Acute Sprain Research Articles

Injury patterns of South African international cricket players over a two-season period

Objective. The aim of the study was to determine the incidence and nature of injury patterns of South African international cricket players. Methods. A questionnaire was completed for each cricketer who presented with an injury during the 2004 - 2005 (S1) and 2005 - 2006 (S2) cricket seasons to determine the anatomical site, month, diagnosis and mechanism of injury. Results. The results showed that 113 injuries were sustained, with a match exposure time of 1 906 hours for one-day internationals (ODIs) and 5 070 hours for test matches. The injury prevalence was 4% per match, while the incidence of injury was 90 injuries per 10 000 hours of matches. Injuries occurred mostly to the lower limbs, back and trunk, upper limbs and head and neck. The injuries occurred primarily during test matches (43%), practices (20%) and practices and matches (19%). Acute injuries comprised 87% of the injuries. The major injuries during S1 were haematomas (20 %), muscle strains (14%) and other trauma (20%), while during S2 the injuries were primarily muscle strains (16%), other trauma (32%), tendinopathy (10%) and acute sprains (12%). The primary mechanisms of injury occurred when bowling (67%), on impact by the ball (batting – 65%, fielding – 26%) and when sliding for the ball (19%). Conclusion. The study provided prospective injury incidence and prevalence data for South African cricketers playing at international level over a two-season period, high-lighting the increased injury prevalence for away matches and an increased match injury incidence for test and ODI matches possibly as a result of increased match exposure time.

Nonsteroidal antiinflammatory drugs (NSAIDs) and paracetamol for acute musculoskeletal injuries: Physiotherapists' understanding of which is safer, more effective, and when to initiate treatment

Physiotherapists are primary care practitioners, and are often the first health professional to consult with patients presenting with acute sprains or strains, and such patients may ask for advice regarding medications. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are readily available without a prescription and are commonly used by patients. The aim of this study was to investigate New Zealand physiotherapists' knowledge regarding the comparative safety, effectiveness, and appropriate timing of paracetamol and NSAIDs for acute musculoskeletal sprains and strains. A questionnaire was mailed to all members of the New Zealand Society of Physiotherapists currently practicing in the field of musculoskeletal physiotherapy (n = 948). Of 278 respondents (29.3%), just over half (52%) thought that NSAIDs were more effective than paracetamol in the treatment of sprains and strains. Almost half (45%) believed that NSAIDs should be withheld because of the potential for interrupting the beneficial role of inflammation in healing and that NSAIDs could increase bleeding into the injured tissue. In contrast, the majority of respondents (81%) recognised that there was no need to withhold paracetamol in the initial postinjury period. Knowledge regarding safety, effectiveness, and risks of paracetamol and NSAIDs may assist physiotherapists to recommend appropriate management of acute musculoskeletal injuries, within regulatory boundaries.

Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain

Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Case-control study. Laboratory. Ten individuals with acute ankle sprains (6 females, 4 males; age= 19.2 ± 3.8 years, height= 169.4 ± 8.5 cm, mass= 66.3 ± 11.6 kg) and 10 healthy individuals(6 females,4 males; age= 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass= 66.3 ± 10.2 kg) participated. The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (H(max)) and maximal muscle response (M(max)) and was then normalized using the H(max):M(max) ratio. The soleus MNPE in the ankle-sprain group was higher in the injured limb (H(max):M(max) = 0.63; 95% confidence interval [Cl],0.46, 0.80) than the uninjured limb (H(max):M(max) = 0.47; 95%Cl, 0.08, 0.93)(t(6) = 3.62,P =.01).In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (H(max):M(max) =0.06; 95% Cl, 0.01, 0.10) than in the uninjured ankle (H(max):M(max) =0.22; 95%Cl, 0.09, 0.35),but this finding was not different (t(9) =-2.01, P =.07). No differences were detected between injured (0.22; 95% Cl, 0.14, 0.29) and uninjured (0.25; 95%Cl, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t(9) =-0.739, P =.48). We found no side-to-side differences in any muscle among the healthy group. Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles.

Neuromuscular patterns in chronic ankle instability

BackgroundAnkle sprains are the most frequent injury in sports. Up to 40% of acute sprains develop chronic ankle instability (CAI). CAI may be seen either as mechanical (ligamentous) instability or...

