Prevention of soccer injuries Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? High-intensity training with a bi-directional bicycle pedal improves performance in mechanically unstable ankles--a prospective randomized study of 19 subjects. Prevention of injuries in young female players in European team handball. A prospective intervention study. Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability Effect of coordination training on proprioception of the functionally unstable ankle. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. Effect of Ankle Disk Training Combined with Tactile Stimulation to the Leg and Foot on Functional Instability of the Ankle The effect of talocrural joint manipulation on range of motion at the ankle. The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Early functional treatment for acute ligament injuries of the ankle joint. A multi-station proprioceptive exercise program in patients with ankle instability. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Treatment for partial tears of the lateral ligament of the ankle: a prospective trial.
To study the efficacy of an injury prevention program in a r and omized trial , 12 teams ( 180 players ) in a male senior soccer division were followed up for 6 months . The 12 teams were allocated at r and om to two groups of six teams , one being given a prophylactic program and the other serving as control . The program was based on previous studies of injury mechanisms . It comprised ( 1 ) correction of training , ( 2 ) provision of optimum equipment ; ( 3 ) prophylactic ankle taping ; ( 4 ) controlled rehabilitation ; ( 5 ) exclusion of players with grave knee instability ; ( 6 ) information about the impor tance of disciplined play and the increased risk of injury at training camps ; and ( 7 ) correction and supervision by doctor(s ) and physiotherapist(s ) . The injuries in the test teams were 75 % fewer than in the controls . The most common types of soccer injuries , sprains and strains to ankles and knees , were all significantly reduced . It is concluded that the pro posed prophylactic program , including close supervi sion and correction by doctors and physiotherapists , significantly reduces soccer injuries Abstract . This prospect i ve r and omized intervention investigated whether training on a balance board could reduce the amount of traumatic injuries of the lower extremities in female soccer players . A total of 221 female soccer players from 13 different teams playing in the second and third Swedish divisions volunteered to participate in the study . Seven teams ( n=121 ) were r and omized to an intervention group and six teams ( n=100 ) to a control group and were followed during one outdoor season ( April – October ) . Before and after the season muscle flexibility and balance/postural sway of the lower extremities were measured in the players . There were no significant differences in age , height , weight , muscle flexibility and balance/postural sway of the lower extremities between the intervention and the control group . During the season the players in the intervention group performed a special training program consisting of 10–15 min of balance board training in addition to their st and ard soccer practice and games . After a 37 % drop-out the intervention group consisted of 62 players and the control group of 78 players . The results showed no significant differences between the groups with respect either to the number , incidence , or type of traumatic injuries of the lower extremities . The incidence rate of " major " injuries was higher in the intervention group than in the control group . Four of five anterior cruciate ligament injuries occurred in the intervention group , which means that we could not prevent severe knee injuries in female soccer players with balance board training . However , among the players who had been injured during the 3-month period prior to this investigation there were significantly more players from the control group than from the intervention group who sustained new injuries during the study period A bi-directional bicycle pedal that combines proprioceptive training and evertor strengthening has been developed for the treatment of residual instability after ankle sprains . A prospect i ve r and omized study was carried out on 19 subjects with recurrent ankle sprains and positive stress X-ray films . The subjects were r and omized to use either a bi-directional test pedal or a traditional uni-directional bicycle pedal and then completed a 6-week high-intensity training program on a cycle ergometer . Assessment of training intensity level was based on maximum oxygen uptake values , heart rate and lactate concentration in blood at various submaximal workloads . After completion of the training program , the subjects who had used the test pedal increased peak eversion torque at 180 degrees degrees s-1 by 14.2 % ( P = 0.020 ) , reduced figure-of-eight running time by 0.24 s ( P = 0.003 ) , improved single leg stance speed from 72.5 % to the maximum speed of 80 % ( P = 0.005 ) , and improved Karlsson functional score by 5.1 points ( P = 0.005 ) . In the control group , single leg stance improved from 56.1 to 67.8 % ( P = 0.018 ) , but otherwise no significant effects were found . This study indicates that short-term high-intensity training with a bi-directional pedal improves ankle performance and may be an option in the treatment of recurrent ankle sprains Young female players in European h and ball have a very high injury incidence , up to 50 injuries per 1000 hours of game . More than half of these injuries happen without any external cause . The aim of the study was to investigate the effect of an intervention programme design ed to reduce the number of injuries in young female players in European h and ball , with special emphasis on injuries in the lower extremities . The programme was created using elite athlete training programmes and those design ed for rehabilitation of injured athletes with functional instability of their ankles and rupture of the anterior cruciate ligament . It included