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Journal of Athletic Training 2013To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. (Review)
Review
OBJECTIVE
To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes.
BACKGROUND
Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented.
RECOMMENDATIONS
The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.
Topics: Ankle Injuries; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Athletic Injuries; Athletic Tape; Braces; Chronic Disease; Cryotherapy; Diagnostic Imaging; Electric Stimulation Therapy; Exercise Test; Fractures, Bone; Humans; Inflammation; Joint Instability; Ligaments, Articular; Physical Examination; Physical Therapy Modalities; Rest; Secondary Prevention; Shoes; Sports Medicine; Sprains and Strains
PubMed: 23855363
DOI: 10.4085/1062-6050-48.4.02 -
Sports Health 2018High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a...
CONTEXT
High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management.
EVIDENCE ACQUISITION
PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 3.
RESULTS
When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process.
CONCLUSION
Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.
Topics: Ankle Injuries; Ankle Joint; Athletes; Athletic Injuries; Conservative Treatment; Football; Humans; Sprains and Strains
PubMed: 28759316
DOI: 10.1177/1941738117720639 -
Journal of Sports Science & Medicine Dec 2018Hamstring strain injury is a multifactorial and complex problem involving interactions among various factors. Information about risk factors for this injury is...
Hamstring strain injury is a multifactorial and complex problem involving interactions among various factors. Information about risk factors for this injury is inconsistent among studies because the strong effects of confounding factors and injury situations are often ignored. We investigated the relationship between hamstring strain induced by high-speed running and intrinsic risk factors, including hip muscle morphology and function, by excluding the influences of confounding factors. Sixty-one male track and field athletes (age, 19.6 ± 1.1 years; 95% confidence interval, 19.3-19.9) who often performed high-speed running were monitored throughout one season. Before the season, we measured hip and knee strength, muscle thickness of the gluteus maximus and biceps femoris, and hip and knee joint range of motion (ROM). We also obtained information about each athlete's history of hamstring injury by questionnaire. Eighteen athletes sustained hamstring strain injuries induced by high-speed running. Eighteen uninjured athletes who had the same profile of confounding factors as the injured athletes were selected as controls. Previously injured athletes had a significantly higher injury rate than uninjured athletes (p < .05; odds ratio, 2.85). No other measurements had a significant relationship with the occurrence of injury. However, passive hip ROM (flexion and extension) tended to be larger in the injured than control group. A history of hamstring strain was a strong risk factor for hamstring strain injury, and it may affect other factors. Therefore, the risk factors for hamstring strain injury should be investigated by eliminating the impact of a history of hamstring strain.
Topics: Adolescent; Athletes; Athletic Injuries; Case-Control Studies; Hamstring Muscles; Humans; Knee Joint; Leg Injuries; Male; Prospective Studies; Range of Motion, Articular; Risk Factors; Running; Sprains and Strains; Young Adult
PubMed: 30479534
DOI: No ID Found -
Journal of Athletic Training 2012Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem.
OBJECTIVE
To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain.
STUDY SELECTION
Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults.
DATA SOURCES
MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually.
DATA EXTRACTION
We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models.
DATA SYNTHESIS
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. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest.
CONCLUSIONS
Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.
Topics: Adult; Ankle Injuries; Ankle Joint; Cold Temperature; Exercise Therapy; Humans; Immobilization; Lateral Ligament, Ankle; Rest; Sprains and Strains; Treatment Outcome
PubMed: 22889660
DOI: 10.4085/1062-6050-47.4.14 -
Sports Medicine (Auckland, N.Z.) Apr 2024Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied... (Review)
Review
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
Topics: Humans; Biomechanical Phenomena; Hamstring Muscles; Sprains and Strains; Running; Athletic Injuries
PubMed: 37725240
DOI: 10.1007/s40279-023-01925-x -
The Journal of Orthopaedic and Sports... May 2013Randomized, double-blind, parallel-group clinical trial. (Comparative Study)
Comparative Study Randomized Controlled Trial
STUDY DESIGN
Randomized, double-blind, parallel-group clinical trial.
