National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes.

OBJECTIVE: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. BACKGROUND: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. RECOMMENDATIONS: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

Effect of high-voltage pulsed current on recovery after grades I and II lateral ankle sprains.

CONTEXT: High-voltage pulsed current (HVPC), a form of electrical stimulation, is known to curb edema formation in laboratory animals and is commonly applied for ankle sprains, but the clinical effects remain undocumented. OBJECTIVE: To determine whether, as an adjunct to routine acute and subacute care, subsensory HVPC applied nearly continuously for the first 72 h after lateral ankle sprains affected time lost to injury. DESIGN: Multicenter, randomized, double-blind, placebo-controlled trial. SETTING: Data were collected at 9 colleges and universities and 1 professional training site. PARTICIPANTS: 50 intercollegiate and professional athletes. INTERVENTIONS: Near-continuous live or placebo HVPC for 72 h postinjury in addition to routine acute and subacute care. MAIN OUTCOME MEASURE: Time lost to injury measured from time of injury until declared fit to play. RESULTS: Overall, time lost to injury was not different between treated and control groups (P = .55). However, grade of injury was a significant factor. Time lost to injury after grade I lateral ankle sprains was greater for athletes receiving live HVPC than for those receiving placebo HVPC (P = .049), but no differences were found between groups for grade II sprains (P = .079). CONCLUSIONS: Application of subsensory HVPC had no clinically meaningful effect on return to play after lateral ankle sprain.

Effects of Ibuprofen and High-Voltage Electric Stimulation on Acute Edema Formation After Blunt Trauma to Limbs of Rats.

Context: Ibuprofen is widely used to manage pain and inflammation after orthopaedic trauma, but its effect on acute swelling has not been investigated. Cathodal high-voltage pulsed current (CHVPC) at 120 pulses per second and 90% of visible motor threshold is known to curb edema formation after blunt trauma to the hind limbs of rats.Objective: To examine the effects of ibuprofen, continuous CHVPC, and simultaneous ibuprofen and CHVPC on acute edema formation after blunt trauma to the hind limbs of rats.Design: Randomized, parallel-group, repeated-measures design.Setting: Laboratory animal facility.Participants: A total of 21 3-month-old Zucker Lean rats (mass = 288 +/- 55 g) were studied.Intervention(s): We assessed the effects of ibuprofen, continuous CHVPC, and simultaneous ibuprofen and CHVPC on acute edema formation after blunt trauma to the hind limbs of rats.Main Outcome Measure(s): Limb volumes were measured immediately before and after trauma and every 30 minutes over the 4 hours of the experiment.Results: Volumes of treated limbs of all 3 experimental groups were smaller (P < .05) than those of untreated limbs, but no treatment was more effective than another.Conclusions: Ibuprofen, CHVPC, and simultaneous ibuprofen and CHVPC effectively curbed edema after blunt injury by roughly 50% relative to untreated but similarly injured control limbs of rats.

Cool-Water Immersion and High-Voltage Electric Stimulation Curb Edema Formation in Rats.

OBJECTIVE: Although cryotherapy and high-voltage electric stimulation, both alone and in combination, are commonly applied to curb acute edema, little evidence from randomized controlled studies supports these procedures. Our purpose was to examine the effects of cool-water immersion (CWI) at 12.8 degrees C (55 degrees F), cathodal high-voltage pulsed current (CHVPC) at 120 pulses per second and 90% of visible motor threshold, and the combination of CWI and CHVPC (CWI + CHVPC) on edema formation after impact injury to the hind limbs of rats. DESIGN AND SETTING: Both feet of 34 rats were traumatized after hind-limb volumes were determined. Animals were randomly assigned to 1 of 3 groups: CWI (n = 10), CHVPC (n = 10), or CWI + CHVPC (n = 14). One randomly selected hind limb of each rat was exposed to four 30-minute treatments, interspersed with four 30-minute rest periods beginning immediately after posttraumatic limb volumes were determined. Contralateral limbs served as controls. Limbs remained dependent during all treatments, rest periods, and volumetric measurements. SUBJECTS: We used 34 anesthetized Zucker Lean rats in this study. MEASUREMENTS: We measured limb volumes immediately before and after trauma and after each of 4 treatment and rest periods. RESULTS: Volumes of treated limbs of all 3 experimental groups were smaller (P <.05) than those of untreated limbs. No treatment was more effective than another. CONCLUSIONS: Cool-water immersion, cathodal high-voltage electric stimulation, and simultaneous application of these treatments were effective in curbing edema after blunt injury. Combining CWI and CHVPC was not more effective than either CWI or CHVPC alone.

Effects of Cool-Water Immersion and High-Voltage Electric Stimulation for 3 Continuous Hours on Acute Edema in Rats.

OBJECTIVE: Cool-water immersion (CWI) at 12.8 degrees C (55 degrees F), cathodal high-voltage pulsed current (CHVPC) at 120 pulses per second and 90% of visible motor threshold, or the combination of CWI and CHVPC, applied 30 minutes on, 30 minutes off for 4 hours, are known to curb edema formation after blunt trauma to the hind limbs of rats. Our purpose was to examine the effects of extending treatment times to 3 continuous hours after blunt trauma to the hind limbs of rats. DESIGN AND SETTING: A randomized, parallel-groups design of 22 subjects was used. Volumes of traumatized limbs, randomly assigned to CWI (n = 7), CHVPC (n = 8), or CWI followed by CHVPC (n = 7) were compared with those of injured but untreated limbs with analysis of variance. SUBJECTS: Twenty-two anesthetized Zucker lean rats (mass = 293 +/- 27 g). MEASUREMENTS: We measured limb volumes immediately before and after trauma and every 30 minutes over the 4-hour experiment. RESULTS: Volumes of treated limbs of all 3 experimental groups were smaller than those of untreated limbs (P <.05). No treatment was more effective than another. CONCLUSIONS: Exposure to either 3 hours of CWI or CHVPC or to 1 hour of CWI followed by 2 hours of CHVPC effectively curbed edema after blunt injury. These results suggest that these common treatments are effective only during application and hint that application should be maintained throughout the period during which edema is forming.