793 DOI: 10.1016/j.ptsp.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI). OBJECTIVE To compare the efficacy of proprioceptive training to resistance training with elastic bands for treating CAI as measured by the Star Excursion Balance Test (SEBT), the Foot and Ankle Ability Measure (FAAM), and the Cumberland Ankle Instability Tool (CAIT). METHOD Our systematic study and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, and ScienceDirect databases were searched for randomized clinical trials on proprioceptive and resistance training. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). RESULTS Five studies involving 259 patients were included in the review. According to the findings of the meta-analysis, proprioceptive training was similarly effective with resistance training in SEBT and FAAM measures. Compared with resistance exercise, proprioceptive training demonstrated some benefits in CAIT scores (weighted mean difference [WMD] = -2.21, 95% CI = -4.05-0.36), but these intervention results were not clinically significant (MDC, MCID score >3 points). CONCLUSION Low-quality evidence from studies showed that neither of the interventions was superior on the SEBT or the FAAM scores in individuals with CAI because no clinically significant differences were found. More high-quality studies comparing the two interventions are needed to draw firm conclusions.
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Affiliation(s)
- Christos Fakontis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Paris Iakovidis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Konstantinos Kasimis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Dimitrios Lytras
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece.
| | - Georgios Koutras
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
| | - Antonis Fetlis
- Laboratory of Biomechanics & Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, Alexander Campus P.O. Box 141, 57 400, Sindos, Thessaloniki, Greece
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21
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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Kobayashi T, Kodesho T, Kinami K, Takahashi A, Taniguchi K, Taniguchi K. Characteristics of the static muscle stiffness of ankle plantar flexors in individuals with chronic ankle instability. J Med Ultrason (2001) 2023; 50:561-570. [PMID: 37640966 DOI: 10.1007/s10396-023-01360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Individuals with chronic ankle instability (CAI) have deficits in closed kinetic chain dorsiflexion that may perpetuate injury. Determining the characteristics of muscle stiffness in the plantar flexors of individuals with CAI may help in developing appropriate treatments. We aimed to highlight the characteristics of static muscle stiffness in ankle plantar flexor muscles during the passive dorsiflexion of the ankle joint in individuals with CAI. METHODS A total of 30 patients were included in the study based on the International Ankle Consortium criteria. The patients were categorized evenly into healthy, coper, and CAI groups (i.e., 10 patients in each group). After measuring the dorsiflexion range of motion (non-weight-bearing/weight-bearing) of the ankle joint, the static muscle stiffness measurements of the medial gastrocnemius, lateral gastrocnemius, soleus, and peroneus longus were obtained. The measurements were performed during the knee joint's extension and 50° flexion and passive dorsiflexion between the range of 40° plantar flexion and 20° dorsiflexion. RESULTS The dorsiflexion range of motion of the CAI group was significantly smaller than that of the healthy and coper groups in the weight-bearing position. No interaction was observed for muscle stiffness in both the knee flexion and extension positions, and no significant differences were identified among the three groups. The shear modulus of the soleus at 20° ankle dorsiflexion with knee flexion had a significant negative correlation with the weight-bearing range of motion of the ankle. CONCLUSION The limitation in the weight-bearing dorsiflexion range of motion in CAI was largely due to factors other than the increased elasticity of the ankle plantar flexor muscles.
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Affiliation(s)
- Takumi Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan.
| | - Taiki Kodesho
- Department of Sport Science and Research, Japan Institute of Sports Sciences (JISS), Tokyo, Japan
| | - Keita Kinami
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan
| | - Ayuka Takahashi
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan
| | - Konatsu Taniguchi
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan
| | - Keigo Taniguchi
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
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Tang Y, Liang P, Pan J, Zhang C, Ren H, Cheng S, Kong PW. Effects of Ankle Orthoses, Taping, and Insoles on Postural Stability of Individuals with Chronic Ankle Instability: A Systematic Review. Healthcare (Basel) 2023; 11:2570. [PMID: 37761767 PMCID: PMC10530830 DOI: 10.3390/healthcare11182570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and diminished function. Foot and ankle external supports are commonly used in clinical practice and research for treating CAI. This systematic review aimed to assess the effects of foot and ankle external supports on the postural stability of individuals with CAI to guide clinical practice and inform future research. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases from 1 January 2012 to 1 November 2022. Eighteen studies involving individuals with CAI were chosen in this systematic review. The quality of the included studies and risk of bias were assessed using Cochrane Collaboration's tool for randomized controlled trials, the Newcastle-Ottawa Scale for case-control studies, and the DELPHl-list for crossover trial studies. The external supports included in this review were ankle orthoses (elastic, semi-rigid, and active orthoses), taping (kinesiotaping and fibular reposition taping), and insoles (textured and supportive insoles). The outcome measures included static and dynamic postural stability tests, such as the single-leg stance test, star excursion balance test, Y-balance test, single-leg landing test, lateral jump test, walking test, and running test. The results showed that elastic orthoses, Kinesiotaping, and textured insoles demonstrated potential benefits in improving postural stability in individuals with CAI. Elastic orthoses decreased ankle joint motion variability, kinesiotaping facilitated cutaneous receptors and proprioceptive feedback, while textured insoles increased tactile stimulation and foot position awareness. However, the effects of semi-rigid orthoses, fibular reposition taping, and arch support insoles were inconsistent across studies. Future research should explore the long-term effects of these external supports, analyze the effects of different characteristics and combinations of supports, and employ standardized outcome measures and testing protocols for assessing postural stability.
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Affiliation(s)
- Yunqi Tang
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
| | - Peiyao Liang
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Jingwen Pan
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore 308232, Singapore
| | - Cui Zhang
- Sport Biomechanics Laboratory, Shandong Institute of Sports Science, Jinan 250014, China;
- Graduate School, Shandong Physical Education University, Jinan 250014, China
| | - Hui Ren
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Shizhe Cheng
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Pui Wah Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
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Ammendolia A, de Sire A, Lippi L, Ammendolia V, Spanò R, Reggiani A, Invernizzi M, Marotta N. Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial. Sports (Basel) 2023; 11:180. [PMID: 37755857 PMCID: PMC10537008 DOI: 10.3390/sports11090180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains. METHODS Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3). RESULTS After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported. CONCLUSIONS Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.
