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Journal of Athletic Training Nov 2017Reference: Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and... (Review)
Review
UNLABELLED
Reference: Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244.
CLINICAL QUESTION
Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?
DATA SOURCES
The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof.
STUDY SELECTION
Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates.
DATA EXTRACTION
Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate.
MAIN RESULTS
Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000).
CONCLUSIONS
Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.
Topics: Ankle Injuries; Ankle Joint; Humans; Physical Therapy Modalities; Proprioception; Sports; Sprains and Strains
PubMed: 29140127
DOI: 10.4085/1062-6050-52.11.16 -
British Journal of Sports Medicine Mar 2014Lateral ankle sprains are common and can have detrimental consequences to the athlete. Joint mobilisation/manipulation may limit these outcomes. (Review)
Review
BACKGROUND
Lateral ankle sprains are common and can have detrimental consequences to the athlete. Joint mobilisation/manipulation may limit these outcomes.
OBJECTIVE
Systematically summarise the effectiveness of manual joint techniques in treatment of lateral ankle sprains.
METHODS
This review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-assisted literature search of MEDLINE, CINHAL, EMBASE, OVID and Physiotherapy Evidence Database (PEDro) (January 1966 to March 2013) was used with the following keywords alone and in combination 'ankle', 'sprain', 'injuries', 'lateral', 'manual therapy', and 'joint mobilisation'. The methodological quality of individual studies was assessed using the PEDro scale.
RESULTS
After screening of titles, abstracts and full articles, eight articles were kept for examination. Three articles achieved a score of 10 of 11 total points; one achieved a score of 9; two articles scored 8; one article scored a 7 and the remaining article scored a 5. Three articles examined joint techniques for acute sprains and the remainder examined subacute/chronic ankle sprains. Outcome measures included were pain level, ankle range of motion, swelling, functional score, stabilometry and gait parameters. The majority of the articles only assessed these outcome measures immediately after treatment. No detrimental effects from the joint techniques were revealed in any of the studies reviewed.
CONCLUSIONS
For acute ankle sprains, manual joint mobilisation diminished pain and increased dorsiflexion range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.
Topics: Ankle Injuries; Athletic Injuries; Humans; Immobilization; Manipulation, Orthopedic; Randomized Controlled Trials as Topic; Range of Motion, Articular; Treatment Outcome
PubMed: 23980032
DOI: 10.1136/bjsports-2013-092763 -
The Australian Journal of Physiotherapy 2006This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic... (Comparative Study)
Comparative Study Review
This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.
Topics: Acute Disease; Ankle Injuries; Exercise Therapy; Female; Humans; Injury Severity Score; Joint Instability; Male; Manipulation, Orthopedic; Prognosis; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Risk Assessment; Sprains and Strains; Treatment Outcome
PubMed: 16515420
DOI: 10.1016/s0004-9514(06)70059-9 -
Clinical Rehabilitation Dec 2018To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes... (Meta-Analysis)
Meta-Analysis
OBJECTIVE:
To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials.
DATA SOURCES:
The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018.
METHODS:
RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations.
RESULTS:
Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense.
CONCLUSION:
Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.
Topics: Ankle Injuries; Athletic Injuries; Humans; Incidence; Physical Therapy Modalities; Proprioception; Sprains and Strains
PubMed: 29996668
DOI: 10.1177/0269215518788683 -
Clinical Rehabilitation Dec 2021To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability. (Meta-Analysis)
Meta-Analysis
Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis.
AIM
To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability.
METHOD
The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed.
RESULTS
Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (-0.15, 0.58)).
CONCLUSIONS
Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance.
SYSTEMATIC REVIEW REGISTRATION NUMBER
CRD42021224179.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Postural Balance; Resistance Training
PubMed: 34058832
DOI: 10.1177/02692155211022009 -
Foot (Edinburgh, Scotland) Mar 2018The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal... (Meta-Analysis)
Meta-Analysis Review
The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal is to increase flexibility, the most commonly used technique is stretching. However, it remains unknown which stretching technique and parameters are the most effective to increase flexibility. Hence, the aim of the current review was to investigate the influence of chronic stretching on ankle dorsiflexion range of motion (DFROM) of healthy individuals. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, LILACS, and manual search from inception to February 2017. Randomized and controlled clinical trials that have analyzed the influence of chronic stretching on DFROM were included. On the other hand, studies with special populations (children, and people with any dysfunction/disease), and articles with no control group were excluded. Twenty studies were included out of 493 identified. The meta-analysis was performed according to the stretching technique used in the study. The results show that static stretching (5.17°; 95% CI: 4.39-5.95; I: 0%) and proprioceptive neuromuscular facilitation (4.32°; 95% CI: 1.59-7.04; I: 46%) are effective in increasing DFROM. Ballistic stretching did not show positive results to increase DFROM (3.77°; 95% CI: -0.03 to 7.56; I: 46%). In conclusion, chronic stretching is an effective way of improving ankle mobility in healthy individuals, especially when it contains a static component.
