Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis.

BACKGROUND: Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle. PURPOSE: This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain. METHODS: A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES). RESULTS: Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function. CONCLUSION: PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol. REGISTRATION: PROSPERO registration number (CRD42021292930).

The morphology of osseous structure in subtalar joint with chronic ankle instability.

BACKGROUND: Osseous structures have been demonstrated as risk factors for chronic ankle instability (CAI). Previously, the researchers only focused on the osseous structures of ankle, but ignored the osseous structures of subtalar joint(STJ). Accordingly, the aim of our study was to investigate the morphological characteristics of STJ osseous structures in CAI. METHODS: 52 patients with CAI and 52 sex- and age- matched control subjects were enrolled from The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. The lateral radiographs of ankle in weight-bearing were used to compare the diversity of the two groups. Specifically, The Length of calcaneus, Calcaneal facet height and Absolute foot height, Böhler's angle, Gissane's angle, Calcaneal inclination angle, Talocalcaneal angle, Tibiotalar angle, Tibiocalcaneal angle, Talar-horizontal angle, talar declination angle, facet inclination angle were gauged in the two groups. RESULTS: The Böhler's angle, Calcaneal inclination, Talocalcaneal angle, Tibiotalar angle, Talar-horizontal angle, Talar declination angle, Facet inclination angle and Absolute foot height of CAI group were significantly higher than normal control group (P < 0.05). There were no significant differences in Gissane's angle, Tibiocalcaneal angle, Length of calcaneus and Calcaneal facet height between patients with CAI and normal controls (P > 0.05). CONCLUSIONS: The osseous structures of STJ in CAI patients are different from normal people in morphology. Therefore, we should pay more attention to the changes of STJ anatomical parameters in the diagnosis and prevention of CAI. LEVEL OF EVIDENCE: Ⅲ.

Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI).

The knee is a joint that is often injured in sport, with a large and increasing number of ligament tears and repairs; postoperative complications can lead to poor outcome, such as stiffness. Beyond the well-known and well-described intra- and extra-articular causes of postoperative stiffness, the present study introduces the concept of a central reflex motor inhibition mechanism called arthrogenic muscle inhibition (AMI). AMI occurs after trauma and can be defined as active knee extension deficit due to central impairment of Vastus Medialis Obliquus (VMO) contraction, often associated with spinal reflex hamstring contracture. This explains the post-traumatic flexion contracture that is so common after knee sprain. The clinical presentation of AMI is easy to detect in consultation, in 4 grades from simple VMO inhibition to fixed flexion contracture by posterior capsule retraction in chronic cases. After recent anterior cruciate ligament (ACL) tear, more than 55% of patients show AMI, reducible in 80% of cases by simple targeted exercises initiated in consultation. Practically, in patients who have sustained knee sprain, it is essential to screen for this reflex mechanism and assess reducibility, as AMI greatly aggravates the risk of postoperative stiffness. In case of hemarthrosis, we recommend joint aspiration, which provides immediate benefit in terms of pain and motor inhibition. In case of persistent AMI, classical electrostimulation and "cushion crush", as used by all physiotherapists, are ineffective. To reduce the risk of postoperative stiffness, no surgery should be considered until AMI has resolved. LEVEL OF EVIDENCE: expert opinion.

[Observation of the therapeutic effect on acute ankle sprain treated with surrounding needling and cold compression].

