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.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
hip osteoarthritis is most disabling condition and surgery is a consequence of the same. but if this condition can assess on time so it can be manageable with conservative treatment and decrease the prevalence of AVN. further life of an individual become better.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
hip osteoarthritis is most disabling condition and surgery is a consequence of the same. but if this condition can assess on time so it can be manageable with conservative treatment and decrease the prevalence of AVN. further life of an individual become better.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
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.
meniscus injury explained with treatment and videos to help understand the use of MRI to help understand injury to meniscus and help diagnose meniscal tear
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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3. Introduction
Ligamentous Anatomy of Ankle
Classification
Mechanism of Injury
Signs and Symptoms
Epidemiology
Diagnostic Tools
Differential Diagnosis
Management
Evidence Based Rehabilitation.
Recommendations.
4. Mr. Nasir is a 35-year-old computer programmer who
plays Basketball at the local recreation center. He
sustained a massive inversion sprain of his right ankle
when landing on foot of an opponent after jumping
to rebound the basketball. He wrapped the ankle
and iced it for 2 days. On the 3rd day he went for a
radiograph. No fracture was detected, But he does
have a Grade 2 Instability of the Anterior talofibular
ligament. Observation revealed swelling and
discoloration in the anterior and lateral ankle region.
He experienced a marked increase in pain wit
inversion and Planterflexion tests, with anterior gliding
of the talus, and with palpation over the involved
ligament. Because of muscle guarding strength was
not tested.
5. Ankle injuries are among the most
common injuries presenting to primary
care offices and emergency
departments.
Also known as twist ankle, rolled ankle
or ankle ligament injury.
Recurrent ankle sprains can lead to
functional instability and loss of normal
ankle kinematics and proprioception,
which can result in recurrent injury,
chronic instability, and early
degenerative bony changes.
That
has to
hurt!!!
Boruta PM, Bishop JO, Braly WG, Tullos HS. Acute lateral ankle
ligament injuries: a literature review. Foot Ankle 1990; 11:107.
6. Three ligaments make up the lateral
ankle ligament complex.
Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)
Usually anterior Talofibular
Ligament (ATFL) is affected
Function of Ligaments
Ankle ligaments provide
mechanical stability,
Proprioceptive information, and
directed motion for the joint.
Attarian DE, McCrackin HJ, DeVito DP, McElhaney JH, Garrett
WE Jr. Biomechanical characteristics of human ankle
ligaments. Foot Ankle. Oct 1985;6(2):54-8
7. Grade I (First Degree)
The ligament damage has occurred without
any significant instability developing.
Grade II (Second Degree)
The ligament has been more significantly
damaged, but there is no significant instability.
Grade III (Third Degree)
The ligaments have been torn and instability
has resulted.
Moreira V, Antunes F (2008). "[Ankle sprains: from diagnosis to
management. the physiatric view]". Acta Med Port (in
Portuguese) 21 (3): 285–92
8. Types of Ankle Sprain
Lateral (Inversion) Sprains
Approximately 70-85% of ankle
sprains are inversion injuries.
High (Syndesmotic) Sprain
A high ankle sprain is an injury to
the large ligaments above the
ankle that join together the
bones of the lower leg.
Medial (Eversion) Sprains
This affect the medial side of the
foot and deltoid ligament is
stretched
9. The foot is placed in forced inversion
and plantar flexion
It can be from an unstable/irregular surface
Also caused by forced trauma
11. Sprained ankles have been estimated to
constitute up to 30% of injuries seen in
sports medicine clinics. More than 23,000
people per day in the United States,
including athletes and non-athletes,
require medical care for ankle sprains.
Stated another way, incident cases have
been estimated at 1 case per 10,000
persons per day.
Mahaffey D, Hilts M, Fields KB. Ankle and foot injuries in sports. Clin
Fam Pract; 1999:1(1):233-50
12.
13. The Ottawa ankle
rules are a set of
guidelines for
clinicians to help
decide if a patient
with foot or ankle pain
should be offered X-
rays to diagnose a
possible bone
fracture.
Sensitivity: 98.5%
Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle
rules to exclude fractures of the ankle and mid-foot: systematic
review. BMJ 2003; 326:417.
14. The rules are as follows :
An ankle series (Ankle Radiograph) is only indicated for
patients who have pain in the malleolar zone AND
i. Have bone tenderness at the posterior edge or tip of
the lateral or medial malleolus OR
ii. Are unable to bear weight both immediately after
the injury and for four steps in the emergency
department or doctor's office.
