Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of preventive interventions for lateral ankle sprain in the general population. DATA SOURCES: A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022. REVIEW METHODS: Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies. RESULTS: Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss. CONCLUSION: Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.

Concurrent Validity and Reliability of a Handheld Dynamometer in Measuring Isometric Shoulder Rotational Strength.

CONTEXT: Measuring isometric shoulder rotational strength is clinically important for evaluating motor disability in athletes with shoulder injuries. Recent evidence suggests that handheld dynamometry may provide a low-cost and portable method for the clinical assessment of isometric shoulder strength. OBJECTIVE: To investigate the concurrent validity and the intrarater and interrater reliability of handheld dynamometry for measuring isometric shoulder rotational strength. DESIGN: Cross-sectional study. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-nine young, healthy participants. MAIN OUTCOME MEASURES: The peak isometric strength of the internal rotators and external rotators, measured by handheld dynamometry (in newton) and isokinetic dynamometry (in newton meter). INTERVENTIONS: Maximal isometric shoulder rotational strength was measured as participants lay supine with 90° shoulder abduction, neutral rotation, 90° elbow flexion, and forearm pronation. Measurements were performed independently by 2 different physiotherapists and in 3 different sessions to evaluate interrater and intrarater reliability. The data obtained by handheld dynamometry were compared with those obtained by isokinetic testing to evaluate concurrent validity. RESULTS: The intraclass correlation coefficients for interrater reliability in measuring maximum isometric shoulder external and internal rotation strength were .914 (95% confidence interval [CI], .842-.954) and .842 (95% CI, .720-.914), respectively. The intrarater reliability values of the method for measuring maximal shoulder external and internal rotation strength were 0.865 (95% CI, 0.757-0.927) and 0.901 (95% CI, 0.820-0.947), respectively. The Pearson correlation coefficients between the handheld and isokinetic dynamometer measurements were .792 (95% CI, .575-.905) for external rotation strength and .664 (95% CI, .419-.839) for internal rotation strength. CONCLUSIONS: The handheld dynamometer showed good to excellent reliability and moderate to good validity in measuring maximum isometric shoulder rotational strength. Therefore, handheld dynamometry could be acceptable for health and sports professionals in field situations to evaluate maximum isometric shoulder rotational strength.

Influence of Shoulder Position on Functional Control Ratio During Isokinetic Assessment.

CONTEXT: One of the possible mechanisms leading to secondary impingement syndrome may be the strength imbalance of shoulder rotators which is known as functional control ratio (FCR). The FCR is a ratio dividing the eccentric peak torque of the external rotators by the concentric peak torque of the internal rotators. Previous studies have focused on the reproducibility and reliability of isokinetic assessment, but there is little information on the influence of variable shoulder positions on FCR. OBJECTIVE: To compare shoulder FCR across 3 different shoulder abduction positions during isokinetic assessment. DESIGN: Cross-sectional study. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-one healthy young university students (age 22.35 [0.95] y, weight 60.52 [9.31] kg, height 168.23 [9.47] cm). INTERVENTIONS: The concentric peak torque of internal rotators and eccentric peak torque of external rotators of right shoulder were measured on an isokinetic dynamometer. MAIN OUTCOME MEASURES: Concentric peak torque of the internal rotators and eccentric peak torque of the external rotators, measured using an isokinetic dynamometer. RESULTS: The concentric peak torque of internal rotators was significantly lower at 120° shoulder abduction compared with other positions (P < .001). The FCR was significantly higher at 120° shoulder abduction than 90° (P = .002) or 60° (P < .001) shoulder abduction because of the lower concentric peak torque. No significant difference was found in the FCR between the other 2 shoulder positions (P = .14). CONCLUSIONS: Shoulder position variations may influence FCR because of weakness of the internal rotators. Rehabilitation and injury prevention training programs should specifically focus on strengthening the internal rotators at more elevated angles of shoulder abduction.