OBJECTIVE: To observe the difference in the therapeutic effect on acute ankle sprain treated with the combination of surrounding needling and cold compression in comparison of the conventional cold compression. METHODS: The patients with acute ankle sprain were randomly divided into control group (33 cases) and observation group (35 cases). In the first 3 days of treatment, the conventional cold compression was used in the control group, while the surrounding needling technique of acupuncture was combined with cold compression in the observation group. Separately, along the distal-lateral side of the leg, and the lateral sides of the heel and the dorsal part of the foot, 3 or 4 needles were inserted in each part，total 9 to 12 needles, toward the center of swelling and pain site, and distributed in a fan shape. The needles were retained for 30 min and the acupuncture therapy was delivered once daily. Since the 4th day of treatment, the hot compress and the static stretching exercise of the ankle joint were adopted in the two groups, once daily for 1 week. The visual analogue scale (VAS) score for ankle pain and ankle swelling degree were compared between the two groups before and after 3-day treatment, as well as the score of American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale was evaluated. RESULTS: After 3-day treatment, VAS score was decreased in both groups (P<0.01), and the score in the observation group was lower than that of the control group (P<0.01). Ankle swelling degree was relieved in both groups (P<0.01), and there was no significant difference between the two groups. After 1 week of treatment, the scores of AOFAS ankle-hindfoot scale were improved in both groups (P<0.01), and the score in the observation group was higher than the control group (P<0.05). CONCLUSION: Either the combined therapy of surrounding needling and cold compression or the conventional cold compression can effectively relieve pain and swelling induced by acute ankle sprain. The therapeutic effect of the combined therapy is superior to the conventional cold compression for the motor function improvement of ankle joint.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain.

INTRODUCTION: Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE: Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN: Randomized clinical trial; assessor-blind; before and after comparison. SETTING: Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S): Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS: Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS: Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION: The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

Effects of eight week core stability training on stable- and unstable-surface on ankle muscular strength, proprioception, and dorsiflexion in athletes with chronic ankle instability.

BACKGROUND: Chronic ankle instability (CAI) is a common injury among athletes. Research has reported reduced dorsiflexion range of motion, impairment of proprioception, and decreased muscle strength of the ankle in people with CAI. The aim of this research was to examine the effects of 8-week core stability training on stable and unstable surfaces on ankle muscular strength, proprioception, and dorsiflexion range of motion (ROM) in athletes with CAI. METHODS: Thirty-six athletes with CAI (age 22.42 ± 2.76 years; height 169.11 ± 3.52 cm; weight 68.46 ± 2.75 kg) participated in this study. They were divided into three groups: unstable-surface group (UG) (n = 12), stable-surface group (SG) (n = 12), and control group (CG) (n = 12). The UG and SG performed the core stability exercise protocol for 8 weeks, 3 sessions per week. The CG received their usual care and daily activities. Outcomes were measured pre-sessions and post-sessions. RESULTS: The peak torque showed significant increases in the UG and SG compared with the CG during plantar flexion, dorsiflexion, inversion, and eversion (P < 0.05). There were also significant increases in UG compared with SG (P < 0.05). The proprioception showed significant decreases in UG compared with SG and CG (P < 0.05). The dorsiflexion ROM showed significant increases in UG and SG compared with CG. There were also significant increases in UG compared with SG (P < 0.05). CONCLUSIONS: It seems that core stability exercises on trampoline surface helps improve the measured parameters in athletes with ankle instability. Therefore, this type of training is recommended as a therapeutic option for Individuals with CAI.

Within-session and between-session effects of auditory biofeedback training on center of pressure location during gait in patients with chronic ankle instability.

OBJECTIVES: To establish preliminary gait training dosage parameters for patients with chronic ankle instability (CAI) by determining the within-session and between-session effects of auditory biofeedback training on center of pressure (COP) location during gait. DESIGN: Observational Longitudinal. SETTING: Laboratory. PARTICIPANTS: 19 participants with CAI, 8 participants who did not receive auditory biofeedback (NoFeedback group) and 11 participants who did receive auditory biofeedback (AuditoryFeedback group) over an 8-session 2-week intervention. MAIN OUTCOME MEASURES: COP location was measured at the start and at each 5-min interval during treadmill walking across all eight 30-min training sessions. RESULTS: The AuditoryFeedback group had significant within-session lateral-to-medial shifts in COP location during only session-1 at the 15-min (45% of stance; peak mean difference = 4.6 mm), 20-min (35% and 45%; 4.2 mm), and 30-min time intervals (35% and 45%; 4.1 mm). Furthermore, the AuditoryFeedback group had significant between-session lateral-to-medial shifts in COP location at session-5 (35-55% of stance; 4.2 mm), session-7 (35%-95%; 6.7 mm), and session-8 (35%-95%; 7.7 mm). The NoFeedback group had no significant changes in COP location within-sessions or between-sessions. CONCLUSIONS: Participants with CAI who received auditory biofeedback during gait needed an average of 15-min during session-1 to meaningfully shift their COP location medially and 4-sessions before retaining the adapted gait pattern.