A foot series (Foot Radiograph) is only indicated for
patients who have pain in the midfoot zone AND
i. Have bone tenderness at the base of the fifth
metatarsal or at the navicular OR
ii. Are unable to bear weight both immediately after
the injury and for four steps in the emergency
department or doctor's office.
15. Anterior Draw Test
Purpose:
To test for ligamentous
laxity or instability in the
ankle. This test primarily
assesses the strength of
the Anterior Talofibular
Ligament.
Diagnostic Accuracy:
Sensitivity: .71
Specificity: .33
Docherty, Carrie. "Reliability of the Anterior Drawer and Anterior
Tilt Tests using the Ligmaster Joint Arthometer." 2009
16. External Rotation Test
Purpose:
To help identify a
tibiofibular Syndesmotic
injury (high ankle sprain).
The term "high ankle
sprain" refers to an isolated
injury to the tibiofibular
syndesmosis
Diagnostic Accuracy:
Sensitivity: 20
Specificity: 84.5
Cesar, Paulo. "Comparison of Magnetic Resonance Imaging
to Physical Examination for Syndesmotic Injury After Lateral
Ankle Sprain ." American Orthopaedic Foot and Ankle
Society. 32.2 (2011): n. page. Web. 23 Sep. 2012
17. Talar Tilt test
Purpose:
The talar tilt test detects
excessive ankle
inversion. If the
ligamentous tear
extends posteriorly into
the calcaneofibular
portion of the lateral
ligament, the lateral
ankle is unstable and
talar tilt occurs.
Diagnostic Accuracy:
Sensitivity: 67
Specificity: 75
Extracted from Orthopedic Physical Examination Tests:
An Evidence-Based Approach: "Medial Talar Tilt Stress Test": Hertel
et al. Sensitivity 67, Specificity 75, LR+ 2.7, LR- 0.44
18. Lateral malleolus fracture
Osteochondral injury to talus
Posterior-lateral talar process fracture
Anterior process of calcaneus (beak) fracture
Achilles tendon injury
Fifth metatarsal fracture (styloid process or base)
Subtalar joint injury
Calcaneo-fibular Ligament sprain
Posterior talo-fibular ligament sprain
Calcaneo-cuboid ligament sprain
Young CC et al, Ankle sprain, Medscape, Sep 2011
20. Max. protection
phase
Mod. Protection
phase
Min. protection
phase
Return to activity
1-3 Days 4-10 Days 11-21 Days 3-8 weeks
• PRICE formula
• Protection with a
splint
• Icing every
2hours during 1st
48hours
• Elevation to
reduce swelling
• Gentle
mobilization to
inhibit pain
• Partial WB with
crutches
• Muscle-setting
Techniques
• Non weight
bearing AROM
• Cross-fiber
massage
• Grade 2 joint
mobilization
• Toa curls
• Seated calf
stretches
• Endurance
training
• strengthening
exercises of
intrinsic foot
muscles
• Weight bearing as
tolerated
• Initiate Eccentric
ex.
• Toe walks
• Subtalar
mobilization
• Tape or Brace for
sports or other
strenuous
activities
• Proprioception/
balance board ex
• ↑ Weight bearing as
tolerated
• Agility drills.
• Adv. Exercises
Static→dynamic
• Isokinetic resistance
training
• Specific sport training
• Protective bracing for
participation into a
sports
Caroline, Kysner, and Colby Lyn Allen. "Therapeutic Exercise Foundation and
Techniques." FA. Davis, Philadelphia (1988).
21. Surgical repair of ruptured ankle ligaments is
sometimes considered in patients with ankle
sprains.
It is Usually indicated for Grade III ankle sprain
A meta-analysis that looked at controlled trials
of surgery for acute ruptures of lateral ankle
ligaments found that compared with functional
treatment, patients treated with surgery were
significantly less likely to experience giving-way
of the ankle (relative risk 0.23, 95% CI 0.17-0.31).
Pijnenburg AC, Van Dijk CN, Bossuyt PM, Marti RK. Treatment of
ruptures of the lateral ankle ligaments: a meta-analysis. J Bone
Joint Surg Am 2000; 82:761
22.
23. Reference Study Design Study method Results
Bleakley, C. M.
