Efectos de ejercicios especializados en la rehabilitación del esguince de tobillo grado 1 en futbolistas / Effects of specialized exercises in the rehabilitation of grade 1 ankle sprain in soccer players

Introducción: Las lesiones en los futbolistas provocan limitaciones en la movilidad osteomuscular, provocando un descanso pasivo, y por ende el no cumplimiento del principio de sistematicidad del entrenamiento; por lo cual, puede provocar abandono deportivo en casos extremos, y normalmente disminución del rendimiento. La recuperación mediante terapia requiere una valoración de su eficiencia, siendo necesario estudiar las acciones más efectivas desde el punto de vista terapéutico. Objetivo: Valorar los efectos de un proceso de intervención con ejercicios terapéuticos para la rehabilitación del esguince de tobillo grado 1 en futbolistas. Métodos: Investigación descriptiva/explicativa de orden cuasiexperimental y enfoque longitudinal (4 años de estudio), investigando a 43 futbolistas con una lesión previa en el tobillo por esguince grado 1 (Grupo 1: Experimental, Grupo 2: Control), interviniendo al grupo experimental con tres fases de tratamiento, que incluye un grupo de ejercicios físicos especializados para fortalecer y mantener las condiciones óptimas del musculo. Resultados: El grupo experimental requiere menos tiempo para recuperarse de una lesión por esguince (p ( 0,001), mientras que la reincidencia de la lesión fue menor que en el grupo control (p ( 0,019) en un periodo de cuatro años. Conclusiones: El proceso de intervención ha sido efectivo al lograse una mejor rehabilitación en la muestra experimental, en términos de prontitud en el proceso de recuperación, y en términos de disminución de las recaídas en un periodo de cuatro años. Una vez recuperado el deportista, se recomienda proseguir sistemáticamente con el proceso de fortalecimiento y prevención en las sesiones de entrenamiento, y en el hogar(AU)

Introduction: Injuries in soccer players cause limitations in musculoskeletal mobility, causing a passive rest, and therefore non-compliance with the principle of systematic training; Therefore, it can cause sports abandonment in extreme cases, and usually a decrease in performance. Recovery through therapy requires an assessment of its efficiency, and it is necessary to study the most effective actions from the therapeutic point of view. Objective: To assess the effects of an intervention process with therapeutic exercises for the rehabilitation of grade 1 ankle sprain in soccer players. Methods: Descriptive/explanatory research of quasi-experimental order and longitudinal approach (4 years of study), researching 43 soccer players with a previous ankle injury due to grade 1 sprain (Group 1: Experimental, Group 2: Control), intervening in the experimental group. with three phases of treatment, which includes a group of specialized physical exercises to strengthen and maintain optimal muscle conditions. Results: The experimental group required less time to recover from a sprain injury (p ( 0.001), while the recurrence of the injury was less than in the control group (p ( 0.019) in a period of four years. Conclusions: The intervention process has been effective in achieving better rehabilitation in the experimental sample, in terms of speed in the recovery process, and in terms of reducing relapses in a four years period. Once the athlete has recovered, it is recommended to systematically continue with the strengthening and prevention process in training sessions and at home(AU)

Gait biofeedback and impairment-based rehabilitation for chronic ankle instability.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.

Progressive rehabilitation of the sprained ankle: A novel treatment method.

OBJECTIVES: This randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma. METHODS: Measurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I-III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data. RESULTS: After one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p<0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion. CONCLUSION: Early fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs.

Outcome of a neuromuscular training program on recurrent ankle sprains. Does the initial type of healthcare matter?