Platelet-Rich Plasma Improves Strength and Speed of Recovery in an Active-Duty Soldier with Isolated Injury to the Lateral Collateral Ligament of the Knee: A Case Report.

Ligamentous injuries of the knee occur in the military, but constitute an overwhelmingly disproportionate number of medical discharges, which can be due to prolonged recovery through traditional use of physical therapy (PT) and other non-operative modalities. The use of platelet-rich plasma (PRP) may substantially increase the speed of recovery and patient outcomes but is little explored for less common isolated ligamentous injuries, such as the lateral collateral ligament, especially in active-duty populations. We describe the use of PRP in a young, otherwise healthy active-duty male to treat an isolated LCL injury with significant positive outcomes. These findings support consideration for early use of PRP in similar cases to improve recovery timelines and aid in return to duty.

[Regularities of acupoint compatibility and application characteristics of methods of needling and moxibustion in the treatment of ankle sprain based on complex network analysis].

OBJECTIVE: To analyze the compatibility regularities of acupoints and the application characteristics of needling-moxibustionmethods in the treatment of ankle sprain by using complex network technology, so as to provide the basis and treatment ideas. METHODS: The clinical research articles on acupuncture treatment of ankle joint sprain published from November 2011 to November 2021 were retrieved from databases of CNKI, Wanfang Data knowledge service platform, VIP information Chinese journal service platform and PubMed by using key words of "acupuncture""moxibustion" "acupuncture and moxibustion" "ankle injury" "ankle sprain" "injured ankle" and "syndesmotic injuries". After screening these articles according to our inclusion and exclusion criteria, a database of acupuncture treatment of ankle sprain was established. Then, analysis on the occurrence frequency of acupoints and their related meridians, and methods of needling manipulation, and the association rule analysis (quantitative analysis) about the closeness between acupoints, and the degree of support and confidence coefficient were conducted for acquiring the acupoint combinations with higher correlation in the compatibility using Apriori algorithm after modeling (with IBM SPSS Modeler18.0 software). Gephi 0.9.2 software was used to make complex network analysis, for which "k-core hierarchical analysis" and "community analysis" were used as the methods to analyze the network structure of acupoints, and the confidence value was used as the index to measure the importance of acupoints. RESULTS: A total of 201 articles meeting the criteria were collected, including 196 articles in Chinese and 5 in English. A total of 236 acupuncture prescriptions were extracted, involving 61 acupoints, with a total frequency of occurrence being 846. The top 10 acupoints were Ashi point, Kunlun (BL60), Jiexi (ST41), Qiuxu (GB40), Shenmai (BL62), Yanglingquan (GB34), Taixi (KI3), Zhaohai (KI6), Xuanzhong (GB39) and Shangqiu (SP5), with the occurrence frequency being 109, 79, 70, 68, 63, 59, 53, 52, 37 and 34, respectively. The results of descriptive analysis showed that the top 5 meridians were Gallbladder Meridian of Foot-shaoyang, Bladder Meridian of Foot-taiyang, Kidney Meridian of Foot-shaoyin, Stomach Meridian of Foot-yangming and Spleen Meridian of Foot-taiyin, with the frequency being 181, 153, 116, 105 and 53, respectively. Complex network analysis displayed that after "k-core hierarchical analysis" and "Community division", two communities were reserved, mainly involving 15 core acupoints such as Ahshi point, GB40, ST14, BL62, GB34, KI6, BL60, KI3, GB39, Zusanli (ST36), SP5; Taichong (LR3), Zulinqi (GB41), Sanyinjiao (SP6) and Rangu (KI2). The results of association rule analysis showed that the most relevant acupoint combination is "BL60-ST41" (support degree 34.83％), followed by "BL60-KI3" (support degree 26.37%), reflecting the principle of selection of local acupoint for ankle sprain. The therapeutic methods are filiform needle acupuncture, and the reducing technique and uniform reinforcing and reducing manipulation are the most commonly used approaches, but the reinforcing method is rarely used. CONCLUSION: In the treatment of ankle sprain, local acupoints and Ashi points are mainly used, in combination with reducing or uniform reinforcing and reducing manipulations, as well as the method of needling and moxibustion, which provides a good reference for clinical practice.

