OBJECTIVE:To compare the changes in gait parameters before and after the treatment of lateral ankle sprain using the rotating-pulling-poking manipulation, and explore the potential bio-mechanical mechanism of this man...OBJECTIVE:To compare the changes in gait parameters before and after the treatment of lateral ankle sprain using the rotating-pulling-poking manipulation, and explore the potential bio-mechanical mechanism of this manipulation. METHODS:Forty patients with lateral ankle sprains were randomly divided into two groups in a 1∶1 ratio using a random number table. The experimental group were treated by rotating-pulling-poking manipulation and elastic bandage external fixation, while the control group were treated by ice compress and elastic bandage external fixation. The treatment courses of the two groups were both 2 weeks. We used a three-dimensional motion capture system for kinematic measurements and a Bertec gait analysis force measurement system for mechanical measurements, and compared the changes in gait parameters between the two groups of patients before and after treatment. RESULTS:Intragroup comparison showed that the support time, swing time, peak of back extension, peak of plantar flexion, peak of toe pedal force, and peak of heel landing force of the affected feet in the experimental group were significantly improved compared to those before treatment(P < 0.05). The swing time of the affected feet in the control group was significantly improved compared to that before treatment(P < 0.05). The inter group comparison showed that the gait speed, stride length, peak of back extension, peak of plantar flexion, peak of toe pedal force, and peak of heel landing force of the affected feet in the experimental group were significantly better than those in the control group(P < 0.05). CONCLUSIONS:The rotating-pulling-poking manipulation can effectively improve the patient's gait and range of motion of the affected ankle joint, and enhance the negative gravity in the vertical direction of the affected foot, and the braking and driving forces in the front and back directions. This may be the potential biomechanical mechanism of the rotating-pulling-poking manipulation for treating lateral ankle sprain.展开更多
BACKGROUND The tear of the gluteus medius and minimus tendons can cause chronic buttock pain,especially in middle-aged individuals;these tears occur mostly in association with degenerative changes in the muscles and t...BACKGROUND The tear of the gluteus medius and minimus tendons can cause chronic buttock pain,especially in middle-aged individuals;these tears occur mostly in association with degenerative changes in the muscles and tendons.Chronic injuries are more common than acute injuries,and concurrent injuries to the gluteus medius and minimus tendons without chronic pain are rare,especially isolated injuries to both sides of the gluteus minimus;such a case has not yet been reported.CASE SUMMARY The authors present a case of bilateral acute traumatic injuries to the gluteus minimus during buttock strengthening exercises in a 75-year-old male patient.The patient completely returned to his pre-injury lifestyle after 8 weeks of injury,with no limitations,but the diagnosis was initially delayed due to misdiagnosis as lumbar radiculopathy,resulting in unnecessary socio-economic burden on the patient.CONCLUSION When treating patients who complain of hip pain,it is important to consider various causes to make a correct diagnosis.展开更多
Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The pr...Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The present paper examines some subjects with a previous history of acute inversion ankle sprain who have developed a subsequent condition of instability, grouping them according to inclusion criteria and analyzing them through four field tests considered objective by the scientific literature: SEBT test, BEES test, TIBT test, SHT test. The data obtained were stored in order to compare them following a re-education protocol aimed at improving proprioception, balance, walking and strengthening the extrinsic and intrinsic muscles of the foot. per year. The subjects were then divided into two categories: subjects with CAI > 1 year and subjects with CAI ≤ 1 year. A protocol lasting 6 weeks was administered to both groups, trying to work on improving balance in single stance, improving static and dynamic stability, strengthening the gluteus medius and maximus (pelvis stabilizers) and strengthening of the intrinsic muscles of the foot. At the end of the protocol the subjects were all re-evaluated with the same field tests used previously and the data obtained were compared both with the pre-protocol data and with the data measured by the control subjects.展开更多
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this...BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.展开更多
Objective To observe the clinical effect of acupuncture on the obsolete lateral malleolus joint sprain. Methods Thirty-one cases of patients with obsolete lateral malleolus joint sprain were selected. Jiexi （解溪 ST...Objective To observe the clinical effect of acupuncture on the obsolete lateral malleolus joint sprain. Methods Thirty-one cases of patients with obsolete lateral malleolus joint sprain were selected. Jiexi （解溪 ST 41） were penetrated to Shenmei （申脉 BL 61）, and Yanglingquan （阳陵泉 GB 34） was applied. The needles were retained for 30 min, and the treatment was performed only once, with follow-up visit after 1 month. Results All the patients were cured after treatment, and without relapse on the follow-up visit after 1 month. Conclusion The clinical effect of acupuncture on the obsolete lateral malleolus joint sprain is remarkable.展开更多
Objective: this experiment briefly analyzes the understanding and treatment of ankle sprain in the department of orthopedics and traumatology of traditional Chinese medicine. Methods: five years from May 2020 to May 2...Objective: this experiment briefly analyzes the understanding and treatment of ankle sprain in the department of orthopedics and traumatology of traditional Chinese medicine. Methods: five years from May 2020 to May 2021 were selected as the time points, and the years from 2020 to 2021 were recent years. Therefore, the research results are more time-sensitive and referential. From the patients received in the hospital during this period of time, 68 cases of study subjects with medication standard were selected and randomly divided into the control group and the experimental group with 34 patients in each group. The patients in the control group were treated with traditional Chinese medicine, while the patients in the experimental group were treated with massage. After the experiment, the therapeutic effect, recovery time of ankle sprain and patients' satisfaction with the treatment were compared between the two groups. Results: the effective rate of treatment in the experimental group was as high as 94.1%, while that in the control group was only 82.3%, the difference was statistically significant (p < 0.05). In addition, the patients in the experimental group were 94.1% satisfied with the treatment, while the patients in the control group were 79.4% satisfied with the treatment. The patients in the experimental group were more satisfied with the treatment. Conclusion: according to the results of the experiment, it can be seen that the therapeutic effect of the traditional Chinese medicine massage combined with traditional Chinese medicine application is better than the conventional treatment, which can not only shorten the treatment time, speed up the recovery of the patients, but also increase the satisfaction of the patients.展开更多