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Affiliation(s)
- Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Valerio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Riccardo Spanò
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Andrea Reggiani
- Physical and Rehabilitative Medicine, Casa di Cura La Madonnina, 20122 Milan, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Zhang J, Yang K, Wang C, Gu W, Li X, Fu S, Song G, Wang J, Wu C, Zhu H, Shi Z. Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:606-612. [PMID: 36931594 PMCID: PMC10466191 DOI: 10.1016/j.jshs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/12/2022] [Accepted: 02/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients. METHODS All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS. RESULTS A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0-4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93-1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02-1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05-4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30-5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39-4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI. CONCLUSION MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.
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Affiliation(s)
- Jieyuan Zhang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Kai Yang
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Cheng Wang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Wenqi Gu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Xueqian Li
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Shaoling Fu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Guoxun Song
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Jiazheng Wang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Chenglin Wu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Hongyi Zhu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China; Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China.
| | - Zhongmin Shi
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai 200233, China; Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai 200233, China.
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Wen Z, Lyu R, Wang W, Hua X, Yu Y, Zeng K, Kong L, Wang J. The effect of Tuina based on the concept of hip-knee-ankle conjugation in patients with chronic ankle instability: study protocol for a randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1165548. [PMID: 37691913 PMCID: PMC10491012 DOI: 10.3389/fresc.2023.1165548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023]
Abstract
Background Chronic ankle instability (CAI) is a common sports injury disease and characterized by limited mobility, perceived instability and muscle weakness, combined treatment of hip-knee-ankle is a common rehabilitation method. Tuina, as a traditional Chinese manual therapy, is usually used for CAI, but many of them only focus on the local ankle joint rather than the combination of hip and knee joint. Therefore, we have designed a randomized controlled trial (RCT) to investigate the effects of Tuina base on the concept of hip-knee-ankle conjugation on the stability and balance of lower limbs and ankle function in patients with CAI. Methods We have designed a randomized controlled trial. A total of 72 participants with CAI will be randomly divided into functional training groups and hip-knee-ankle Tuina combined with functional training group in a 1:1 ratio. Participants in control group will receive 8 sessions of functional training (30 min per session, twice a week for 4 weeks). Participants in intervention group will receive 8 sessions of Tuina combined with functional training (twice a week for 4 weeks). The primary outcomes include the Y-Balance Test (YBT) and Cumberland Ankle Instability Tool (CAIT). The Secondary outcomes include the Foot and Ankle Ability Measure (FAAM) and ankle range of motion (ROM). The outcome assessments will be conducted before the first intervention and after the last intervention. Discussion The aim of this study is to explore a safe and effective manipulation program and serve as reference for clinical treatment of CAI and expect to provide the necessary theoretical and practical support to our future research. Clinical Trial Registration Chinese Clinical Trail Registry ChiCTR2300068274.
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Affiliation(s)
- Zonglin Wen
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruoyun Lyu
- Department of Traditional Chinese Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Wei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xia Hua
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifeng Yu
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zeng
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingjun Kong
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - JianWei Wang
- Department of Tuina, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Rowe PL, Bryant AL, Egerton T, Paterson KL. External Ankle Support and Ankle Biomechanics in Chronic Ankle Instability: Systematic Review and Meta-Analysis. J Athl Train 2023; 58:635-647. [PMID: 36521172 PMCID: PMC10569247 DOI: 10.4085/1062-6050-0208.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks. DATA SOURCES A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021. STUDY SELECTION Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support. DATA EXTRACTION Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings. DATA SYNTHESIS A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient. CONCLUSIONS Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.
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Affiliation(s)
- Patrick L. Rowe
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Adam L. Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kade L. Paterson
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
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Gribble PA, Bain KA, Davidson CD, Hoch MC, Kosik KB. Yoga as a balance intervention for middle-age and older adults with history of lateral ankle sprain: An exploratory study. J Bodyw Mov Ther 2023; 35:190-195. [PMID: 37330768 DOI: 10.1016/j.jbmt.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/20/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Balance deficiencies are common among aging adults. Musculoskeletal injuries such as lateral ankle sprains (LAS) also contribute to compromised balance; potentially amplifying the postural insufficiencies in these age groups with a history of LAS. Yoga has emerged as an effective balance training intervention for aging adults; but limited application exists in these age cohorts with LAS history. This study may provide important guidance for the implementation of this intervention in these populations. METHODS In this cohort design study, middle-age and older adults with a history of LAS completed an 8-week beginner-level yoga class. Balance was measured before and after the yoga intervention statically (force plate) and dynamically (star excursion balance test [SEBT]) using single-limb balance tasks. RESULTS Following the yoga intervention, older adults improved static postural control in the anterior-posterior direction, as well as dynamic postural control in selected reach directions of the SEBT relative to the middle-age adults. CONCLUSION This is an important step in exploring how to help the aging population that likely has amplifications in balance deficiencies due to a common musculoskeletal injury, LAS. While more work is needed to determine how to optimize and document balance improvements in aging adults with LAS history, yoga appears to be a promising form of intervention, particularly for older adults.
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Affiliation(s)
| | | | | | | | - Kyle B Kosik
- University of Kentucky, College of Health Sciences, USA
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Jankaew A, Chen JC, Chamnongkich S, Lin CF. Therapeutic Exercises and Modalities in Athletes With Acute Hamstring Injuries: A Systematic Review and Meta-analysis. Sports Health 2023; 15:497-511. [PMID: 35996322 PMCID: PMC10293564 DOI: 10.1177/19417381221118085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury. OBJECTIVE To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries. DATA SOURCES Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021. STUDY SELECTION A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study. RESULTS Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis. CONCLUSION The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence. PROSPERO REGISTRATION CRD42020183035.
