Abstract:Ankle sprain is one of the most common musculoskeletal sports injury encountered. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee. The purpose of the review study is to study the pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of ankle sprain. There is a high incidence rate of approximately 75% of lateral ankle sprain; it also possesses a high incidence rate of re-injury. Recent researches have proved that immobilization post ankle sprain facilitates ligament healing and enhances the rehabilitative protocol. In addition to that the other treatment protocols are to be implemented as an adjunct for instance graded joint mobilization, proprioceptive training and balance training. Altering current rehabilitative protocol to enhance the joint range of motion and to maintain the soft tissue integrity with stringent immobilization, and including graded joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction.
Keyword:Ankle joint, Sprain, Ligament, Immobilization, Proprioceptive, Pathophysiology, Sports, Athletic, Degeneration.
Lower limb alignment in young female athletes is associated with knee joint m...peertechzpublication
Background: Increased rotational forces and knee valgus forces puts strain on the anterior cruciate
ligament, frequently ruptured in female athletes. Increased internal hip rotation and increased knee valgus
alignment, possible risk factors for anterior cruciate ligament rupture, are more common in women than
men.
In this presentation I’m going to inform you briefly about a novel arthroscopic technique for athletic pubalgia. You may have heard it as “sports hernia or groin injury………” but in fact is a groin pain syndrome, particularly common in sports that require athletes to perform repetitive kicking..
Risk of Anterior Cruciate Ligament Rupture With Generalized Joint Laxity Foll...Apollo Hospitals
THE function of the anterior cruciate ligament (ACL) is to
provide stability to the knee and minimize stress across the knee joint. It restrains excessive forward movement of the tibia in relation to the femur. It also limits rotational
movements of the knee. A hard twist or excessive pressure on the ACL can tear or rupture the ligament, resulting in high levels of short-term disability and extensive rehabilitation. The cost of treatment & rehabilitation of an ACL injured person is also phenomenal.
1. Athletic pubalgia, also known as sports hernia or core muscle injury, is a chronic lower abdominal and groin pain in athletes without a true hernia.
2. It results from an injury to structures like the pubic aponeurosis from opposing forces of the adductor longus and rectus abdominus muscles at the pubic symphysis during athletic activities.
3. Physical examination findings include tenderness over the pubic tubercle and pain with resisted hip adduction or sit-ups reproducing the symptoms. Diagnostic imaging includes pelvic x-rays to evaluate for injuries or conditions like femoroacetabular impingement that may be associated with athletic pubalgia.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
There are several common injuries that can occur in javelin throwers, including injuries to the elbow, shoulder, and back. Key factors that can help prevent these injuries are having proper throwing technique, sufficient strength and conditioning of the whole body, adequate flexibility and joint range of motion, and supervision of athletes. Common elbow injuries include "thrower's elbow" which can result from improper technique producing excess strain on the ligaments. Shoulder injuries often involve displacement of the humeral head and can be addressed through strengthening exercises. Back injuries typically involve muscle strains or stress fractures from the alternating flexion and extension demands on the lumbar spine during the throw.
Lower limb alignment in young female athletes is associated with knee joint m...peertechzpublication
Background: Increased rotational forces and knee valgus forces puts strain on the anterior cruciate
ligament, frequently ruptured in female athletes. Increased internal hip rotation and increased knee valgus
alignment, possible risk factors for anterior cruciate ligament rupture, are more common in women than
men.
In this presentation I’m going to inform you briefly about a novel arthroscopic technique for athletic pubalgia. You may have heard it as “sports hernia or groin injury………” but in fact is a groin pain syndrome, particularly common in sports that require athletes to perform repetitive kicking..
Risk of Anterior Cruciate Ligament Rupture With Generalized Joint Laxity Foll...Apollo Hospitals
THE function of the anterior cruciate ligament (ACL) is to
provide stability to the knee and minimize stress across the knee joint. It restrains excessive forward movement of the tibia in relation to the femur. It also limits rotational
movements of the knee. A hard twist or excessive pressure on the ACL can tear or rupture the ligament, resulting in high levels of short-term disability and extensive rehabilitation. The cost of treatment & rehabilitation of an ACL injured person is also phenomenal.
1. Athletic pubalgia, also known as sports hernia or core muscle injury, is a chronic lower abdominal and groin pain in athletes without a true hernia.
2. It results from an injury to structures like the pubic aponeurosis from opposing forces of the adductor longus and rectus abdominus muscles at the pubic symphysis during athletic activities.
3. Physical examination findings include tenderness over the pubic tubercle and pain with resisted hip adduction or sit-ups reproducing the symptoms. Diagnostic imaging includes pelvic x-rays to evaluate for injuries or conditions like femoroacetabular impingement that may be associated with athletic pubalgia.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
There are several common injuries that can occur in javelin throwers, including injuries to the elbow, shoulder, and back. Key factors that can help prevent these injuries are having proper throwing technique, sufficient strength and conditioning of the whole body, adequate flexibility and joint range of motion, and supervision of athletes. Common elbow injuries include "thrower's elbow" which can result from improper technique producing excess strain on the ligaments. Shoulder injuries often involve displacement of the humeral head and can be addressed through strengthening exercises. Back injuries typically involve muscle strains or stress fractures from the alternating flexion and extension demands on the lumbar spine during the throw.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Sportsman’s hernia is a complex entity with injuries occurring at different levels in the groin region. Each damaged anatomical structure gives rise to a different set of symptoms and signs making the diagnosis difficult. The apprehension of a hernia is foremost in the mind of the surgeon. Absence of a hernia sac adds to the confusion. Hence awareness of this condition is essential for the general surgeon to avoid misdiagnosis.