OBJECTIVE： Several studies have reported that acupuncture is effective for treatment of acute lumbar sprain, but they neglected to consider that acupuncture cannot remarkably improve lumbar activity. We performed a r...OBJECTIVE： Several studies have reported that acupuncture is effective for treatment of acute lumbar sprain, but they neglected to consider that acupuncture cannot remarkably improve lumbar activity. We performed a randomized controlled trial to evaluate the effect of acupuncture-movement therapy versus conventional acupuncture in the trea ment of acute lumbar sprain. METHODS： Sixty patients were randomized into four groups： the acupuncture-movement （AM） group, sham acupuncture-movement （SAM） group, conventional acupuncture （CA） group, and physical therapy （PT） group. Patients in the AM group were treated with acupuncture at Yintang （EX-HN 3） and exercise of the lumbar region during acupuncture. Patients in the SAM group were treated with sham acupuncture at Yintang （EX-HN 3） and exercise of the lumbar region during sham acupuncture. Con- ventional acupuncture was performed in the CA group, and physical therapy was applied in the PT group. Each treatment lasted for 20 min. Patients were assessed before and after treatment using a visual analogue scale （VAS） and the Roland Morris Questionnaire （RMQ）. RESULTS： The VAS and RMQ scores in the AM group were significantly lower after than before treatment （P 〈 0.01）. The AM group reported lower RMQ scores in after-treatment and 24 h after treatment and lower VAS score in 24 h after treatment in comparison with those of the CA, SAM, and PT groups （P 〈 0.05）. CONCULSlON： Acupuncture-movement therapy is effective for treating acute lumbar sprain with a persistent pain-relief and remarkable improvement of lumbar activity. Movement, that is, lumbar exercise during acupuncture, enhances the effect of acupuncture.展开更多
Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus,...Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significantlong-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and nonanatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.展开更多
Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial ri...Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.展开更多
Background'. Up to 74% of people with a history of ankle sprain develop chronic ankle instability (CAI). One commonly reported residualimpairment is ankle pain;however, it has not been included in models or inclus...Background'. Up to 74% of people with a history of ankle sprain develop chronic ankle instability (CAI). One commonly reported residualimpairment is ankle pain;however, it has not been included in models or inclusion criteria for CAL We investigated the prevalence of pain inpeople with CAI and the association between presence of pain and other CAI characteristics.Methods'. Retrospective data from 1147 participants with CAI (age 26.6 ± 10.7 years, 59% female) were collated from previous studies that usedthe Cumberland Ankle Instability Tool as an assessment tool. Pain was assessed from Item 1 of the Cumberland Ankle Instability Tool, whichasks participants about ankle pain. Responses were divided into 3 categories: pain during daily activities, pain during moderate/vigorous physicalactivities, and no pain. The presence of pain was analyzed with descriptive statistics, the correlation between pain category and CAI characteris・tics was analyzed by /2 tests and factors associated with each pain category were analyzed by logistic regression.Results'. Among the participants, 60.1% (n = 689) reported ankle pain. Of all participants, 12.4% (n = 142) reported pain during daily activities,47.7% (n = 547) reported pain during moderate/vigorous physical activities, and 39.9% (n = 458) reported no pain. There was a strong associationbetween ankle instability and ankle pain (/2 = 122.2, p < 0.001, OR = 53& 95% confidence interval (CI): 3.84—7.53). Perceived ankle instability,age and unilateral ankle sprains were independently associated with pain (ankle instability: /2 = 43.29, p < 0.001;age: /2 = 30.37,p < 0.001;unilateral ankle sprains: /2 = 6.25, p < 0.05). There was no significant difference in the presence of pain between genders.Conclusion-. The prevalence of pain in people with CAI was high and was related to perceived ankle instability. Number of sprains, age, genderand unilateral or bilateral sprain did not modify this result except for the first pain category (pain during daily activities). There is large gap incurrent knowledge about the impact of pain in people with CAI, and this topic needs further investigation.展开更多
Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop la...Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop landing activity in subjects with chronic ankle instability (CAI)compared to healthy subjects with no history of CAI.Methods:Ten healthy subjects and 10 subjects who had multiple ankle sprains participated in the study as the control and unstable subjects,respectively.The CAI subjects were age,body mass index and gender matched with the control subjects.The arch index and ankle functions of the subjects were measured in a subject screening session.During the biomechanical test session,participants performed five trials of drop landing from 0.6 m,wearing no brace ( NB),ElementTM brace and ASO brace.Simultaneous recording of three-dimensional kinematic (240 Hz)and GRF (1200 Hz) data were performed.Results:The CAI subjects had lower ankle functional survey scores.The arch index and deformity results showed greater arch deformity of ElementTM against a static load than in NB and ASO due to greater initial arch position held by the brace.CAI participants had greater eversion velocity than healthy coutrols.The ASO brace reduced the first peak vertical GRF whereas ElementTM increased 2nd peak vertical GRF.ElementTM brace reduced eversion range of motion (ROM) and peak eversion velocity compared to NB and ASO.In addition,ElementTM reduced dorsiflexion ROM and increased peak plantarflexion moment compared to NB and ASO.Conclusion:Results of static arch measurements and dynamic ankle motion suggest that the restrictions offered by both braces are in part due to more dorsiflexed ankle positions at contact,and higher initial arch position and stiffer ankle for ElementTM.展开更多