Diclofenac epolamine topical patch relieves pain associated with ankle sprain

Background:Sports-related injuries, such as sprains and strains, commonly occur during exercise and athletic events. Current therapy includes nonsteroidal anti-inflammatory drugs (NSAIDs), which have a high incidence of upper gastrointestinal side effects. The present study assessed the efficacy and safety of the diclofenac epolamine topical patch (DETP, 1.3%), a topical NSAID for the treatment of acute minor sprains and strains.Methods:This multicenter, randomized, placebo-controlled clinical study enrolled adult patients (n = 134) with acute ankle pain (due to a minor sprain) occurring less than 48 hours prior to entering the study. Patients were treated with either the DETP or a placebo topical patch daily for seven days. Pain intensity was evaluated during the first six hours after application of the patch, and on treatment days 1, 2, 3, and 7.Results:Patients treated with the DETP experienced a significantly greater reduction in pain associated with their ankle injury compared with placebo, beginning four hours after the first patch application (P = 0.02). The DETP was well tolerated and was comparable with placebo in terms of safety.Conclusion:Overall, the results of this study demonstrate that the DETP is an effective analgesic for local treatment of pain in mild acute ankle sprain.

Aquatic Versus Land-based Exercises as Early Functional Rehabilitation for Elite Athletes with Acute Lower Extremity Ligament Injury: A Pilot Study

To compare outcomes between aquatic and land-based exercises during early-phase recovery from acute lower extremity ligament injuries in elite athletes. A single-blinded, covariate adaptive randomized, controlled study. National training center for elite athletes. Twenty-two athletes with isolated grade I or II ligament injury in ankles or knees were randomized into either an aquatic or land-based exercise group. Early functional rehabilitation program (ranging, strengthening, proprioceptive training, and functional exercises) was performed in both groups. All exercises were identical except for the training environment. Data were collected at baseline and at 2 and 4 weeks using a visual analog scale (VAS) for pain; static stability (overall stability index [OSI] level 5 and 3); dynamic stability (TCT), and percentage single-limb support time (%SLST). Both groups showed decreases in VAS, OSI 5 and 3, and TCT, with a concomitant increase in %SLST at 2 and 4 weeks (P < .05). No significant differences were detected between the 2 groups in any of the outcome measures. However, the line graphs for VAS, OSI 3, TCT, and %SLST in the aquatic exercise group were steeper than those in the land-based exercise group indicating significant group by time interactions (P < .05). These data indicate that the aquatic exercise group improved more rapidly than the land-based exercise group. For elite athletes with acute ligament sprains in the lower limb, aquatic exercises may provide advantages over standard land-based therapy for rapid return to athletic activities. Consequently, aquatic exercise could be recommended for the initial phase of a rehabilitation program.

Observation of the clinical effects of DING’s rolling technique for acute lumbar sprains

To observe the clinical effects of DING’s Rolling Technique for acute lumbar sprain. All of 243 cases of acute lumbar sprain were randomly allocated into two groups. One is the treatment group, in which 131 cases were treated with DING’s Rolling Technique. The other is the control group, in which 112 cases were treated with needling at Houxi (SI 3), and routine tuina. In the treatment group, 98 cases were cured, 33 cases improved, and there were no cases exhibiting zero effects. In the control group, 80 cases were cured, 29 cases improved, and 3 cases experienced no effect. There is no significant difference in the effective rate between the two groups. the tuina method, DING’s Rolling Technique has good clinical effects on acute lumbar sprain with easy manipulation.

Evidence-based treatment for ankle injuries: a clinical perspective

The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-term effects. Electro-physical agents do not appear to enhance outcomes and are not recommended. Exercise may reduce the occurrence of recurrent ankle sprains and may be effective in managing chronic ankle instability. After surgical fixation for ankle fracture, an early introduction of activity, administered via early weight-bearing or exercise during the immobilization period, may lead to better outcomes. However, the use of a brace or orthosis to enable exercise during the immobilization period may also lead to a higher rate of adverse events, suggesting that this treatment regimen needs to be applied judiciously. After the immobilization period, the focus of treatment for ankle fracture should be on a progressive exercise program.