Topics: Ankle Joint; Exercise Therapy; Female; Healthy Volunteers; Humans; Male; Muscle Stretching Exercises; Range of Motion, Articular; Reference Values; Time Factors
PubMed: 29223884
DOI: 10.1016/j.foot.2017.09.006 -
Journal of Sports Science & Medicine Mar 2020Although the role of shoe constructions on running injury and performance has been widely investigated, systematic reviews on the shoe construction effects on running...
Although the role of shoe constructions on running injury and performance has been widely investigated, systematic reviews on the shoe construction effects on running biomechanics were rarely reported. Therefore, this review focuses on the relevant research studies examining the biomechanical effect of running shoe constructions on reducing running-related injury and optimising performance. Searches of five databases and Footwear Science from January 1994 to September 2018 for related biomechanical studies which investigated running footwear constructions yielded a total of 1260 articles. After duplications were removed and exclusion criteria applied to the titles, abstracts and full text, 63 studies remained and categorised into following constructions: (a) shoe lace, (b) midsole, (c) heel flare, (d) heel-toe drop, (e) minimalist shoes, (f) Masai Barefoot Technologies, (g) heel cup, (h) upper, and (i) bending stiffness. Some running shoe constructions positively affect athletic performance-related and injury-related variables: 1) increasing the stiffness of running shoes at the optimal range can benefit performance-related variables; 2) softer midsoles can reduce impact forces and loading rates; 3) thicker midsoles can provide better cushioning effects and attenuate shock during impacts but may also decrease plantar sensations of a foot; 4) minimalist shoes can improve running economy and increase the cross-sectional area and stiffness of Achilles tendon but it would increase the metatarsophalangeal and ankle joint loading compared to the conventional shoes. While shoe constructions can effectively influence running biomechanics, research on some constructions including shoe lace, heel flare, heel-toe drop, Masai Barefoot Technologies, heel cup, and upper requires further investigation before a viable scientific guideline can be made. Future research is also needed to develop standard testing protocols to determine the optimal stiffness, thickness, and heel-toe drop of running shoes to optimise performance-related variables and prevent running-related injuries.
Topics: Achilles Tendon; Ankle Joint; Athletic Performance; Biomechanical Phenomena; Equipment Design; Forefoot, Human; Humans; Metatarsophalangeal Joint; Running; Shoes; Stress, Mechanical
PubMed: 32132824
DOI: No ID Found -
Sports Health 2021Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect... (Meta-Analysis)
Meta-Analysis
CONTENT
Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks.
OBJECTIVE
To determine the effects of foot strike techniques on running biomechanics.
DATA SOURCES
The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018.
STUDY SELECTION
The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model.
RESULTS
FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08; < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; < 0.001) compared with RFS.
CONCLUSION
Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
Topics: Achilles Tendon; Ankle; Biomechanical Phenomena; Foot; Gait Analysis; Humans; Knee; Risk Factors; Running; Stress, Mechanical
PubMed: 32813597
DOI: 10.1177/1941738120934715 -
The Cochrane Database of Systematic... Oct 2019Idiopathic toe walking (ITW) is an exclusionary diagnosis given to healthy children who persist in walking on their toes after they should typically have achieved a... (Review)
Review
BACKGROUND
Idiopathic toe walking (ITW) is an exclusionary diagnosis given to healthy children who persist in walking on their toes after they should typically have achieved a heel-toe gait. The literature discusses conservative and surgical interventions using a variety of treatment modalities. Young children and children without a limitation in ankle dorsiflexion (the upwards movement of the foot towards the shin of the leg) are commonly treated with conservative interventions. Older children who continue toe walking and present with limitations in ankle dorsiflexion are sometimes treated with surgical procedures. This systematic review is needed to evaluate the evidence for any intervention for the treatment of ITW. The conclusions of this review may support decision making by clinicians caring for children with ITW. It may also assist families when deciding on treatment options for their children with ITW. Many of the treatments employed have financial implications for parents or healthcare services. This review also aims to highlight any deficits in the current research base.
