Mentoring Minutes: Chronic Ankle Sprains

The all-to-common inversion ankle sprain. How to assess and treat to improve outcomes and limit them from turning into chronic ankle instability. Research is pretty clear: balance and proprioceptive training until the cows come home, then progress to single leg hopping.

Reference & Notes:

Van Ochten JM et al., Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments. JOSPT.  2014 Nov, 44:11, 862-71 

  • 23,000 ankle injuries daily; up to 34% of ankle sprains continue to have symptoms 6 months later.

  • 20 RCT’s included to evaluate most beneficial treatment for decreasing pain and function, and reducing recurrences.

  • Initial treatment: POLICE (Protected Optimal Loading, Ice, Compression Elevation;

  • Biggest benefit at 4 weeks was following proprioceptive training (use of wobble boards, discs, airex, bosu; progressed from eyes open to closed; static to dynamic training (Lateral and change or direction single limb hoping).

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Exercises for Post Op Rotator Cuff Repair

Want to know the 9 best exercises for the early stages of post op rotator cuff repair. A Systematic Review from 2017, looked at EMG activity of over 45 different exercises and narrowed it down to these 9 with the least amount of rotator cuff EMG activity. Hint: not all pendulums are the same, and pulleys were not on the list.

Source:

A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair Journal of Orthopaedic; Sports Physical Therapy 2017 47:12, 931-944 

  • Identified passive and active assisted ROM exercises, using EMG, that would be most appropriate in the early/acute states following RC repair, to limit retear rates. Authors were looking for exercises that had <15% MVIC

  • Retear rates are dependent on size of the tear; tissue quality; the location, type, and chronicity of the tear; previous and/or concomitant surgery; and individual patient factors such as smoking, body mass, and physical activity.

  • A total of 43 different exercises were evaluated, with 9 meeting the cut off criteria of <15% MVIC.

  • Most active assistive exercises using  a bar or a pulley to elevate the operated limb tended to generate over 15% MVIC, suggesting that their use early in rehabilitation may be inappropriate.

  • For Supraspinatus: ER bar assisted (supine or standing) or wall assisted; supine press up (opp arm assist) , washcloth press up (hands close together); towel slides (flexion and scaption); pendulums (small); prone scapular retractions; scapular protraction on a swiss ball

  • For Infraspinatus: forward bow, towel slides (flexion and scaption), scapular protraction on a swiss ball, supine self assisted; prone scapular retraction, washcloth press up (hands close together), pendulums (small), supine bar assisted ER (supine or standing).

Prevalence

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  • Primary shoulder dislocate peaks in the second and sixth decade

  • 98% of cases, shoulder displaces anteriorly

  • 2% of cases, shoulder displaces posteriorly

  • 95% of first-time shoulder dislocations result from either a forceful collision, falling on an outstretched arm or a sudden wrenching movement

  • 5% of dislocations have an atraumatic origin (minor incidents such as raising the arm or moving during sleep

  • 70% of people who have dislocated can expect to dislocate again within 2 years of the initial injury

  • Younger and older subjects have a comparable incidence of primary shoulder dislocation

  • Incidence of recurrent dislocation is much more frequent in adolescent population

  • Dislocation reported to recur in:

    • 66% to 100% of people aged 20 years or under

    • 13% to 63% of people aged between 20 and 40 years old

    • 0% to 16% of people aged 40 years or older