A course Review from James Moore's Sporting Hip and Groin Course - February 2016 (Highly Recommend!). Following my attendance of the course, i performed my own research on 'The Sporting Hip and Groin' and incorporated this into the course review which I presented to the Sports Science and Medicine staff at Wigan Athletic FC. Further references available upon request.
Overuse injurues in overhead athletes 3vineet bansal
Overuse shoulder injuries are common in overhead athletes such as swimmers, throwers, and racquet sport players. Epidemiological studies show that up to 50% of elite handball players and 67% of elite swimmers experience shoulder pain. Overuse injuries result from repetitive microtrauma to tendons, muscles, ligaments and bones from the overhead motion of these sports. Prevention focuses on reducing training errors and volumes, strengthening the scapular muscles and rotator cuff, and addressing biomechanical faults. Rehabilitation incorporates kinetic chain exercises, eccentric strengthening, and a gradual return to overhead activity.
This document summarizes evidence on treatments for inversion ankle sprains. A systematic review found functional treatment to be more effective than immobilization, resulting in earlier return to sports and work, less swelling and objective instability, and greater patient satisfaction. A randomized controlled trial also found that manual physical therapy combined with exercises led to greater improvements in pain and function over 6 months compared to a home exercise program alone, with a lower recurrence rate. In summary, functional treatment and manual physical therapy are more effective approaches for inversion ankle sprains than immobilization or home exercises alone.
The document discusses injuries that can occur in windmill style softball pitchers, including nerve injuries. It summarizes several studies that found a high percentage (over 70%) of softball players sustained injuries from pitching, most from overuse. Common injuries included strains, peripheral nerve injuries like neurapraxia, and injuries to the shoulder and elbow from the high torques involved in windmill pitching. Improper mechanics can increase risks, while proper mechanics and rest are important for prevention. Nerve injuries like ulnar nerve injuries and musculocutaneous nerve injuries have also been reported. NSAID use is also common among injured pitchers to mask pain. Overall the document emphasizes the importance of examining pitching mechanics and the entire kinetic
Changes in shoulder range of motion after pitching in baseball playersSatoshi Kajiyama
1) A study of 67 professional baseball pitchers found significant decreases in shoulder internal rotation, total shoulder motion, and elbow extension immediately after pitching that persisted for 24 hours.
2) No changes were seen in the non-dominant arm, suggesting the effects were due to the pitching motion itself.
3) The decreases may be due to high eccentric muscle contractions of the shoulder external rotators and elbow flexors during pitching, causing acute musculotendinous adaptations and altered range of motion.
This document discusses work-related musculoskeletal injuries among physical and occupational therapists. It provides background on laws and policies requiring safe patient handling policies. Statistics are presented on prevalence of injuries among PTs and OTs, with the low back, hands, shoulders and neck being most commonly injured body parts. A study found 16.7% of PTs reported multiple injuries over 3 years. Suggestions to reduce injuries include using lift teams, proper body mechanics, ergonomic settings, and insoles like Superfeet which research shows can reduce impact forces.
This document provides an overview of anatomy, biomechanics, diagnosis, and rehabilitation of groin and hip injuries. It begins with the objectives, then covers anatomy and biomechanics, including muscle imbalance and fascial slings. Diagnosis sections cover subjective assessments like mechanisms of injury and objective tests like range of motion and impingement tests. Common pathologies are discussed like athletic pubalgia, labral tears, and adductor and hip injuries. Rehabilitation principles and a progressive exercise plan are outlined.
Maintain joint flexibility and muscle tone with daily aerobic activity. During flare-ups, avoid stress on joints and prolonged standing. A balanced, low-calorie diet is recommended, as obesity is a risk factor for osteoarthritis. Regular strengthening exercises that are tailored to the type of osteoarthritis can help delay needs for surgery and provide relief from pain and stiffness. Gentle, low-impact sports and assistive devices may also help protect joints and reduce pain.
Female athletes are 4 times more likely than males to suffer ACL tears, with around 200,000 occurring annually in the US. This is due to various intrinsic and extrinsic risk factors in females, such as smaller ACL size, increased knee laxity, and quadriceps-dominant muscle activation patterns. Females also tend to land with more extended knees and increased valgus angles. Prospective studies show that neuromuscular training programs focusing on improving landing mechanics, increasing hamstring activation, and enhancing proprioception can significantly reduce the risk of ACL tears in female athletes.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
This document summarizes components of ACL injury prevention programs including dynamic warmups, plyometrics, strengthening, proprioception, agilities, and flexibility exercises. It discusses studies that showed training programs incorporating jump training, strength training, and plyometrics reduced ACL injury rates in female athletes compared to untrained groups. The PEP program at USC demonstrated an up to 88% reduction in ACL injuries compared to control groups. Effective prevention programs address all phases to develop neuromuscular control and coordination to reduce risky movement patterns.
The document discusses hamstring tendon avulsion injuries, repair surgery, and rehabilitation. It describes the anatomy of the three main hamstring tendons - biceps femoris, semimembranosis, and semitendinosis. Hamstring injuries typically occur due to strong eccentric contractions when the knee is extended and hip is flexed. Surgical repair is recommended for complete avulsions. Post-surgical rehabilitation is divided into four phases, starting with non-weight bearing and progressing to running, cutting, and sport-specific drills over 3-6 months before returning to full activity.
Bryan English - classification of muscle injuries in sportMuscleTech Network
Bryan English
Medical Director Middlesbrough Football Club. Member of Technical Advisory Group in Sports Science. The English Institute of Sport
-
Terminology and classification of muscle injuries in sport: a Munich consensus statement
(6th MuscleTech Network Workshop)
14th October, Barcelona
This document provides background information and outlines a study examining the effect of physical therapy on post-operative hip osteoarthritis patients. It introduces the problem of hip injuries and osteoarthritis in elderly patients. The purpose is to determine if physical therapy can help patients regain mobility after hip replacement surgery for osteoarthritis. The study will observe 5 patients undergoing physical therapy after surgery, measuring their range of motion and pain levels over time. It is hypothesized that physical therapy programs can improve range of motion for these patients.
