Dimitrios Stasinopoulos

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

Background: Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players. Objective: To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players. Methods: Participants were 52 players who suffered ankle sprains during the season 1998–1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999–2000 season. Data were collected at the end of the season. Results: The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains. Conclusions: Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.

An exercise programme for the management of lateral elbow tendinopathy

Background: Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the arm with a well-defined clinical presentation. The aim of this study is to describe the use and effects of strengthening and stretching exercise programmes in the treatment of LET. Eccentric exercises: Slow progressive eccentric exercises for LET should be performed with the elbow in extension, forearm in pronation, and wrist in extended position (as high as possible). However, it is unclear how the injured tendon, which is loaded eccentrically, returns to the starting position without experiencing concentric loading and how the “slowness” of eccentric exercises should be defined. Nor has the treatment regimen of the eccentric exercises of a supervised exercise programme been defined. Stretching exercises: Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing and maintaining it in a maximal position of stretch. We recommend the position should be held for 30–45 s, three times before and three times after eccentric exercises during each treatment session with a 30 s rest interval between each procedure. The treatment region of static stretching exercises when a supervised exercise programme is performed is unknown. Discussion: A well designed trial is needed to study the effectiveness of a supervised exercise programme for LET consisting of eccentric and static stretching exercises. The issues relating to the supervised exercise programme should be defined so that therapists can replicate the programme.

Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis

Objective: To compare the effectiveness of Cyriax physiotherapy, a supervised exercise programme, and polarized polychromatic non-coherent light (Bioptron light) in the treatment of lateral epicondylitis. Design: Controlled clinical trial. Setting: Rheumatology and rehabilitation centre. Subjects: This study was carried out with 75 patients who had lateral epicondylitis. They were allocated to three groups by sequential allocation. Interventions: Group A (n=25) was treated with Cyriax physiotherapy. A supervised exercise programme was given to group B (n=25). Group C (n=25) received polarized polychromatic non-coherent light (Bioptron light). All patients received three treatments per week for four weeks. Outcomes: Pain was evaluated using a visual analogue scale and function using a visual analogue scale and pain-free grip strength at the end of the four-week course of treatment (week 4), one month (week 8), three months (week 16) and six months (week 28) after the end of treatment. Results: The supervised exercise programme produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment (P<0.05) and at any of the follow-up time points (P<0.05). Conclusion: The supervised exercise programme should be the first treatment option for therapists when they manage lateral epicondylitis patients. If this is not possible, Cyriax physiotherapy and polarized polychromatic non-coherent light (Bioptron light) may be suitable.

Cyriax physiotherapy for tennis elbow/lateral epicondylitis

Tennis elbow or lateral epicondylitis is one of the most common lesions of the arm with a well defined clinical presentation, which significantly impacts on the community. Many treatment approaches have been proposed to manage this condition. One is Cyriax physiotherapy. The effectiveness and reported effects of this intervention are reviewed.

Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis)

Randomised controlled trials were reviewed to evaluate the evidence of the effectiveness of extracorporeal shock wave therapy in the management of tennis elbow. Seven relevant trials were found, which had satisfactory methodology but conflicting results. Further research with well designed randomised control trials is needed to establish the absolute and relative effectiveness of this intervention for tennis elbow.

Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy

Background Home and supervised exercise programmes consisting of stretching and eccentric exercises have been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined their comparative efficacy effectiveness. Objective In this study, whether a home exercise programme is more successful than a supervised exercise programme in treating patients with LET was investigated. Methods Patients with unilateral LET for at least 4 weeks were included in this trial. They were sequentially allocated to receive either a home exercise programme or a supervised exercise programme five times a week for 12 weeks. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. Outcome measures were pain, using a visual analogue scale, and function, using a visual analogue scale and the pain-free grip strength. Patients were evaluated at baseline, at the end of treatment (week 12), and 3 months (week 24) after the end of treatment. Results 70 patients met the inclusion criteria. At the end of treatment, there was a decline in pain and a rise in function in both groups compared with baseline (p<0.0005, paired t test). There were significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-month follow up; the supervised exercise programme produced the largest effect (p<0.0005, independent t test). Conclusions Supervised exercise programme is superior to home exercise programme to reduce pain and improve function in patients with LET at the end of the treatment and at the follow-up. Further research is needed to confirm our results.

Treatment of spondylolysis with external electrical stimulation in young athletes: a critical literature review

Lumbar spondylolysis is a common cause of low back pain in adolescent athletes. It is a unilateral or bilateral defect of the pars interarticularis. The cause is still a matter of debate. A wide range of conservative treatments has been used. The purpose of this critical literature review is to investigate the efficacy of external electrical stimulation in the healing of this disorder.

Comparing the effects of exercise program and low-level laser therapy with exercise program and polarized polychromatic non-coherent light (bioptron light) on the treatment of lateral elbow tendinopathy.

BACKGROUND DATA The use of low-level laser therapy (LLLT) and polarized polychromatic non-coherent light as supplements to an exercise program has been recommended for the management of lateral elbow tendinopathy (LET). OBJECTIVE To investigate whether an exercise program supplemented with LLLT is more successful than an exercise program supplemented with polarized polychromatic non-coherent light in treating LET. MATERIALS AND METHODS Patients with unilateral LET for at least 4 wk were sequentially allocated to receive either an exercise program with LLLT or an exercise program with polarized polychromatic non-coherent light. The exercise program consisted of eccentric and static stretching exercises of wrist extensors. In the LLLT group a 904-nm Ga-As laser was used in continuous mode, and the power density was 130 mW/cm(2), and the dose was 0.585 J/point. In the group receiving polarized polychromatic non-coherent light the Bioptron 2 was used to administer the dose perpendicularly to the lateral epicondyle at three points at an operating distance of 5-10 cm for 6 min at each position. The outcome measures were pain and function and were evaluated at baseline, at the end of the treatment (week 4), and 3 mo after the end of treatment (week 16). RESULTS Fifty patients met the inclusion criteria. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline (p < 0.0005 on the paired t-test). There were no significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-mo follow-up (p > 0.0005 on the independent t-test). CONCLUSIONS The results suggest that the combination of an exercise program with LLLT or polarized polychromatic non-coherent light is an adequate treatment for patients with LET. Further research to establish the relative and absolute effectiveness of such a treatment approach is needed.

Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy

Study Design: RCT. Introduction: Lateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric‐concentric loading and, isometric exercises are indicated to reduce and manage tendon pain. Purpose of the Study: To compare the effectiveness of eccentric training, eccentric‐concentric training, and eccentric‐concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Methods: A randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric‐concentric and Group C who had eccentric‐concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain‐free grip strength at the end of the 4‐week course of treatment (week 4) and 1 month (week 8) after the end of treatment. Results: The eccentric‐concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow‐up time points (P < .05). Conclusion: The eccentric‐concentric training combined with isomentric contractions was the most effective treatment. Future well‐designed studies are needed to confirm the results of the present trial. Level of evidence: III.

The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains.

Abstract Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p < 0.0005 for each). Conclusions These data provide preliminary evidence of the efficacy of Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.