OBJECTIVES
To assess the effects of conservative and surgical interventions in children with ITW, specifically effects on gait normalisation, ankle range of motion, pain, frequency of recurrence, and any adverse effects.
SEARCH METHODS
On 29 April 2019, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus, and PEDro. We searched the following registers of clinical trials for ongoing and recently completed trials: the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP, apps.who.int/trialsearch), and ClinicalTrials.gov (clinicaltrials.gov). We searched conference proceedings and other grey literature in the BIOSIS databases and System for Information on Grey Literature in Europe (OpenGrey, opengrey.eu). We searched guidelines via the Turning Research Into Practice database (TRIP, tripdatabase.com) and National Guideline Clearinghouse (guideline.gov). We did not apply language restrictions.
SELECTION CRITERIA
We considered randomised or quasi-randomised trials for inclusion in the review if they involved participants diagnosed with ITW gait in the absence of a medical condition known to cause toe walking, or associated with toe walking. As there is no universally accepted age group for ITW, this review includes ITW at any age, who have been toe walking for more than six months, who can or cannot walk with a heel-toe gait, and who may or may not have limited dorsiflexion of the ankle joint.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodological procedures. The primary outcome was improvement in toe walking (defined as greater than 50% of time spent heel-toe walking). Secondary outcomes were active and passive range of motion of the ankle joint, pain, recurrence of ITW after treatment, and adverse events. We assessed the certainty of the evidence using the GRADE framework.
MAIN RESULTS
Four studies, comprising 104 participants, met the inclusion criteria. One study did not report data within the appropriate follow-up timeframe and data from two studies were insufficient for analysis. The single study from which we extracted data had 47 participants and was a randomised, controlled, parallel-group trial conducted in Sweden. It tested the hypothesis that combined treatment with serial casting and botulinum toxin type A (BTX) was more effective than serial casting alone in reducing ITW gait.This study found that more participants treated with BTX improved (defined as toe walking less than 50% of the time, as reported by parents) (risk ratio (RR) 1.21, 95% confidence interval (CI) 0.57 to 2.55; 1 trial, 46 participants; very low-certainty evidence). However, there was little or no difference between groups in passive ankle joint dorsiflexion range of movement on the right with the knee extended (mean difference (MD) -1.48º, 95% CI -4.13 to 1.16; 1 trial, 47 participants), on the right with the knee flexed (MD -0.04º, 95% CI -1.80 to 1.73; 1 trial, 46 participants), on the left with the knee flexed (MD 1.07, 95% CI -1.22 to 3.37), or on the left with the knee extended (MD 0.05, 95% CI -0.91 to 1.91). Nor was there a clear difference between the groups in recurrence of toe-walking gait (assessed via severity of toe walking (graded 1 (mild), 2 (moderate), or 3 (severe)) on gait analysis, analysed as continuous data: MD 0.34 points, 95% CI -0.09 to 0.78; 46 participants). In principle, MDs greater than zero (i.e.) positive values) would favour BTX and casting and negative values would favour casting alone. We have not reported effects as better or worse because all results were from evidence of very low certainty. We downgraded the certainty of evidence because of study limitations (outcome assessment was not blinded) and imprecision. Outcomes of pain and active range of motion were not reported in the included study.In terms of adverse events, calf pain was reported twice in the casting-only group and three times in the BTX group. There were three minor skin problems in each group and one reported case of pain directly after BTX injection. The report did not state if calf pain and skin irritation were from the same or different participants. The study authors reported that adverse events did not alter treatment adherence.
AUTHORS' CONCLUSIONS
The certainty of evidence from one study, which compared serial casting with serial casting with BTX for ITW in children, was too low for conclusions to be drawn. A further three studies reported outcomes relating to BTX, footwear, exercises, and different types of orthoses as interventions, however the outcome data were too limited to assess their effects.
PubMed: 31587271
DOI: 10.1002/14651858.CD012363.pub2 -
Sports Medicine (Auckland, N.Z.) Mar 2011Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports... (Review)
Review
Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.
Topics: Ankle Injuries; Ankle Joint; Athletic Tape; Braces; Compression Bandages; Edema; Humans; Joint Instability; Pain; Pain Management; Recovery of Function; Secondary Prevention; Sprains and Strains; Treatment Outcome
PubMed: 21395362
DOI: 10.2165/11584370-000000000-00000