A SYSTEMATIC REVIEW STUDY TO DETERMINE THE CAUSATIVE FACTORS AND THE REHABILI...paperpublications3
This document summarizes a systematic review study that examined the causative factors and rehabilitation approaches for lateral ankle sprains. The review studied the pathophysiology, predisposing risk factors, and current evidence on therapeutic modalities and exercises used to treat ankle sprains. The review found that immobilization after ankle sprains facilitates ligament healing and rehabilitation. Graded joint mobilization, proprioceptive training, and balance training should also be included as adjunct treatments.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Sportsman’s hernia is a complex entity with injuries occurring at different levels in the groin region. Each damaged anatomical structure gives rise to a different set of symptoms and signs making the diagnosis difficult. The apprehension of a hernia is foremost in the mind of the surgeon. Absence of a hernia sac adds to the confusion. Hence awareness of this condition is essential for the general surgeon to avoid misdiagnosis.
A course Review from James Moore's Sporting Hip and Groin Course - February 2016 (Highly Recommend!). Following my attendance of the course, i performed my own research on 'The Sporting Hip and Groin' and incorporated this into the course review which I presented to the Sports Science and Medicine staff at Wigan Athletic FC. Further references available upon request.
Overuse injurues in overhead athletes 3vineet bansal
Overuse shoulder injuries are common in overhead athletes such as swimmers, throwers, and racquet sport players. Epidemiological studies show that up to 50% of elite handball players and 67% of elite swimmers experience shoulder pain. Overuse injuries result from repetitive microtrauma to tendons, muscles, ligaments and bones from the overhead motion of these sports. Prevention focuses on reducing training errors and volumes, strengthening the scapular muscles and rotator cuff, and addressing biomechanical faults. Rehabilitation incorporates kinetic chain exercises, eccentric strengthening, and a gradual return to overhead activity.
This document summarizes evidence on treatments for inversion ankle sprains. A systematic review found functional treatment to be more effective than immobilization, resulting in earlier return to sports and work, less swelling and objective instability, and greater patient satisfaction. A randomized controlled trial also found that manual physical therapy combined with exercises led to greater improvements in pain and function over 6 months compared to a home exercise program alone, with a lower recurrence rate. In summary, functional treatment and manual physical therapy are more effective approaches for inversion ankle sprains than immobilization or home exercises alone.
The document discusses injuries that can occur in windmill style softball pitchers, including nerve injuries. It summarizes several studies that found a high percentage (over 70%) of softball players sustained injuries from pitching, most from overuse. Common injuries included strains, peripheral nerve injuries like neurapraxia, and injuries to the shoulder and elbow from the high torques involved in windmill pitching. Improper mechanics can increase risks, while proper mechanics and rest are important for prevention. Nerve injuries like ulnar nerve injuries and musculocutaneous nerve injuries have also been reported. NSAID use is also common among injured pitchers to mask pain. Overall the document emphasizes the importance of examining pitching mechanics and the entire kinetic
Changes in shoulder range of motion after pitching in baseball playersSatoshi Kajiyama
1) A study of 67 professional baseball pitchers found significant decreases in shoulder internal rotation, total shoulder motion, and elbow extension immediately after pitching that persisted for 24 hours.
2) No changes were seen in the non-dominant arm, suggesting the effects were due to the pitching motion itself.
3) The decreases may be due to high eccentric muscle contractions of the shoulder external rotators and elbow flexors during pitching, causing acute musculotendinous adaptations and altered range of motion.
This document discusses work-related musculoskeletal injuries among physical and occupational therapists. It provides background on laws and policies requiring safe patient handling policies. Statistics are presented on prevalence of injuries among PTs and OTs, with the low back, hands, shoulders and neck being most commonly injured body parts. A study found 16.7% of PTs reported multiple injuries over 3 years. Suggestions to reduce injuries include using lift teams, proper body mechanics, ergonomic settings, and insoles like Superfeet which research shows can reduce impact forces.
This document provides an overview of anatomy, biomechanics, diagnosis, and rehabilitation of groin and hip injuries. It begins with the objectives, then covers anatomy and biomechanics, including muscle imbalance and fascial slings. Diagnosis sections cover subjective assessments like mechanisms of injury and objective tests like range of motion and impingement tests. Common pathologies are discussed like athletic pubalgia, labral tears, and adductor and hip injuries. Rehabilitation principles and a progressive exercise plan are outlined.
Maintain joint flexibility and muscle tone with daily aerobic activity. During flare-ups, avoid stress on joints and prolonged standing. A balanced, low-calorie diet is recommended, as obesity is a risk factor for osteoarthritis. Regular strengthening exercises that are tailored to the type of osteoarthritis can help delay needs for surgery and provide relief from pain and stiffness. Gentle, low-impact sports and assistive devices may also help protect joints and reduce pain.
Female athletes are 4 times more likely than males to suffer ACL tears, with around 200,000 occurring annually in the US. This is due to various intrinsic and extrinsic risk factors in females, such as smaller ACL size, increased knee laxity, and quadriceps-dominant muscle activation patterns. Females also tend to land with more extended knees and increased valgus angles. Prospective studies show that neuromuscular training programs focusing on improving landing mechanics, increasing hamstring activation, and enhancing proprioception can significantly reduce the risk of ACL tears in female athletes.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
This document summarizes components of ACL injury prevention programs including dynamic warmups, plyometrics, strengthening, proprioception, agilities, and flexibility exercises. It discusses studies that showed training programs incorporating jump training, strength training, and plyometrics reduced ACL injury rates in female athletes compared to untrained groups. The PEP program at USC demonstrated an up to 88% reduction in ACL injuries compared to control groups. Effective prevention programs address all phases to develop neuromuscular control and coordination to reduce risky movement patterns.
