1/9. Strategy of exercise prescription using an unloading technique for functional rehabilitation of an athlete with an inversion ankle sprain.STUDY DESIGN: Case study. OBJECTIVES: To demonstrate how an exercise program can be designed with specific sets, repetitions, and rest periods, and to enhance the healing process in early stages of rehabilitation when injured tissues cannot tolerate full body weight. Our goal was to enhance ankle tissue healing by reducing gravitational force through a prescriptive exercise and unloading program. BACKGROUND: This report describes a treatment method that we used to rehabilitate a collegiate soccer player with a Grade II inversion ankle sprain. This athlete sprained his ankle 6 weeks before the start of rehabilitation and was unable to participate in soccer due to persistent pain and impaired function. methods AND MEASURES: A 2-week functional training program was implemented, consisting of exercises chosen for specific task simulation related to soccer. Gravitational force was mechanically altered by suspending the subject or by supporting the subject on a variable incline plane. weight-bearing was controlled so that the subject could perform exercises without pain. The outcome measures were ankle range of motion (ROM), maximum pain-free isometric strength, vertical force during unilateral squats, and unilateral hop time and distance. RESULTS: pain-free weight-bearing capacity increased over the 2-week course of rehabilitation and the subject was able to return to playing soccer without pain. The ratios (involved to uninvolved extremity) at time of discharge from physical therapy were 87% to 103% for ankle ROM, 75% to 93% for isometric ankle strength, 91% for unilateral squats, 88% for unilateral hop time, and 86% for unilateral hop distance. CONCLUSIONS: Return to function can be achieved in a short period by exercise that is performed with a gradual increase in pain-free weight-bearing capacity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. weight-bearing immobilization and early exercise treatment following a grade II lateral ankle sprain.STUDY DESIGN: Case study. OBJECTIVES: To describe a protocol used in the rehabilitation of a grade II lateral ankle sprain, emphasizing brief immobilization with a removable boot, weight bearing as tolerated, and progression of early exercise. BACKGROUND: The optimum conservative treatment of severe grade II ankle sprains remains undefined. Short-term benefits of early mobilization have won favor over immobilization by casting; however, pain and ankle joint instability often linger. The timing of weight bearing as a variable that influences recovery has largely been ignored when either treatment is considered. methods AND MEASURES: The patient was a 17-year-old girl who had sustained a left ankle inversion sprain while playing high school basketball. The sprained ankle was placed in an immobilizer boot for 1 week, and weight bearing was encouraged. She received instructions for active exercise and for resistive exercise with elastic tubing. Volumetric and active range of motion measurements and gait observation provided indicators of rehabilitation progress. A digital inclinometer was used to measure active range of motion in the sagittal plane. Vertical ground reaction forces recorded with an instrumented treadmill documented gait symmetry. RESULTS: The patient responded well to the course of treatment, returning to full participation in basketball 2 weeks after the injury. The injured ankle had 29% (19 degrees) less active range of motion than the nonimpaired ankle at the beginning of physical therapy. The injured ankle also displaced 50 mL more water compared with the nonimpaired ankle at the start of treatment. Four weeks after beginning treatment, the sprained ankle had 4 degrees less active range of motion and displaced 5 mL more water compared with the nonimpaired ankle. As a college athlete, the patient has remained free of subjective complaints of ankle pain, instability, and swelling. CONCLUSION: weight-bearing immobilization combined with early exercise provided safe and effective treatment for this patient, who suffered a grade II lateral ankle sprain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle.Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor.- - - - - - - - - - ranking = 3.8294856296602keywords = physical examination, physical (Clic here for more details about this article) |
4/9. Ankle sprain: an unexpected complication.Blunt arterial injury is usually caused by high velocity trauma and can result in intimal dissection. We present a case of a professional footballer who sustained an intimal tear of the posterior tibial artery following a minor eversion injury of the ankle. The injury was noticed because of the physical demands of this patient's profession. This was confirmed by an arteriogram and was treated with bypass surgery using an arm vein. Arterial intimal injury has not been reported previously with this type of injury. A high index of suspicion is needed to diagnose these injuries and revascularisation either by primary anastomosis or vein interposition graft is suggested.