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40%of all sports-related injuries.It is especially common in basketball,American football,and soccer.The majority of sprains aff...Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40%of all sports-related injuries.It is especially common in basketball,American football,and soccer.The majority of sprains affect the lateral ligaments,particularly the anterior talofibular ligament.Despite its high prevalence,a high proportion of patients experience persistent residual symptoms and injury recurrence.A detailed history and proper physical examination are diagnostic cornerstones.Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules.Several interventions have been recommended in the management of acute ankle sprains including rest,ice,compression,and elevation,analgesic and anti-inflammatory medications,bracing and immobilization,early weight-bearing and walking aids,foot orthoses,manual therapy,exercise therapy,electrophysical modalities and surgery(only in selected refractory cases).Among these interventions,exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.An exercise program should be comprehensive and progressive including the range of motion,stretching,strengthening,neuromuscular,proprioceptive,and sport-specific exercises.Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables,manual tests for stability,and functional performance testing.There are some common myths and mistakes in the management of ankle sprains,which all clinicians should be aware of and avoid.These include excessive imaging,unwarranted non-weightbearing,unjustified immobilization,delay in functional movements,and inadequate rehabilitation.The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.展开更多
Purpose:The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability(CAI),lateral...Purpose:The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability(CAI),lateral ankle sprain copers,and healthy controls.Methods:Twenty-three participants with CAI,23 lateral ankle sprain copers,and 24 healthy control participants volunteered.Active motor threshold(AMT),normalized motor-evoked potential(MEP),and cortical silent period(CSP)were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.Results:Participants with CAI had significantly longer CSP at 100%of AMT and lower normalized MEP at 120%of AMT compared to lateral ankle sprain copers(CSP100%:p=0.003;MEP120%:p=0.044)and controls(CSP100%:p=0.041;MEP120%:p=0.006).Conclusion:This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI.Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.展开更多
Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （M...Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （MG）, peroneus longus （PL）, and tibialis anterior （TA） muscles. Methods： Twelve recreational athletes performed five drop landings from an overhead bar of 30 cm height on to three surfaces： a flat surface, a 25° inversion surface, and a combined surface of 25° inversion and 25° plantarflexion. The kinematic variables and integrated EMG （IEMG） of the three muscles were assessed using a one-way repeated measures ANOVA and a 3 × 3 （surface × muscle） ANOVA, respectively （p 〈 0.05）. Results： The IEMG results showed a significant muscle by surface interaction. The flat surface induced higher TA activity than the two tilted surfaces. The inverted surface produced significantly higher inversion peak angle and velocity than the flat surface, but similar PL activity across the surfaces. The MG IEMG, ankle plantarflexion angle, and inversion range of motion were significantly higher for the combined surface compared to the inverted surface. Conclusion： These findings suggest that compared to the inversion surface, the combined plantarflexion and inversion surface seems to provide a more unstable surface condition for lateral ankle sprains during landing.展开更多
Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity ...Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity information in the literature,the detailed mechanism of ankle sprain is still unrevealed.The purpose of our case report is to present 2 accidental ankle giving way incidents for participants with chronic ankle instability(CAI)and compare to their normal trials with data of kinematics,kinetics,and electromyography(EMG).Case description:Two young female participants accidentally experienced the ankle giving way when landing on a 25°lateral-tilted force plate.3 D kinematics,kinetics,and muscle activity were recorded for the lower extremity.Qualitative comparisons were made between the giving way trials and normal trials for joint angles,angular velocities,moments,centers of pressure and EMG linear envelopes.Results:One participant’s giving way trial displayed increased ankle inversion and internal rotation angles in the pre-landing phase and at initial contact compared to her normal trials.Another participant’s giving way trial exhibited greater hip abduction angles and delayed activation of the peroneus longus muscle in the pre-landing phase versus her normal trials.Conclusion:A vulnerable ankle position(i.e.,more inverted and internally rotated),and a late activation of peroneus activity in the pre-landing phase could result in the ankle giving way or even sprains.A neutral ankle position and early activation of ankle evertors before landing may be helpful in preventing ankle sprains.展开更多
Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a...Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury. In the case of operative treatment the method of fixation, the height and number of screws and the need for hardware removal are still under discussion. Furthermore, intraoperative assessment of the accuracy of reduction of the fibula in the incisura using fluoroscopy is difficult. A possible solution might be the assessment with intraoperative three-dimensional imaging. The aim of this article is to provide a current concepts review of the clinical presentation, diagnosis and treatment of syndesmotic injuries.展开更多