[Clinical efficacy and time-effect relationship of dynamic qi acupuncture for acute lumbar sprain].

OBJECTIVE: To observe the clinical efficacy of dynamic qi acupuncture for acute lumbar sprain, and to explore the differences of different needle retention time on the improvement of pain, lumbar mobility and lumbar dysfunction. METHODS: A total of 160 patients with acute lumbar sprain were randomly divided into an observation group A (40 cases, 4 cases dropped off), an observation group B (40 cases, 2 cases dropped off), an observation group C (40 cases, 4 cases dropped off) and a medication group (40 cases, 6 cases dropped off). The patients in the observation group A, the observation group B and the observation group C were treated with acupuncture at "lumbago point" and Sanjian (LI 3) on the left side, and during the needles were kept for 10, 20 and 30 min respectively, the patients were required to take tolerable lumbar active activities, once a day; the patients in the medication group were treated with celecoxib capsules, 0.2 g each time, twice a day. All the patients were treated for 5 d. Before and after treatment, the scores of numerical rating scale-11 (NRS-11), lumbar range of motion (ROM) and modified Oswestry disability index (ODI) were observed, and the clinical efficacy of each group was evaluated. RESULTS: After treatment, the scores of NRS-11, ROM and ODI in each group were decreased compared before treatment (P<0.01). The decreased degree of NRS-11, ROM and ODI in each observation group was greater than that in the medication group (P<0.05), and the decreased degree of ROM and ODI in the observation group B and the observation group C was greater than that in the observation group A (P<0.05). The total effective rates were 94.4% (34/36) in the observation group A, 94.7% (36/38) in the observation group B and 97.2% (35/36) in the observation group C, respectively, which were higher than 79.4% (27/34) in the medication group (P<0.05). CONCLUSION: Dynamic qi acupuncture with needle retention for 10, 20 and 30 min all could effectively improve the pain, lumbar mobility and lumbar dysfunction in patients with acute lumbar sprain. If the lumbar dysfunction is severe, needle retention for 20 min or more is recommended.

Efficacy comparison of acupuncture and balanced acupuncture combined with TongduZhengji manipulation in the treatment of acute lumbar sprain.

OBJECTIVE: To compare the curative effect of balanced acupuncture combined with TongduZhengji manipulation vs acupuncture in the treatment of acute lumbar sprain. METHODS: Clinical data of 71 patients with acute lumbar sprains in our hospital from January 2020 to December 2020 were retrospectively analyzed. Patients were divided into single group (n=35) and combined group (n=36) based on treatment methods. The single group received only acupuncture treatment, while the combined group received balanced acupuncture combined with TongduZhengji manipulation. The treatment efficacy, pain level, lumbar function and motion of the lumbar spine were compared between the two groups. RESULTS: The Visual Analogue Scale (VAS) scores of the combined group were lower than those of the single group after 3, 4, and 5 days of treatment (P<0.05). There was no significant difference in VAS scores between the two groups after 1 and 2 days of treatment (P>0.05). The Roland-Morris Disability Questionnaire (RMDQ) score of the combined group showed no significant difference compared with that of the single group after 1 and 2 days of treatment (P>0.05), and were lower than those of the single group after 3, 4, and 5 days of treatment (P<0.05). The Japanese Orthopedic Association (JOA) score of the combined group after 1, 2, and 3 days of treatment showed no significant difference compared with the single group (P>0.05), and was higher than that of the single group after 4 and 5 days of treatment (P<0.05). The Range of Motion (ROM) score of the combined group showed no significant difference compared with the single group after 1 and 2 days of treatment (P>0.05), and was lower than that of the single group after 3, 4, and 5 days of treatment (P<0.05). The total effective rate of treatment in the combined group was significantly higher than that in the single group (91.67% vs. 71.43%) (P<0.05). CONCLUSION: Compared with acupuncture alone, balanced acupuncture combined with TongduZhengji manipulation can significantly reduce the pain level and improve lumbar spine mobility as well as lumbar spine function, exhibiting better curative effect than acupuncture only.