The document discusses hamstring tendon avulsion injuries, repair surgery, and rehabilitation. It describes the anatomy of the three main hamstring tendons - biceps femoris, semimembranosis, and semitendinosis. Hamstring injuries typically occur due to strong eccentric contractions when the knee is extended and hip is flexed. Surgical repair is recommended for complete avulsions. Post-surgical rehabilitation is divided into four phases, starting with non-weight bearing and progressing to running, cutting, and sport-specific drills over 3-6 months before returning to full activity.
Bryan English - classification of muscle injuries in sportMuscleTech Network
Bryan English
Medical Director Middlesbrough Football Club. Member of Technical Advisory Group in Sports Science. The English Institute of Sport
-
Terminology and classification of muscle injuries in sport: a Munich consensus statement
(6th MuscleTech Network Workshop)
14th October, Barcelona
This document provides background information and outlines a study examining the effect of physical therapy on post-operative hip osteoarthritis patients. It introduces the problem of hip injuries and osteoarthritis in elderly patients. The purpose is to determine if physical therapy can help patients regain mobility after hip replacement surgery for osteoarthritis. The study will observe 5 patients undergoing physical therapy after surgery, measuring their range of motion and pain levels over time. It is hypothesized that physical therapy programs can improve range of motion for these patients.
A SYSTEMATIC REVIEW STUDY TO DETERMINE THE CAUSATIVE FACTORS AND THE REHABILI...paperpublications3
This document summarizes a systematic review study that examined the causative factors and rehabilitation approaches for lateral ankle sprains. The review studied the pathophysiology, predisposing risk factors, and current evidence on therapeutic modalities and exercises used to treat ankle sprains. The review found that immobilization after ankle sprains facilitates ligament healing and rehabilitation. Graded joint mobilization, proprioceptive training, and balance training should also be included as adjunct treatments.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
Anterior Cruciate Ligament Injury: Identification of Risk Factors and Prevent...Fernando Farias
Injury to the anterior cruciate ligament (ACL) is common and affects
young individuals, particularly girls, who are active in sports that involve
jumping, pivoting, as well as change of direction. ACL injury is associ-
ated with potential long-term complications including reduction in ac-
tivity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors
have been identified, which include anatomic variations, neuromuscular
deficits, biomechanical abnormalities, playing environment, and hormonal
status. Multicomponent prevention programs have been shown to be ef-
fective in reducing the incidence of this injury in both girls and boys. Pro-
grams should include a combination of strengthening, stretching, aerobic
conditioning, plyometrics, proprioceptive and balance training, as well as
education and feedback regarding body mechanics and proper landing
pattern. Preventive programs should be implemented at least 6 wk prior to
competition, followed by a maintenance program during the season.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
This document summarizes a study investigating the impact of ankle guards on ankle injuries in basketball. The study aimed to identify the most common injury types and mechanisms, and examine if ankle guard use affects injury prevalence and severity. Participants completed a questionnaire on ankle injuries and guard use. Results found minor differences in variables between guard users and non-users, and no significant differences (p<0.05) in variables based on guard use. Overall, the findings suggest no benefit to wearing ankle guards for reducing injury prevalence or severity in basketball.
Introduction
Achilles Tendon, the largest and strongest tendon in the human body is formed by fusion of the tendinous portion of calf muscles; the gastrocnemius and soleus [1,2]. Achilles tendon can largely with stand tensional forces of locomotion. The incidence of Achilles tendon injuries has increased considerably during the pastdecade [1-5]. Such injuries account for 45% of all sports related injuries among athletes and general public. Achilles tendon complaints generally represent most tendon problems in any population and can be divided into “Spontaneous ruptures” (excessive loadinginduced injury/degeneration of tendon without any predisposing systemic diseases); and “Overuse injuries” (traced to sports and exercise-related overuse). Sometimes, a systemic disease, such as rheumatoid arthritis may manifest with Achilles tendon symptoms, but this represents only a minority (~2%) of all cases [1,6].
This document discusses the case of a 35-year-old man who sustained a Grade 2 sprain of his right ankle while playing basketball. On examination, swelling and discoloration were observed over the anterior and lateral ankle, with increased pain on inversion and plantarflexion tests. Radiographs showed no fracture but instability of the anterior talofibular ligament. The document then provides background information on ankle anatomy, classifications of ankle sprains, symptoms, diagnostic tools and differential diagnoses, non-surgical and surgical management options, and evidence for various rehabilitation techniques.
This document discusses the case of a 35-year-old man who sustained a Grade 2 sprain of the anterior talofibular ligament in his right ankle while playing basketball. On examination, swelling and discoloration were observed over the anterior and lateral ankle, with increased pain on inversion and plantarflexion tests. Radiographs did not reveal any fractures. The document then provides background information on ankle anatomy, the classification of ankle sprains, signs and symptoms, epidemiology, diagnostic tests, differential diagnoses, conservative and surgical management options, and the evidence for rehabilitation techniques.
Hip pain is a common presentation that can affect patients of all ages. The differential diagnosis of hip pain is broad and includes both intra-articular and extra-articular pathology that varies by age. A thorough history and physical examination are essential to accurately diagnose the cause of hip pain. Initial imaging should include an x-ray of the pelvis and hip, while MRI is useful for detecting soft tissue injuries. Magnetic resonance arthrography is particularly helpful for diagnosing labral tears within the hip joint.
This document provides a literature review on pelvic complex fractures and rehabilitation. It discusses the epidemiology, mechanisms of injury, classifications, complications, management, and rehabilitation of pelvic fractures. Evidence is presented from several studies on topics like venous thromboembolism rates after pelvic fractures, urethral injuries associated with pelvic fractures, and mobility outcomes in elderly patients with pelvic fractures. The review covers classifications including Tile's and Young-Burgess systems and classifications of acetabular and sacral fractures. Rehabilitation protocols are summarized from studies on postoperative management and mobilization after surgical fixation of pelvic fractures.