Background:Stochastic resonance stimulation(SRS) transmits subsensory electrical Gaussian white noise into the body to enhance sensorimotor function.This therapy has improved static single leg balance in subjects with...Background:Stochastic resonance stimulation(SRS) transmits subsensory electrical Gaussian white noise into the body to enhance sensorimotor function.This therapy has improved static single leg balance in subjects with functional ankle instability.However,the effect of this stimulation on dynamic single leg balance is not known.Improvements in dynamic single leg balance with SRS may have implications For enhancing functional rehabilitation for ankle instability.Thus,the purpose of this study was to determine the effects of SRS on dynamic single leg balance in subjects with functional ankle instability. Methods:This study was an experimental research design and data were collected in a sports medicine research laboratory.Twelve subjects with functional ankle instability(69±15 kg;173±10 cm;21±2 years) reported a history of ankle sprains and instability at the ankle with physical activity.A single leg jump-landing test was used to assess dynamic balance.Subjects were required to jump between 50% and 55% of the maximal vertical jump height,land on a single leg atop a force plate,and stabilize as quickly as possible.Jump-landing tests were performed with and without SRS.Three trials were performed for each treatment condition(SRS and control).A randomized block design was used to determine test order.Anterior/posterior and medial/lateral time-to-stabilization were computed to assess dynamic balance.Lesser time indicated better stability.One-tailed paired samples t tests were used for analysis(α≤0.05). Results:SRS improved anterior/posterior time-to-stabilization(stochastic resonance = 1.32±0.31 s,control = 1.74±0.80 s,p = 0.03),but did not enhance medial/lateral time-to-stabilization(stochastic resonance = 1.95±0.40 s,control = 1.92±0.48 s,p = 0.07). Conclusion:Clinicians might use SRS to facilitate balance improvements with sagittal plane dynamic single leg balance exercises that patients may not be able to perform otherwise.展开更多
OBJECTIVE:To observe the effect of electroacupuncture(EA) on force-displacement value(FDV)of muscle state and the temperature index of infrared thermogram in patients with acute lumbar muscle sprain.METHODS:Patients w...OBJECTIVE:To observe the effect of electroacupuncture(EA) on force-displacement value(FDV)of muscle state and the temperature index of infrared thermogram in patients with acute lumbar muscle sprain.METHODS:Patients with acute lumbar muscle sprain were randomly divided into a medication group and an EA group.The medication group(n-60) were treated with diclofenac sodium dual release enteric-coated capsules,75 mg per day for 7days.The EA group(n = 60) received EA at bilateral Houxi(SI 3),Jiaji(EX-B2),and Ashi points,at 20-30 mm depth and 10-25 Hz frequency for 20 min daily for 7 days.Muscle states were determined by measuring FDVs of the bilateral lumbar muscle with a Myotonometer fast muscle state detector.The temperature index of the lumbar skin was measured before and after treatment with a Fluke Ti30 non-refrigerated focal plane infrared thermal imaging detector.RESULTS:There were no significant pre-treatment differences between the medication group and the EA group in mean FDV(P = 0.052) or temperature index of the lumbar skin(P = 0.25).The cure rate was 63.3%in the EA group and 53.3%in the medication group.The total efficacy in the EA group(93.3%) was not significantly different from that in the medication group(86.6%,P = 0.204).After treatment,the mean FDV of the lumbar muscle significantly increased in both groups(P < 0.05 for both groups);the FDV increase in the EA group was significantly higher than in the medication group(P = 0.015).The temperature index was also significantly increased in both groups(P < 0.05 for both groups);the infrared thermogram in the EA group indicated significantly greater recovery compared to the medication group(P = 0.026).CONCLUSION:Both EA and diclofenac sodium markedly improved acute lumbar sprain,but EA better improved the rehabilitation and regeneration of FDVs and temperature index of infrared thermogram of the muscle.展开更多
Lateral ankle instability is one of the most common and well-recognized conditions presenting to foot and ankle surgeons.It may exist as an isolated entity or in conjunction with other concomitant pathology,making it ...Lateral ankle instability is one of the most common and well-recognized conditions presenting to foot and ankle surgeons.It may exist as an isolated entity or in conjunction with other concomitant pathology,making it important to appropriately diagnose and identify other conditions that may need to be addressed as part of treatment.These associated conditions may be a source of chronic pain,even when the instability has been appropriately treated,or may lead to failure of treatment by predisposing the patient to ankle inversion injuries.The primary goal of this editorial is to provide a brief summary of the common techniques used in the delayed reconstruction of lateral ankle ligamentous injuries and present a method we have successfully employed for over 15 years.We will also briefly discuss the diagnosis and treatment of the more common associated conditions,which are important to identify to achieve satisfactory results for the patient.We present the outcomes of 250 consecutive reconstructions performed over the last 10 years and describe our operative technique for addressing lateral ankle ligamentous injuries.展开更多
Background:The Identification of Functional Ankle Instability(IdFAI)is a valid and reliable tool to identify chronic ankle instability;however,it was developed in English,thus limiting its usage only to those who can ...Background:The Identification of Functional Ankle Instability(IdFAI)is a valid and reliable tool to identify chronic ankle instability;however,it was developed in English,thus limiting its usage only to those who can read and write in English.The objectives of our study were to(1)cross-culturally adapt a Chinese(Mandarin)version of the IdFAI and(2)determine the psychometric properties of the Chinese version IdFAI.Methods:The cross-cultural adaptation procedures used by the investigators and translators followed previously published guidelines and included 6 stages:(1)initial translation,(2)synthesis of the translations,(3)back translation,(4)developing the pre-final version for field testing,(5)testing the pre-final version,and(6)finalizing the Chinese version of IdFAI(IdFAI-C).Five psychometric properties of the IdFAI-C were assessed from results of 2 participant groups:bilingual(n=20)and Chinese(n=625).Results:A high degree of agreement was found between the English version of IdFAI and IdFAI-C(intra-class correlation_(2,1)=0.995).An excellent internal consistency(Cronbach'sα=0.89),test—retest reliability(intra-class correlation_(2,1)=0.970),and construct validity(r(625)=0.67)was also found for the IdFAI-C.In addition,the results of exploratory and confirmatory factor analysis indicated that ankle instability was the only construct measured from the IdFAI.Conclusion:The IdFAI-C is a highly reliable and valid self-report questionnaire that can be used to assess ankle instability.Therefore,we suggest that it can be used to effectively and accurately assess chronic ankle instability in clinical settings for Chinese-speaking individuals.展开更多
基金the National Traditional Chinese Medicine Inheritance and Innovation Team Project:Traditional Chinese Medicine Innovation Team for Prevention and Treatment of Bone and Joint Degenerative Diseases (No. ZYYCXTD-C-202003)National Natural Science Foundation of China:the study on the Quantification and Mechanism of the rotating-pulling-poking manipulation in the Treatment of Lateral Ankle Sprain (No. 81473694)China Academy of Chinese Medical Sciences Science and Technology Innovation Project:Establishment and Promotion of a Simulation Operation Evaluation System for Rotating-pulling-poking Manipulation (CI2021A02015)。