Radial Head Fracture Following a Fall

A 26-year-old man who was serving in the military was referred to a physical therapist for an acute right elbow sprain following a fall on an outstretched hand 36 hours prior. The patient reported immediate pain and restricted elbow motion following the injury. Because the history and physical examination findings were concerning for a possible radial head fracture, the physical therapist ordered elbow radiographs. The anterior-to-posterior radiographic view revealed a nondisplaced longitudinal radial head fracture involving the lateral one third of the radial head, while the lateral radiographic view revealed lucencies anterior and posterior to the distal humerus, indicating displacement of the anterior and posterior fat pads due to joint effusion. The patient was referred to an orthopaedic physician for fracture management. At 6 weeks following the injury, he successfully returned to full unrestricted activity, with no residual deficits. J Orthop Sports Phys Ther 2010;40(1):30. doi:10.2519/jospt.2010.0401

Injury patterns of South African provincial cricket players over two seasons

Objective. To determine the incidence and nature of injury patternsin elite cricketers over two seasons.Methods. Physiotherapists and/or doctors working with 4 provincial teams completed a questionnaire for each cricketer who presented with an injury during the 2004 - 2005 (S1) and 2005 - 2006 (S2) cricket seasons. This was done to determine: (i) the anatomical site of injury; (ii) the month of injury during the season; (iii) the diagnosis using the OSCIS injury classification system; (iv) the mechanism of injury; (v) whether it was a recurrence of a previous injury; (vi) whether the injury had recurred again during the season; and (vii) biographical data.Results. The results showed that 180 injuries (S1 – 84; S2 – 96)were sustained. On average the teams spent 2 472 hours on matches, 4 148 on practices and 1 612 on fitness training during the two-season period. The injury prevalence was 8% per match, while the injury incidence was 30/10 000 hours of match, practice and training time, with the match incidence being 74 injuries/ 10 000 hours and the training incidence 15 injuries/10 000 hours. Bowling (29%), fielding and wicket-keeping (27%) and batting (19%) accounted for the majority of injuries. The occurrence of injuries was predominantly to the lower limbs (S1 – 45%; S2 – 42%),back and trunk (S1 – 19%; S2 – 19%), upper limbs (S1 – 19%; S2 – 22%), head and neck (S1 – 6%; S2 – 3%), and related to illnesses (S1 – 11%; S2 – 14%). The injuries occurred primarily during first-class matches (39%), limited-overs matches (22%), and practices (17%), and some were of gradual onset (20%). Acute injuries comprised 78% of injuries. The majority of injuries were first-time injuries (76%), with 11% and 14% recurrent injuries from the previous and current seasons, respectively. The major injuries during S1 were haematomas (19%), muscle strains(17%) and other trauma (14%), while during S2 the injuries were primarily muscle strains (16%), other trauma (20%), tendinopathy (16%) and acute sprains (15%). The primary mechanisms of injury occurred in the delivery stride when bowling (19%) and overbowling (7%), on impact by the ball when batting (11%), and on sliding to field the ball (6%).Conclusion. The results indicate a pattern of cause of injury, withthe fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.

Medical and Psychosocial Diagnoses in Women With a History of Intimate Partner Violence

We characterized the relative risk of a wide range of diagnoses in women with a history of intimate partner violence (IPV) compared with never-abused women. The sample comprised 3568 English-speaking women who were randomly sampled from a large US health plan and who agreed to participate in a telephone survey to assess past-year IPV history using questions from the Behavioral Risk Factor Surveillance System (physical, sexual, and psychological abuse) and the Women's Experience with Battering Scale. Medical and psychosocial diagnoses in the past year were determined using automated data from health plan records. We estimated the relative risk of receiving diagnoses for women with a past-year IPV history compared with women with no IPV history. In age-adjusted models, compared with never-abused women, abused women had consistently significantly increased relative risks of these disorders: psychosocial/mental (substance use, 5.89; family and social problems, 4.96; depression, 3.26; anxiety/neuroses, 2.73; tobacco use, 2.31); musculoskeletal (degenerative joint disease, 1.71; low back pain, 1.61; trauma-related joint disorders, 1.59; cervical pain, 1.54; acute sprains and strains, 1.35); and female reproductive (menstrual disorders, 1.84; vaginitis/vulvitis/cervicitis, 1.56). Abused women had a more than 3-fold increased risk of being diagnosed with a sexually transmitted disease (3.15) and a 2-fold increased risk of lacerations (2.17) as well as increased risk of acute respiratory tract infection (1.33), gastroesophageal reflux disease (1.76), chest pain (1.53), abdominal pain (1.48), urinary tract infections (1.79), headaches (1.57), and contusions/abrasions (1.72). Past-year IPV history was strongly associated with a variety of medical and psychosocial conditions observed in clinical settings.