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Affiliation(s)
- Amornthep Jankaew
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jih-Ching Chen
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Samatchai Chamnongkich
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
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Zwipp H. Conservative Functional Treatment of Acute Fibular Ligament Rupture of the Ankle. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:454-460. [PMID: 37198926 PMCID: PMC10481941 DOI: 10.3238/arztebl.m2023.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary surgical repair to conservative functional treatment. METHODS This review is based on publications retrieved by a selective search in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and meta-analyses on surgical versus conservative treatment from the years 1983 to 2023. RESULTS 10 of 11 prospective randomized trials of surgical versus conservative treatment conducted between 1984 and 2017 did not reveal any significant difference in the overall outcome. These findings were confirmed in two meta-analyses and two systematic reviews that were published between 2007 and 2019. Isolated benefits in the surgical group were outweighed by a variety of postoperative complications. The anterior fibulotalar ligament (AFTL) was ruptured in 58% to 100% of cases, followed by the fibulocalcaneal ligament combined with the LFTA in 58% to 85%, and the posterior fibulotalar ligament (mostly incomplete ruptures) in 1.9% to 3%. CONCLUSION Conservative functional treatment is now the standard treatment in acute fibular ligament rupture of the ankle because it is low-risk, low-cost, and safe. Primary surgery is indicated in only 0.5% to 4% of cases. Physical examination for tenderness to palpation and for stability, as well as stress ultrasonography, can be used to differentiate sprains from ligamentous tears. MRI is superior only for the detection of additional injuries. Stable sprains can be successfully treated with an elastic ankle support for a few days, and unstable ligamentous ruptures with an orthosis for 5 to 6 weeks. Subsequent physiotherapy with proprioceptive exercises is the best way to prevent recurrent injury.
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Affiliation(s)
- Hans Zwipp
- TU Dresden, Dresden University of Technology, Center for Orthopedics and Trauma Surgery,Dresden
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Bleakley C, Netterström-Wedin F. Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models. BMC Musculoskelet Disord 2023; 24:511. [PMID: 37349749 DOI: 10.1186/s12891-023-06653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mechanical loading is purported to restore ligament biomechanics post-injury. But this is difficult to corroborate in clinical research when key ligament tissue properties (e.g. strength, stiffness), cannot be accurately measured. We reviewed experimental animal models, to evaluate if post-injury loading restores tissue biomechanics more favourably than immobilisation or unloading. Our second objective was to explore if outcomes are moderated by loading parameters (e.g. nature, magnitude, duration, frequency of loading). METHODS Electronic and supplemental searches were performed in April 2021 and updated in May 2023. We included controlled trials using injured animal ligament models, where at least one group was subjected to a mechanical loading intervention postinjury. There were no restrictions on the dose, time of initiation, intensity, or nature of the load. Animals with concomitant fractures or tendon injuries were excluded. Prespecified primary and secondary outcomes were force/stress at ligament failure, stiffness, laxity/deformation. The Systematic Review Center for Laboratory animal Experimentation tool was used to assess the risk of bias. RESULTS There were seven eligible studies; all had a high risk of bias. All studies used surgically induced injury to the medial collateral ligament of the rat or rabbit knee. Three studies recorded large effects in favour of ad libitum loading postinjury (vs. unloading), for force at failure and stiffness at 12-week follow up. However, loaded ligaments had greater laxity at initial recruitment (vs. unloaded) at 6 and 12 weeks postinjury. There were trends from two studies that adding structured exercise intervention (short bouts of daily swimming) to ad libitum activity further enhances ligament behaviour under high loads (force at failure, stiffness). Only one study compared different loading parameters (e.g. type, frequency); reporting that an increase in loading duration (from 5 to 15 min/day) had minimal effect on biomechanical outcomes. CONCLUSION There is preliminary evidence that post-injury loading results in stronger, stiffer ligament tissue, but has a negative effect on low load extensibility. Findings are preliminary due to high risk of bias in animal models, and the optimal loading dose for healing ligaments remains unclear.
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Affiliation(s)
- Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown campus, Newtownabbey, UK
| | - Fredh Netterström-Wedin
- Division of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
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de Cesar Netto C, Valderrabano V, Mansur NSB. Multidirectional Chronic Ankle Instability: What Is It? Foot Ankle Clin 2023; 28:405-426. [PMID: 37137631 DOI: 10.1016/j.fcl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Not all ankle sprains are the same and not all ankles behave the same way after an injury. Although we do not know the mechanisms behind an injury producing an unstable joint, we do know ankle sprains are highly underestimated. While some of the presumed lateral ligament lesions might eventually heal and produce minor symptoms, a substantial number of patients will not have the same outcome. The presence of associated injuries, such as additional medial chronic ankle instability, chronic syndesmotic instability, has been long discussed as a possible reason behind this. To explain multidirectional chronic ankle instability, this article aims to present the literature surrounding the condition and its importance nowadays.
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Affiliation(s)
- Cesar de Cesar Netto
- University of Iowa, Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA; Duke University Medical Center, USA.
