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Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols.British Journal of Sports Medicine Aug 2006The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known.
OBJECTIVE
To compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains.
SUBJECTS
Sportsmen (n = 44) and members of the general public (n = 45) with mild/moderate acute ankle sprains.
METHODS
Subjects were randomly allocated, under strictly controlled double blind conditions, to one of two treatment groups: standard ice application (n = 46) or intermittent ice application (n = 43). The mode of cryotherapy was standardised across groups and consisted of melting iced water (0 degrees C) in a standardised pack. Function, pain, and swelling were recorded at baseline and one, two, three, four, and six weeks after injury.
RESULTS
Subjects treated with the intermittent protocol had significantly (p<0.05) less ankle pain on activity than those using a standard 20 minute protocol; however, one week after ankle injury, there were no significant differences between groups in terms of function, swelling, or pain at rest.
CONCLUSION
Intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury.
Topics: Acute Disease; Adult; Ankle Injuries; Athletic Injuries; Cryotherapy; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Pain; Soft Tissue Injuries; Sprains and Strains; Treatment Outcome
PubMed: 16611722
DOI: 10.1136/bjsm.2006.025932 -
Canadian Medical Association Journal Sep 1979
Topics: Adolescent; Athletic Injuries; Canada; Child; Fractures, Bone; Humans; Skating; Sprains and Strains
PubMed: 497940
DOI: No ID Found -
BMC Musculoskeletal Disorders Dec 2007Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities employed in the immediate management of acute soft tissue... (Randomized Controlled Trial)
Randomized Controlled Trial
The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946].
BACKGROUND
Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities employed in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established. Intermittent ice applications are thought to exert a significant analgesic effect. This could facilitate earlier therapeutic exercise after injury, potentially allowing for a quicker return to activity. The primary aim of the forthcoming study is therefore to examine the safety and effectiveness of combining intermittent ice applications with periods of therapeutic exercise in the first week after an acute ankle sprain.
METHODS/DESIGN
The study is a randomised controlled trial. 120 subjects with an acute grade I or grade II ankle sprain will be recruited from Accident & Emergency and a University based Sports Injury Clinic. Subjects will be randomised under strict double-blind conditions to either a standard cryotherapy (intermittent ice applications with compression) or cryokinetic treatment group (intermittent ice applications with compression and therapeutic exercise). After the first week, treatment will be standardised across groups. Assessor blinding will be maintained throughout the trial. Primary outcome will be function, assessed using the Lower Extremity Functional Scale (LEFS). Additional outcomes will include pain (10 cm Visual Analogue Scale), swelling (modified figure-of-eight method) and activity levels (activPALtrade mark physical activity monitor, PAL Technologies, Glasgow, UK). Diagnostic Ultrasound (Episcan-1-200 high frequency ultrasound scanning system, Longport International Ltd, PA) will also be used to assess the degree of soft tissue injury. After baseline assessment subjects will be followed up at 1, 2, 3 & 4 weeks post injury. All data will be analysed using repeated measures analysis of co-variance (ANCOVA).
DISCUSSION
This paper describes the rationale and design of a randomised controlled trial which will examine the effectiveness of two different cryotherapy protocols in the early management of acute ankle sprain.
TRIAL REGISTRATION
ISRCTN13903946.
Topics: Acute Disease; Ankle Injuries; Cryotherapy; Emergency Medical Services; Exercise Therapy; Humans; Ice; Research Design; Rest; Sprains and Strains
PubMed: 18093299
DOI: 10.1186/1471-2474-8-125 -
Sports Health 2024
Topics: Humans; Hamstring Muscles; Sprains and Strains; Athletic Injuries
PubMed: 37278326
DOI: 10.1177/19417381231175880 -
California Medicine Apr 1956The postconcussion syndrome is a definite entity, and the patient's complaints are due to legitimate injury. The following three factors contribute to the...
The postconcussion syndrome is a definite entity, and the patient's complaints are due to legitimate injury. The following three factors contribute to the symptomatology:1. Headaches, caused by the associated sprain of the cervical spine with resultant radiculitis-giving rise to muscle spasm and suboccipital headaches.2. Vertigo, due to trauma of the vestibular and labyrinthine apparatus.3. A vasomotor imbalance and instability resulting from the reaction to "stress."In treatment of an unconscious patient great care must be taken to prevent anoxia and to balance the fluids and electrolytes. If coma develops following brain injury, hemorrhage into the cerebellar fossa as well as above the tentorium must be considered.
Topics: Brain; Brain Injuries; Cervical Vertebrae; Coma; Craniocerebral Trauma; Humans; Post-Concussion Syndrome; Sprains and Strains; Wounds and Injuries
PubMed: 13304695
DOI: No ID Found -
BMJ Clinical Evidence Jun 2010NSAIDs 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 a... (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 a 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 oral NSAIDs? What are the effects of topical NSAIDs; and of co-treatments to reduce the risk of gastrointestinal adverse effects of oral NSAIDs? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2009 (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 36 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: differences in efficacy among different oral NSAIDs, between oral and topical NSAIDs, and between oral NSAIDs and alternative analgesics; dose-response relationship of oral NSAIDs; and H(2) blockers, misoprostol, or proton pump inhibitors to mitigate gastrointestinal adverse effects of oral NSAIDs.
