Anterior knee laxity is greater in athletic females who attain menarche at a younger age.

PURPOSE: Females with above-average anterior knee laxity values are at increased risk of anterior cruciate ligament (ACL) injury. The purpose of this study was to examine the effects of menarche age (MA) and menarche offset on anterior knee laxity in young, physically active women. METHODS: Anterior knee laxity (KT-2000) and menstrual characteristics (per self-report) were recorded in 686 Slovenian sportswomen from team handball, volleyball and basketball club sports (average years sport participation: 7.3 ± 3.6 years). Females were stratified into four groups based on their self-reported age at menarche: 9-11, 12, 13 and 14+ years. Anterior knee laxity was compared across MA groups using a univariate analysis of variance (ANOVA) with Bonferroni correction, with and without controlling for factors that could potentially differ between groups and influence anterior knee laxity. Females were then stratified into four groups based on the number of years they were away from their age at onset of menarche. Groups were compared using a univariate ANOVA with Bonferroni correction, with and without controlling for factors that differed between groups and could influence anterior knee laxity. RESULTS: Anterior knee laxity was greater in females who attained menarche at 12 years of age (6.4 ± 1.5 mm) or younger (6.6 ± 1.6 mm) compared to 14 years of age or older (5.8 ± 1.2 mm) (p < 0.001; partial η2 = 0.032). Anterior knee laxity was 0.7-1.4 mm greater in females who were 5 or more years away from menarche compared to those who were within 2 years of menarche (5.8 ± 1.3 mm; p < 0.001). CONCLUSION: Anterior knee laxity is greater in females who attained menarche at a younger age and in females who are 5 or more years postmenarche. Age of menarche represents a critical pubertal event that is easy for women to recall and may provide important insights into factors that moderate anterior knee laxity, a risk factor for ACL injury in women. LEVEL OF EVIDENCE: Level IV.

The effect of open kinetic chain knee extensor resistance training at different training loads on anterior knee laxity in the uninjured.

BACKGROUND: The commonly used open kinetic chain knee extensor (OKCKE) exercise loads the sagittal restraints to knee anterior tibial translation. OBJECTIVE: To investigate the effect of different loads of OKCKE resistance training on anterior knee laxity (AKL) in the uninjured knee. STUDY DESIGN: non-clinical trial. METHODS: Randomization into one of three supervised training groups occurred with training 3 times per week for 12 weeks. Subjects in the LOW and HIGH groups performed OKCKE resistance training at loads of 2 sets of 20 repetition maximum (RM) and 20 sets of 2RM, respectively. Subjects in the isokinetic training group (ISOK) performed isokinetic OKCKE resistance training using 2 sets of 20 maximal efforts. AKL was measured using the KT2000 arthrometer with concurrent measurement of lateral hamstrings muscle activity at baseline, 6 weeks and 12 weeks. RESULTS: Twenty six subjects participated (LOW n = 9, HIGH n = 10, ISOK n = 7). The main finding from this study is that a 12-week OKCKE resistance training programme at loads of 20 sets of 2RM, leads to an increase in manual maximal AKL. CONCLUSIONS: OKCKE resistance training at high loads (20 sets of 2RM) increases AKL while low load OKCKE resistance training (2 sets of 20RM) and isokinetic OKCKE resistance training at 2 sets of 20RM does not.

Effect of repeated passive anterior loading on human knee anterior laxity.

BACKGROUND: Increased knee anterior laxity results when the anterior cruciate ligament is injured. This increased laxity can cause knee dysfunction. Until recently this laxity was believed to be only diminished through surgery. But recent findings indicate that knee anterior laxity may be decreased with repeated loading of the knee. OBJECTIVE: The purpose of this study was to test the hypothesis that regular passive anterior loading of the uninjured human knee would enhance its stiffness. STUDY DESIGN: Randomized controlled trial. METHODS: Knee anterior laxity was tested using an arthrometer in 22 young, uninjured females before, during and after a 3 month period during which passive anterior loading was applied by a trained physiotherapist over 5 sessions per week to a randomly assigned knee. RESULTS: Knee anterior laxity was not affected by the passive anterior loading of the knee. CONCLUSIONS: Given that in this study repeated passive loading of the knee did not change knee anterior laxity, it would be easy to conclude that this training is ineffective and no further research is required. We caution against this given the relatively short duration and possibly insufficient intensity of the training and the population studied; individuals with normal joint laxity. We recommend that future research be performed that consists of individuals with lax joints who receive training for prolonged periods.