| | - Victor Valderrabano
- Swiss Ortho Center & University of Basel, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland
| | - Nacime Salomão Barbachan Mansur
- University of Iowa, Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA; Escola Paulista de Medicina - Universidade Federal de São Paulo, 740 Botucatu Street, Sao Paulo, SP, Brazil 04023-062
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Hong CC, Calder J. The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact. Foot Ankle Clin 2023; 28:187-200. [PMID: 37137618 DOI: 10.1016/j.fcl.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Wagemans J, Taeymans J, Kuppens K, Baur H, Bleakley C, Vissers D. Determining key clinical predictors for chronic ankle instability and return to sports with cost of illness analysis: protocol of a prospective cohort study. BMJ Open 2023; 13:e069867. [PMID: 37164478 PMCID: PMC10174038 DOI: 10.1136/bmjopen-2022-069867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Ankle sprains are common in sports and the general population. Although considered innocuous, a large proportion has residual complaints such as recurrent ankle sprains and develop chronic ankle instability. Although some predicting factors are identified, there is no unequivocality regarding the development of chronic ankle instability, nor about the optimal rehabilitation for an acute ankle sprain. Alongside the biomechanical impairments, ankle sprains are a burden on society due to substantial economic costs. Therefore, we aim to identify key clinical predictors of chronic ankle instability or recovery after acute lateral ankle sprain. Additionally, we aim to determine cost-of-illness of patients who developed chronic ankle instability. METHODS AND ANALYSIS This prospective cohort study (Clinicaltrials.gov: NCT05637008 - pre-results) aims to recruit adult (18-55 years) patients with an acute lateral ankle sprain who are active in sports. Clinical assessments and patient-reported outcome measures will be used to collect data at 7-14 days, 6 weeks, 12 weeks and 12 months after enrolment in the study. The primary outcome will be chronic ankle instability at 12-month follow-up. Salient outcomes will be analysed by logistic regression to determine association with the development of chronic ankle instability. Participants will fill in a cost diary containing direct and indirect costs related to their injury. ETHICS AND DISSEMINATIONS The ethical committee of the Antwerp University Hospital (B3002022000138) has given approval of the protocol and consent forms on 10 October 2022. We perform this study according to the Helsinki Declaration. We will present results at conferences or webinars and publish in peer-reviewed articles.NCT05637008.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
- Department of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Jan Taeymans
- Department of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - Heiner Baur
- Department of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Science, Ulster University, Newtownabbey, UK
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
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Wang F, Guan Y, Bamber Z, Cao X, Qi Q, Niu W, Chen B. Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis. Clin Rehabil 2023; 37:585-602. [PMID: 36630892 DOI: 10.1177/02692155221137640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Fanjia Wang
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yonghao Guan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zoe Bamber
- Division of Orthopaedics, Trauma and Sports Medicine, Faculty of Medicine and Health Sciences, School of Medicine, 6123University of Nottingham, Nottingham, UK
| | - Xianxin Cao
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Qi Qi
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Wenxin Niu
- Department of Rehabilitation Sciences, 481875Tongji University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Bak J, Thorborg K, Clausen MB, Johannsen FE, Kirk JW, Bandholm T. Using the app "Injurymap" to provide exercise rehabilitation for people with acute lateral ankle sprains seen at the Hospital Emergency Department-A mixed-method pilot study. PLOS DIGITAL HEALTH 2023; 2:e0000221. [PMID: 37186574 PMCID: PMC10184914 DOI: 10.1371/journal.pdig.0000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute lateral ankle sprains (LAS) account for 4-5% of all Emergency Department (ED) visits. Few patients receive the recommended care of exercise rehabilitation. A simple solution is an exercise app for mobile devices, which can deliver tailored and real-time adaptive exercise programs. PURPOSE The purpose of this pilot study was to investigate the use and preliminary effect of an app-based exercise program in patients with LAS seen in the Emergency Department at a public hospital. MATERIALS AND METHODS We used an app that delivers evidence-based exercise rehabilitation for LAS using algorithm-controlled progression. Participants were recruited from the ED and followed for four months. Data on app-use and preliminary effect were collected continuously through the exercise app and weekly text-messages. Baseline and follow-up data were collected though an online questionnaire. Semi-structured interviews were performed after participants stopped using the app. Results: Health care professionals provided 485 patients with study information and exercise equipment. Of those, 60 participants chose to enroll in the study and 43 became active users. The active users completed a median of 7 exercise sessions. Most of the active users were very satisfied or satisfied (79%-93%) with the app and 95.7% would recommend it to others. The interviews showed that ankle sprains were considered an innocuous injury that would recover by itself. Several app users expressed they felt insufficiently informed from the ED health care professionals. Only 39% felt recovered when they stopped exercising, and 33% experienced a recurrent sprain in the study period. Conclusion: In this study, only few patients with LAS became active app users after receiving information in the ED about a free app-based rehabilitation program. We speculate the reason for this could be the perception that LAS is an innocuous injury. Most of the patients starting training were satisfied with the app, although few completed enough exercise sessions to realistically impact clinical recovery. Interestingly more than half of the participants did not feel fully recovered when they stopped exercising and one third experienced a recurrent sprain. TRIAL-IDENTIFIERS https://clinicaltrials.gov/ct2/show/NCT03550274, preprint (open access): https://www.medrxiv.org/content/10.1101/2022.01.31.22269313v1.
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Affiliation(s)
- Jonas Bak
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mikkel Bek Clausen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen N, Denmark
| | - Finn Elkjær Johannsen
- Institute of Sports Medicine Copenhagen, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Injurymap Aps, Copenhagen N, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Denmark
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Ryman Augustsson S, Sjöstedt E. A test battery for evaluation of muscle strength, balance and functional performance in subjects with chronic ankle instability: a cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:55. [PMID: 37055818 PMCID: PMC10099642 DOI: 10.1186/s13102-023-00669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Studies investigating ankle condition in subjects with chronic ankle instability (CAI) using an on-the-field test battery are scarce. Understanding which tests that are most challenging for these subjects has the potential to set realistic goals in rehabilitation and return-to-sports criteria. Thus, the primary aim of this study was to investigate CAI subjects regarding strength, balance and functional performance with an easily used test battery that required minimal equipment. METHODS This study was conducted with a cross-sectional design. A total of 20 CAI subjects, engaged in sports, and 15 healthy subjects serving as a control group, were tested for assessment of strength, balance and functional performance. A test battery was developed accordingly; isometric strength in inversion and eversion, the single leg stance test (SLS), single leg hop for distance (SLHD) and side hop test. The limb symmetry index was calculated to determine whether a side-to-side lower limb difference could be classified as normal or abnormal. The sensitivity of the test battery was also calculated. RESULTS The subjects were 20% weaker on the injured side compared with the non-injured side in eversion (p < 0.01) and 16% weaker in inversion (p < 0.01) (Table 2). For the SLS test, the mean score of the injured side was 8 points (67%) higher (more foot lifts) compared to the non-injured side (p < 0.01). The mean distance of the SLHD was 10 cm (9%) shorter for the injured side compare to the non-injured side (p = 0.03). The mean number of side hop was 11 repetitions (29%) fewer for the injured side compare to the non-injured side (p < 0.01). Six of the 20 subjects obtained abnormal LSI values in all five tests whereas none obtained normal values in all tests. The sensitivity of the test battery was 100%. CONCLUSION Deficits in muscle strength, balance and functional performance appear to be present in CAI subjects with the largest impairments in balance and side hop performance, which stresses the need for return to sport criteria for this group of subjects. TRIAL REGISTRATION Registered retrospectively on 24/01/2023. NCT05732168.