the use of an ankle disk for 10 - 15 min at all practice sessions , for one 10-month season ( August 1995-May 1996 ) . Twenty-two teams participated in the study , and were r and omly assigned to the intervention or control group . Eleven teams with 111 players were r and omised to the intervention group and 11 teams with 126 players to the control group . Data were analysed using a t-test for continuous variables , chi2- analysis and Fisher 's exact test for dichotomous variables and multivariate methods to determine odds-ratios . The results indicated that using the intervention programme decreased the numbers of both traumatic and overuse injuries significantly . The differences in injuries between the groups were 80 % during games and 71 % during practice . In addition , the players in the control group had a 5.9 times higher risk of acquiring an injury than the players in the intervention group Objectives : To examine the effect of six weeks of strength and proprioception training on eversion to inversion isokinetic strength ratios ( E/I ratios ) in subjects with unilateral functional ankle instability . Methods : Thirty eight subjects were r and omly assigned to one of four treatment groups : strength training ( S ) ; proprioception training ( P ) ; strength + proprioception training ( B ) ; control ( C ) . Isokinetic strength was tested before and after training using a Kin Com 125 automatic positioning isokinetic dynamometer . Subtalar joint eversion and inversion motions  were tested both concentrically and eccentrically through a range of motion involving 40 ° . All peak torque and average torque values were normalised for body mass . E/I ratios were calculated from average torque and peak torque measures by taking the concentric eversion value and combining it with the eccentric inversion value . Data were analysed using a mixed model analysis of variance with repeated measures on the test factor . Average torque and peak torque E/I ratios at 30 and 120 ° /s were analysed separately . Results : There were no significant differences in average torque and peak torque E/I ratios of the functionally unstable ankle for any of the groups after training compared with before . Conclusions : Six weeks of strength and proprioception training ( either alone or combined ) had no effect on isokinetic measures of strength in subjects with self reported unilateral functional instability . Further studies examining this agonist ( concentric ) to antagonist ( eccentric ) muscle group strength ratio are needed Exercises to improve joint proprioception and coordination of the functionally unstable ankle are advocated throughout the literature , yet there is little evidence that these exercise have any effect on proprioception and balance . The purpose of this study was to determine the effects of a 6-week coordination and balance training program on proprioception of subjects with functional ankle instability . Forty-five subjects ( age = 22.53 + /- 3.95 years , height = 172.04 + /- 10.0 cm , weight = 71.72 + /- 15.7 kg ) were r and omly placed into a control ( Group 1 ) , sham ( Group 2 ) , or experimental ( Group 3 ) group . The experimental group trained 3 days per week , 10 minutes each day , performing various balance and proprioception exercises .  Postural sway and active and passive joint position sense were assessed . Analysis of variance for postural sway modified equilibrium score for anterior and posterior sway , as well as medial and lateral sway revealed significant four-way interactions . Tukey post hoc analyses revealed that Group 3 performed significantly better ( p < .05 ) than Group 1 and Group 2 on the posttests . There were no significant differences for joint position sense or postural sway index . Results suggest that balance and coordination training can improve some measures of postural sway . It is still unclear if joint position sense can be improved in the functionally unstable ankle STUDY OBJECTIVE The purpose of this study was to evaluate the efficacy of osteopathic manipulative treatment ( OMT ) as administered in the emergency department ( ED ) for the treatment of patients with acute ankle injuries . METHODS Patients aged 18 years and older with unilateral ankle sprains were r and omly assigned either to an OMT study group or a control group . Independent outcome variables included edema , range of motion ( ROM ) , and pain . Both groups received the current st and ard of care for ankle sprains and were instructed to return for a follow-up examination . Patients in the OMT study group also received one session of OMT from an osteopathic physician . RESULTS Patients in the OMT study group had a statistically significant ( F = 5.92 , P = .02 ) improvement in edema and pain and a trend toward increased ROM immediately following intervention with OMT . Although at follow-up both study groups demonstrated significant improvement , patients in the OMT study group had a statistically significant improvement in ROM when compared with patients in the control group . CONCLUSIONS Data clearly demonstrate that a single session of OMT in the ED can have a significant effect in the management of acute ankle injuries Twenty-two university students with unilateral functional instability of the ankle participated in this study . They were r and omly assigned to one of two experimental groups . Subjects in both groups were trained to st and on the affected limb on an ankle disk . In group 1 , two pieces of 1-cm wide nonelastic adhesive tape were applied to the skin around the lateral malleolus from the distal third of the lower leg to the sole of the foot before the training sessions . Subjects in group 2 participated in the training sessions without the application of the adhesive tape . Training was performed for 10 minutes a day , five times per week , for a period of 10 weeks . Subjects were tested for postural sway while st and ing on the affected limb before , during , and after the training period . In group 1 , postural sway values decreased significantly after 4 weeks compared with the pretraining performance , and they