scholarly journals The Effectiveness of Deep Oscillation Therapy on Reducing Swelling and Pain in Athletes With Acute Lateral Ankle Sprains

2019 ◽  
Vol 28 (8) ◽  
pp. 902-905
Author(s):  
Matt Hausmann ◽  
Jacob Ober ◽  
Adam S. Lepley
Keyword(s):  
Day Treatment ◽  
Athletic Trainers ◽  
Clinical Effectiveness ◽  
Standard Of Care ◽  
Return To Play ◽  
Ankle Sprains ◽  
Current Standard ◽  
Bottom Line ◽  
Lateral Ankle ◽  
Additional Loss

Clinical Scenario: Ankle sprains are the most prevalent athletic-related musculoskeletal injury treated by athletic trainers, often affecting activities of daily living and delaying return to play. Most of these cases present with pain and swelling in the ankle, resulting in decreased range of motion and strength deficits. Due to these impairments, proper treatment is necessary to avoid additional loss of play and prevent future injuries. Recently, there has been an increased use of deep oscillation therapy by clinicians to manage pain and swelling following a variety of injuries, including ankle sprains. However, very little evidence has been produced regarding the clinical effectiveness of deep oscillation therapy, limiting its application in therapeutic rehabilitation of acute lateral ankle sprains. Clinical Question: Is deep oscillation therapy effective in reducing pain and swelling in patients with acute lateral ankle sprains compared with the current standard of care protection, rest, ice, compression, and elevation? Summary of Key Findings: The literature was searched for studies of level 2 evidence or higher that investigated deep oscillation therapy on pain and inflammation in patients with lateral ankle sprains. Three randomized control trials were located and appraised. One of the 3 studies demonstrate a reduction in pain following 6 weeks of deep oscillation therapy compared with the standard of care or placebo interventions. The 2 other studies, 1 utilizing a 5-day treatment and the other a 1 time immediate application, found no differences in deep oscillation therapy compared with the standard of care. Clinical Bottom Line: There is inconclusive evidence to support the therapeutic use of deep oscillation therapy in reducing pain and swelling in patients with acute lateral ankle sprains above and beyond the current standard of care. In addition, the method of treatment application and parameters used may influence the effectiveness of deep oscillation therapy. Strength of Recommendation: Level B.

scholarly journals Prevention of Lateral Ankle Sprains

2019 ◽  
Vol 54 (6) ◽  
pp. 650-661 ◽  
Author(s):  
Thomas W. Kaminski ◽  
Alan R. Needle ◽  
Eamonn Delahunt
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Athletic Trainers ◽  
Current Evidence ◽  
Controlled Trials ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
Athletic Population ◽  
Randomized Controlled ◽  
Critical Interpretation

Context Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals. Objective To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs. Conclusions External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.

Rural Secondary School Athletic Trainers’ Recognition and Management of Acute Lateral Ankle Sprains: A Retrospective Chart Review

2018 ◽  
Vol 23 (5) ◽  
pp. 200-204
Author(s):  
Robert Vallandingham ◽  
Zachary Winkelmann ◽  
Lindsey Eberman ◽  
Kenneth Games
Keyword(s):  
Test Performance ◽  
Chart Review ◽  
Point Of Care ◽  
Athletic Trainers ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Ankle Sprains ◽  
Long Term Outcomes ◽  
Lateral Ankle

The management of an acute lateral ankle sprain (LAS) affects long-term outcomes, which highlights the need for assessment of practice at the point of care. The purpose of this retrospective chart review was to examine the management strategies for acute LAS as documented in a secondary school’s electronic medical records (EMR) over 2 years. Patient charts noting a LAS diagnosis (n = 107) were identified from the EMR. Most charts indicated palpation and anterior drawer test performance. Cryotherapy (82%) and compression (55%) varied in use. Therapeutic rehabilitation and return-to-activity testing were underreported. Overall, clinical management of acute LAS may not align with best available evidence.

scholarly journals The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes

2021 ◽  
Vol 6 (2) ◽  
pp. 008-017
Author(s):  
Cavazos Jr. G Javier ◽  
Harkless Lawrence B
Keyword(s):  
Best Practice ◽  
Healthcare Providers ◽  
Treatment Strategies ◽  
The United States ◽  
Ankle Injuries ◽  
Return To Play ◽  
Medical Attention ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
True Incidence

Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play. The Lateral Ankle Sprain (LAS) is among the most common type of ankle sprains suffered during athletic activities. Up to 80% of LAS are of the inversion type, and 75% lead to recurrence and instability. Although most individuals experiencing a LAS return to activity within six weeks, many report continued pain, diminished function, and instability. The purpose of this review is to highlight the epidemiology, pathoetiology, pathoanatomy, and biomechanics of the LAS, enabling sports physicians to implement the best practice guidelines and protocols to manage this common enigma.

scholarly journals The Role of Shoe Design in Ankle Sprain Rates Among Collegiate Basketball Players

2008 ◽  
Vol 43 (3) ◽  
pp. 230-233 ◽  
Author(s):  
Claudia K. Curtis ◽  
Kevin G. Laudner ◽  
Todd A. McLoda ◽  
Steven T. McCaw
Keyword(s):  
Ankle Sprain ◽  
Online Survey ◽  
Athletic Trainers ◽  
Ankle Sprains ◽  
Basketball Players ◽  
Lateral Ankle ◽  
Shoe Design ◽  
Collegiate Basketball ◽  
Chi Square Analysis ◽  
Column Group