McDonough, S.
M. et al. Aug
2006.
Cryotherapy for
acute ankle sprains:
a randomised
controlled study of
two different icing
protocols
Randomized
controlled trial
Group 1
n = 46 standard
ice application
Group 2
n = 43 intermittent
ice application.
Function, pain,
and swelling were
recorded at
baseline and
one, two, three,
four, and six
weeks after injury.
It was Assessed
from the study
that Intermittent
applications may
enhance the
therapeutic effect
of ice in pain
relief after acute
soft tissue injury
24. Reference Study Design Study method Results
Michel P.J. van den
Bekerom, et al,
July/Aug. 2012,
What Is the
Evidence for Rest,
Ice, Compression,
and Elevation
Therapy in the
Treatment of Ankle
Sprains in Adults?
Randomized
controlled trial
After deduction of
the overlaps among
the different
databases,
evaluation of the
abstracts, and
contact with some
authors, 24
potentially eligible
trials remained. The
full texts of these
articles were
retrieved and
thoroughly assessed
as described. This
resulted in the
inclusion of 11 trials
involving 868
patients.
It was concluded
that Insufficient
evidence is
available from
randomized
controlled trials to
determine the
relative
effectiveness of
RICE therapy for
acute ankle
sprains in adults.
25. Reference Study Design Study method Results
Axelsen, S. M.
Bjerno, T. 1993,
effect of Laser
therapy in
management of
ankle sprain
Randomized
controlled trial
40 patients were
randomly
selected from the
casualty ward
All pts. Received
the low-level
Laser treatment
unless ankle
sprain was
painless
After assessment
pain was
significantly
reduced. There
was no significant
effect on swelling
and
discoloration.
26. Reference Study Design Study method Results
Green, T. et al. April
2001, Effectiveness
of passive
accessory joint
mobilization on
acute ankle
inversion sprains
Randomized
controlled trial
N=41 subjects with
acute ankle
inversion sprains
(<72 hours) & no
other injury in L.L
were Randomly
Assigned to 1 of 2
treatment groups
1. Control group
Received only
RICE protocol
2. Treatment Group
received
Antero-posterior
gliding of Talus
in addition to
RICE protocol
Study Revealed
that addition of a
talocrural
mobilization to
the RICE protocol
in the
management of
ankle inversion
injuries
necessitated
fewer treatments
to achieve pain-
free dorsiflexion
and to improve
stride speed
27. Reference Study Design Study method Results
Vicenzino, B.
Branjerdporn, M.
et al. july 2006,
Initial changes in
posterior talar
glide and
dorsiflexion of the
ankle after
mobilization with
movement in
individuals with
recurrent ankle
sprain
A double-blind
randomized
crossover
experimental
study
N=16
subjects with
(mean +/- SD age,
19.8 +/- 2.3 years)
with a history of
recurrent lateral
ankle sprain and
deficits in posterior
talar glide (71%)
and weight-bearing
dorsiflexion (34%)
were studie
Treatment group:
weight-bearing
MWM, non-weight-
bearing MWM
Control group:
No treatment
It was found that
Both the weight-
bearing and non-
weight-bearing
MWM treatment
techniques
significantly
improved
posterior talar
glide by 55% and
50% Respectively.
28. Reference Study Design Study method Results
Verhagen, E. A.
van Tulder, M. et
al. Sep. 2005,
Effect of
Proprioceptive
balance board
training
programme for
the prevention of
ankle sprains in
volleyball Players
Prospective
Randomized
controlled trial
n=116 male &
female Volleyball
teams followed
prospectively during
the 2001-2002
season.
Teams were
Randomized into
Control and
Intervention Group
This study
highlights that
Significantly fewer
ankle sprains in
the intervention
group were found
compared to the
control group.
29. Reference Study Design Study method Results
Refshauge, K. M.
Raymond, J. et al.
Feb. 2009,
The effect of ankle
taping on detection
of inversion-eversion
movements in
participants with
recurrent ankle
sprain.
Controlled
laboratory study
16 participants with
recurrent ankle
sprain under 2
conditions: with the
ankle taped or
untaped were
selected. The
threshold for
movement
detection was
examined at 3
velocities (0.1
deg/s, 0.5 deg/s,
and 2.5 deg/s) and
in 2 directions
(inversion and
eversion).