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Affiliation(s)
- Sofia Ryman Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, Kalmar, SE-391 82, Sweden.
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Anastasio AT, Tabarestani TQ, Bagheri K, Bethell MA, Prado I, Taylor JR, Adams SB. A New Trend in Social Media and Medicine: The Poor Quality of Videos Related to Ankle Sprain Exercises on TikTok. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231171117. [PMID: 37151477 PMCID: PMC10161314 DOI: 10.1177/24730114231171117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Social media platforms, like TikTok, have become popular options for the distribution of health care information. Because of the lack of scientific oversight, the quality of health care-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational benefits of ankle sprain-related TikTok videos. Methods TikTok was queried using the hashtag "#anklesprainexercises." One hundred videos were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise evaluation). We hypothesized that information on TikTok related to ankle sprain exercises would be poor in quality. Results The total number of views of the 100 videos was 6 483 412, with a median of 5377.5 (IQR = 1074-20 275). The videos collectively received 385 847 likes, 3642 comments, 55 574 favorites, and 14 918 shares with a median of 267.5 (IQR = 41.5-1678.0), 4.0 (IQR = 0.0-23.0), 42.0 (IQR = 4.8-264.5), and 13.0 (IQR = 1.8-67.8), respectively. General users had a higher percentage of their videos graded as "very poor" (61.8%) in comparison to the number of videos uploaded by health care professionals deemed "very poor" (34.4%). Neither general user nor health care professionals had videos graded as "good" or "excellent." There were significant differences between the 2 groups for DISCERN 1, 3, and ASSES scores. Conclusion Although TikTok is a powerful tool for information distribution, the educational value of the videos related to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of "fair," and no videos reaching a score of "good" or "excellent," health care professionals should be aware of the low-quality content easily accessible on TikTok. Level of Evidence Level III, cross-sectional study.
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Affiliation(s)
- Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
- Albert T. Anastasio, MD, Department of Orthopedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA.
| | | | - Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Isabel Prado
- Duke University School of Medicine, Durham, NC, USA
| | | | - Samuel B. Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Li R, Qin R, Tan Y, Liu H, Wang K, Cheng L. Effect of kinesio taping intervention on the muscle strength and balance of college basketball players with functional ankle instability. Front Physiol 2023; 14:1064625. [PMID: 37064886 PMCID: PMC10090455 DOI: 10.3389/fphys.2023.1064625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Objective: The aim of this study was to investigate the effects of acute Kinesio Taping (KT) intervention on the muscle strength and balance ability of college basketball players with functional ankle instability (FAI).Methods: Thirty college basketball players with FAI were treated with acute KT to test the changes in their muscle strength and balance ability.Results: After acute KT intervention, the ankle dorsiflexion moment and the ankle plantar flexion moment increased by 34% and 19.9%, respectively. The stable plane test with the subjects’ eyes open decreased by 1%, whereas that with the subjects’ eyes closed decreased by 1.1%. The swaying environment test with the subjects’ eyes open increased by 2.4%. The swaying plane test with the subjects’ eyes open increased by 5.1%, whereas that with the subjects’ eyes closed increased by 16.2%. The swaying environment test with the subjects’ eyes open plus the use of a plane increased by 12.1%.Conclusion: KT can increase the isokinetic strength of the ankle dorsum muscle and plantar flexion of college basketball players with FAI. The effect of KT in the static balance test was weaker than that in the dynamic balance test. The findings indicate that KT can significantly improve the balance ability of college basketball players with FAI during dynamic sports.
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Affiliation(s)
- Rui Li
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Rui Qin
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- *Correspondence: Rui Qin, ; Yajun Tan,
| | - Yajun Tan
- Sport Hospital, Chengdu Sport University, Chengdu, China
- *Correspondence: Rui Qin, ; Yajun Tan,
| | | | - Kun Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Liang Cheng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
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Tennler J, Raeder C, Praetorius A, Ohmann T, Schoepp C. Effectiveness of the SMART training intervention on ankle joint function in patients with first-time acute lateral ankle sprain: study protocol for a randomized controlled trial. Trials 2023; 24:162. [PMID: 36869403 PMCID: PMC9985260 DOI: 10.1186/s13063-023-07195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The lateral ankle sprain (LAS) is the most common injury in the field of everyday and sports-related activities. There is a high rate of patients with LAS who will develop chronic ankle instability (CAI). A possible explanation for this high rate is an insufficient rehabilitation and/or a premature return to intense exercise and workloads. Currently, there are general rehabilitation guidelines for LAS but there is a lack of standardized evidenced-based rehabilitation concepts for LAS, which effectively reduce the high CAI rate. The primary aim of the study is to investigate the effectiveness of a 6-week sensorimotor training intervention (SMART-Treatment, SMART) in contrast to standard therapy (Normal Treatment, NORMT) after an acute LAS on perceived ankle joint function. METHODS This study will be a prospective, single-center, interventional randomized controlled trial with an active control group. Patients (14-41 years) with an acute LAS and a MRI confirmed lesion or rupture of at least one ankle ligament will be included. Exclusion criteria are acute concomitant injuries of the ankle, pre-injuries of the ankle, serious lower-extremity injuries of the last 6 months, lower-extremity surgery, and neurological diseases. The primary outcome measure will be the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes include the Foot and Ankle Ability Measurement (FAAM), isokinetic and isometric strength diagnostics, joint repositioning sense, range of motion, measurements of postural control, gait and run analysis, and jump analysis. This protocol will follow the SPIRIT guidance. DISCUSSION Current management of LAS rehabilitation lacks since there is a high rate of patients developing a CAI. It has been shown that exercise therapy improves ankle function in acute LAS as well as in patients with CAI. It is further recommended to address specific impairment domains in ankle rehabilitation. However, empirical data for such a holistic treatment algorithm is missing. Therefore, this study has the potential to improve the healthcare for LAS patients and might be used for a future standardized evidence-based rehabilitation concept. TRIAL REGISTRATION "Prospectively registered" ISRCTN - ISRCTN13640422 17/11/2021; DRKS (German Clinical Trials Register) - DRKS00026049.