OBJECTIVES: To study the impact of initial healthcare for a lateral ankle sprain on the outcome of neuromuscular training (NMT) on recurrent sprains and describe athlete characteristics receiving different types of healthcare. DESIGN: Secondary analysis of three randomized trials. METHOD: From three previous trials evaluating NMT, data on athlete characteristics, type of initial healthcare and a recurrent sprain during one-year follow-up were collected (N = 705). Multilevel logistic regression analyses were used to test the impact of initial healthcare on the outcome of NMT on recurrent sprains. Potential differences in athlete characteristics between different types of healthcare were examined using one-way analysis of variance and Pearson chi-square test. RESULTS: After NMT, 39.7% of the athletes visiting paramedical care reported a recurrent sprain, 21.8% of secondary and 34.0% of primary care. Athletes who visited a physiotherapist reported more recurrent sprains, than those not visiting a physiotherapist (adjusted OR 3.15;95%CI 1.88-5.23). Athletes visiting paramedical (49.7%) and primary care (48.4%) used more braces and/or tape during sport than those not visiting any care (34.2%). CONCLUSIONS: The initial type of healthcare of athletes with an ankle sprain, that consecutively received NMT, seems to impact the occurrence of recurrent sprains. Physiotherapists may be visited by athletes with a poorer prognosis, which may be explained by different athlete characteristics.

Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain. A crossover clinical trial.

BACKGROUND: Midfoot joint impairment is likely following lateral ankle sprain (LAS) that may benefit from mobilization. OBJECTIVE: To investigate the effects of midfoot joint mobilizations and a one-week home exercise program (HEP) compared to a sham intervention and HEP on pain, patient-reported outcomes (PROs), ankle-foot joint mobility, and neuromotor function in young adults with recent LAS. METHODS: All participants were instructed in a stretching, strengthening, and balance HEP and were randomized a priori to receive midfoot joint mobilizations (forefoot supination, cuboid glide and plantar 1st tarsometatarsal) or a sham laying-of-hands. Changes in pain, physical, psychological, and functional PROs, foot morphology, joint mobility, pain-to-palpation, neuromotor function, and dynamic balance were assessed pre-to-post treatment and one-week following. Participants crossed-over following a one-week washout to receive the alternate treatment and were assessed pre-to-post treatment and one-week following. ANOVAs, t-tests, proportions, and 95% confidence intervals (CI) were calculated to assess changes in outcomes. Cohen's d and 95% CI compared treatment effects at each time-point. RESULTS: Midfoot joint mobilization had greater effects (p < .05) in reducing pain 1-week post (d = 0.8), and increasing Single Assessment Numeric Evaluation (immediate: d = 0.6) and Global Rating of Change (immediate: d = 0.6) compared to a sham treatment and HEP. CONCLUSION: Midfoot joint mobilizations and HEP yielded greater pain reduction and perceived improvement compared to sham and is recommended in a comprehensive rehabilitation program following LAS.

Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial.

OBJECTIVE: The primary aim was to compare time from acute hamstring strain injury (HSI) to return-to-play (RTP) clearance following a standardized rehabilitation protocol performed within either pain-free or pain-threshold limits. Secondary aims were to compare isometric knee flexor strength, biceps femoris long head (BFLH) fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up between pain-free and pain-threshold groups. DESIGN: Randomized controlled trial. METHODS: Forty-three men with acute HSIs were randomly allocated to a pain-free (n = 22) or pain-threshold (n = 21) rehabilitation group. Days from HSI to RTP clearance, isometric knee flexor strength, BFLH fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up were reported. RESULTS: Median time from HSI to RTP clearance was 15 days (95% confidence interval [CI]: 13, 17) in the pain-free group and 17 days (95% CI: 11, 24) in the pain-threshold group, which was not significantly different (P = .37). Isometric knee flexor strength recovery at 90° of hip and 90° of knee flexion was greater in the pain-threshold group at RTP clearance by 15% (95% CI: 1%, 28%) and by 15% (95% CI: 1%, 29%) at 2-month follow-up, respectively. Improvement in BFLH fascicle length from baseline was 0.91 cm (95% CI: 0.34, 1.48) greater at 2-month follow-up in the pain-threshold group. Two reinjuries occurred in both the pain-free and pain-threshold groups between RTP clearance and the 6-month follow-up. CONCLUSION: Pain-threshold rehabilitation did not accelerate RTP clearance, but resulted in greater recovery of isometric knee flexor strength and better maintenance of BFLH fascicle length, compared to pain-free rehabilitation. J Orthop Sports Phys Ther 2020;50(2):91-103. Epub 28 Jun 2019. doi:10.2519/jospt.2020.8895.

Functional Outcomes and Psychological Benefits of Active Video Games in the Rehabilitation of Lateral Ankle Sprains: A Case Report.

CONTEXT: The use of active video games (AVG) as a treatment modality in the rehabilitation context is increasing. However, little is known about the functional outcomes and psychological benefits of such rehabilitation in college athletes with lateral ankle sprains (LASs). OBJECTIVE: To examine functional outcomes and psychological benefits of AVG-aided rehabilitation program for LAS. DESIGN: A mixed-methods, single-subject case series design. SETTING: College athletic training clinic. PATIENTS: Two female college soccer players who sustained LAS (grades I and II) during sport participation. INTERVENTION: A 4-week balance training program. One patient completed balance exercises using AVG, whereas the other patient completed traditional balance exercises. MAIN OUTCOME MEASURES: Several validated instruments were used to evaluate different functional outcomes and psychological factors: balance (Balance Error Scoring System, Star Excursion Balance Test), rehabilitation adherence (Rehabilitation Adherence Measure for Athletic Training), foot and ankle function (Foot and Ankle Ability Measure), perceptions of pain (Visual Analog Scale for pain), perceived readiness to return to sport (Injury-Psychological Readiness to Return to Sport Scale), and mood (Brunel Mood Scale). RESULTS: It appears that the balance training protocols (AVG and traditional balance exercises) were equally effective in restoring patient's balance to functional levels. Despite very individualistic processes of rehabilitation, the participants' perceived pain, perceived readiness to return to sport, and mood states were closely linked with objective and subjective functional measures of progress. CONCLUSIONS: Based on the results, AVG has the potential to provide more versatility into the static and dynamic postural control exercises typically used following acute LAS. Moreover, the current results support the existing psychological and biopsychosocial theoretical conceptualizations of athletes' responses to injuries and rehabilitation process.

Improvements in Match-Related Physical Performance of Professional Soccer Players After the Application of an on-Field Training Program for Hamstring Injury Rehabilitation.

CONTEXT: Although there are multiple, validated return-to-play programs following hamstring strain injuries, no studies have evaluated their changes in match performance parameters. OBJECTIVES: The aim of this study was twofold as follows: (1) to determine the changes in match-based physical performance parameters in professional soccer players before and after sustaining a hamstring strain injury and undergoing a soccer-specific rehabilitation program and (2) to observe the progress of these performance parameters 6 to 10 weeks after the player returned from injury. DESIGN: Prospective, quasi-experimental longitudinal study. SETTING: Soccer playing and training grounds. PARTICIPANTS: Nineteen players suffering a hamstring strain injury from 2 male professional teams playing in the Spanish professional football league (La Liga) were followed during the 2015-2016, 2016-2017, and 2017-2018 seasons. INTERVENTION: Participation in on-field training program following a hamstring injury. MAIN OUTCOME MEASURES: Match global positioning system data were collected in the following stages: prior to injury (PRE), after return to play (RTP), program, and 6 to 10 weeks following RTP (C2). Peak velocities and distances ran at sprint velocities showed most likely improvements in C2 versus PRE, and very likely improvements in RTP versus PRE. RESULTS: The distances ran at high and very high intensities, the average velocity, and work-to-rest ratio showed very likely improvements in C2 versus RTP and likely improvements in RTP versus PRE. Likely improvements were observed for all variables in C2 versus RTP. The authors' results showed an improvement of physical performance during competitive match after RTP, compared with PRE. There was a steady progression in the progress, and in 8 months following RTP, there was no injury reported in the players. CONCLUSIONS: The current findings may indicate that the hamstring muscle complex not only recovered completely from the injury but could also withstand a greater training and match load reducing the risk of reinjury.

Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report.