OBJECTIVES
To assess differences between a progressive agility and trunk stabilization rehabilitation program and a progressive running and eccentric strengthening rehabilitation program in recovery characteristics following an acute hamstring injury, as measured via physical examination and magnetic resonance imaging (MRI).
BACKGROUND
Determining the type of rehabilitation program that most effectively promotes muscle and functional recovery is essential to minimize reinjury risk and to optimize athlete performance.
METHODS
Individuals who sustained a recent hamstring strain injury were randomly assigned to 1 of 2 rehabilitation programs: (1) progressive agility and trunk stabilization or (2) progressive running and eccentric strengthening. MRI and physical examinations were conducted before and after completion of rehabilitation.
RESULTS
Thirty-one subjects were enrolled, 29 began rehabilitation, and 25 completed rehabilitation. There were few differences in clinical or morphological outcome measures between rehabilitation groups across time, and reinjury rates were low for both rehabilitation groups after return to sport (4 of 29 subjects had reinjuries). Greater craniocaudal length of injury, as measured on MRI before the start of rehabilitation, was positively correlated with longer return-to-sport time. At the time of return to sport, although all subjects showed a near-complete resolution of pain and return of muscle strength, no subject showed complete resolution of injury as assessed on MRI.
CONCLUSION
The 2 rehabilitation programs employed in this study yielded similar results with respect to hamstring muscle recovery and function at the time of return to sport. Evidence of continuing muscular healing is present after completion of rehabilitation, despite the appearance of normal physical strength and function on clinical examination.
LEVEL OF EVIDENCE
Therapy, level 1b-.
Topics: Adolescent; Adult; Double-Blind Method; Exercise Therapy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Recurrence; Sprains and Strains; Thigh; Treatment Outcome; Young Adult
PubMed: 23485730
DOI: 10.2519/jospt.2013.4452 -
BMJ Clinical Evidence Jun 2007NSAIDs are widely used. Almost 10% of people in The Netherlands used a non-aspirin NSAID in 1987, and the overall use was 11 defined daily doses per 1000 population per... (Review)
Review
INTRODUCTION
NSAIDs are widely used. Almost 10% of people in The Netherlands used a non-aspirin NSAID in 1987, and the overall use was 11 defined daily doses per 1000 population per day. In Australia in 1994, overall use was 35 defined daily doses per 1000 population a day, with 36% of the people receiving NSAIDs for osteoarthritis, 42% for sprain and strain or low back pain, and 4% for rheumatoid arthritis; 35% of the people receiving NSAIDs were aged over 60 years.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: Are there any important differences between NSAIDs? What are the effects of topical NSAIDs; and of co-treatments to reduce the risk of gastrointestinal adverse effects of NSAIDs? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the benefits and harms of the following interventions: alternative analgesics, H(2) blockers, misoprostol, NSAIDs (systemic, topical, differences in efficacy between, dose-response relationship of), proton pump inhibitors.
Topics: Acetaminophen; Acute Disease; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Humans; Osteoarthritis; Proton Pump Inhibitors; Sprains and Strains; Ultrasonic Therapy
PubMed: 19454084
DOI: No ID Found -
BMJ (Clinical Research Ed.) Nov 2016To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains.
DESIGN
A randomised controlled trial of 503 participants followed for six months.
SETTING
Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada.
PARTICIPANTS
The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol.
INTERVENTION
Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy.
MAIN OUTCOME MEASURES
The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months.
RESULTS
The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score.
CONCLUSIONS
In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).
Topics: Adolescent; Adult; Aged; Ankle Injuries; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Quality of Life; Recovery of Function; Sprains and Strains; Surveys and Questionnaires; Treatment Outcome
PubMed: 27852621
DOI: 10.1136/bmj.i5650 -
Journal of Science and Medicine in Sport Dec 2017Ankle sprains due to landing on an opponent's foot are common in basketball. There is no analysis to date that provides a quantification of this injury mechanism. The...