文摘OBJECTIVE:To compare the changes in gait parameters before and after the treatment of lateral ankle sprain using the rotating-pulling-poking manipulation, and explore the potential bio-mechanical mechanism of this manipulation. METHODS:Forty patients with lateral ankle sprains were randomly divided into two groups in a 1∶1 ratio using a random number table. The experimental group were treated by rotating-pulling-poking manipulation and elastic bandage external fixation, while the control group were treated by ice compress and elastic bandage external fixation. The treatment courses of the two groups were both 2 weeks. We used a three-dimensional motion capture system for kinematic measurements and a Bertec gait analysis force measurement system for mechanical measurements, and compared the changes in gait parameters between the two groups of patients before and after treatment. RESULTS:Intragroup comparison showed that the support time, swing time, peak of back extension, peak of plantar flexion, peak of toe pedal force, and peak of heel landing force of the affected feet in the experimental group were significantly improved compared to those before treatment(P < 0.05). The swing time of the affected feet in the control group was significantly improved compared to that before treatment(P < 0.05). The inter group comparison showed that the gait speed, stride length, peak of back extension, peak of plantar flexion, peak of toe pedal force, and peak of heel landing force of the affected feet in the experimental group were significantly better than those in the control group(P < 0.05). CONCLUSIONS:The rotating-pulling-poking manipulation can effectively improve the patient's gait and range of motion of the affected ankle joint, and enhance the negative gravity in the vertical direction of the affected foot, and the braking and driving forces in the front and back directions. This may be the potential biomechanical mechanism of the rotating-pulling-poking manipulation for treating lateral ankle sprain.
文摘BACKGROUND The tear of the gluteus medius and minimus tendons can cause chronic buttock pain,especially in middle-aged individuals;these tears occur mostly in association with degenerative changes in the muscles and tendons.Chronic injuries are more common than acute injuries,and concurrent injuries to the gluteus medius and minimus tendons without chronic pain are rare,especially isolated injuries to both sides of the gluteus minimus;such a case has not yet been reported.CASE SUMMARY The authors present a case of bilateral acute traumatic injuries to the gluteus minimus during buttock strengthening exercises in a 75-year-old male patient.The patient completely returned to his pre-injury lifestyle after 8 weeks of injury,with no limitations,but the diagnosis was initially delayed due to misdiagnosis as lumbar radiculopathy,resulting in unnecessary socio-economic burden on the patient.CONCLUSION When treating patients who complain of hip pain,it is important to consider various causes to make a correct diagnosis.
文摘Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The present paper examines some subjects with a previous history of acute inversion ankle sprain who have developed a subsequent condition of instability, grouping them according to inclusion criteria and analyzing them through four field tests considered objective by the scientific literature: SEBT test, BEES test, TIBT test, SHT test. The data obtained were stored in order to compare them following a re-education protocol aimed at improving proprioception, balance, walking and strengthening the extrinsic and intrinsic muscles of the foot. per year. The subjects were then divided into two categories: subjects with CAI > 1 year and subjects with CAI ≤ 1 year. A protocol lasting 6 weeks was administered to both groups, trying to work on improving balance in single stance, improving static and dynamic stability, strengthening the gluteus medius and maximus (pelvis stabilizers) and strengthening of the intrinsic muscles of the foot. At the end of the protocol the subjects were all re-evaluated with the same field tests used previously and the data obtained were compared both with the pre-protocol data and with the data measured by the control subjects.
文摘BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
文摘Objective To observe the clinical effect of acupuncture on the obsolete lateral malleolus joint sprain. Methods Thirty-one cases of patients with obsolete lateral malleolus joint sprain were selected. Jiexi （解溪 ST 41） were penetrated to Shenmei （申脉 BL 61）, and Yanglingquan （阳陵泉 GB 34） was applied. The needles were retained for 30 min, and the treatment was performed only once, with follow-up visit after 1 month. Results All the patients were cured after treatment, and without relapse on the follow-up visit after 1 month. Conclusion The clinical effect of acupuncture on the obsolete lateral malleolus joint sprain is remarkable.
文摘Objective: this experiment briefly analyzes the understanding and treatment of ankle sprain in the department of orthopedics and traumatology of traditional Chinese medicine. Methods: five years from May 2020 to May 2021 were selected as the time points, and the years from 2020 to 2021 were recent years. Therefore, the research results are more time-sensitive and referential. From the patients received in the hospital during this period of time, 68 cases of study subjects with medication standard were selected and randomly divided into the control group and the experimental group with 34 patients in each group. The patients in the control group were treated with traditional Chinese medicine, while the patients in the experimental group were treated with massage. After the experiment, the therapeutic effect, recovery time of ankle sprain and patients' satisfaction with the treatment were compared between the two groups. Results: the effective rate of treatment in the experimental group was as high as 94.1%, while that in the control group was only 82.3%, the difference was statistically significant (p < 0.05). In addition, the patients in the experimental group were 94.1% satisfied with the treatment, while the patients in the control group were 79.4% satisfied with the treatment. The patients in the experimental group were more satisfied with the treatment. Conclusion: according to the results of the experiment, it can be seen that the therapeutic effect of the traditional Chinese medicine massage combined with traditional Chinese medicine application is better than the conventional treatment, which can not only shorten the treatment time, speed up the recovery of the patients, but also increase the satisfaction of the patients.