Changes in Active Ankle Dorsiflexion Range of Motion after Acute Inversion Ankle Sprain

Posterior calf stretching is believed to improve active ankle dorsiflexion range of motion (AADFROM) after acute ankle-inversion sprain. To describe AADFROM at baseline (postinjury) and at 2-wk time periods for 6 wk after acute inversion sprain. Randomized trial. Sports clinic. 11 men and 11 women (age range 11-54 y) with acute inversion sprain. Standardized home exercise program for acute inversion sprain. AADFROM with the knee extended. Time main effect on AADFROM was significant (F3,57 = 108, P < .001). At baseline, mean active sagittal-plane motion of the ankle was 6 degrees of plantar flexion, whereas at 2, 4, and 6 wk AADFROM was 7 degrees, 11 degrees, and 11 degrees, respectively. AADFROM increased significantly from baseline to week 2 and from week 2 to week 4. Normal AADFROM was restored within 4 wk after acute inversion sprain.

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.

Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach

Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. e purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for e cacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine arti- cles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to di erences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT e ectiveness. e best evidence suggests that the efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.

The effect of isokinetic and proprioception training on strength, movement and gait parameters after acute supination injury of the ankle ligaments

The effects of a three-week isokinetic training compared to typical proprio -ceptive training on parameters of strength, movement and gait function after acute ankle ligament sprain were investigated. Thirty-nine patients were randomly allocated to two comparison groups. In group 1 (n=20)a proprioceptive training and in group 2 (n=19) an isokinetic strength training (Cybex 6000®) were administered. Thepatients of both groups underwent training five times a week for three weeks. Before and at the end of the treatmentcourse, in both groups isokinetic strength was tested, the range of motion in the ankle joint was recorded and gait wasanalyzed (multicomponent strength measurement platform, Henschel-System®). The maximum isokinetic torque(60°/s) [Nm] and the contact time (monopedal support time) of the injured leg during gait cycle were the basis for evaluation.The data obtained show that in group 2 a significantly greater increase of the maximum isokinetic torque wasattained in almost all range of motion of the ankle joint in the course of treatment. A t the same time, in group 2 theshortening of the contact time in the stance phase of the injured leg could be compensated. The active range of motionin the ankle joint was less at the end of treatment in group 2 than in group 1. The isokinetic training obviously did notonly lead to better strength regeneration, but also to a functionally more stable ankle joint with a rhythmically moreevenly balanced stance phase of the gait cycle. These results suggest that the used isokinetic training had positive effects on functional stability after acute ankle sprain.

Treatment of Common Deficits Associated with Chronic Ankle Instability

Lateral ankle sprains are amongst the most common injuries incurred by athletes, with the high rate of reoccurrence after initial injury becoming of great concern. Chronic ankle instability (CAI) refers to the development of repetitive ankle sprains and persistent residual symptoms post-injury. Some of the initial symptoms that occur in acute sprains may persist for at least 6 months post-injury in the absence of recurrent sprains, despite the athlete having returned to full functional activity. CAI is generally thought to be caused by mechanical instability (MI) or functional instability (FI), or both. Although previously discussed as separate entities, recent research has demonstrated that deficits associated with both MI and FI may co-exist to result in CAI. For clinicians, the main deficits associated with CAI include deficits in proprioception, neuromuscular control, strength and postural control. Based on the literature reviewed, it does seem that subjects with CAI have a deficit in frontal plane ankle joint positional sense. Subjects with CAI do not appear to exhibit any increased latency in the peroneal muscles in response to an external perturbation. Preliminary data suggest that feed-forward neuromuscular control may be more important than feed-back neuromuscular control and interventions are now required to address deficits in feed-forward neuromuscular control. Balance training protocols have consistently been shown to improve postural stability in subjects with CAI. Subjects with CAI do not experience decreased peroneus longus strength, but instead may experience strength deficits in the ankle joint invertor muscles. These findings are of great clinical significance in terms of understanding the mechanisms and deficits associated with CAI. An appreciation of these is vital to allow clinicians to develop effective prevention and treatment programmes in relation to CAI.