It was found that
Taping the ankle
decreased the
ability to detect
movement in the
inversion-eversion
plane in
participants with
recurrent ankle
sprain.
30. Patient-reported comfort
and satisfaction during
treatment with a semi-rigid
brace was significantly
increased. The rate of skin
complication in this group
was significantly lower
compared to the tape
group (14.6% versus 59.1%,
P < 0.0001).
Lardenoye S, Theunissen E, Cleffken B, Brink PR, de Bie RA,
Poeze M. The effect of taping versus semi-rigid bracing on
patient outcome and satisfaction in ankle sprains: a
prospective, randomized controlled trial. BMC musculoskeletal
disorders. 2012; 13: 81
31. Reference Study Design Study method Results
Boyce, S. H.
Quigley, M. A.
Campbell, S. Jan.
2005,
Management of
ankle sprains: a
randomized
controlled trial of
the treatment of
inversion injuries
using an elastic
support bandage
or an Aircast
ankle brace
Prospective
Randomized
controlled trial
N=50 pts.
Randomized into 2
Groups
Group 1:
Elastic support
bandage +
standard RICE
Group 2:
Air cast brace +
standard RICE
It was analyzed that
the use of an
Aircast ankle brace
produces a
significant
improvement in
ankle joint function
compared with
standard
management with
an elastic support
bandage.
32. Reference Study Design Study method Results
Ismail, M. M.
Ibrahim, M. M.
et al. June, 2010,
Plyometric training
versus resistive
exercises after
acute lateral ankle
sprain
Randomized
controlled trial
N=22 athletes
(aged from 20 to 35
years) of both sexes
with grade I or II
unilateral inversion
ankle sprain (at
least 3 weeks after
acute injury) were
randomly allocated
Group 1:
Pylometric training
Group 2:
Resistive training for
6 weeks
Isokinetic peak
torque/body weight
for invertors and
evertors at 30 & 120
degree/s
This study reports
that Plyometrics
were more effective
than resistive
exercises in
improving
functional
performance of
athletes after lateral
ankle sprain.
33. A Metaanalysis suggests that
Subjects who were Braced
with Ankle-Stirrup has
significantly Reduced
Inversion Stress at ankle than
those who were not braced.
Kimura IF, Nawoczenski DA, Epler M, Owen MG. Effect of the AirStirrup
in Controlling Ankle Inversion Stress. The Journal of orthopedic and
sports physical therapy. 1987; 9(5): 190-3
34. There is a strong evidence that
Star Excursion Balance training is
more effective than the
conventional therapy program in
improving functional stability of
the sprained ankle.
Chaiwanichsiri D, Lorprayoon E, Noomanoch L. Star excursion balance
training: effects on ankle functional stability after ankle sprain. Journal of
the Medical Association of Thailand = Chotmaihet thangphaet. 2005; 88
Suppl 4: S90-4.
35. Mild sprain
Acute phase (0-3 days): reducing pain and swelling, partial load-bearing
Information/advice: rest, elevate foot, perhaps ice, load-bearing (perhaps with
crutches) determined by pain, actively moving foot and toes
Instruction: compression bandage
If necessary re-evaluation / check-up after 1 week.
Severe sprain
Acute phase: as in mild sprain
Proliferation phase: regaining functions and activities; increasing loads
tape or brace: depending on load-bearing capacity required and patient's preference
exercises for functions and activities: range of motion, active stability, coordination, and
walking
Early remodeling phase: increasing muscular strength, active (functional) stability,
walking
exercises for functions and activities: dynamic stability, balance, coordination
Late remodeling phase: regaining ADL activities
exercises for activities: progression to normal load-bearing, exercises at home
If recovery normal, treatment once a week, maximum duration of treatment 6 weeks.
Wees P, Lenssen A, Feijts Y, Bloo H, van Morsel S, Ouderland R, et al. KNGF guideline for physical
therapy in patients with acute ankle sprain-practice guidelines. Suppl Dutch J Phys Ther. 2006;
116: 1-30.
36. •PRICE
•Ankle Taping/Bracing/ splints
•Gentle Mobilization
•Strengthening ex for intrinsic foot Muscles
•Proprioception training
•Balance training
•Plyometric training to regain functional level of
activity
Acute Injury/
Minor Tear
•Surgical Repair
Chronic or
recurrent Ankle
Sprain
Being a Physiotherapist I’ll recommend: