We are reporting here the case of a 29 year old male Caucasian professional football athlete who suffered a sport-related ankle sprain in April 2019. The injury occurred during a regular exercise session on artificial turf as an inversion sprain accompanied by plantar flexion. The patient was immediately evaluated by a sports medicine specialist who confirmed the category and the degree of injury (grade II ankle sprain) by physical examination. The patient was an apparently healthy young men (age 29 years, weight 77.0 kg, height 184.0 cm, professional experience 11 years), with no history of ankle sprain (or other lower extremity injuries) in the past 6 months, and no cardiometabolic or other musculoskeletal disorders. Written informed consent was obtained from the patient in accordance with the Declaration of Helsinki, and study protocol approved by the local IRB at the FSPE Applied Bioenergetics Lab at the University of Novi Sad (A14-2019).
At the initial examination immediately after the injury, right ankle was painful, swollen and warm, and had increased laxity on testing ( Figure 1, Panel a). Self-completed visual analog scale (VAS) score for pain was 50 points (moderate pain). Figure-of-eight method of measuring ankle joint swelling at the injured ankle revealed 56.5 cm, with weight-bearing lunge test (WBLT) showing 43.1 mm. The patient demonstrated a diminished ability to bear weight.
Hydrotherapy with super-saturated hydrogen-rich water was used as an exclusive treatment (besides rest) with the main aim to reduce symptoms and signs of acute ankle sprain, and it was hoped to speed up the acute recovery. Super-saturated hydrogen-rich water was produced by putting a magnesium-producing formulation (10 g) into a 3-L stationary whirlpool with tap water of neutral temperature (20 C). Hydrogen was produced by a following reaction: Mg + H 2O   H 2 + Mg(OH) 2, with concentration of hydrogen in a whirlpool ~ 8 ppm. The intervention was provided by HRW Natural Health Products Inc. (catalogue number 6-27843; New Westminster, BC, Canada). Throughout the 24 hours after the ankle sprain, the participant received six 30-min ankle baths (e.g. one hydrotherapy every 4 hours), with the first session given immediately after an initial examination (~ 60 min after the injury). During each session, the foot and ankle of injured leg were immersed in a stationary whirlpool. All hydrotherapies were formulated and supervised by a health care professional.
At the 24-h follow-up examination ( Figure 1, Panel b), VAS score for pain dropped to 20 points (mild pain), with ankle circumference decreased to 54.9 cm; WBLT improved to 55.0 mm. The patient reported no side effects of hydrogen intervention (e.g. pain, cramps, tingling, discoloration of skin, burning, itching, rash), as evaluated with open-ended questionnaire administered at the end of each session of hydrotherapy, and at 24-h follow-up.