The effect of three degrees of elevation on swelling in acute inversion ankle sprains

The use of elevation is a central tenant in the treatment of acute soft tissue injuries, the most appropriate degree of elevation for swelling reduction is yet to be established The aim of this study was to determine the acute effect different degrees of limb elevation on the amount of swelling present in patients with acute first and second degree anterior Talo-fibular ligament sprains. Thirty patients with a diagnosed grade 1 or 2 anterior Talo-fibular ligament (ATFL) sprains (injuries 24 to a maximum 72 h old) participated in the study. Subjects were randomly allocated to one of three groups, either 0°, 20° or 60° elevation. Each subject was elevated to the group angle for 30 min, following 30 min elevation the patients undertook two sets of 20 repetitions full (available) range dorsi to plantar flexion at 0° elevation. Volumetric measurement of the foot and ankle (water displacement method) and girth measurement of ankle (using a tape measure) were made pre-elevation, post-elevation and post-exercise. MANCOVA analysis revealed a significant effect for treatment on post elevation girth and volume measurements ( p < 0.0001 ) and post exercise girth and volume measurements ( p < 0.0001 ). Post-hoc stepwise comparisons revealed post-elevation and post-exercise volume and girth measurements to show a significantly greater reduction in 60° vs. 20° ( p < 0.0001 ), 60° vs. 0° ( p < 0.0001 ) and 20° vs. 0° ( p < 0.003 ). The results of this study would indicate that in acute ATFL sprains 60° of limb elevation provides the most effective acute means of swelling reduction.

A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

Background Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. Hypothesis There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. Results Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. Conclusion Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.

Practical Management: Nonsteroidal Antiinflammatory Drug (NSAID) Use in Athletic Injuries

Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently used in the treatment of acute athletic injuries, often for analgesic purposes as the evidence to support enhanced healing is limited. However, the current evidence on NSAID use in athletic injury is slowly growing. On the basis of animal models and limited human studies, some practical management guidelines can be drawn to assist the sports physician. Specifically, NSAIDs are not recommended in the treatment of completed fractures, stress fractures at higher risk of nonunion, or in the setting of chronic muscle injury. The only exception may be very short-term use (eg, a few days) for analgesic purposes only. Judicious use of NSAIDs may be more appropriate in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury. However, length of treatment should always be kept as short as possible, with consideration of the specific type of injury, level of dysfunction, and pain.

Ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint

Objectives To determine the efficacy of ultrasound treatment in the management of acute lateral ligament sprains of the ankle joint. Design Single-blind randomized controlled trial. Setting Physiotherapy Department of St Luke's Hospital, Malta. Participants Thirty-four patients with acute lateral ligament sprains of the ankle joint presenting to the Accident and Emergency Department of St Luke's Hospital, Malta were randomly assigned to one of three treatment groups: active ultrasound treatment group ( n=12); placebo ultrasound treatment group ( n=10); no ultrasound treatment group ( n=12). Main outcome measures Pain (visual analogue scale), swelling (tape measure), range of motion during dorsiflexion and plantarflexion (universal 360° goniometer), and postural stability (balance error scoring system) were measured on days 1 (baseline), 8, 15 and 22. Results No statistically significant differences ( α=0.05) between treatment groups were detected in any outcome measure. Within treatment groups, statistically significant differences ( α=0.05) were detected in pain, swelling, range of motion during dorsiflexion and plantarflexion, and postural stability. Conclusions At the dose and duration used, ultrasound treatment does not increase the effectiveness of management of acute lateral ligament sprains of the ankle joint, with respect to the following outcomes: pain, swelling, range of motion during dorsiflexion and plantarflexion, and postural stability.