The effect of knee extensor open kinetic chain resistance training in the ACL-injured knee.

PURPOSE: To investigate the effect of different loads of knee extensor open kinetic chain resistance training on anterior knee laxity and function in the ACL-injured (ACLI) knee. METHODS: Fifty-eight ACLI subjects were randomised to one of three (12-week duration) training groups. The STAND group trained according to a standardised rehabilitation protocol. Subjects in the LOW and HIGH group trained as did the STAND group but with the addition of seated knee extensor open kinetic chain resistance training at loads of 2 sets of 20 repetition maximum (RM) and 20 sets of 2RM, respectively. Anterior knee laxity and measurements of physical and subjective function were performed at baseline, 6 and 12 weeks. Thirty-six subjects were tested at both baseline and 12 weeks (STAND n = 13, LOW n = 11, HIGH n = 12). RESULTS: The LOW group demonstrated a reduction in 133 N anterior knee laxity between baseline and 12 weeks testing when compared to the HIGH and the STAND groups (p = 0.009). Specifically, the trained-untrained knee laxity decreased an average of approximately 5 mm in the LOW group while remaining the same in the other two groups. CONCLUSION: Twelve weeks of knee extensor open kinetic chain resistance training at loads of 2 sets of 20RM led to a reduction in anterior knee laxity in the ACLI knee. This reduction in laxity does not appear to offer any significant short-term functional advantages when compared to a standard rehabilitation protocol. These results indicate that knee laxity can be decreased with resistance training of the thigh muscles. LEVEL OF EVIDENCE: Randomised controlled trial, Level II.

The effect of thigh muscle activity on anterior knee laxity in the uninjured and anterior cruciate ligament-injured knee.

PURPOSE: The main purpose of this study was to describe the nature of the relationship between hamstring muscle activity and anterior knee laxity. METHODS: This was a cross-sectional study. Anterior knee laxity was measured at 133N and manual maximal forces using the KT2000 knee arthrometer, in 8 ACL-injured and 13 uninjured individuals. Electromyographic activity of the lateral hamstrings was measured during laxity testing. Subjects contracted the hamstrings during anterior knee laxity testing at eight predetermined levels of maximal voluntary isometric contraction. RESULTS: Volitional contraction of the lateral hamstrings reduced anterior knee laxity logarithmically for both the 133N and manual maximal tests in both the ACL-injured and uninjured knees. A simple linear regression model, with the log of percentage of maximum lateral hamstrings activity as the sole predictor, explained approximately 70-80% of the variation in anterior knee laxity. Both ACL-injured and uninjured subjects reduced anterior knee laxity at the same rate with increases in muscle activity. However, initial lateral hamstrings muscle activity had a greater effect on percentage anterior knee laxity scores in the ACL-injured as compared to the uninjured knee. CONCLUSIONS: Lateral hamstrings activity reduces anterior knee laxity in a nonlinear manner, whereby the initial lower level of activation produces the greatest change in anterior knee laxity. Therefore, hamstrings muscle activity must be monitored during anterior knee laxity testing.

Inter-rater reliability of the GNRB® knee arthrometer.

BACKGROUND: In clinical settings, where arthrometers are mainly used by different clinicians, knowing the inter-rater reliability of the instrument is crucial in order for the results from different examiners to be accurately interpreted and limitations fully understood. The aim of this study was to evaluate the inter-rater reliability of the GNRB® knee arthrometer. METHODS: Knee anterior laxity in both knees was tested in a group of young, uninjured subjects (N=27, 13 females) by two examiners. Knee anterior laxity was calculated at test forces of 134 N and 250 N with values presented for the unstandardised and standardised conditions (relative to patellar stabilisation force). RESULTS: The ICCs ranged from 0.220 to 0.424. CONCLUSIONS: The inter-rater reliability of the GNRB® knee arthrometer is low.

Bench testing of a knee joint arthrometer.