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Affiliation(s)
- Janina Tennler
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany.
| | - Christian Raeder
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany
| | - Arthur Praetorius
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany
| | - Tobias Ohmann
- Research Department, BG Klinikum Duisburg, Duisburg, Germany
| | - Christian Schoepp
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany.,Department of Trauma and Reconstructive Surgery, University Hospital, Essen, Germany
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Wagemans J, Bleakley C, Taeymans J, Kuppens K, Schurz AP, Baur H, Vissers D. Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review. Phys Ther Sport 2023; 60:75-83. [PMID: 36716507 DOI: 10.1016/j.ptsp.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. https://twitter.com/jentewagemans
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; SOMT University of Physiotherpy Education, Amersfort, the Netherlands
| | | | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Negahban H, Daghiani M, Raeesi J, Sayyed Hosseinian SH, Mousavian A, Varasteh Hajipour M, Sahebalam M. Comparing the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability: Randomized controlled trial. Clin Rehabil 2023; 37:362-372. [PMID: 36330694 DOI: 10.1177/02692155221134993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). DESIGN Two-arm, parallel-group, randomized, double-blind, controlled trial. PARTICIPANTS 60 patients with unilateral CAI. INTERVENTION integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). OUTCOMES Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. RESULTS The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95-25.37), meanConventional = 29.46 (24.09-34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). CONCLUSION Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients' functional ability.
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Affiliation(s)
- Hossein Negahban
- School of Paramedical Science, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Orthopaedic Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Daghiani
- School of Paramedical Science, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Raeesi
- School of Paramedical Science, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Alireza Mousavian
- Orthopaedic Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohamad Sahebalam
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, 440827Iran University of Medical Sciences, Tehran, Iran
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Effect of Braces on Performance in the Context of Chronic Ankle Instability. Foot Ankle Clin 2023; 28:145-154. [PMID: 36822684 DOI: 10.1016/j.fcl.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Ankle braces are commonly recommended for prevention of ankle sprains, especially secondary sprains, rehabilitation, and return to normal activity or sport after injury. One common resistance to use is the feeling that braces will impede functional performance. For people with chronic ankle instability, the limited research indicates that the use of semirigid, lace-up, or soft-shell braces will not affect, and in some cases, may enhance performance. Activities that could be enhanced are jumping, hopping, and dynamic balance.
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Wang Y, Li Q, Xue X, Xu X, Tao W, Liu S, Li Y, Wang H, Hua Y. Neuroplasticity of pain processing and motor control in CAI patients: A UK Biobank study with clinical validation. Front Mol Neurosci 2023; 16:1096930. [PMID: 36866356 PMCID: PMC9971622 DOI: 10.3389/fnmol.2023.1096930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Background Pain plays an important role in chronic ankle instability (CAI), and prolonged pain may be associated with ankle dysfunction and abnormal neuroplasticity. Purpose To investigate the differences in resting-state functional connectivity among the pain-related brain regions and the ankle motor-related brain regions between healthy controls and patients with CAI, and explore the relationship between patients' motor function and pain. Study design A cross-database, cross-sectional study. Methods This study included a UK Biobank dataset of 28 patients with ankle pain and 109 healthy controls and a validation dataset of 15 patients with CAI and 15 healthy controls. All participants underwent resting-state functional magnetic resonance imaging scanning, and the functional connectivity (FC) among the pain-related brain regions and the ankle motor-related brain regions were calculated and compared between groups. The correlations between the potentially different functional connectivity and the clinical questionnaires were also explored in patients with CAI. Results The functional connection between the cingulate motor area and insula significantly differed between groups in both the UK Biobank (p = 0.005) and clinical validation dataset (p = 0.049), which was also significantly correlated with Tegner scores (r = 0.532, p = 0.041) in patients with CAI. Conclusion A reduced functional connection between the cingulate motor area and the insula was present in patients with CAI, which was also directly correlated with reduction in the level of patient physical activity.
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Affiliation(s)
- Yiran Wang
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Xiao'ao Xue
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Xiaoyun Xu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Weichu Tao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Sixu Liu
- Department of Biomedical Engineering, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunyi Li
- Department of Biomedical Engineering, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China,Human Phenome Institute, Fudan University, Shanghai, China,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Fudan University, Shanghai, China,He Wang ✉
| | - Yinghui Hua
- Department of Sports Medicine, Fudan University, Shanghai, China,Yiwu Research Institute of Fudan University, Yiwu, China,*Correspondence: Yinghui Hua ✉
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45
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Fong DTP, Mok KM, Thompson IM, Wang Y, Shan W, King MA. A lateral ankle sprain during a lateral backward step in badminton: A case report of a televised injury incident. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:139-144. [PMID: 33744478 PMCID: PMC9923400 DOI: 10.1016/j.jshs.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND This study presents a kinematic analysis of an acute lateral ankle sprain incurred during a televised badminton match. The kinematics of this injury were compared to those of 19 previously reported cases in the published literature. METHODS Four camera views of an acute lateral ankle sprain incurred during a televised badminton match were synchronized and rendered in 3-dimensional animation software. A badminton court with known dimensions was built in a virtual environment, and a skeletal model scaled to the injured athlete's height was used for skeletal matching. The ankle joint angle and angular velocity profiles of this acute injury were compared to the summarized findings from 19 previously reported cases in the published literature. RESULTS At foot strike, the ankle joint was 2° everted, 33° plantarflexed, and 18° internally rotated. Maximum inversion of 114° and internal rotation of 69° was achieved at 0.24 s and 0.20 s after foot strike, respectively. After the foot strike, the ankle joint moved from an initial position of plantarflexion to dorsiflexion-from 33° plantarflexion to 53° dorsiflexion (range = 86°). Maximum inversion, dorsiflexion, and internal rotation angular velocity were 1262°/s, 961°/s, and 677°/s, respectively, at 0.12 s after foot strike. CONCLUSION A forefoot landing posture with a plantarflexed and internally rotated ankle joint configuration could incite an acute lateral ankle sprain injury in badminton. Prevention of lateral ankle sprains in badminton should focus on the control and stability of the ankle joint angle during forefoot landings, especially when the athletes perform a combined lateral and backward step.