基金Supported by Study the mechanism based on the p38MAPK signal pathway mediated by Cautery moxibustion therapy of Hui medicine treatment IDD(The National Natural Science Foundation of China,No.81360567)Evaluation of different moxibustion doses for low back pain:a randomized controlled clinical trial of moxibustion therapy on CV4(Ningxia Natural Science Foundation,No.NZ11208)
文摘OBJECTIVE： Several studies have reported that acupuncture is effective for treatment of acute lumbar sprain, but they neglected to consider that acupuncture cannot remarkably improve lumbar activity. We performed a randomized controlled trial to evaluate the effect of acupuncture-movement therapy versus conventional acupuncture in the trea ment of acute lumbar sprain. METHODS： Sixty patients were randomized into four groups： the acupuncture-movement （AM） group, sham acupuncture-movement （SAM） group, conventional acupuncture （CA） group, and physical therapy （PT） group. Patients in the AM group were treated with acupuncture at Yintang （EX-HN 3） and exercise of the lumbar region during acupuncture. Patients in the SAM group were treated with sham acupuncture at Yintang （EX-HN 3） and exercise of the lumbar region during sham acupuncture. Con- ventional acupuncture was performed in the CA group, and physical therapy was applied in the PT group. Each treatment lasted for 20 min. Patients were assessed before and after treatment using a visual analogue scale （VAS） and the Roland Morris Questionnaire （RMQ）. RESULTS： The VAS and RMQ scores in the AM group were significantly lower after than before treatment （P 〈 0.01）. The AM group reported lower RMQ scores in after-treatment and 24 h after treatment and lower VAS score in 24 h after treatment in comparison with those of the CA, SAM, and PT groups （P 〈 0.05）. CONCULSlON： Acupuncture-movement therapy is effective for treating acute lumbar sprain with a persistent pain-relief and remarkable improvement of lumbar activity. Movement, that is, lumbar exercise during acupuncture, enhances the effect of acupuncture.
文摘Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significantlong-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and nonanatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.
基金supported by the Biomedicine Supporting Program of Shanghai "Science and Technology Innovation Plan" (19441902400)the Ningxia Hui Autonomous Region Key R&D program (2020BCH01001)+1 种基金the Shanghai "Science and Technology Innovation Action Plan" Domestic Science and Technology Cooperation Project (20025800200)the Clinical Research Program of Shanghai Municipal Health Commission (201940367)。
文摘Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.
基金supported by a Ph.D.scholarship from Najran University in Najran,Saudi Arabia
文摘Background'. Up to 74% of people with a history of ankle sprain develop chronic ankle instability (CAI). One commonly reported residualimpairment is ankle pain;however, it has not been included in models or inclusion criteria for CAL We investigated the prevalence of pain inpeople with CAI and the association between presence of pain and other CAI characteristics.Methods'. Retrospective data from 1147 participants with CAI (age 26.6 ± 10.7 years, 59% female) were collated from previous studies that usedthe Cumberland Ankle Instability Tool as an assessment tool. Pain was assessed from Item 1 of the Cumberland Ankle Instability Tool, whichasks participants about ankle pain. Responses were divided into 3 categories: pain during daily activities, pain during moderate/vigorous physicalactivities, and no pain. The presence of pain was analyzed with descriptive statistics, the correlation between pain category and CAI characteris・tics was analyzed by /2 tests and factors associated with each pain category were analyzed by logistic regression.Results'. Among the participants, 60.1% (n = 689) reported ankle pain. Of all participants, 12.4% (n = 142) reported pain during daily activities,47.7% (n = 547) reported pain during moderate/vigorous physical activities, and 39.9% (n = 458) reported no pain. There was a strong associationbetween ankle instability and ankle pain (/2 = 122.2, p < 0.001, OR = 53& 95% confidence interval (CI): 3.84—7.53). Perceived ankle instability,age and unilateral ankle sprains were independently associated with pain (ankle instability: /2 = 43.29, p < 0.001;age: /2 = 30.37,p < 0.001;unilateral ankle sprains: /2 = 6.25, p < 0.05). There was no significant difference in the presence of pain between genders.Conclusion-. The prevalence of pain in people with CAI was high and was related to perceived ankle instability. Number of sprains, age, genderand unilateral or bilateral sprain did not modify this result except for the first pain category (pain during daily activities). There is large gap incurrent knowledge about the impact of pain in people with CAI, and this topic needs further investigation.
基金supported in part by DeRoyal Industries, Inc.,Powell,TN,USA
文摘Purpose:The purpose of this study was to examine effects of a sport version of a semi-rigid ankle brace (ElementTM) and a soft ankle brace (ASO) on ankle biomechanics and ground reaction forces (GRFs) during a drop landing activity in subjects with chronic ankle instability (CAI)compared to healthy subjects with no history of CAI.Methods:Ten healthy subjects and 10 subjects who had multiple ankle sprains participated in the study as the control and unstable subjects,respectively.The CAI subjects were age,body mass index and gender matched with the control subjects.The arch index and ankle functions of the subjects were measured in a subject screening session.During the biomechanical test session,participants performed five trials of drop landing from 0.6 m,wearing no brace ( NB),ElementTM brace and ASO brace.Simultaneous recording of three-dimensional kinematic (240 Hz)and GRF (1200 Hz) data were performed.Results:The CAI subjects had lower ankle functional survey scores.The arch index and deformity results showed greater arch deformity of ElementTM against a static load than in NB and ASO due to greater initial arch position held by the brace.CAI participants had greater eversion velocity than healthy coutrols.The ASO brace reduced the first peak vertical GRF whereas ElementTM increased 2nd peak vertical GRF.ElementTM brace reduced eversion range of motion (ROM) and peak eversion velocity compared to NB and ASO.In addition,ElementTM reduced dorsiflexion ROM and increased peak plantarflexion moment compared to NB and ASO.Conclusion:Results of static arch measurements and dynamic ankle motion suggest that the restrictions offered by both braces are in part due to more dorsiflexed ankle positions at contact,and higher initial arch position and stiffer ankle for ElementTM.