Effects of gait training with auditory biofeedback on biomechanics and talar cartilage characteristics in individuals with chronic ankle instability: A randomized controlled trial.

BACKGROUND: Altered walking gait is a typical impairment following ankle sprains which may increase susceptibility to recurring injuries and development of posttraumatic osteoarthritis at the ankle. There is a lack of targeted gait training interventions focusing on specific modifications in individuals with chronic ankle instability (CAI). Additionally, there is a need to focus on cartilage health changes following gait training to mitigate osteoarthritis progression. RESEARCH QUESTION: To determine the immediate and retention effects of gait training using auditory biofeedback (AudFB) in patients with chronic ankle instability (CAI) on biomechanics and talar cartilage characteristics. METHODS: Eighteen participants with CAI were randomly assigned into Control (n = 7) or AudFB (n = 11) groups. Each group completed 8-sessions of 30-minute treadmill walking. The AudFB group received biofeedback through a pressure sensor fashioned to the lateral foot and instructions to walk while avoiding noise from the sensor. The Control group did not receive instructions during sessions. An in-shoe insole system measured peak pressure, maximum force, and center of the pressure gait line (COP) during walking. Ultrasonography captured talar cartilage thickness and echo intensity before and after walking. Biomechanics and ultrasound were measured at baseline, immediately, and 1-week after the intervention. Repeated measures mixed-methods analysis of variance assessed changes within groups across time. RESULTS: The AudFB group significantly reduced pressure and force in the lateral foot and medially shifted their COP at Immediate and 1-week Post. There were no observed changes in the Control group. In addition, neither group demonstrated changes in ultrasound measures at follow-up. SIGNIFICANCE: Implementation of auditory biofeedback during gait training can be a valuable tool for clinicians treating patients with CAI.

Short-Term Effect of Manual Therapy & Taping on Subacute Ankle Sprains with Potential Syndesmotic Sprain: A Case Series.

STUDY DESIGN: Case Series. BACKGROUND: Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping. METHODS: Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed. RESULTS: All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3-8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1-8 weeks). DISCUSSION: A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings. LEVEL OF EVIDENCE: Therapy, 4.

Effect of dynamic tape on postural sway in individuals with chronic ankle instability.

OBJECTIVE: To examine the effects of dynamic tape on balance control in subjects with chronic ankle instability (CAI). METHODS: This two group experimental pre- and post-treatment design included 18 individuals with CAI and 18 controls. The single-limb stance test with eyes open and closed, standing on a force plate (Accusway Plus; AMTI) for 30 s, was conducted before, 10 min (T1) and 24 h (T24) after a dynamic tape application over the gastrocnemius muscle. Outcome measurements were: mean sway velocity, sway area (circular area), and standard deviation of the body center of pressure path length in both mediolateral and anteroposterior directions. Individuals with poor (unable to perform a single leg test for at least 30 s, eyes closed) vs. good postural stability, were also compared. RESULTS: In both groups, a repeated analysis of variance demonstrated a significant time main effect on sway velocity (F = 14.95; p < 0.001) and path length (F = 14.95; p < 0.001) during eyes closed. Post-hoc analysis revealed a significant decrease in T1 values compared to baseline. When comparing individuals with poor vs good stability amongst the CAI group, a statistically significant interaction was observed between group, time on sway velocity and path length (F = 3.92; p < 0.05) during eyes closed. In the poor postural group, most T1 values were significantly lower than baseline. CONCLUSIONS: Dynamic tape when applied to posterior calf muscles, enhanced balance control with no difference between CAI individuals and controls. The contribution of the tape was greater in those with poor postural stability.