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Affiliation(s)
- Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Kam-Ming Mok
- Office of Student Affairs, Lingnan University, Hong Kong 999077, China; Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Isobel M Thompson
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Yuehang Wang
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Wei Shan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK; China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
| | - Mark A King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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Kramer Z, Woo Lee Y, Sherrick R. Acute Ankle Sprains. Clin Podiatr Med Surg 2023; 40:117-138. [PMID: 36368838 DOI: 10.1016/j.cpm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding the types of ankle sprains is essential in determining the most appropriate treatment and preventing substantial missed time from sports. Commonly known and recognized is an acute lateral ankle sprain, however, a differentiation should also be made to understand high (syndesmotic) ankle sprains as the mechanism of injury and recovery periods differ between these two types.
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Affiliation(s)
- Zachary Kramer
- Scripps Memorial Hospital, 310 Santa Fe Drive #112, Encinitas, CA 92024, USA
| | - Yessika Woo Lee
- Dignity Health, St. Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Ryan Sherrick
- Foot & Ankle Surgery, Innovative Medical Solutions Foot & Ankle Institute, 2080 Century Park East, STE 710, Los Angeles, CA 90067, USA
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Zhang J, Wang C, Li X, Fu S, Gu W, Shi Z. Platelet-rich plasma, a biomaterial, for the treatment of anterior talofibular ligament in lateral ankle sprain. Front Bioeng Biotechnol 2022; 10:1073063. [PMID: 36619392 PMCID: PMC9817145 DOI: 10.3389/fbioe.2022.1073063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Because of the rising prevalence of anterior talofibular ligament (ATFL) damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. Platelet-rich plasma (PRP) includes several growth factors linked to a favorable healing response, however none of the studies involved both quality evaluation and clinical results to evaluate this treatment. Purpose: To determine the clinical results of PRP injections into the ATFL in lateral ankle sprain (LAS) patients, as well as the quality of the ATFL based on radiographic outcomes. Methods: Patients with clinically confirmed grade II LAS for the first time (n = 83) were examined. The clinical outcomes of three types of injection methods were evaluated: none, once within 48 h after the sprain, and once more 4 weeks later after first injection. PRP was injected into the tear site of the ATFL using ultrasound guidance, and all ankles were immobilized for 2 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) were used to assess the results at 2, 6, 8, 24, and 48 weeks of follow-up. The signal/noise ratio (SNR) value of Magnetic Resonance Imaging (MRI)-based ATFL signal intensity can disclose ATFL quality. The ATFL SNR results were then assessed 8, 24 and 48 weeks following the first injection to compare ATFL quality. Results: The PRP injection groups outperformed the control group in terms of clinical outcomes, and the two injections group outperformed other groups in terms of pain reduction and functional outcome at 8 weeks. The clinical results of all groups were comparable at 6 and 12 months follow-up. ATFL SNR findings improved significantly across all groups over time. At the same follow-up time, the PRP injection groups outperformed the control group, and the best SNR result showed in the two injections group at the final follow-up. Conclusion: PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. The two PRP injections group produced considerably better clinical results and quality of the ATFL in short-term follow-up.
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Affiliation(s)
- Jieyuan Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Cheng Wang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xueqian Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Shaoling Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Wenqi Gu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai, China,*Correspondence: Wenqi Gu, ; Zhongmin Shi,
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,*Correspondence: Wenqi Gu, ; Zhongmin Shi,
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Moore IS, Bitchell CL, Vicary D, Rafferty J, Robson BC, Mathema P. Concussion increases within-player injury risk in male professional rugby union. Br J Sports Med 2022; 57:bjsports-2021-105238. [PMID: 36588427 PMCID: PMC10086303 DOI: 10.1136/bjsports-2021-105238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union. METHODS This prospective cohort study in Welsh professional male rugby union analysed within-player and between-player injury risk for five common injuries: concussion, thigh haematoma, hamstring muscle strain, lateral ankle sprain and acromioclavicular joint sprain. Survival models quantified within-player injury risk by comparing precommon (before) injury risk to postcommon (after) injury risk, whereas between-player subsequent injury risk was quantified by comparing players who had sustained one of the common injuries against those who had not sustained the common injury. HRs and 95% CIs were calculated. Specific body area and tissue type were also determined for new injuries. RESULTS Concussion increased the within-player overall injury risk (HR 1.26 (95% CI 1.11 to 1.42)), elevating head/neck (HR 1.47 (95% CI 1.18 to 1.83)), pelvic region (HR 2.32 (95% CI 1.18 to 4.54)) and neurological (HR 1.38 (95% CI 1.08 to 1.76)) injury risk. Lateral ankle sprains decreased within-player injury risk (HR 0.77 (95% CI 0.62 to 0.97)), reducing head/neck (HR 0.60 (95% CI 0.39 to 0.91)), upper leg and knee (HR 0.56 (95% CI 0.39 to 0.81)), joint and ligament (HR 0.72 (95% CI 0.52 to 0.99)) and neurological (HR 0.55 (95% CI 0.34 to 0.91)) injury risk. Concussion (HR 1.24 (95% CI 1.10 to 1.40)), thigh haematomas (HR 1.18 (95% CI 1.04 to 1.34)) and hamstring muscle strains (HR 1.14 (95% CI 1.01 to 1.29)) increased between-player subsequent injury risk. CONCLUSION Elevated within-player injury risk was only evident following concussive injuries, while lateral ankle sprains reduced the risk. Both concussion and ankle injuries altered head/neck and neurological injury risk, but in opposing directions. Understanding why management of ankle sprains might be effective, while current concussion management is not at reducing such risks may help inform concussion return to play protocols.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Danielle Vicary