文摘Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40%of all sports-related injuries.It is especially common in basketball,American football,and soccer.The majority of sprains affect the lateral ligaments,particularly the anterior talofibular ligament.Despite its high prevalence,a high proportion of patients experience persistent residual symptoms and injury recurrence.A detailed history and proper physical examination are diagnostic cornerstones.Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules.Several interventions have been recommended in the management of acute ankle sprains including rest,ice,compression,and elevation,analgesic and anti-inflammatory medications,bracing and immobilization,early weight-bearing and walking aids,foot orthoses,manual therapy,exercise therapy,electrophysical modalities and surgery(only in selected refractory cases).Among these interventions,exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.An exercise program should be comprehensive and progressive including the range of motion,stretching,strengthening,neuromuscular,proprioceptive,and sport-specific exercises.Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables,manual tests for stability,and functional performance testing.There are some common myths and mistakes in the management of ankle sprains,which all clinicians should be aware of and avoid.These include excessive imaging,unwarranted non-weightbearing,unjustified immobilization,delay in functional movements,and inadequate rehabilitation.The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
文摘Purpose:The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability(CAI),lateral ankle sprain copers,and healthy controls.Methods:Twenty-three participants with CAI,23 lateral ankle sprain copers,and 24 healthy control participants volunteered.Active motor threshold(AMT),normalized motor-evoked potential(MEP),and cortical silent period(CSP)were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.Results:Participants with CAI had significantly longer CSP at 100%of AMT and lower normalized MEP at 120%of AMT compared to lateral ankle sprain copers(CSP100%:p=0.003;MEP120%:p=0.044)and controls(CSP100%:p=0.041;MEP120%:p=0.006).Conclusion:This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI.Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.
文摘Purpose： The purpose of this study was to examine the effects of landing kinematics and electromyographic （EMG） activities of medial gastrocnemius on a combined inversion and plantarflexion surface on the ankle （MG）, peroneus longus （PL）, and tibialis anterior （TA） muscles. Methods： Twelve recreational athletes performed five drop landings from an overhead bar of 30 cm height on to three surfaces： a flat surface, a 25° inversion surface, and a combined surface of 25° inversion and 25° plantarflexion. The kinematic variables and integrated EMG （IEMG） of the three muscles were assessed using a one-way repeated measures ANOVA and a 3 × 3 （surface × muscle） ANOVA, respectively （p 〈 0.05）. Results： The IEMG results showed a significant muscle by surface interaction. The flat surface induced higher TA activity than the two tilted surfaces. The inverted surface produced significantly higher inversion peak angle and velocity than the flat surface, but similar PL activity across the surfaces. The MG IEMG, ankle plantarflexion angle, and inversion range of motion were significantly higher for the combined surface compared to the inverted surface. Conclusion： These findings suggest that compared to the inversion surface, the combined plantarflexion and inversion surface seems to provide a more unstable surface condition for lateral ankle sprains during landing.
文摘Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity information in the literature,the detailed mechanism of ankle sprain is still unrevealed.The purpose of our case report is to present 2 accidental ankle giving way incidents for participants with chronic ankle instability(CAI)and compare to their normal trials with data of kinematics,kinetics,and electromyography(EMG).Case description:Two young female participants accidentally experienced the ankle giving way when landing on a 25°lateral-tilted force plate.3 D kinematics,kinetics,and muscle activity were recorded for the lower extremity.Qualitative comparisons were made between the giving way trials and normal trials for joint angles,angular velocities,moments,centers of pressure and EMG linear envelopes.Results:One participant’s giving way trial displayed increased ankle inversion and internal rotation angles in the pre-landing phase and at initial contact compared to her normal trials.Another participant’s giving way trial exhibited greater hip abduction angles and delayed activation of the peroneus longus muscle in the pre-landing phase versus her normal trials.Conclusion:A vulnerable ankle position(i.e.,more inverted and internally rotated),and a late activation of peroneus activity in the pre-landing phase could result in the ankle giving way or even sprains.A neutral ankle position and early activation of ankle evertors before landing may be helpful in preventing ankle sprains.
文摘Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury. In the case of operative treatment the method of fixation, the height and number of screws and the need for hardware removal are still under discussion. Furthermore, intraoperative assessment of the accuracy of reduction of the fibula in the incisura using fluoroscopy is difficult. A possible solution might be the assessment with intraoperative three-dimensional imaging. The aim of this article is to provide a current concepts review of the clinical presentation, diagnosis and treatment of syndesmotic injuries.
文摘Background:Stochastic resonance stimulation(SRS) transmits subsensory electrical Gaussian white noise into the body to enhance sensorimotor function.This therapy has improved static single leg balance in subjects with functional ankle instability.However,the effect of this stimulation on dynamic single leg balance is not known.Improvements in dynamic single leg balance with SRS may have implications For enhancing functional rehabilitation for ankle instability.Thus,the purpose of this study was to determine the effects of SRS on dynamic single leg balance in subjects with functional ankle instability. Methods:This study was an experimental research design and data were collected in a sports medicine research laboratory.Twelve subjects with functional ankle instability(69±15 kg;173±10 cm;21±2 years) reported a history of ankle sprains and instability at the ankle with physical activity.A single leg jump-landing test was used to assess dynamic balance.Subjects were required to jump between 50% and 55% of the maximal vertical jump height,land on a single leg atop a force plate,and stabilize as quickly as possible.Jump-landing tests were performed with and without SRS.Three trials were performed for each treatment condition(SRS and control).A randomized block design was used to determine test order.Anterior/posterior and medial/lateral time-to-stabilization were computed to assess dynamic balance.Lesser time indicated better stability.One-tailed paired samples t tests were used for analysis(α≤0.05). Results:SRS improved anterior/posterior time-to-stabilization(stochastic resonance = 1.32±0.31 s,control = 1.74±0.80 s,p = 0.03),but did not enhance medial/lateral time-to-stabilization(stochastic resonance = 1.95±0.40 s,control = 1.92±0.48 s,p = 0.07). Conclusion:Clinicians might use SRS to facilitate balance improvements with sagittal plane dynamic single leg balance exercises that patients may not be able to perform otherwise.