OBJECTIVES
Ankle sprains due to landing on an opponent's foot are common in basketball. There is no analysis to date that provides a quantification of this injury mechanism. The aim of this study was to quantify the kinematics of this specific injury mechanism and relate this to lateral ankle ligament biomechanics.
DESIGN
Case series.
METHODS
The model-based image-matching technique was used to quantify calcaneo-fibular-talar kinematics during four ankle inversion sprain injury incidents in televised NBA basketball games. The four incidents follow the same injury pattern in which the players of interest step onto an opponent's foot with significant inversion and a diagnosed ankle injury. A geometric analysis was performed to calculate the in vivo ligament strains and strain rates for the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL).
RESULTS
Despite the controlled selection of cases, the results show that there are two distinct injury mechanisms: sudden inversion and internal rotation with low levels of plantarflexion; and a similar mechanism without internal rotation. The first of these mechanisms results in high ATFL and CFL strains, whereas the second of these strains the CFL in isolation.
CONCLUSIONS
The injury mechanism combined with measures of the ligament injury in terms of percentage of strain to failure correlate directly with the severity of the injury quantified by return-to-sport. The opportunity to control excessive internal rotation through proprioceptive training and/or prophylactic footwear or bracing could be utilised to reduce the severity of common ankle injuries in basketball.
Topics: Adult; Ankle Injuries; Athletic Injuries; Basketball; Biomechanical Phenomena; Humans; Image Processing, Computer-Assisted; Ligaments, Articular; Male; Rotation; Sprains and Strains; Television
PubMed: 28587794
DOI: 10.1016/j.jsams.2017.05.006 -
BMJ (Clinical Research Ed.) Jul 2009To evaluate the effectiveness of an unsupervised proprioceptive training programme on recurrences of ankle sprain after usual care in athletes who had sustained an acute... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effectiveness of an unsupervised proprioceptive training programme on recurrences of ankle sprain after usual care in athletes who had sustained an acute sports related injury to the lateral ankle ligament.
DESIGN
Randomised controlled trial, with one year follow-up.
SETTING
Primary care.
PARTICIPANTS
522 athletes, aged 12-70, who had sustained a lateral ankle sprain up to two months before inclusion; 256 (120 female and 136 male) in the intervention group; 266 (128 female and 138 male) in the control group.
INTERVENTION
Both groups received treatment according to usual care. Athletes allocated to the intervention group additionally received an eight week home based proprioceptive training programme.
MAIN OUTCOME MEASURE
Self reported recurrence of ankle sprain.
RESULTS
During the one year follow-up, 145 athletes reported a recurrent ankle sprain: 56 (22%) in the intervention group and 89 (33%) in the control group. Nine athletes needed to be treated to prevent one recurrence (number needed to treat). The intervention programme was associated with a 35% reduction in risk of recurrence. Cox regression analysis showed significantly fewer recurrent ankle sprains in the intervention than in the control group. This effect was found for self reported recurrent ankle sprains (relative risk 0.63, 95% confidence interval 0.45 to 0.88), recurrent ankle sprains leading to loss of sports time (0.53, 0.32 to 0.88), and recurrent ankle sprains resulting in healthcare costs or lost productivity costs (0.25, 0.12 to 0.50). No significant differences were found between medically treated athletes in the intervention group and medically treated controls. Athletes in the intervention group who were not medically treated had a significantly lower risk of recurrence than controls who were not medically treated.
CONCLUSIONS
The use of a proprioceptive training programme after usual care of an ankle sprain is effective for the prevention of self reported recurrences. This proprioceptive training was specifically beneficial in athletes whose original sprain was not medically treated.
TRIAL REGISTRATION
ISTRCN34177180.
Topics: Adolescent; Adult; Aged; Ankle Injuries; Athletic Injuries; Child; Exercise Therapy; Female; Home Care Services; Humans; Male; Middle Aged; Patient Compliance; Proprioception; Secondary Prevention; Self Care; Sprains and Strains; Young Adult
PubMed: 19589822
DOI: 10.1136/bmj.b2684