were within the normal range after not more than 6 weeks of training . In group 2 , the values did not improve significantly compared with the pretraining performance until after 6 weeks of training , and they were not within the normal range until after 8 weeks of training . The findings suggest that the 2-week earlier correction of postural sway in group 1 was due to an increased afferent input from skin receptors that were stimulated by the traction of the adhesive tape OBJECTIVE To determine whether a single high-velocity , low-amplitude thrust manipulation to the talocrural joint altered ankle range of motion . DESIGN A r and omized , controlled and blinded study . SUBJECTS Asymptomatic male and female volunteers ( N = 41 ) . METHODS Subjects were r and omly assigned into either an experimental group ( n = 20 ) or a control group ( n = 21 ) . Both ankles of subjects in the experimental group were manipulated by using a single high-velocity , low-amplitude thrust to the talocrural joint . Pretest and posttest measurements of passive dorsiflexion range of motion were taken . RESULTS No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects . A significantly greater pretest dorsiflexion range of motion existed in those ankles in which manipulation produced an audible cavitation . CONCLUSION Manipulation of the ankle does not increase dorsiflexion range of motion in asymptomatic subjects . Ankles that displayed a greater pretest range of dorsiflexion were more likely to cavitate , raising the possibility that ligament laxity may be associated with the tendency for ankles to cavitate OBJECTIVE The purpose of this study was to determine the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains . DESIGN A single-blind , comparative , controlled pilot study . SETTING Technikon Natal Chiropractic Day Clinic . PARTICIPANTS Thirty patients with subacute and chronic grade I and grade II ankle inversion sprains . Patients were recruited from the public ; they responded to advertisements placed in newspapers and on notice boards around the campus and local sports clubs . INTERVENTION Each of the 15 patients in the treatment group received the ankle mortise separation adjustment . Each of the 15 patients in the placebo group received 5 minutes of detuned ultrasound treatment . Each participant received a maximum of 8 treatment sessions spread over a period of 4 weeks . MAIN OUTCOME MEASURE Patients were evaluated at the first treatment , at the final treatment , and at a 1-month follow-up consultation . Subjective scores were obtained by means of the short-form McGill Pain Question naire and the Numerical Pain Rating Scale 101 . Objective measurements were obtained from goniometer readings measuring ankle dorsiflexion range of motion and algometer readings measuring pain threshold over the ankle lateral ligaments . A functional evaluation of ankle function was also used . RESULTS Although both groups showed improvement , statistically significant differences in favor of the adjustment group were noted with respect to reduction in pain , increased ankle range of motion , and ankle function . CONCLUSIONS This study appears to indicate that the mortise separation adjustment may be superior to detuned ultrasound therapy in the management of subacute and chronic grade I and grade II inversion ankle sprains Ankle sprains are often complicated by functional instability and repeated sprains . Rehabilitation with wobble boards in patients with functional instability has been tested , and significant improvement has been found compared to no training . The aim of this study was to investigate whether the number of patients with residual symptoms following ankle sprains could be reduced by training on a wobble board during 12-week recovery period . In addition , the influence of training in the time course reduction of edema was investigated . We performed a prospect i ve study including 61 patients , all active in sports for more than 2 hours a week with primary ankle sprains . The effect of a 12-week training program with wobble board was compared with no training .  Forty-eight patients completed the study . In the follow-up period ( mean X = 230 days ) , we found significantly fewer recurrent sprains , and significantly fewer patients in the training group had functional instability of the ankle compared with the no training group . There were no differences in the two groups in the time which elapsed before patients were painless at walking , during running , or at sports . Volumetric measurements revealed no difference in the speed of reduction of hematoma and edema of the ankle and foot between the two groups . We conclude that training on a wobble board early after primary stage 2 ankle sprains is effective in reducing residual symptoms following this lesion and that training does not seem to affect the time course reduction in edema Physiotherapists frequently use manipulative therapy techniques to treat dysfunction and pain result ing from ankle sprain . This study investigated whether a Mulligan 's mobilization with movement ( MWM ) technique improves talocrural dorsiflexion , a major impairment following ankle sprain , and relieves pain in subacute population s. Fourteen subjects with subacute grade II lateral ankle sprains served as their own control in a repeated measures , double-blind r and omized controlled trial that measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold . The subacute ankle sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle . Significant improvements in dorsiflexion occurred initially post-MWM ( F(2,26 ) = 7.82 , P = 0.002 ) , but no significant changes in pressure or thermal pain threshold were observed after the treatment condition . Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains . The mechanism by which this occurs requires investigation if we are to better underst and the role of manipulative therapy in ankle sprain management Eighty-six patients with acute ( < 24 h ) grade II or III lateral ligament ruptures were r and omized into two different non-surgical treatment groups . The main difference in treatment protocol s between the two groups was during the first week after injury . Group I ( n = 46 ) was to receive functional treatment using specially design ed compression pads , elevation of the injured foot ( 24 h ) , repeated elastic wrapping ( compression b and age followed by ankle tape ) , early full weight-bearing and proprioceptive range-of-motion training . Group II ( n = 40 ) was to receive conventional treatment with an elastic b and age , partial weight bearing and crutches until the pain subsided . One week after the injury , patients from both groups were given identical rehabilitation instructions . No early surgery was performed . The mean follow-up period was 18 months . The functional results were satisfactory in 91 % of the patients in group I and in 87 % of the patients in group II ( NS ) . Five patients had been operated on due to recurrent instability , two in group I and three in group II ( NS ) . The mean sick leave was significantly shorter in group I ; 5.6 + /- 4.2 days compared with 10.2 + /- 6.8 days in group II . Return to sports activities was also significantly earlier in group I , 9.6 + /- 4.8 days compared with 19.2 + /- 9.5 days in group II . In this study , non-surgical treatment of acute grade II and III ligament injuries of the ankle produced satisfactory results in the majority of patients . Early functional treatment result ed in shorter sick leave and facilitated an earlier return to sports , but it did not influence the final results PURPOSE The aim of the present study was to investigate the effects of a 6-wk multi-station proprioceptive exercise program that is easy to integrate in normal training programs . METHODS Patients with chronic ankle instability were used , and results of three testing procedures before and afterward were compared : joint position sense , postural sway , and muscle reaction times to sudden inversion events on a tilting platform . A total of 30 subjects with 48 unstable feet were evaluated ( exercise group : N = 31 ; control group : N = 17 ) . RESULTS In the exercise group , the results showed a significant improvement in joint position sense and postural sway as well as significant changes in muscle reaction times . CONCLUSION Based on the present results , a multi-station proprioceptive exercise program can be recommended for prevention and rehabilitation of recurrent ankle inversion injuries The effect of an early rehabilitation program , including postural training , on  ankle joint function after an ankle ligament sprain was investigated prospect ively . Ninety-two subjects , matched for age , sex , and level of sports activity , were r and omized to a control or training group . All subject received the same st and ard information regarding early ankle mobilization . In addition , the training group participated in supervised physical therapy rehabilitation ( 1 h , twice weekly ) with emphasis on balance training .  Postural sway , position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury , and at 12 months re-injury data were obtained . In the training group , there was a significant difference between the injured and uninjured side for plantar flexion ( P < 0.01 ) , eversion ( P < 0.01 ) and inversion ( P < 0.05 ) , but not for dorsiflexion at 6 weeks . In the control group , there was a significant difference between the injured and uninjured side for plantar flexion ( P < 0.01 ) , eversion ( P < 0.01 ) , inversion ( P < 0.01 ) , and dorsiflexion ( P < 0.05 ) at 6 weeks . Postural sway , but not position sense , differed between the injured and uninjured side in both groups ( P < 0.01 ) at 6 weeks . The side-to-side percent differences were similar in both groups for all variables ( P > 0.05 ) at 6 weeks , and there were no side-to-side differences at 4 months in either group . In the control group , 11/38 ( 29 % ) suffered a re-injury , while this number was only 2/29 ( 7 % ) in the training group ( P < 0.05 ) . These data showed that an ankle injury result ed in reduced ankle strength and postural control at 6 weeks , but that these variables had normalized at 4 months , independent of the supervised rehabilitation . However , the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries , and therefore may play a role in injury prevention This study investigated effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on relative risk of selected injuries in 1093 male Army recruits undertaking 12 weeks of intensive training . Prior to training , ankle dorsiflexion range was measured and recruits were allocated to stretch and control groups using a quasi-r and om procedure . The stretch group stretched calf muscles under supervision prior to all intense exercise . The control group stretched upper limb muscles instead . Forty-eight injuries were recorded . Survival analysis indicated that ankle dorsiflexion range was a strong predictor of injury ( p = 0.03 ) . Definitive evidence of an effect of stretching on injury risk was not found ( p = 0.76 ) , but the sample size may have been insufficient to detect such an effect There is debate about the most appropriate form of treatment for partial tears of the lateral ligament of the ankle , which are common after inversion injuries . A prospect i ve trial of four forms of treatment was carried out . The forms of treatment used were : no treatment with only a minimal b and age , Tubigrip support , immobilisation in plaster-of-Paris , and physiotherapy . The end point was taken when the patient returned to work or had a low score on an objective clinical scale . Early mobilisation , with or without physiotherapy , was found to offer the most rapid return to functional activity .  Patients who had had their ankle immobilised in plaster-of-Paris required more days off work and longer attendance at a follow-up clinic . Inversion injuries are common and cause absence from work and discomfort for the patient . These findings suggest that mobilisation with physiotherapy , although not practical for all patients , is the most satisfactory course of treatment
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