Topics: Acetaminophen; Acute Disease; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Humans; Incidence; Osteoarthritis; Proton Pump Inhibitors; Sprains and Strains; Ultrasonic Therapy
PubMed: 21733202
DOI: No ID Found -
Einstein (Sao Paulo, Brazil) 2023Miranda et al. reported a correlation between the significance of injuries to osseous, chondral, tendon, and ligamentous tissues in participants with low-grade versus...
UNLABELLED
Miranda et al. reported a correlation between the significance of injuries to osseous, chondral, tendon, and ligamentous tissues in participants with low-grade versus high-grade acute ankle sprains. They demonstrated that participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of structural abnormalities compared to those with low-grade sprains. Special attention should be paid to acute ankle sprains in emergency settings to avoid failure in detecting severe injuries that could lead to chronic pain, impairment, or instability. Participants presenting acute ankle sprains (<15 days) were divided into low-grade versus high-grade sprain,according to the presence of a complete tear in at least one component of lateral ligament complex. High-grade ankle sprains group presented increased rates of medial malleolus bone bruise, deltoid ligament tears,extensor retinaculum lesions, and articular effusion. The calcaneonavicular distance was statistically shorter in patients with high-grade sprains (median, 3.0mm) when compared to those with low-grade sprains (median, 4.0mm) Objective: To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains.
METHODS
We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex.
RESULTS
The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001).
CONCLUSION
Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.
Topics: Male; Humans; Adult; Retrospective Studies; Sprains and Strains; Ankle Joint; Magnetic Resonance Imaging; Ankle Injuries; Rupture; Edema
PubMed: 37820199
DOI: 10.31744/einstein_journal/2023AO0162 -
Medicine and Sport Science 2005To review the available football epidemiology literature to identify risk factors, facilitate injury prevention and uncover deficiencies that may be addressed by future... (Review)
Review
OBJECTIVE
To review the available football epidemiology literature to identify risk factors, facilitate injury prevention and uncover deficiencies that may be addressed by future research.
DATA SOURCES
A literature search of Sports Discus (1940-2003), Eric (1967-2003), EMBASE (1988-2003), MEDLINE (1966-2003), CINAHL (1984-2003), and Web of Science (1993-2003) identified the published articles on American football in athletes of high school age and younger.
MAIN RESULTS
Injury rate increases with the level of play (grade in school), player age, and player experience. The lower extremity (knee and ankle joints) is most frequently injured. Football injuries are much more common in games than in practice, and occur to players who are being tackled, tackling or blocking. Most injuries are mild, including contusion, strain and sprain. Rule changes with the prohibition of initial contact with the helmet or face-mask reduced catastrophic head and neck injuries.
CONCLUSION
Although no sport or recreational activity is completely risk-free, football epidemiology research is critical to injury prevention. The existing medical literature provides some valuable insights, but an increased emphasis on prospective research is required to test the efficacy of preventative measures. Quality research may contribute to a reduction in football injury risk by defining the role of player conditioning and strength training, coaching of safety fundamentals, avoidance of dangerous activities, as well as proper medical supervision and care. Sports medicine personnel, coaches, and officials must strive to minimize injuries through progressive education, improved coaching techniques, effective officiating, and equipment modifications.
Topics: Adolescent; Age Factors; Athletic Injuries; Child; Contusions; Football; Humans; Lower Extremity; Risk Factors; Sports Equipment; Sprains and Strains
PubMed: 16247262
DOI: 10.1159/000085392 -
Bulletin of the NYU Hospital For Joint... 2012Hamstring injuries are a frequent injury in athletes. Proximal injuries are common, ranging from strain to complete tear. Strains are managed nonoperatively, with rest... (Review)
Review
Hamstring injuries are a frequent injury in athletes. Proximal injuries are common, ranging from strain to complete tear. Strains are managed nonoperatively, with rest followed by progressive stretching and strengthening. Reinjury is a concern. High grade complete tears are better managed surgically, with reattachment to the injured tendon or ischial tuberosity. Distal hamstring injury is usually associated with other knee injuries, and isolated injury is rare.
Topics: Athletic Injuries; Humans; Leg Injuries; Muscle, Skeletal; Orthopedic Procedures; Recurrence; Sprains and Strains; Tendon Injuries; Treatment Outcome
PubMed: 22894694
DOI: No ID Found -
Journal of Athletic Training Jun 2021To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed...
OBJECTIVE
To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations.
DATA SOURCES
PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period.
STUDY SELECTION
Studies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation.
DATA EXTRACTION
Data were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation.
DATA SYNTHESIS
A total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29-6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38-8.65) and 1 of 4 studies with an all-female sample (RR = 4.28).
CONCLUSIONS
Strong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.
Topics: Ankle Injuries; Female; Humans; Incidence; Male; Sprains and Strains
PubMed: 34375983
DOI: 10.4085/1062-6050-168-20