The KT1000 and KT2000 knee joint arthrometers (MEDmetric Corp, San Diego, California) have been shown to overestimate the measurement of knee joint sagittal laxity. The purpose of this study was to investigate the accuracy of the KT arthrometers as measures of anterior and posterior linear displacement. The anterior and posterior linear displacements of 3 KT arthrometers (2 KT1000 arthrometers and 1 KT2000 arthrometer) were compared with the simultaneous displacement measured by a precision linear Vernier Dial Test Indicator (Davenport Ltd, London, United Kingdom). The displacement calculated using the analog output of the KT2000 was also compared with the values on the KT2000 displacement dial. Compared with the Vernier Dial Test Indicator, the KT arthrometers overestimated anterior linear displacement by between 22% and 24%. True anterior displacement for all 3 arthrometers, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT value by 0.79. When compared with the Vernier Dial Test Indicator, the KT arthrometers underestimated posterior linear displacement by between 18% and 19%. True posterior displacement, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT1000 value by 1.17 and the KT2000 value by 1.16. The internal apparatus of the KT2000 and KT1000 knee joint arthrometers overestimates anterior displacement and underestimates posterior displacement with a predictable relative systematic error. Future validation studies should use these correction equations to assess the accuracy of the KT arthrometers. Sagittal plane knee laxity measured with the KT devices requires systematic correction for optimal accuracy.

Effectiveness of rocker sole shoes in the management of chronic low back pain: a randomized clinical trial.

STUDY DESIGN: Multicenter, assessor-blind, randomized, clinical trial. OBJECTIVE: To compare the effectiveness of rocker sole footwear to traditional flat sole footwear as part of the management for people with low back pain (LBP). SUMMARY OF BACKGROUND DATA: During the past decade, persistent advertising has claimed that footwear constructed with a rocker sole will reduce LBP. However, there is no robust evidence to support these claims. METHODS: One hundred fifteen people with chronic LBP were randomized to wear rocker sole shoes or flat sole shoes for a minimum of 2 hours each day while standing and walking. Primary outcome was the Roland Morris Disability Questionnaire (RMDQ). In addition, participants attended an exercise and education program once a week for 4 weeks and wore their assigned shoes during these sessions. Participants were assessed without their knowledge of group allocation prerandomization, and at 6 weeks, 6 months, and 1 year (main outcome point). Analysis was by intention-to-treat method. RESULTS: At 12 months, data from 44 of 58 (77.2%) of the rocker sole group and 49 of 57 (84.5%) of the flat sole group were available for analysis. In the rocker sole group, mean reduction in RMDQ was -3.1 (95% CI [confidence interval], -4.5 to -1.6), and in the flat sole group, it was -4.4 (95% CI, -5.8 to -3.1) (a greater negative value represents a greater reduction in disability). At 6 months, more people wearing flat shoes compared with those wearing rocker shoes demonstrated a minimal clinically important improvement in disability (53.2% and 31.1%, respectively; P = 0.03). Between-group differences were not significant for RMDQ or any secondary outcomes (e.g., pain) at any time. People reporting pain when standing and walking at baseline (n = 59) reported a greater reduction in RMDQ at 12 months in the flat sole group (-4.4 [95% CI, -6.0 to -2.8], n = 29) than the rocker sole group (-2.0 [95% CI, -3.6 to -0.4], n = 30) (P < 0.05). CONCLUSION: Rocker sole shoes seem to be no more beneficial than flat sole shoes in affecting disability and pain outcomes in people with chronic LBP. Flat shoes are more beneficial for LBP aggravated by standing or walking. LEVEL OF EVIDENCE: N/A.

The immediate effects of open kinetic chain knee extensor exercise at different loads on knee anterior laxity in the uninjured.

BACKGROUND: There is evidence that anterior laxity may be affected by knee extensor open kinetic chain (OKC) exercise with responses being load-dependent. The aim of this study is to evaluate the immediate and short-term changes in passive knee anterior laxity following a single session of OKC knee extensor exercise. METHODS: Thirty two participants were randomly allocated to perform either high load (20 sets of 2 repetitions) or low load (2 sets of 20 repetitions) knee extensor OKC exercise with knee anterior laxity assessed before exercise, immediately after exercise and 45 and 90min after exercise with a KT-2000 arthrometer using a 133N force. RESULTS: A significant effect of time was observed on knee laxity (p<0.001). However, a significant interaction of time and group was not found (p=0.54) and so the results presented here are for the combined (low and high load) group mean±standard deviation knee anterior laxity (mm) in the exercised leg: 7.2±2.2 (baseline), 8.2±2.3 (immediate post exercise, 14% change from baseline), 8.1±2.3 (45min post exercise, 12% change from baseline), and 7.7±2.2/0.29 (6.9) (90min post exercise, 7% change from baseline). CONCLUSION: OKC knee extensor exercise at high loads and low loads causes an immediate increase in knee laxity that begins to decrease within 90min.

