Angela Clough

Prevention of ankle sprain: A systematic review

Abstract Objectives Ankle sprains are the most common injury to occur among athletes worldwide. In 2005 an ankle sprain was estimated to cost a total of £317, and that 80% of these injuries cause time off work. Treatment of ankle sprains has been extensively researched; however, the prevention aspect has not been so thoroughly studied. This systematic review aimed to collect and review all available high-quality research investigating the prevention of ankle sprains. Methods Research was collected via the Sport Discus, Medline, Cinahl and Pubmed databases. Hull Universitys Library system was also searched. Inclusion criteria were prepared to identify high-quality research. The search consisted of the following words including Boolean operators: ankle, sprain, ligament, strain, taping, bracing, strapping, orthotics, prevention, and support. Results Within the inclusion criteria 26 papers were identified from a possible 3634 to be eligible for this study. The papers identified were allocated to their relevant categories: bracing, taping, or orthotics. Discussion Bracing was identified as the best and cheapest intervention to prevent ankle sprains. Ankle taping showed signs of supporting the ankle joint but only for a maximum of 20 minutes. The theory that ankle taping can increase proprioception requires more research. Research on orthotics revealed that they can play an important role in limiting ankle sprains. We conclude that still further research must be carried out to identify the best method to prevent ankle sprains.

Clinical tests for the sacro-iliac joint: a literature review

Abstract Objective: To identify which physical examination tests have the highest sensitivity, specificity, and predictive values for determining the presence of sacro-iliac joint injuries and/or dysfunction when compared with the gold standard of a sacro-iliac joint block. Subjects and Methods: The search was conducted on Medline and EMBASE using a list of criteria established by van der Wurff. Results: Twenty-seven papers were found but only three met the inclusion criteria investigating the reliability of clinical sacro-iliac tests and using local anaesthetic block as the standard. Conclusions: Despite possible shortcomings of the gold standard of anaesthetic block, the literature recommends the use of up to five tests and that, if three or more tests are positive, acceptable sensitivity, specificity and the predictive values are achieved.

Physiotherapy: Making a difference for the next 100 years – Stop sleepwalking into obscurity. A personal reflection

Abstract The progress of physiotherapy up to the present introduces a state of the discipline assessment. A self-assessment routine is described, which can be used by any health professional. The new initiative of the Chartered Society of Physiotherapy, Physiotherapy Works, comprises efforts to raise the awareness of the public, patients, healthcare providers and physiotherapists themselves of the evidence of benefits of physiotherapy. Four areas of focus relate to social care, falls prevention, orthopaedic rehabilitation and primary care.

Literature review to justify the use of autologous blood injections in the treatment of lateral epicondyle tendinopathy

Abstract Objective To review the available literature on the use of autologous blood injections in the treatment of lateral epicondyle tendinopathy. Method Databases of EMBASE, PubMed, Psychinfo, and Medline OvidSP were searched for English language human studies without limit of time. Main search keywords were autologous blood, blood products, lateral epicondylitis, and tennis elbow. All papers not using autologous blood were removed and search further refined using the NHS e-Library, The Knowledge Network, utilizing Dynamed to search under lateral epicondylitis and autologous blood. Owing to the low number of trials all papers using autologous blood were included. Results Review revealed three case study reports, four randomized controlled trials (RCTs) and two meta-analyses. Conclusion There is no level 1 evidence for efficacy, but encouragingly there is no evidence of harm and the obvious conclusion is that an adequately powered, primary care anatomically guided injection trial of autologous blood is required to progress the debate.