基金Supported by the Study on the Clinical Curative Effect and Standardization of Acupuncture and Tuina Treatment of Acute Lumbar Sprain from the Projects of Science and Technology Commission of Shanghai Municipality(No.10DZ1974700)the Clinical Research on Acupuncture and Tuina Treatment of Acute Lumbar Sprain Scheme Optimization and Rehabilitation Evaluation from Shanghai Municipal Health Bureau(No.2010QL035A)+2 种基金the Research on the Spreading Appropriate Technology of TCM in Shanghai(No.2010G007A)the Study on the Inheritance of Lushi Acupuncture about Shanghai Traditional Chinese Medicine Schools(No.ZYSNXD-CC-HPGC-JD-004)the Program of TCM Personnel Training in Shanghai(No.ZY3-RCPY-2-2034)
文摘OBJECTIVE:To observe the effect of electroacupuncture(EA) on force-displacement value(FDV)of muscle state and the temperature index of infrared thermogram in patients with acute lumbar muscle sprain.METHODS:Patients with acute lumbar muscle sprain were randomly divided into a medication group and an EA group.The medication group(n-60) were treated with diclofenac sodium dual release enteric-coated capsules,75 mg per day for 7days.The EA group(n = 60) received EA at bilateral Houxi(SI 3),Jiaji(EX-B2),and Ashi points,at 20-30 mm depth and 10-25 Hz frequency for 20 min daily for 7 days.Muscle states were determined by measuring FDVs of the bilateral lumbar muscle with a Myotonometer fast muscle state detector.The temperature index of the lumbar skin was measured before and after treatment with a Fluke Ti30 non-refrigerated focal plane infrared thermal imaging detector.RESULTS:There were no significant pre-treatment differences between the medication group and the EA group in mean FDV(P = 0.052) or temperature index of the lumbar skin(P = 0.25).The cure rate was 63.3%in the EA group and 53.3%in the medication group.The total efficacy in the EA group(93.3%) was not significantly different from that in the medication group(86.6%,P = 0.204).After treatment,the mean FDV of the lumbar muscle significantly increased in both groups(P < 0.05 for both groups);the FDV increase in the EA group was significantly higher than in the medication group(P = 0.015).The temperature index was also significantly increased in both groups(P < 0.05 for both groups);the infrared thermogram in the EA group indicated significantly greater recovery compared to the medication group(P = 0.026).CONCLUSION:Both EA and diclofenac sodium markedly improved acute lumbar sprain,but EA better improved the rehabilitation and regeneration of FDVs and temperature index of infrared thermogram of the muscle.
文摘Lateral ankle instability is one of the most common and well-recognized conditions presenting to foot and ankle surgeons.It may exist as an isolated entity or in conjunction with other concomitant pathology,making it important to appropriately diagnose and identify other conditions that may need to be addressed as part of treatment.These associated conditions may be a source of chronic pain,even when the instability has been appropriately treated,or may lead to failure of treatment by predisposing the patient to ankle inversion injuries.The primary goal of this editorial is to provide a brief summary of the common techniques used in the delayed reconstruction of lateral ankle ligamentous injuries and present a method we have successfully employed for over 15 years.We will also briefly discuss the diagnosis and treatment of the more common associated conditions,which are important to identify to achieve satisfactory results for the patient.We present the outcomes of 250 consecutive reconstructions performed over the last 10 years and describe our operative technique for addressing lateral ankle ligamentous injuries.
文摘Background:The Identification of Functional Ankle Instability(IdFAI)is a valid and reliable tool to identify chronic ankle instability;however,it was developed in English,thus limiting its usage only to those who can read and write in English.The objectives of our study were to(1)cross-culturally adapt a Chinese(Mandarin)version of the IdFAI and(2)determine the psychometric properties of the Chinese version IdFAI.Methods:The cross-cultural adaptation procedures used by the investigators and translators followed previously published guidelines and included 6 stages:(1)initial translation,(2)synthesis of the translations,(3)back translation,(4)developing the pre-final version for field testing,(5)testing the pre-final version,and(6)finalizing the Chinese version of IdFAI(IdFAI-C).Five psychometric properties of the IdFAI-C were assessed from results of 2 participant groups:bilingual(n=20)and Chinese(n=625).Results:A high degree of agreement was found between the English version of IdFAI and IdFAI-C(intra-class correlation_(2,1)=0.995).An excellent internal consistency(Cronbach'sα=0.89),test—retest reliability(intra-class correlation_(2,1)=0.970),and construct validity(r(625)=0.67)was also found for the IdFAI-C.In addition,the results of exploratory and confirmatory factor analysis indicated that ankle instability was the only construct measured from the IdFAI.Conclusion:The IdFAI-C is a highly reliable and valid self-report questionnaire that can be used to assess ankle instability.Therefore,we suggest that it can be used to effectively and accurately assess chronic ankle instability in clinical settings for Chinese-speaking individuals.