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Stemcell Research Paper on avascular necrosis-AVN-by Dr.Pradeep MahajanDr Pradeep Mahajan
This case report describes the treatment of a 35-year-old male patient with avascular necrosis of the left femoral head using a cell-based therapy. The patient had a 10-year history of left hip pain and was diagnosed with stage II avascular necrosis. He underwent a treatment involving harvesting bone marrow concentrate, stromal vascular fraction from adipose tissue, and platelet-rich plasma, which were injected into the affected area. Follow-up over one year showed improved hip range of motion and pain, and radiological evidence of reduced necrosis and improved joint space. The report concludes the cell-based treatment halted progression of avascular necrosis in this patient.
Osteoartritis (OA) adalah salah satu jenis artritis yang paling sering dialami oleh sebagian orang. Penyakit ini merupakan penyakit sendi degeneratif yang mempengaruhi tulang rawan persendian. OA terjadi akibat rusaknya kartilago yang melindungi dan memberi bantalan bagi sendi.
A Study to Evaluate Spatial Gait Parameters in Patients of Osteoarthritic KneeIOSR Journals
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A SYSTEMATIC REVIEW STUDY TO DETERMINE THE CAUSATIVE FACTORS AND THE REHABILITATIVE APPROACH FOR LATERAL ANKLE SPRAIN
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A SYSTEMATIC REVIEW STUDY TO DETERMINE THE CAUSATIVE FACTORS AND THE REHABILITATIVE APPROACH FOR LATERAL ANKLE SPRAIN
1SHASHANK GHAI, 2ISHAN GHAI
1Physiotherapist, Savig Healthcare Clinic, New Delhi, India
2Research Scholar, Jacobs University gGmbh, Bremen, Germany
Abstract: Ankle sprain is one of the most common musculoskeletal sports injury encountered. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee. The purpose of the review study is to study the pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of ankle sprain. There is a high incidence rate of approximately 75% of lateral ankle sprain; it also possesses a high incidence rate of re-injury. Recent researches have proved that immobilization post ankle sprain facilitates ligament healing and enhances the rehabilitative protocol. In addition to that the other treatment protocols are to be implemented as an adjunct for instance graded joint mobilization, proprioceptive training and balance training. Altering current rehabilitative protocol to enhance the joint range of motion and to maintain the soft tissue integrity with stringent immobilization, and including graded joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction.
Keywords: Ankle joint, Sprain, Ligament, Immobilization, Proprioceptive, Pathophysiology, Sports, Athletic, Degeneration.
I. INTRODUCTION
The lateral ankle sprain is amongst the most common injuries sustained during athletic/recreational activities. Specifically, more than 45,000 ankle sprains are estimated to occur per day in Europe. Despite the frequency of lateral ankle sprain, the trauma is often erroneously believed to be an inconsequential injury. As a consequence of the societal insignificance assigned to lateral ankle sprain, about 55% of people who suffer from an ankle sprain do not seek treatment from a health care professional thus, the true incidence of trauma may be much larger. Around 70% of the patients that suffer from repetitive lateral ankle sprain experience chronic symptoms after the initial injury in case the condition is left unattended. The development of these residual symptoms has been termed chronic ankle instability1. Not only does the chronic ankle instability limit physical activity, but also leads to articular degeneration of the talus, and thus increasing the risk of degenerative osteoarthritis. With the high incidence of chronic ankle instability and potential for the development of ankle osteoarthritis, it is essential that the lateral ankle sprain is managed effectively from the onslaught2-5. The aim of this systemic review is to study three important aspects that are important to properly manage lateral ankle sprain and to prevent the development of chronic ankle instability:
The pathophysiology of lateral ankle sprain.
Predisposing factors relating to lateral ankle sprain.
The current evidence regarding therapeutic modalities and exercises used for treating the lateral ankle sprain.
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Diagram 1
II. PATHOPHYSIOLOGY
The lateral ankle sprain results in impairment to the passive ligamentous structures of the ankle joint. Indeed, forceful ankle plantar flexion and inversion, the most common mechanism of injury, often leads to tearing of the lateral ligaments of the ankle. Specifically, the anterior talofibular ligament (Diagram 1.0) reported to be the weakest is first ligament injured 4-9. Trauma to the anterior talofibular ligament is followed by additional damage to the calcaneofibular ligament and finally to the posterior talofibular ligament. Isolated injury to the anterior talofibular ligament occurs in 66% of lateral ankle sprain while anterior talofibular ligament and calcaneofibular ligament ruptures occur concurrently in another 20%7. Trauma to the posterior talofibular ligament is highly uncommon because of the great amount of force required to do impairment, as considerably as the amount of dorsiflexion needed to strain the ligament. The level of dorsiflexion required to filter out the posterior talofibular ligament places the ankle joint in a compact state and so adjusting it in a more stable position which cuts the likeliness of harm to the ligament8-10. In summation to the lateral ligament structures of the talocrural joint, the subtalar ligaments are also prone be injured. Rubin and Witten were the first to examine the subtalar instability as an independent clinical entity; however, they assumed that injury to the subtalar joint often occurs in combination with injury to the lateral ankle ligaments11-13.