Abstract Context: Much of the recent focus in shoe design and engineering has been on improving athletic performance. Currently, this improvement has been in the form of “cushioned column systems,” which are spring-like in design and located under the heel of the shoe in place of a conventional heel counter. Concerns have been raised about whether this design alteration has increased the incidence of ankle sprains. Objective: To examine the incidence of lateral ankle sprains in collegiate basketball players with regard to shoe design. Design: Prospective cohort study. Setting: Certified athletic trainers at 1014 National Collegiate Athletic Association (NCAA)-affiliated schools sponsoring basketball during the 2005–2006 regular season were notified of an online questionnaire. Athletic trainers at 22 of the 1014 schools participated. Patients or Other Participants: A total of 230 basketball players (141 males, 89 females; age  =  20.2 ± 1.5 years) from NCAA Division I–III basketball programs sustained lateral ankle sprains. Main Outcome Measure(s): Ankle sprain information and type of shoe worn (cushioned column or noncushioned column) were collected via online survey. The incidence of lateral ankle sprains and type of shoes worn were compared using a chi-square analysis. Results: No difference was noted in ankle sprain incidence between groups (χ2  =  2.44, P  =  .20, relative risk  =  1.47, 95% confidence interval [CI]  =  0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI  =  0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI  =  0.51, 4.22). Conclusions: No increased incidence of ankle sprains was associated with shoe design.

scholarly journals National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

2013 ◽  
Vol 48 (4) ◽  
pp. 528-545 ◽  
Author(s):  
Thomas W. Kaminski ◽  
Jay Hertel ◽  
Ned Amendola ◽  
Carrie L. Docherty ◽  
Michael G. Dolan ◽  
...  
Keyword(s):  
Health Care ◽  
Conservative Management ◽  
Health Care Professionals ◽  
Preventive Measures ◽  
Athletic Trainers ◽  
Position Statement ◽  
Return To Play ◽  
Initial Assessment ◽  
Ankle Sprains ◽  
National Athletic Trainers Association

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

2010 ◽  
Vol 19 (4) ◽  
pp. 399-410 ◽  
Author(s):  
Frank C. Mendel ◽  
Michael G. Dolan ◽  
Dale R. Fish ◽  
John Marzo ◽  
Gregory E. Wilding
Keyword(s):  
High Voltage ◽  
Outcome Measure ◽  
Return To Play ◽  
Laboratory Animals ◽  
Pulsed Current ◽  
Clinical Effects ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
Main Outcome Measure ◽  
Subacute Care

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.

Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

2020 ◽  
Vol 26 (28) ◽  
pp. 3468-3496
Author(s):  
Emilio Rodrigo ◽  
Marcio F. Chedid ◽  
David San Segundo ◽  
Juan C.R. San Millán ◽  
Marcos López-Hoyos
Keyword(s):  
Kidney Transplantation ◽  
Acute Rejection ◽  
Rescue Therapy ◽  
Standard Of Care ◽  
Rejection Rate ◽  
New Drugs ◽  
High Dose ◽  
Current Standard ◽  
Antibody Mediated Rejection ◽  
Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

scholarly journals Inhibition of Glycine Re-Uptake: A Potential Approach for Treating Pain by Augmenting Glycine-Mediated Spinal Neurotransmission and Blunting Central Nociceptive Signaling

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 864
Author(s):  
Christopher L. Cioffi
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Therapeutic Potential ◽  
Opioid Analgesic ◽  
Critical Role ◽  
Analgesic Efficacy ◽  
Standard Of Care ◽  
Current Standard ◽  
Glycine Transporters ◽  
Pathological Pain

Among the myriad of cellular and molecular processes identified as contributing to pathological pain, disinhibition of spinal cord nociceptive signaling to higher cortical centers plays a critical role. Importantly, evidence suggests that impaired glycinergic neurotransmission develops in the dorsal horn of the spinal cord in inflammatory and neuropathic pain models and is a key maladaptive mechanism causing mechanical hyperalgesia and allodynia. Thus, it has been hypothesized that pharmacological agents capable of augmenting glycinergic tone within the dorsal horn may be able to blunt or block aberrant nociceptor signaling to the brain and serve as a novel class of analgesics for various pathological pain states. Indeed, drugs that enhance dysfunctional glycinergic transmission, and in particular inhibitors of the glycine transporters (GlyT1 and GlyT2), are generating widespread interest as a potential class of novel analgesics. The GlyTs are Na+/Cl−-dependent transporters of the solute carrier 6 (SLC6) family and it has been proposed that the inhibition of them presents a possible mechanism by which to increase spinal extracellular glycine concentrations and enhance GlyR-mediated inhibitory neurotransmission in the dorsal horn. Various inhibitors of both GlyT1 and GlyT2 have demonstrated broad analgesic efficacy in several preclinical models of acute and chronic pain, providing promise for the approach to deliver a first-in-class non-opioid analgesic with a mechanism of action differentiated from current standard of care. This review will highlight the therapeutic potential of GlyT inhibitors as a novel class of analgesics, present recent advances reported for the field, and discuss the key challenges associated with the development of a GlyT inhibitor into a safe and effective agent to treat pain.

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