Robotic knee laxity testing: reliability and normative data.

PURPOSE: To evaluate the reliability of the GeNouRoB knee arthrometer and present normative values of knee anterior laxity using this device on young females. METHODS: Anterior laxity in both knees was tested in two groups of young, uninjured females using the hamstrings electromyography biofeedback feature of the device. There were 13 participants in the group tested for reliability and 23 for the normative study. Laxity (mm of movement of the proximal tibia in the anterior direction relative to the femur) was calculated at test forces of 134 N and 250 N with values presented for the unstandardised and standardised (relative to stabilisation force) conditions. RESULTS: The relative reliability (95% limits of agreement) of the device for laxity at a test force of 134 N was 2 to 3mm. Left knee anterior laxity was almost 1mm greater than the right. CONCLUSIONS: The relative reliability of the GeNouRoB arthrometer is comparable to the KT device. In agreement with previous work on the nonrobotic KT arthrometer, the knee anterior laxity values found with the GeNouRoB are greater in the left as compared to the right knee.

Using the knee-specific Hughston Clinic Questionnaire, EQ-5D and SF-6D following arthroscopic partial meniscectomy surgery: a comparison of psychometric properties.

PURPOSE: To compare the psychometric properties of the Hughston Clinic Questionnaire (HCQ), EQ-5D and SF-6D in patients following arthroscopic partial meniscectomy surgery. METHODS: A total of 84 participants (86% men; mean age 40) were recruited. The questionnaires were completed on average 5 days, 6 weeks and 6 months after surgery and compared for internal consistency, convergent validity, sensitivity to change and floor and ceiling effects. RESULTS: Internally, the HCQ was the most consistent instrument (α = 0.923) followed by the SF-6D and EQ-5D. The EQ-5D and SF-6D were moderately correlated with the HCQ (ρ = 0.499 and 0.394, respectively). Six weeks after surgery, the most sensitive measures were the HCQ and EQ-5D (effect size: 2.04 and 0.99, respectively), at 6 months, with a smaller cohort (n = 42), again it was the HCQ and EQ-5D (effect size: 2.03 and 1.04, respectively). The SF-6D demonstrated no ceiling or floor effect during the study; the HCQ demonstrated a ceiling affect for 5% of respondents at 6 months after surgery compared to 26% of respondents for the EQ-5D. CONCLUSION: For this patient population, our findings indicated that the EQ-5D was more consistently responsive to change over time, as a utility index was better at distinguishing differences between groups and reflected the results of the joint-specific HCQ for knee recovery better than the SF-6D. It is therefore recommended that for similar populations, the EQ-5D is preferable to the SF-6D for utilisation alongside the HCQ.

Rate and risk of anterior cruciate ligament injury among sportswomen in Slovenia.

CONTEXT: Anterior cruciate ligament (ACL)-injury rate is greater among female athletes than among male athletes. OBJECTIVE: To investigate the rate and risk of ACL injury among Slovenian sportswomen playing professional basketball, team handball, or volleyball. DESIGN: Prospective cohort study. SETTING: The Slovenian National Organizations of basketball, team handball, and volleyball. PATIENTS OR OTHER PARTICIPANTS: During the 2003-2004 season, we prospectively followed 585 Slovenian sportswomen registered in the Slovenian National Organizations of basketball, team handball, and volleyball. MAIN OUTCOME MEASURE(S): We asked sportswomen and coaches to document the occurrence of every significant traumatic knee injury requiring medical attention. Injury rate and injury risk were calculated for sportswomen in each sport group. To calculate injury rate, we estimated the average exposure of each sportswoman during the research period. RESULTS: During the 2003-2004 season, 585 Slovenian sportswomen sustained 12 ACL injuries. The ACL-injury risk was different in athletes participating in the various sports, with basketball players having the greatest ACL-injury risk and volleyball players having the lowest ACL-injury risk (P  =  .04). The risk of ACL injury among Slovenian sportswomen was 2.1 per 100 athletes (95% confidence interval  =  0.9, 3.2), whereas the rate of ACL injury was 0.037 per 1000 exposure hours (95% confidence interval  =  0.016, 0.06). CONCLUSIONS: Overall differences in injury risk were found among sports, but no differences were noted among divisions within sports. No differences for injury rate were observed between or within sports. The rate and risk of ACL injury among Slovenian sportswomen are high, with basketball players having the greatest ACL-injury risk.

Is knee laxity change after ACL injury and surgery related to open kinetic chain knee extensor training load?

OBJECTIVE: The purpose of this study was to evaluate whether knee anterior laxity changes after anterior cruciate ligament injury and surgery are related to aspects of thigh muscle resistance training during rehabilitation. DESIGN: Forty-nine subjects (13 females) diagnosed with an anterior cruciate ligament-deficient knee or who had undergone anterior cruciate ligament reconstructive surgery participated in this study. The subjects trained their knee extensors in the open kinetic chain during a 6-wk program, and the relationship of aspects of training (for example, absolute resistance load) and other factors to anterior laxity change during this period were analyzed using linear regression analysis. RESULTS: The only factor found to be significantly related (r = -0.347) to anterior knee laxity change was average absolute load used in training the knee extensors. CONCLUSIONS: These results offer some early clinical support for increasing the strain on the anterior cruciate ligament graft (in patients treated with reconstruction) or other passive restraints to anterior tibial displacement, during rehabilitation after anterior cruciate ligament injury and reconstruction surgery to promote decreased knee anterior laxity.

Correlates of knee anterior laxity in sportswomen.

The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R(2)=0.089; p<0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury.

Knee anterior laxity: a risk factor for traumatic knee injury among sportswomen?

The purpose of this study was to investigate if knee anterior laxity, measured with an arthrometer, is a risk factor for traumatic knee injury in sportswomen. To allow a more complete analysis, other, easily measured variables such as anthropometry, lower leg characteristics, sport exposure and menstrual cycle characteristics were also evaluated as possible risk factors. Subjects were Slovenian sportswomen aged between 11 and 41 years participating in basketball, team handball and volleyball (N = 540). Sportswomen were tested in the pre-season and followed for one season. The data collection included: written informed consent, background questionnaire, anthropometric tests, leg dominance assessment, navicular drop test (measurement of foot pronation), passive knee extension assessment and measurement of knee anterior laxity with a KT arthrometer. Several sets of data analysis were performed including logistic regression analysis in order to build a model for predicting traumatic knee injury among sportswomen. Height and average hours of training per week were found to differ significantly (P < 0.05) between injured and uninjured sportswomen. More sportswomen injured their non-dominant leg. Traumatic knee injuries among Slovenian sportswomen participating in basketball, team handball and volleyball are associated with higher amounts of training, greater body height and greater knee anterior laxity. Only 1% of the variability in traumatic knee injuries among sportswomen were explained with those variables suggesting that there are many other variables associated with traumatic knee injuries among sportswomen than were tested in this study.

Factors related to early recovery rate after partial knee meniscectomy.

A main role of clinicians treating patients after orthopedic surgery is to inform patients about their anticipated recovery rate and recovery endpoint. In estimating recovery rate, clinicians consider a series of potentially influencing factors, including the type and severity of injury and the characteristics of the patient. Unfortunately, this is done largely without evidence to support factors believed to be important in recovery rate. To our knowledge, no studies exist where factors that might influence recovery rate after arthroscopic partial meniscectomy have been evaluated. Eighty-three patients (11 women and 72 men) were evaluated 4 days after and then again 6 weeks after knee arthroscopic partial meniscectomy surgery. Recovery rate was calculated by dividing the change in a patient's Hughston Clinic knee self-assessment questionnaire during this period by his or her baseline Hughston score and relationships to independent variables (gender, age, body mass index [BMI], injury chronicity, affected meniscus, Hughston Clinic knee self-assessment score at baseline, knee flexion passive range of motion, and knee circumference). These were evaluated using backward stepwise regression analysis. The relationship between recovery rate and the independent variables was statistically significant (P,.05) for the following variables: injury chronicity, gender, and gender/injury type combination. The most unexpected finding in this study was the statistically nonsignificant relationship between recovery rate and the following variables: age, Hughston score, BMI, knee swelling, and knee flexion passive range of motion loss.

Correlates of knee extensor training load used in rehabilitation after knee surgery.

Resistance training is one of the major components of rehabilitation after musculoskeletal injury and surgery. Despite the importance of resistance training and the frequency of its use in rehabilitation, little is known about factors that are related to training load that might be useful in devising and monitoring training in a patient and comparing training intensities between individuals and groups. We hypothesized that the following would show a statistically significant relationship to training load: injury chronicity, self-assessed knee function (Hughston Clinic questionnaire), knee swelling (injured-uninjured midpatellar knee girth), uninjured knee girth, and body mass. The purpose of this study was to evaluate whether factors such as body mass are related to the load used in training the knee extensors in rehabilitation after knee surgery. Thirty-six individuals undergoing early-phase rehabilitation after knee arthroscopic meniscectomy surgery participated in this study. Subjects were tested 5 days after surgery, just prior to commencing a 6-week outpatient rehabilitation program, and again soon after the end of this rehabilitation program. The independent variables evaluated were age, gender, body mass, meniscus injured, injury chronicity, knee function self-assessment, knee swelling (injured-uninjured midpatellar girth), uninjured knee girth, and knee flexion and extension passive range of motion (difference between injured and uninjured side). The dependent variable was the load used for training the knee extensors on the knee extension machine in the final training session prior to the posttest. The only variable exhibiting a statistically significant (p = 0.001) relationship to knee extensor final training was age (r = -0.529). This finding, that age was the only variable to have a significant relationship with training load, suggests that clinicians' expectation of training intensity should decrease with an increase in the patient's age in the range studied (20-58 years) for patients recovering from knee arthroscopic meniscectomy.

Comparison of conventional resistance training and the fly-wheel ergometer for training the quadriceps muscle group in patients with unilateral knee injury.

A fly-wheel ergometer (FWE) offering resistance training of the knee extensors has been designed for space travel and found to be effective during bed rest. The possibility exists that this device is also effective in training the knee extensors after knee injury. The purpose of this study was to compare the FWE to standard knee extensor training equipment for their effects on individuals with a history of knee injury, a group who commonly suffer from weakness of the knee extensors that effects their function. Twenty-nine subjects completed the study, which included tests of knee self-assessment, knee extensor static and dynamic muscle strength, size and neural activation as well as single leg power output, standing balance and vertical jump performance. Both groups showed statistically significant (P < 0.05) improvements in these variables over the 3-month training period but no differences were noted between the groups. The FWE appears to be as effective as standard resistance training equipment for improving knee extensor muscle group size and performance after knee injury.

A literature review of autograft and allograft anterior cruciate ligament reconstruction.

Knee anterior cruciate ligament reconstructive surgery has significantly evolved and now includes the option of using an allograft. This has resulted in numerous studies evaluating the advantages and disadvantages of allografts. The purpose of this literature review is to evaluate this research and present important findings to allow the selection of the most appropriate graft source when considering allograft versus autograft reconstruction.

Effect of neuromuscular electrical stimulation on ankle swelling in the early period after ankle sprain.

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation (NMES) is frequently used to decrease swelling in the early period after ankle sprain. The purpose of this study was to evaluate its effectiveness in this treatment. SUBJECTS: Thirty-four subjects (11 female, 23 male; mean age=30.2 years) who were recovering from ankle sprain participated. METHODS: Outcome measures were ankle-foot volume, ankle girth, and self-assessed ankle function. Three testing raining sessions occurred within 5 days of injury. Subjects were randomly assigned to 1 of 3 groups: a group that received NMES treatment, a group that received submotor ES treatment (designed to act as a control group), and a group that received sham treatment. RESULTS: There were no statistically significant differences among the groups for ankle-foot volume and self-assessed ankle function. The statistically significant differences for ankle girth may have been compromised due to the significantly different values among groups at baseline. Ankle girth measurements were shown to be statistically significant from session 1 to session 3 for the NMES group but not for the other 2 groups. DISCUSSION AND CONCLUSION: The results indicate that NMES, as designed and used in this study, is not effective in decreasing ankle-foot volume or increasing self-assessed ankle function in the early period after ankle sprain.