Further, the incidence of subtalar instability is estimated to be in between 70% to 85% in individuals with chronic ankle instability12-14. With damage to the ligaments supports of the ankle post a lateral ankle sprain, an associated increase in the motion available between the bones of the ankle/foot complex occurs15. The resulting hypermobility can be measured qualitatively and by trial and error by implementing various clinical techniques such as manual stress tests, instrumented arthrometry and stress radiographs. In order to regain stability of the ankle joint, immediate care and rehabilitation should focus upon enhancing ligament reconstruction. In the acute duration the rehabilitation is procured by protecting the joint by immobilizing it by using protective braces and using crutches for locomotion further slowly adding exercises that aid the newly laid down collagen align along the forces of the ankle. The review study postulates that it contains about six weeks for ligament healing to take place. However, studies have also documented joint laxity six months post injury16. The chronic laxity developed might be as a consequence of inappropriate rehabilitation, this demands the need for further study into the type of attention and treatment that will best facilitate tissue healing, and normal joint use17-22.
III. PREDISPOSING RISK FACTORS
Determining the predisposing risk factors is essential in preventing lateral ankle sprain. Indeed, this kind of review study attempts to identify specific characteristics (both intrinsic and extrinsic) that increase an individual‟s chance of suffering a lateral ankle sprain20-23. Nevertheless, the greatest benefit of risk factor research is that the findings allow clinicians to
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apply focused therapeutic interventions to compensate and/or limit the effects of identifying risk genes. A few prospective studies that have examined the predisposing factors related to lateral ankle sprain, but the researches that had been conducted have reported several intrinsic and extrinsic risk factors. Numerous intrinsic factors have been examined, but the most correlated factor is a chronicle of a previous ankle sprain24. Unfortunately, the literature studies remain contradictory upon the thing, with several studies reporting that a history of a previous lateral ankle sprain both increases and has no effect on an individual‟s risk of having a recurrent lateral ankle sprain. Additional factors that have been reported to enhance an individual‟s risk of recurrent lateral ankle sprain, including: height and weight, limb dominance, ankle joint laxity, anatomical alignment, muscle strength, muscle reaction time and postural sway25. Further prospective research is necessary to better understand if these factors actually predispose patients to lateral ankle sprain. Standardized to the intrinsic risk factors, the literature has consistently reported that patients with a previous account of lateral ankle sprain who wear ankle braces or use supportive taping have lower incidence of lateral ankle sprain than those that do not24-29. Research hypothesizes that the reduction in lateral ankle sprain may be preferable to either the mechanical support, i.e. bracing or taping and with the enhanced proprioception offered by the proprioceptive training. Established on the available evidence, it seems that those patients who earlier had suffered from lateral ankle sprain should wear ankle braces and/or athletic tape when taking part in physical activity as it is an efficient way of preventing recurrent lateral ankle sprain. An analysis conducted by Olmsted et al indicated that braces are better in terms of price savings compared to taping. Other extrinsic factors that have been examined include shoe type, duration and strength of competition and player status11,30-35. The research has not shown either factor to significantly increase or decrease the risk of developing or injuring the ankle. Further prospective research is required to evaluate both intrinsic and extrinsic factors relating to the lateral ankle sprain. The evidence however proves ankle bracing as the most efficient method to manage lateral ankle sprain31-36.
IV. MANAGEMENT STRATEGIES
Acute lateral ankle sprain management typically involves pressure, rest, ice, compression, elevation (PRICE) further electrotherapeutic modalities, for example (TENS) transcutaneous electrical stimulation, (IFT) Interferential therapy, (LASER) therapy light amplification and stimulated emission of radiation can also be implemented to stipulate soft issue injury. In addition, that implementation of restrictive taping, bandaging and bracing is also beneficial. Severe lateral ankle sprain cases are to be treated with strict immobilization for a few days until optimal recovery has taken place and inflammation subsided37. Numerous investigations have evaluated the efficacy of rehabilitation techniques in improving clinical outcomes post lateral ankle sprain. The inquiries have been principally concentrated on short term outcomes, including: pain, range of motion. Even so, the high share of injury occurrence (up to 70%) and development of chronic ankle instability (up to 75%) after a lateral ankle sprain, suggests that further research of both short and long-term outcomes following rehabilitation is required8,38-46. Currently, cross-sectional and case control investigations have identified numerous mechanical and neuromuscular impairments in subjects suffering with chronic ankle instability and post-traumatic ankle osteoarthritis, the long-term sequel of acute lateral ankle sprain. Researchers have argued that many of these handicaps can be processed with a mixture of healing modalities and practices. The three impairments that have been implicated as causal agents of chronic ankle instability, and are the focus of this review study they include increased joint laxity, arthrokinematic impairments, and balance deficits45-52.
