Effects of taping and exercise on ankle joint movement in subjects with chronic ankle instability: a preliminary investigation.

OBJECTIVE: To examine the effects of ankle joint taping and exercise on ankle joint sagittal plane and rear-foot frontal plane movement in subjects with chronic ankle instability. DESIGN: Laboratory-based, repeated-measures study. SETTING: University biomechanics laboratory. PARTICIPANTS: Subjects with chronic ankle instability (N=11) as defined by the Cumberland Ankle Instability Tool. INTERVENTIONS: Each participant performed 3 single-leg drop landings onto a forceplate under 3 different conditions. These conditions were: condition 1 (no tape), condition 2 (taped), and condition 3 (postexercise taped). MAIN OUTCOME MEASURES: Kinematic data were used to identify ankle joint sagittal plane and rear-foot frontal plane positions at 50 ms before initial contact (IC) and at IC, under each of the conditions. RESULTS: There was a significant effect on the angle of ankle joint plantar flexion, both at 50 ms before IC (F(2,18)=29.4, P<.001) and at IC (F(2,18)=16.1, P<.001), as a result of the application of tape. Post hoc analysis revealed that condition 1 (no tape) resulted in significantly greater plantar flexion angle at 50 ms before IC than condition 2 (taped) (7.7+/-3.0 degrees ; P=.002) and condition 3 (postexercise taped) (8.3+/-4.8 degrees ; P=.01). Similarly, condition 1 (no tape) resulted in significantly greater plantar flexion at IC than both condition 2 (taped) (5.3+/-3.2 degrees ; P<.001) and condition 3 (postexercise taped) (5.3+/-4.4 degrees ; P=.001). No significant differences were evident between condition 2 (taped) and condition 3 (postexercise taped) (P>.05). CONCLUSIONS: These results indicate that taping acted to reduce the degree of plantar flexion at both 50 ms before and at IC with the ground, and that these reductions were retained even after exercise.

Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis: A retrospective cohort study.

BACKGROUND: Acute pancreatitis is a commonly encountered emergency but accurately predicting that subset of patients who will become systemically unwell has proven difficult. Simple haematological prognostic markers, such as red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR), could identify such patients. The aim of this study was to assess the usefulness of RDW and NLR measured on admission as predictors of mortality and intensive care (ICU) or high dependency unit (HDU) admission in patients with acute pancreatitis. MATERIALS AND METHODS: All patient who presented to our institution with acute pancreatitis between August 2013 and August 2016 were retrospectively identified using the prospectively maintained Hospital In-Patient Enquiry (HIPE) discharge audit. Data on survival, admission to HDU or ICU, length of stay and haematological parameters including RDW and NLR on presentation to the emergency department were collected. RESULTS: A total of 185 patients with acute pancreatitis were included of which 23 (12%) patients had a RDW above the upper limit of normal (ULN), which was associated with a significantly increased likelihood of admission to ICU or HDU (RR3.5; p = 0.01); 117 (63%) patients had a NLR above 5 on presentation, which also increased the risk of ICU or HDU admission (RR 8.1; p = 0.01). Patients who had both a RDW above the ULN and a raised NLR had an increased risk of inpatient mortality (RR 9.9; p = 0.04). CONCLUSION: RDW and NLR can identify patients at increased risk of severe acute pancreatitis on presentation to the Emergency Department.

Neuromuscular training to enhance sensorimotor and functional deficits in subjects with chronic ankle instability: A systematic review and best evidence synthesis.

OBJECTIVE: To summarise the available evidence for the efficacy of neuromuscular training in enhancing sensorimotor and functional deficits in subjects with chronic ankle instability (CAI). DESIGN: Systematic review with best evidence synthesis. DATA SOURCES: An electronic search was conducted through December 2009, limited to studies published in the English language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all included articles was also undertaken. METHODS: Studies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or adults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme. The primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical heterogeneity, data was analysed using a best-evidence synthesis. RESULTS: Fourteen studies were included in the review. Meta-analysis with statistical pooling of data was not possible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken. There is limited to moderate evidence to support improvements in dynamic postural stability, and patient perceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of effectiveness for neuromuscular training for improving static postural stability, active and passive joint position sense (JPS), isometric strength, muscle onset latencies, shank/rearfoot coupling, and a reduction in injury recurrence rates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular intervention. CONCLUSION: There is limited to moderate evidence of effectiveness in favour of neuromuscular training for various measures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies, shank/rearfoot coupling and injury recurrence rates. Strong evidence of effectiveness was lacking for all outcome measures. All but one of the studies included in the review were deemed to have a high risk of bias, and most studies were lacking sufficient power. Therefore, in future we recommend conducting higher quality RCTs using appropriate outcomes to assess for the effectiveness of neuromuscular training in overcoming sensorimotor deficits in subjects with CAI.

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report.

BACKGROUND: Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. METHODS: The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT) scores, 2 Star Excursion Balance Test (SEBT) reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs) during walking. RESULTS: CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. CONCLUSIONS: The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.