INTRODUCTION: Without a definitive single pathoanatomical origin for groin pain, management is difficult. The purpose of this case report is to describe the differential diagnosis and management of an individual with a traumatic groin strain. Case Description: A 47-year-old sedentary male truck driver presented to physical therapy with a 2-month history of right medial groin pain. Pushing the gas pedal and sitting were painful activities. Pain was 3-8/10 on the Numeric Pain Rating Scale (NPRS). The patient reported 46/80 on the Lower Extremity Functional Scale. Examination: Tenderness was noted along the adductor longus muscle belly, right pubic ramus and hip range of motion was limited. Special tests directed at the hip and pelvic region indicated intraarticular and pelvic dysfunction. Treatment included hip and pubic symphysis joint mobilizations, lumbopelvic manipulation, adductor longus soft-tissue mobilization, and core strengthening. Outcome: 12 sessions of physical therapy resulted in LEFS to 80/80, Global Rating of Change (GROC) + 7, and NPRS 0/10 at worst. The patient returned to full work without restriction. Discussion: Groin pain has many pathoanatomical drivers. Management of a traumatic groin injury requires a thorough evaluation and a global treatment approach, in order to improve outcomes and reduce the risk of the pathology becoming chronic.

Ankle Sprains: Evaluation, Rehabilitation, and Prevention.

Ankle sprains affect athletic populations at high rates. Athletes who suffer an ankle sprain frequently go on to develop persistent symptoms, resulting in significant resources spent toward treatment, rehabilitation, and prevention. A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription. This narrative review aims to present an approach to evaluation of high and low ankle sprains for athletes of all levels. The authors review the current evidence for ankle sprain treatment and rehabilitation. Strategies for prevention of recurrent sprains and return to play considerations also are discussed.

A 14-Day Recovery and Physical Activity Levels After an Ankle Sprain in Mice.

CONTEXT: Research is needed to find ways of improving physical activity after a lateral ankle sprain. OBJECTIVE: To investigate the effects of a prolonged rest period on lifelong activity after a surgically induced ankle sprain. DESIGN: Controlled laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 18 male CBA/J mice (age at surgery = 7 weeks). MAIN OUTCOME MEASURE(S): We transected the anterior talofibular ligament and calcaneofibular ligament of the right hindlimb. Each mouse was placed in a separate cage and randomized into 1 of 3 groups of 6 mice each. A running wheel was placed in each cage at 3 days, 7 days, or 14 days after surgery. Physical activity was measured daily. Daily duration (ie, time spent on the wheel), distance, and running speed were examined using analysis of variance (group × age) with repeated measures at 15-week periods to approximate the first 3 quartiles of the lifespan. RESULTS: From weeks 3 to 15 after surgery, we observed no differences in duration, distance, or running speed among groups (P > .05). From weeks 16 to 30, distance (F2,14 = 0.57, P = .041) and running speed (F2,14 = 0.93, P = .01) were greater in the 14-day group than in the 3- and 7-day groups. From weeks 31 to 45, duration (F2,14 = 0.74, P = .02), distance (F2,14 = 0.95, P = .009), and running speed (F2,14 = 1.05, P = .007) were greater in the 14-day group than in the 3- and 7-day groups. CONCLUSIONS: Our findings suggest that the longer recovery period of 14 days can increase activity levels throughout the lifespan after a severe ankle sprain. Rest after an ankle injury is critical to restoring physical activity levels across the lifespan. Rest and time away from exercise after an ankle sprain may be necessary to restore physical activity to normal, uninjured levels.

Delayed conservative treatment of an acute lateral ankle sprain in a non-athlete female following walking boot immobilisation.

Lateral ankle sprains are a common injury with an estimated occurrence rate of 23 000 per day in the USA. Prolonged immobilisation and delayed referral to physical therapy are associated with poorer outcomes. The patient was a 49-year-old woman working as a surgical technologist. She sustained an inversion injury to her left ankle while descending from a stool. Her primary care physician examined her, issued a Controlled Ankle Movement (CAM) walking boot and immobilised her ankle for 6 weeks. Patients with grade I and II lateral ankle sprains who are treated with early mobilisation and referral to physical therapy have demonstrated earlier return to function compared with patients who are treated with prolonged immobilisation and delayed referral. Nevertheless, it remains common for individuals who have sustained a lateral ankle sprain to be immobilised. This case study highlights the importance of early mobilisation and early physical therapy referral for patients with lateral ankle sprains.

Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis.

OBJECTIVE: The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN: Systematic review and narrative synthesis. DATA SOURCES: The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS: No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION: There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.

Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis.

OBJECTIVES: To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION: Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS: Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS: Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.

Validity of an On-Field Readaptation Program Following a Hamstring Injury in Professional Soccer.

CONTEXT: Despite the presence of various injury prevention programs, the rate of hamstring injuries and reinjuries is increasing in soccer, warranting the need for a soccer-specific rehabilitation program. OBJECTIVE: To develop and validate a new, functional on-field program for the rehabilitation and readaptation of soccer players after a hamstring strain injury through a panel of experts; and determine the usefulness of the program through its application in professional soccer players. DESIGN: A 13-item program was developed, which was validated by a panel of experts and later applied to professional soccer players. SETTING: Soccer training ground. PARTICIPANTS: Fifteen strength and conditioning and rehabilitation fitness coaches with a professional experience of 15.40 (1.57) years in elite clubs and national teams in Europe validated the program. The program was later applied to 19 professional soccer players of the Spanish First Division (La Liga). INTERVENTIONS: Once a player sustained a clinically diagnosed injury, the player would first be subject to mobilization and strengthening exercises in the gym after undergoing treatment by percutaneous needle electrolysis. The player would then complete an on-field readaptation program consisting of 13 drills arranged in a progressive manner in terms of complexity. The drills integrated various aspects of repeated sprint abilities, retraining and reeducation of biomechanical patterns, and neuromuscular control of the core and lower limbs. MAIN OUTCOME MEASURES: Aiken's V for each item of the program and number of days taken by the players to return to play. RESULTS: The experts evaluated all items of the program very highly, as seen from Aiken's V values between 0.78 and 0.98 (0.63-0.99) for all drills, while the return to play was in 22.42 (2.32) days. CONCLUSION: This program has the potential to help a player suffering from a hamstring strain injury to adapt to real-match conditions in the readaptation phase through the application of sports-specific drills that were very similar to the different injury mechanisms.

Evaluation of the effect of elastic bandage on the ankle basketball players with and without chronic instability / Avaliação do efeito da bandagem elástica no tornozelo de jogadores de basquete com e sem instabilidade crônica / Evaluación del efecto del vendaje elástica en el tobillo de atletas de baloncesto con y sin inestabilidad crónica

INTRODUCTION: Basketball is a sport that requires good motor coordination as well as intense and multidirectional movements. Chronic ankle instability affects about 40% of patients who have sustained a sprain injury. In order to minimize the effects of this dysfunction, functional elastic tape has been widely used due to its mechanical properties, having some positive effects on athletes' functional performance. OBJECTIVE: To evaluate the effect of elastic tapes on the ankles of basketball players with and without chronic instability. METHOD: Thirteen athletes from a varsity basketball team of both sexes, aged between 18 and 30 years (23.2 ± 3.2 years), who had been playing the sport for at least one year and trained at least twice a week. The subjects were assessed using the anterior drawer test for the presence or absence of chronic ankle instability and in three different situations: placebo, elastic tape and control, and the order of use of the implements was randomly determined, using the Star Excursion Balance Test (SEBT) to assess the ankle stability of these athletes. RESULTS: Among the eight directions proposed in the SEBT, there was statistical significance in the difference in three directions for the placebo method in comparison to elastic taping and control. There was no statistical significance in the difference in four directions between the assessments, and there was no statistical significance in the difference in all directions between the control and elastic tapes. CONCLUSION: It can be inferred from the study that elastic taping does not have positive effects on joint stability in athletes with and without chronic instability, taking into account their functionality. Levef of Evidence I; High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals. (AU)