V. ACUTE CARE/IMMOBILIZATION PHASE
Immediately post a lateral ankle sprain the primary goals are to effectively manage pain, control inflammation and protect the joint so that the healing process can be started. In the intense form of healing, the most important structures to protect are the lateral ligaments of the ankle, as the traumatic mechanism have caused increased laxity in the joint structure. In the past, the majority of the studies has focused upon functional rehabilitation post a lateral ankle sprain25,38,42,52-54. But with the high recurrence rates of lateral ankle sprain and further development of chronic ankle instability later, which results in the development of degenerative arthritis at the ankle joint. Nevertheless, functional rehabilitation may not permit enough time for the ligaments of the ankle to heal and the stability to be repaired. Indeed, increased laxity has been described using both subjective, i.e. ankle giving way, or notions of instability and objective i.e. manual stress tests, radiographs outcome measures55. Unfortunately, ankle laxity often persists despite treatment. Specifically, positive anterior drawer tests were present in approximately 3%–31% of subjects six months after injury and feelings of instability were present in 7%–42% of subjects up to one year post injury. There remains a large need for data obtained from reliable and
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quantifiable methods of measuring ankle laxity. For instance, Hubbard and Cordova assessed the natural recovery of ankle ligament laxity post-acute lateral ankle sprain with an instrumented ankle arthrometer. More specifically, the authors quantified the anterior-posterior load displacement and inversion eversion rotational laxity characteristics of the ankle subtalar joint complex within three days after injury and again eight weeks after trauma43,56-63. The results indicate that ankle laxity did not significantly decrease over eight weeks, which suggests that the lateral ligaments of the ankle need to be protected for a longer period than eight weeks if mechanical stability is to be restored post an acute lateral ankle sprain. These studies however provide strong evidence that better and longer protection of the ankle joint post an acute lateral ankle sprain is essential for restoring the mechanical stability of the ankle joint64. If mechanical stability is not fixed, increased laxity would further contribute to mechanical adaptations for instance greater laxity in joint structures, altered joint alignment and deficits in sensorimotor control, i.e. impaired balance, altered movement patterns and recurrent injury as a maladaptive compensation of the alterations in joint laxity and/or sensorimotor control8,65. To help examine the effects of immobilization, a multicenter prospective randomized controlled test was conducted examining three different mechanical supports, for example Aircast brace, Bledsoe boot compared with that of a dual-layer tubular compression bandage in promoting recovery post severe lateral ankle sprain. A total of 584 patients with lateral ankle sprain were followed over nine months. The principal issue was that the quality of ankle function measured using the foot and ankle score. The research proclaimed that the patients that received a below knee cast had a more speedy recovery than those compared to the tubular compression bandage with clinically significant benefits in quality of ankle function three months post trauma, Bledsoe boots though were reported to be the least effective treatment throughout the recovery period66-73. Established on the data, a short period of immobilization in a below knee cast or Aircast ankle brace may result in faster recovery than the current measure of rehabilitation. In summation to that the researchers recommended the below knee cast because it presented the wide range of benefit. Nevertheless, future research is needed to find out if similar benefits will be establish in more objective standards such as ligament laxity and postural control36,58,63,72-75. A research concluded by Beynnon et al also examined the type of immobilization that had the best results. The authors stratified acute lateral ankle sprain based on the degree (I, II, or III). Patients were then randomized to undergo functional treatment with different cases of ankle immobilization. They compared a lateral ankle spraintic wrap, Air Stirrup ankle brace, Air stirrup ankle brace with a lateral ankle spraintic wrap and fiber lateral ankle sprains walking cast. They reported that the treatment of grade I and grade II ankle sprains with the help of Air Stirrup brace combined with a lateral ankle spraintic wrap allowed patients to return to preinjury function quicker than the other immobilizers. For grade III sprains, there were no differences between the Air stirrup brace and the fiber Lateral ankle sprains walking cast71-79. The topics in the research conducted by the Lamb et al study were studied to have severe ankle sprains, which may be why they reported the below-knee cast as most favorable. In less severe sprains less stringent immobilization like an Air Stirrup brace combined with a lateral ankle spraintic wrap may best restore function, but in more serious cases the below knee cast may best enable return to normal function28,37,39,56. Established along the research available to treat an acute lateral ankle sprain, some kind of immobilization needs to be applied to help protect the joint and allow ligament healing to take place. Thus, lateral ankle sprints or tubular wraps are not recommended because research suggests that they do not offer enough shelter to permit return of social occasion. An Air Stirrup brace with lateral ankle sprints wraps for grade I and grade II, and below knee casts for grade III sprain might be the most efficient treatment strategy to preclude long term pathology. After a period of controlled immobilization functional exercises are necessary to rehabilitate the joint80-86.
VI. JOINT MOBILIZATIONS
To date a range of manipulative therapy techniques including Maitland‟s mobilizations, Mulligan‟s mobilizations with movement, and High velocity, low amplitude thrusts, have all been postulated to be effective treatment methods for acute lateral ankle sprain. Indeed, manipulative therapy techniques are theorized to reduce pain, improve function and increase range of motion via the restoration of arthro-kinematic motions i.e. rolling, gliding, spinning motion of the joint surfaces upon each other thus recommendations to employ these techniques make intuitive sense. Further, at that place is a heavy deal of anecdotal evidence in the form of published case studies backing the role of manipulative therapies to improve various outcome measures in acute lateral ankle sprain, a recent follow-up study indicated that multiple high velocity, low amplitude thrusts delivered over several treatment sessions resulted in a statistical trend towards improving pain, pressure scores and self-report levels of pain upon a Visual analog scale33,43,56-59,73,87-90. Further, a single treatment session, which involved multiple osteopathic and manipulative techniques, immediately reduced self-reported pain relative to a control group in patients with an acute lateral ankle sprain. Similarly, studies that used multiple manipulative techniques delivered over several treatment sessions reported significant improvements in pain outcome measures91. Therefore, the current data
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strongly indicate that multiple manipulative therapy treatments are exceedingly good to improve outcome measures associated with pain in patients with an acute lateral ankle sprain92. However, the exact number of treatments and the dosage within each treatment session remains unknown and should be the focus of future research prospects. The available literature also suggests that both active and passive range of motion has improved following the rescue of multiple treatment sessions consisting of Maitland‟s mobilization and high velocity low amplitude thrusts90-93. Additionally, significant improvement in non-weight bearing range of apparent movement was described after the legal transfer of a variety of manipulative therapy techniques over a two week intervention. Nevertheless, single treatment sessions regardless of the manipulative therapy technique used have failed to improve range of motion in patients with an acute lateral ankle sprain, in patients who had earlier suffered from lateral ankle sprain more than six months prior to testing, and in uninjured controls54,66-75,88-91. Therefore, the cumulative data suggest that multiple treatment sessions are required to assess the range of motion improvements in patients suffering from an acute lateral ankle sprain. Nevertheless, substantial improvements in dorsiflexion range of motion have been reported after just a single treatment session of Maitland‟s mobilizations in patients who underwent a lengthy period of ankle immobilization for a sort of pathological conditions. Therefore, it seems that even if acute lateral ankle sprain patients are immobilized following a lateral ankle sprain, ankle joint mobilizations could be utilized to help restore range of movement. Additionally, investigations that used several techniques during multiple treatment sessions also found improvements in self-reported use. Likewise, a single treatment session consisting of two manipulative therapy techniques leads to an immediate redistribution of foot loading patterns during static stance relative to a placebo laying of hands procedure in patients with acute grade II lateral ankle sprain77,81-91. Based on this evidence, it appears that multiple treatment sessions are needed to consistently see improvements in a variety of outcome measures, regardless of the specific manipulative therapy technique used, in patients with an acute lateral ankle sprain. All the same, no investigation has directly compared the strength of different manipulative therapy techniques on any outcome measures in patients with an acute lateral ankle sprain. Hence, direct comparisons of manipulative therapy techniques should be the focal point of the future research endeavors.
VII. BALANCE EXERCISES
One of the most commonly examined sensorimotor outcome measured post the lateral ankle sprain is single leg postural control. A prospective investigation has demonstrated that single leg postural control is impaired for at least four weeks post trauma. Further, recent systematic reviews have shown that postural control is impaired on both the involved as well as the uninvolved limb relative to an uninjured control group within six weeks of a lateral ankle sprain. The presence of bilateral balance impairments as well as bilateral alterations at joints proximal to the ankle suggests changes in the motor control patterns that are centrally mediated44,67-73,91. Further, impaired postural control is linked with an increased danger of ankle injury and because of this strong association; balance training is a common part of therapeutic intervention programs used by allied health care practitioners to handle an acute lateral ankle sprain. Fortunately, balance training is efficient in improving postural control scores in subjects with an acute lateral ankle sprain and at reducing the risk of recurrent lateral ankle sprains. The effectiveness of balance training is hypothesized to be preferable to the modality‟s ability to repair and/ or correct feed-forward and feedback neuromuscular control alterations that have taken place as a consequence of a lateral ankle sprain. Indeed, neural adaptations occur at multiple sites within the central nervous system as a result of balance training intervention programs. In other words, balance training capitalizes on the incredible lateral ankle sprain possibilities of the central nervous system and enhances a patient‟s ability to react to both internal and external perturbations. While balance training improves postural control the exact treatment dosage needed to cause balance improvements and cut down the risk of recurrent injury remains unknown93,95. For example, postural control improvements have been reported after only three days and after weeks of balance training. While rapid improvements are extremely exciting to patients and clinicians alike, Bahr reports that the longer a correspondence training program is implemented the greater preventative effects accrue from the plan. Balance training, investigations primarily use prospective cohort designs where the baseline measures represent postural control prior to the intervention but not pre- injury postural control values. So while the literature suggests that balance training improves postural control, it is not clear if balance training restores postural control to pre-injury balance values. While balance training is efficient in restoring postural control, recent investigations have identified several adjunctive treatments that may further heighten the strength of balance training including stochastic resonance and the patient‟s attentional focus. Stochastic resonance is the entry of low degrees of sub sensory or mechanical disturbance into the nervous system during balance training. This technique is thought to enhance the sensorimotor system‟s ability to detect afferent information from a number of origins which is believed to subsequently result in a more efficient motor response from the cardinal nervous system, a vital
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element for maintaining equilibrium along the neurological and musculoskeletal structures91-97. Stochastic resonance has improved postural stability in healthy young and elderly people when compared to postural stability tests without stimulation present. Additionally, stochastic resonance stimulation applied during balance training improved both static and dynamic postural stability before and with greater efficacy than balance, coordination training alone in both healthy and subjects with chronic ankle instability88, 92-96. However, the effectiveness of stochastic resonance in patients with acute lateral ankle sprain has not been investigated. Attentional focus, principally in the area of motor control has also been investigated in an attempt to enhance learning motor skills including postural control. There are two types of attentional focus: internal attentional focus and external attentional focus. An instance of internal attentional focus is when a clinician instructs the patient to „stand as yet as possible‟ when completing a balance training task and/or course of study. These instructions address the patient‟s attention towards themselves and emphasize an internal attentional focus. Nevertheless, research shows that an external attentional focus, i.e. focusing on the result of their movement enhances motor skill learning more effectively. For example, an external attentional focus resulted in greater acquisition, retention and transfer of postural control when compared to an internal attentional focus in patients suffering from an acute lateral ankle sprain. Researchers hypothesize that an external attentional focus facilitates more effective movement patterns by allowing the sensorimotor system to self-organize, so leaving the completion of movement patterns to be more automated. While balance training is effective, the exact dosage, type of use and level of intensity needed to improve various indices of postural control and reduce recurrent injury may never be recognized because these issues are most likely multi-actorial in nature. Still, balance training is effective and therefore, patients with a history of lateral ankle sprain should complete a correspondence training program because:
The balance training is hypothesized to enhance neuromuscular control deficits.
The balance training enhances postural control, a measure associated with an increased danger of sustaining lateral ankle sprain.
The balance training reduces the recurrence of lateral ankle sprain.
VIII. CONCLUSION
Short and long term disability after an acute lateral ankle sprain remains a public health concern. Research reports instability and joint laxity to still be present over six months after injury. Acutely, evidence suggests rigid immobilization as an effective means to help restore joint stability. In summation to the need for proper acute care, two adjunctive therapies should be a part of the rehabilitation process: joint mobilizations and balance training. The literature has reported the benefit of using both to help improve function and balance training has been shown to cut the incidence of wound. Further future research is indispensable to find out the test dose of treatments and rehabilitation modalities to best maximize function and prevent chronic joint dysfunction.
ACKNOWLEDGEMENT
The Authors would sincerely like to thank Ms. Tricia Hubbard and Mr. Erik Wikstrom for their expert research work. The study was carried out at the Sports rehabilitation department of Savig Healthcare Clinics, New Delhi, India.
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