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Ben Charles Robson
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Wu CX, Liu HB, Zhao ZN, Wang YB, Luan ZL. Effects of movement direction and limb dominance on ankle muscular force in sidestep cutting. Med Eng Phys 2022; 110:103914. [PMID: 36564139 DOI: 10.1016/j.medengphy.2022.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 10/11/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Sidestep cutting is a critical movement in sports. However, biomechanical research on sidestep cutting has not hitherto reached a consensus. In order to investigate the effects of limb dominance and movement direction on ankle and subtalar joints during sidestep cutting, twelve physically active male participants were recruited in the present study. Trajectory and ground reaction force data were collected by the motion capture system and force platform. Kinematics, kinetics, and muscle forces information were obtained by running OpenSim. Two-way repeated measures ANOVA was performed with movement direction and limb dominance as independent variables. We found that movement direction had a significant effect on ankle dorsiflexion angle. In contrast, the factor of limb dominance had no effect on ankle and subtalar joints angles. For ankle joint moment, the plantarflexion moment was greater by performing a 45° sidestep cutting or using the dominant limb, while the subtalar joint moment was not affected by these two variables. In terms of muscle forces, the soleus of the dominant limb generated greater plantarflexion muscle force on the sagittal plane, while the non-dominant limb tended to contract more strongly (peroneus longus and peroneus brevis) on the frontal plane to stabilize the subtalar joint. Meanwhile, a smaller sidestep cutting angle made participants generate greater plantarflexion muscle forces (soleus and gastrocnemius). In conclusion, our findings indicated that participants should take limb dominance and movement direction into consideration for enhancing athletic performance and reducing the risk of injury during sidestep cutting.
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Affiliation(s)
- Chen-Xiao Wu
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian 116024, China
| | - Hai-Bin Liu
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian 116024, China
| | - Zhi-Nan Zhao
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian 116024, China
| | - Yu-Bin Wang
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian 116024, China
| | - Zhi-Lin Luan
- Advance Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China.
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Götz M, Riederer A, Richter R. Auswirkungen des Trainings der intrinsischen Fußmuskulatur bei Patienten*innen mit Sprunggelenkinstabilität – ein narrativer Review. SPORTVERLETZUNG · SPORTSCHADEN 2022; 36:188-199. [DOI: 10.1055/a-1888-4848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Zusammenfassung
Hintergrund Sprunggelenkdistorsionen stellen eine der häufigsten Verletzungen im Sport dar und können sich als chronische Sprunggelenkinstabilität manifestieren. In der Therapie und Prävention hat sich ein sensomotorischer Trainingsansatz der sprunggelenkumgebenden Strukturen als wirksam erwiesen. Es gibt Hinweise, dass auch ein Training der intrinsischen Fußmuskulatur beispielsweise die Balance verbessern kann.
Ziel Ziel dieses narrativen Reviews ist die Darstellung der Evidenz eines Trainings der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität.
Methode Im Januar 2022 wurde in den Datenbanken PubMed, Cochrane Library, EBSCOhost, PEDro, SPONET und BISp-Surf eine systematische Literaturrecherche durchgeführt, die durch eine Freihandsuche ergänzt wurde. Dabei sollten Metaanalysen, Systematic Reviews und Interventionsstudien inkludiert werden, die Effekte einer Trainingsform der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität untersuchten. Die qualitative Bewertung der Literatur und Evidenz erfolgte anhand des Risk-of-Bias-Tools (RoB-Tool) des Cochrane Handbook sowie angelehnt an das GRADE-System.
Ergebnisse Fünf randomisierte kontrollierte Studien mit insgesamt 150 Proband*innen wurden inkludiert. Vier Studien nutzten die Short-Foot Exercise (SFE), eine Studie die Towel-Curl Exercise (TCE) und eine wandte ein Training der Zehen an. Drei Studien wiesen einen großen, signifikant positiven Effekt (p<0,05) der SFE auf die subjektive Instabilität auf. Die SFE und das Zehentrainingsprogramm hatten signifikant positive Effekte (p<0,05) auf die Balance, wobei die Einbeziehung der SFE in ein Trainingsprogramm zu keinem Vorteil führte. Eine Studie stellte signifikant positive Auswirkungen (p<0,05) der SFE auf die Somatosensibilität fest. Alle 3 Trainingsformen führten zu deutlichen, signifikanten (p<0,05) Verbesserungen funktioneller Aspekte.
Schlussfolgerung Es zeigen sich positive Effekte durch das Training der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität auf die subjektive Instabilität, Balance, Somatosensibilität sowie auf funktionelle Aspekte. Effektive Trainingsformen scheinen die SFE und ein Zehentraining zu sein, diese könnten eine sinnvolle Ergänzung zur konventionellen Therapie darstellen. Die Qualität der Evidenz ist jedoch zu gering, um eine klare Empfehlung aussprechen zu können.
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Affiliation(s)
- Matthias Götz
- Hochschule Furtwangen, Fakultät Gesundheit, Sicherheit, Gesellschaft, Studienzentrum Freiburg, Furtwangen, GERMANY
| | - Angela Riederer
- Hochschule Furtwangen, Fakultät Gesundheit, Sicherheit, Gesellschaft, Studienzentrum Freiburg, Furtwangen, GERMANY
| | - Robert Richter
- Hochschule Furtwangen, Fakultät Gesundheit, Sicherheit, Gesellschaft, Studienzentrum Freiburg, Furtwangen, GERMANY
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