Immediate effects of vibration biofeedback on ankle kinematics in people with chronic ankle instability.

BACKGROUND: People with chronic ankle instability are more inverted during initial contact and loading response which may increase the risk of subsequent ankle injuries. Vibration feedback gait retraining causes medial center of pressure shifts but its impact on ankle kinematics remains unknown. The purpose of this study was to understand kinematic ankle changes in people with chronic ankle instability following vibration feedback gait retraining. METHODS: Nineteen participants with chronic ankle instability walked with vibration feedback for 10 min on a treadmill and for one mile in the real-world. A vibration stimulus occurred at the lower leg when pressure under the 5th metatarsal exceeded a threshold. Three-dimensional kinematics of the ankle were recorded in the lab before and after training. Paired t-tests compared baseline and posttest ankle, hindfoot, and forefoot positions during initial contact and loading response for the lab and real-world conditions. FINDINGS: After lab training the ankle (mean difference:-1.68 ± 1.62°, effect size:0.95) and forefoot (mean difference:-1.68 ± 1.67°, effect size:0.92) were more abducted. After real-world training, the ankle (mean difference:-1.19 ± 2.12°, effect size:0.54) and forefoot (mean difference:-1.87 ± 3.00°, effect size:0.63) were more everted. Similarly the ankle (mean difference:-2.37 ± 4.79°, effect size:0.46) and forefoot (mean difference:-2.78 ± 4.91°, effect size:0.51) were more abducted after real-world training. INTERPRETATION: Vibration feedback decreases inversion and adduction during loading response. However, RW compared to lab training may have more beneficial frontal plane changes for people with chronic ankle instability.

The influence of fascial manipulation on function, ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability.

BACKGROUND: Proprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear. OBJECTIVE: This study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI. DESIGN: Single group, pretest-posttest design. METHODS: Individuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance). RESULTS: There was a significant improvement in the FADI scores (Z = -3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp 2 = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM. CONCLUSION: Since fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.

Fascial therapy, strength exercises and taping in soccer players with recurrent ankle sprains: A randomized controlled trial.

INTRODUCTION: Recurrent ankle sprains are common in soccer players, characterized by restricted range of motion, pain, and decreased proprioception, strength, and postural control. The objective was to evaluate the effectiveness of a fascial therapy and strength training program, combined with kinesiotaping, in improving ankle range of motion, pain, strength and stability in footballers with recurrent sprains. METHOD: A simple blind randomized clinical trial was conducted on soccer players. Thirty-six federated footballers were recruited and randomized to the two study groups. The experimental group received an intervention using myofascial techniques applied to the subastragaline joint, eccentric training with an isoinertial device and neuromuscular taping. The control group was administered an intervention using myofascial techniques on the subastragaline joint and eccentric training with an isoinertial device. The results were recorded for all players at baseline, after 4 weeks of intervention, and at the end of the 4-week follow-up period. RESULTS: Subsequent to intervention and follow-up, we found statistically significant improvements in the experimental group in ankle mobility, strength and stability. The control group exhibited improvements in all study variables. No differences in the improvement of variables were found based on the allocation of athletes to one group or another. CONCLUSION: The combination of fascial therapy and eccentric strength training with an isoinertial device improves ankle mobility, strength and stability in footballers with recurrent ankle sprains. The use of taping techniques failed to provide a greater improvement of the study variables when combined with manual therapy and strength techniques.

Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain.