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options.An unusual case of recurrent myositis ossificans (MO) bilaterally in the hamstring muscles of a 47-year-old athlete secondary to trauma is presented with a review of the literature of current treatment options. MO is a common condition that occurs among athletes in association with muscle and/or tendon strain or contusion. After an extensive literature review, we believe this to be the first case reported of recurrent and bilateral MO in a nonsurgical setting from recurrent hamstring strains. Plain radiographs and physical examination revealed the appearance and chronology of this pathology. Treatment options to improve flexibility and decrease morbidity are discussed along with prophylaxis for future injury. Treatment of mobility and flexibility, rehabilitation goals and treatment with nonsteroidal anti-inflammatory drugs, bisphosphonates, and magnesium are discussed along with prophylaxis.- - - - - - - - - - ranking = 3.8294856296602keywords = physical examination, physical (Clic here for more details about this article) |
6/9. Heterotopic bone formation: a case report.The authors discuss a rare case of heterotopic bone formation in the ankle of an athletic, 20-year-old Caucasian male. After conservative treatment provided minimal relief of symptoms, resection of the talar neck exostosis and inferior, anterior tibial exostosis was performed by an anterior medial approach. Two months postoperatively, after physical therapy, the patient had no pain or limitation of ankle dorsiflexion. He resumed jogging 1 mile per day and performing strenuous exercises.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. hypogonadism as a cause of recurrent muscle injury in a high level soccer player. A case report.Hypogonadotropic hypogonadism is a well known entity in highly trained female athletes. In male sportsmen, resting testosterone levels may be lowered especially in well endurance trained athletes and during high intensity training periods, frequently in combination with excessive weight reduction. However, only few reports illustrate a clinical pathology related to this state. In this report, where we present a case of a high level soccer player with recurrent muscle injuries over several years, hypogonadism was caused by sports activity together with an impaired testicular function (cryptorchidy). Clinical findings included testicular maldevelopment, decreased libido, infertility and a high incidence of muscle strains and delayed post-exercise soreness in mainly eccentric exercised muscle groups. Laboratory findings showed abnormally lowered resting testosterone values, most prominent during training periods, and an unfavourable testosterone/cortisol ratio during recuperation after exercise. With respect to treatment of the problem, neither any form of physical therapy nor rehabilitation program could give long lasting benefit. Using tamoxifen, an anti-oestrogenic drug, which stimulates LH and FSH production, we not only observed normal physiological resting testosterone values and a restoration of the testosterone/cortisol ratio after exercise, but our patient also experienced a higher sexual drive, well being and a spectacular decrease in the muscle injury rate. Although this patient was not a highly endurance trained athlete, we assume that a chronic anabolic/catabolic hormone imbalance may be of greater clinical importance in sports activity based on eccentric and explosive muscle work.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. Syndesmotic ankle sprain in a recreational hockey player.OBJECTIVE: To present a case of distal tibiofibular sprain, a rare injury among ubiquitous lateral ligament sprains of the ankle. CLINICAL FEATURES: A 45-yr-old recreational hockey player was treated for an ankle sprain demonstrating increased translation on the drawer test and pain with inversion stress, but also pain with external rotation and dorsiflexion. x-rays demonstrated no fractures. INTERVENTION AND OUTCOME: The conventional protocol of protect, rest, ice, compress and elevate (PRICE), employed for the more common lateral ankle sprains, was followed by early mobilization and proprioceptive training with a tilt board. Recovery was prolonged, and ossification of the ankle syndesmosis was seen in follow-up radiographs. CONCLUSION: Because management implications and outcome sequelae of the uncommon syndesmotic sprain are more severe than the commonly seen lateral ankle sprain, simple physical examination procedures useful in identifying syndesmotic sprains in the routine examination of the injured ankle are emphasized. These include dorsiflexion and external rotation stress and the "squeeze test."- - - - - - - - - - ranking = 3.8294856296602keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Posteromedial ankle impingement.We present a case of soft tissue impingement in the posteromedial ankle, which has not been previously reported. When a patient presents with chronic posteromedial ankle pain and swelling, clinicians should be suspicious of soft tissue impingement in the posteromedial ankle. Pertinent history and physical examinations are most helpful in the diagnosis of this lesion. Arthroscopic debridement of the hypertrophic soft tissue is successful in returning the patient to his or her previous activities.- - - - - - - - - - ranking = 3.8294856296602keywords = physical examination, physical (Clic here for more details about this article) |