Investigation to compare static stretching and proprioceptive neuromuscular facilitation contract–relax stretching effects on the visco-elastic parameters of the biceps femoris muscle

Abstract Aim: To determine which of two methods, static stretching or proprioceptive neuromuscular facilitation (PNF) contract–relax stretch, has the more significant effect on muscle tone, elasticity and stiffness; and to estimate if the Myoton-3 myotonometer can be used as a valid tool for measuring the effects of stretching. Subjects and Methods: Thirty physically active subjects were assigned to one of three groups, to receive either no stretches (control group), or static stretching or PNF contract-relax stretching. The Myoton-3 myotonometer was used to measure biceps femoris muscle tone, elasticity and stiffness prestretch and post-stretch. Results: One course of static and PNF contract–relax stretches did not show any effect on muscle tone, elasticity or stiffness. The use of the Myoton-3 for measuring the stretching effects remains inconclusive and requires more research.

The management of medial recurrent patella femoral knee pain in a 'masters' runner

This case report presents a familiar problem experienced by competitive runners. It includes the assessment and management of a ‘masters’ runner, combining musculoskeletal medicine approaches with exercise rehabilitation.

Whole upper limb strengthening in treatment of lateral epicondylopathy

Abstract This case report presents a commonly presenting clinical condition in the context of evidence informed literature on tendinopathy and a systematic applied reasoning (SAR) model of clinical problem solving as an aide-memoire to develop the clinical management of lateral epicondylopathy.

Therapeutic effectiveness of a ‘Society of Musculoskeletal Medicine (SOMM) approach’ to mobilization versus a ‘Maitland approach’ in the treatment of neck pain: A comparative pilot study

Abstract Objective A pilot trial to compare a ‘Society of Musculoskeletal Medicine (SOMM) approach’ to mobilization with a ‘Maitland approach’ in neck pain patients. Method Participants were adults with neck pain (central, bilateral, or unilateral neck or scapula pain, without neurology). Five participants were randomly assigned to a SOMM approach or a Maitland approach of manual therapy. All received four weekly treatments and proven adjunct therapies. Pain (visual analogue scale) and function (neck disability index) were assessed before each treatment and after the fourth. Results Irrespective of approach all subjects demonstrated a reduction in pain (to a clinically important level) and an increase in function. The low power of this pilot did not permit differences between groups to be tested. Discussion It would be feasible to investigate these promising trends with a future trial, providing two main limitations are addressed; firstly, recruitment and secondly, the consent process.

Potential complications to consider when assessing and treating the cervical spine

Abstract Complications of spinal manipulative therapy for the neck area continue to be reported. An update of the recent literature is presented to cover aspects of both non-vascular and vascular complications and latest insights into their frequency, causation, and avoidance. In conclusion, the safety of spinal manipulative therapy must be continually reassessed alongside its efficacy, and better reporting of complications will assist that aim.

Rugby players and whiplash where are all the cases

Background Despite efforts to provide a comprehensive diagnosis of whiplash (eg, The Quebec Classification system, 1995; Soderlund & Dennison) it is an ill defined and poorly understood injury. Its occurrence seems to be dependent on a number of contextual variables. Objective The primary objective of this study was to identify the number of cases of whiplash reported in one complete season by professional rugby players. Design A longitudinal design was adopted. The assessment of whiplash was carried out independently of the assessment of the number of incidents that could potentially lead to WAD. The two assessments were blinded to each other. Setting The study was undertaken within a professional rugby club in the north of England. Participants The full first team squad (n=32) were included in the study. Assessment of risk The main independent variables was the number of potential whiplash inducing incidents over the entire season. Main outcome measurements The main outcome measure was the number of whiplash related injuries reported. Results There were six cases of whiplash reported during the entire season. Five followed an on field assessment during the game and the players were deemed fit to continue with play. They needed treatment post injury in readiness for the next game, however in all five cases the injuries were not sufficiently serious to rule the player concerned out of contention for selection and all have missed no matches as a result of their injury. The minimum number of collisions that would have been expected to produce whiplash was found to be three per game. Conclusion It is clear that the number of reported/diagnosed whiplash injuries in this sample is much lower than would be expected if you were to use data from the non-sporting domain. Further investigation into why this discrepancy happens is underway, using physiological, psychological and biomechanical markers.