OBJECTIVE: Distal fibular mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques. METHODS: In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3/wk within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation, edema draining massage, and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure and Patient Global Impression of Improvement Scale were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength. RESULTS: MWM and MWMtape were equally effective and participants demonstrated greater function on the Foot and Ankle Ability Measure at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for Patient Global Impression of Improvement Scale or any of the secondary outcomes. CONCLUSION: There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibular MWM is most effective to achieve activities of daily living and sport function when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit. IMPACT: Distal fibular mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long-term activities of daily living and sport function. In the short term, anteroposterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibular mobilization with movement.

Effects of Dangguixu-san in patients with acute lateral ankle sprain: a randomized controlled trial.

BACKGROUND: Dangguixu-san (DS), a herbal extract, is widely used in Korean medicine to treat pain and swelling caused by ankle sprain. However, there is insufficient evidence regarding the effects of DS on ankle sprains. Accordingly, we assessed the efficacy and safety of DS for the treatment of acute lateral ankle sprain (ALAS). METHODS: This study was a multicenter (two Korean hospitals), randomized, double-blind, placebo-controlled, parallel-arm clinical trial with a 1:1 allocation ratio that included a per-protocol analysis and sub-analysis based on symptom severity. Forty-eight participants (n = 28 at Semyung University Korean Medicine Hospital in Chungju; n = 20 at DongShin University Gwangju Korean Medicine Hospital) with grade I or II ALAS that occurred within 72 h before enrollment were randomized to a DS (n = 24) or placebo (n = 24) group. Both groups received acupuncture treatment once daily for 5 consecutive days and the trial medication (DS/placebo capsule) three times a day for 7 consecutive days. Primary (visual analog scale [VAS] scores for pain) and secondary (Foot and Ankle Outcome Scores [FAOS], edema, and European Quality of Life Five-Dimension-Five-Level Scale [EQ-5D-5L] scores) outcome measures were recorded at baseline (week 0), the end of the intervention (week 1), and 4 weeks after treatment completion (week 5). RESULTS: Forty-six participants completed the trial (n = 23 each). Changes in VAS scores, FAOS Symptom/Rigidity, and FAOS Ache from week 1 to week 5 showed significant differences between the two groups. Sub-analyses showed significant differences in changes of FAOS Ache (week 0 to week 5) and VAS scores, total FAOS, and EQ-5D-5L scores (week 1 to week 5) between the two subgroups (grade II). There were no adverse events and significant negative changes in clinical laboratory parameters in both groups. CONCLUSIONS: Overall, the results of this study are in favor of DS combined with acupuncture and suggest that DS combined with acupuncture is a safe treatment with positive long-term effects in terms of pain reduction and symptom alleviation in patients with grade I or II ALAS. TRIAL REGISTRATION: Clinical Research Information Service KCT0002374 . Registered on July 11, 2017; retrospectively registered.

The effectiveness of mobilization with movement on pain, balance and function following acute and sub acute inversion ankle sprain - A randomized, placebo controlled trial.

OBJECTIVES: To determine the effect of mobilization with movement (MWM) on pain, ankle mobility and function in patients with acute and sub-acute grade I and II inversion ankle sprain. STUDY DESIGN: Randomized placebo controlled trial. SETTING: A general hospital. SUBJECTS: 32 adults with inversion ankle sprain. MAIN OUTCOME MEASURES: The primary outcome was pain intensity on an 11 point Numeric Rating Scale (NRS) with higher score indicating greater pain intensity. Ankle disability identified by the Foot and Ankle Disability index (FADI) with higher score indicating lower disability, functional ankle dorsiflexion range, pressure pain threshold, and dynamic balance measured with the Y balance test were secondary outcomes. RESULTS: Thirty participants completed the study. At each follow-up point, significant differences were found between groups favouring those receiving MWM for all variables. Pain intensity showed a mean difference of 1.7 points (95% confidence interval, 1.4 to 2.1) and 0.9 points (95% confidence interval, 0.5 to 1.3) at one and six-months follow-up respectively. Benefits were also shown for FADI, ankle mobility, pressure pain threshold and balance. CONCLUSION: This study provides preliminary data for the benefits of MWM for acute and sub-acute ankle sprain in terms of pain, ankle mobility, disability and balance.