INTRODUÇÃO: O basquete é um esporte que requer boa coordenação motora e movimentos intensos e multidirecionais. A instabilidade crônica de tornozelo acomete cerca de 40% dos pacientes que sofreram lesão por entorse. Visando minimizar os efeitos dessa disfunção, a fita atlética elástica vem sendo bastante usada por suas propriedades mecânicas, apresentando alguns efeitos positivos sobre o desempenho funcional dos atletas. OBJETIVO: Avaliar o efeito da fita atlética elástica no tornozelo de jogadores de basquete com e sem instabilidade crônica. MÉTODO: Foram avaliados 13 atletas de times de basquete universitário, de ambos os sexos, com idade entre 18 e 30 anos (23,2 ± 3,2 anos), que praticavam a modalidade há pelo menos um ano, com frequência de treino de, no mínimo, duas vezes por semana. Os sujeitos foram avaliados pelo teste de gaveta anterior quanto à presença ou não de instabilidade crônica de tornozelo em três situações distintas: com placebo, com fita atlética elástica e controle, e a ordem de uso dos implementos foi randomicamente determinada, sendo aplicado o Star Excursion Balance Test (SEBT) para avaliar a estabilidade do tornozelo desses atletas. RESULTADOS: Entre as oito direções propostas no SEBT, houve significância estatística na diferença em três direções para o placebo, com relação à fita atlética elástica e o controle. Não houve significância estatística na diferença em quatro direções entre as avaliações e não houve significância estatística na diferença em todas as direções entre as avaliações controle e fita atlética elástica. CONCLUSÃO: A partir deste estudo, foi possível observar que a fita atlética elástica não tem efeitos positivos sobre a estabilização articular em atletas com e sem instabilidade crônica em termos da avaliação da funcionalidade. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante, mas com intervalos de confiança estreitos. (AU)

INTRODUCCIÓN: El baloncesto es un deporte que requiere una buena coordinación motora y movimientos intensos y multidireccionales. La inestabilidad crónica del tobillo afecta a aproximadamente el 40% de los pacientes que han sufrido una lesión de esguince. Con el fin de minimizar los efectos de este trastorno, la cinta atlética elástica viene siendo bastante usada por sus propiedades mecánicas, presentando algunos efectos positivos en el rendimiento funcional de los atletas. OBJETIVO: Evaluar el efecto de la cinta atlética elástica en el tobillo de jugadores de baloncesto con y sin inestabilidad crónica. MÉTODO: Fueron evaluados 13 atletas del equipo de baloncesto universitario, de ambos sexos, con edad entre 18 y 30 años (23,2 ± 3,2 años), que practicaban la modalidad desde hace por lo menos un año, con frecuencia de entrenamiento de, como mínimo, dos veces por semana. Los sujetos fueron evaluados por el test de cajón anterior cuanto a la presencia o no de inestabilidad crónica del tobillo en tres situaciones diferentes: con placebo, con cinta atlética elástica y control, y el orden de uso de los implementos aleatoriamente determinado, siendo aplicado el Star Excursion Balance Test (SEBT) para evaluar la estabilidad del tobillo de estos atletas. RESULTADOS: Entre las ocho direcciones propuestas en el SEBT, hubo significancia estadística en tres direcciones para el placebo, con relación a la cinta atlética elástica y el control. No hubo significancia estadística en la diferencia en cuatro direcciones entre las evaluaciones y no hubo significancia estadística en la diferencia en todas las direcciones entre las evaluaciones control y cinta atlética elástica. CONCLUSIÓN: A partir de este estudio, fue posible observar que la cinta atlética elástica no tiene efectos positivos sobre la estabilización articular en atletas con y sin inestabilidad crónica, en términos de evaluación de la funcionalidad. Nivel de Evidencia I; Estudio clínico aleatorio de alta calidad, con o sin diferencia estadísticamente significativa, pero con estrechos intervalos de confianza. (AU)

The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.

PURPOSE: Hamstring strain is a common sport injury that results in pain and functional limitation. Despite its high frequency in active populations, there is no agreement regarding the best method used for early intervention of hamstring strain. The aim of the present study was to compare the effects of cryotherapy and cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. MATERIALS AND METHODS: Thirty seven elite athletes with an acute grade I or II hamstring strain were randomly assigned to either cryotherapy (n = 19) or cryostretching (n = 18) group, receiving 5 sessions of supervised treatment plus home-based intervention monitored by the therapist. Pre-treatment to post-treatment changes in pain, active and passive knee extension range of motion and functional status were compared between the two groups. RESULTS: Compared to cryotherapy, cryostretching resulted in larger improvement of function and passive knee extension range of motion. Changes in active knee extension range of motion and pain severity were not significantly different between the two groups. CONCLUSION: A rehabilitation protocol involving gentle stretching following cryotherapy is more effective than cryotherapy alone in the improvement of function and passive knee range of motion in patients with grade I and II hamstring strain.