Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, South Africa, 2013. / Background: Lateral ankle sprains and the sequelae of Chronic Ankle Instability Syndrome (CAIS) are common, reaching a peak prevalence of 85%. Manual joint manipulation is an intervention utilised for CAIS. Manipulations are applied either manually or via a mechanical device. The Activator Adjustment Instrument (AAI) is commonly applied to extremities; however, a paucity of research exists, in respect of extremity conditions. Thus this study compared an AAI manipulation with a manual long-axis distraction manipulation (diversified technique) in the treatment of CAIS. Method: This ethics approved, quantitative, randomised controlled clinical trial, of 40 participants allocated between two groups. After receipt of informed consent participants were evaluated against the inclusion criteria and baseline measures were taken. One treatment of either manual or activator manipulation was followed by a measurements-only consultation within 48 hours. A p-value <0.05 was considered statistically significant. Intra- and inter-group analyses were done utilising repeated measures ANOVA tests. Results: Both groups showed a statistically significant improvement on all outcome measures over time, but neither group showed a significant improvement over the other. A trend in the inter-group comparisons reflected parallel improvements in the Algometer, Berg Balance Scale and the dorsiflexion range of motion (objective measures) and non-parallel improvements in the Numerical Pain Rating Scale and Foot and Ankle Disability Index. Conclusion: The results suggested a trend towards subjective improvement in the AAI group, which may have been influenced by the novelty of the AAI. Further research with larger sample sizes and more homogenous participant groups are needed to verify this outcome.

Thesis (M.Tech-:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xv, 121 leaves ; ill. ; 30 cm / According to research, continuing symptoms of pain, instability, crepitus, weakness, stiffness (Pellow and Brantingham, 2001) and swelling (Patel and Warren, 1999:332) commonly follow an acute ankle sprain. The cause of these symptoms is often attributed to the development of a tight sensitive scar (Reid, 1992:251) within the injured ligament. The treatment options available include scar tissue debridement (Bassewitz and Shapiro, 1997), manipulation (Edmond, 1993:164), mobilization, (Hockenbury and Sammarco, 2001) and ultrasound (Thomson, Skinner & Piercy, 1991:43-44). Transverse friction massage could also be used to reduce adhesions (Kessler, 1990:85) and improve mobility of the tissues (Kessler, 1990:140). The Graston Technique Instrument Assisted Soft Tissue Mobilization (GTIASTM) comprises a set of stainless steel instruments (Carey 2003:2) designed to detect and reduce scar tissue and adhesions (Carey 2003:7) by bringing about an area of controlled microtrauma (Hammer, 2003(b):1) and inflammation (Carey 2003:32) through a mechanism similar to that of friction massage.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Cryotherapy is commonly used to decrease pain, swelling and disability in acute injury. The most common form traditionally used is ice packs, with menthol based cooling gels being increasingly used by physicians in place of ice. More recently companies are experimenting with adding herbs containing anti-inflammatory properties to these menthol based gels to enhance their effectiveness. There is a paucity of literature comparing different forms of cryotherapy to one another, and more experiments are necessary to determine if cooling gels containing menthol and cooling gels with menthol and anti-inflammatory herbs are comparable to that of conventional ice pack cryotherapy. Objectives To determine the relative effectiveness of an ice pack, a menthol based gel, a menthol based gel with herbal extracts (combination gel) and placebo gel in the treatment of an acute grade 1 or 2 inversion ankle sprains, in terms of subjective and objective measurements. Any adverse reactions were also noted. Method A placebo controlled randomised, single blinded clinical trial (n=48) was conducted. Participants were randomly allocated into one of the four groups. Each group consisted of 12 people between the ages of 18 and 45. Each participant had a case history, physical and ankle examination prior to being accepted to ensure that they met the inclusion and exclusion criteria. On the initial consultation the respective treatments were administered and participants were instructed on how to apply the gel or ice pack, which they were required to utilise at home three times per day for 3 days. Those receiving the gels were blinded as to which gel they were receiving, all gels looked and smelt the same. On the 4th day the participants returned for data collection and were instructed to stop using the treatment and return 7 days later for further data collection. Statistical analysis consisted of repeated measures of ANOVA and Bonferroni post hoc tests, with a p-value of <0.05 considered statistically significant. Results Intra-group and inter-group analysis showed that all four groups had statistically significant improvements in terms of subjective and objective measurements. The results of the study demonstrated that the effects produced by the two cooling gels containing menthol, are comparable with those of conventional/traditional ice pack cryotherapy in the treatment of acute grade 1 or 2 inversion ankle sprains. No adverse reactions were reported. Conclusion This study found that all four treatment interventions were effective and safe in treating acute grade 1 and 2 inversion ankle sprains, however the ice pack and both cooling gel groups appear to statistically significantly improve treatment outcomes at a similarly higher rate when compared to the placebo gel group.

Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Ankle sprains are reportedly the most common lower limb injury amongst active individuals. Aim: The aim of this study was to investigate whether treatment interventions employed by physiotherapists during the first week of functional rehabilitation of an ankle sprain, at primary care level, were aligned with evidence-based guidelines for acute ankle sprains. Design: A descriptive cross-sectional study was conducted. Participants: A total of 91 physiotherapists from the Western Cape Metropole (WCM) completed questionnaires. Method: Physiotherapists' treatment interventions were recorded based on a case study of a typical moderately sprained ankle. According to classification of the West Point Ankle Grading System, a moderate sprain is a partial macroscopic tear of the ligaments with moderate pain, swelling and tenderness with some loss of motion and mild to moderate instability of the joint. Anticipated return to sport is two to six weeks. Relative occurrence of selected interventions during the first week of rehabilitation was calculated. Chi-square tests were used to compare differences between physiotherapists' responses and the recommendations of the practice guidelines. Results: Physiotherapists' overall selections of treatment interventions were in alignment with the "Koninklijk Nederlands Genootschap voor Fysiotherapie" (KNGF) guidelines and correlated positively to the recommendations stipulated by KNGF therein. Physiotherapists indicated many interventions for which good evidence exists: compression, cryotherapy, early mobilisation, and neuromuscular exercises. It is of concern that 49% – 91% (n = 91) physiotherapists indicated some form of manual mobilisations for which there is a lack of evidence, and more than two-thirds indicated the application of an electrotherapy intervention, which is not recommended in the guidelines. Conclusion: Physiotherapists should reconsider interventions for which there is no evidence as this may reduce cost of care, without compromising patient outcomes. / AFRIKAANSE OPSOMMING: Verslae dui daarop dat verstuite enkels die mees algemene besering van die onderste ledemaat van aktiewe persone is. Doelwit: Die doel van hierdie ondersoek was om vas te stel of fisioterapeute in primere gesondheidsorg se keuse van rehabilitasie tegnieke gedurende die eerste week van funksionele rehabilitasie na 'n enkel besering, op koers is met bewysgebaseerde kliniese riglyne in die hantering van akute enkel beserings. Ontwerp: 'n Beskrywende deursnit ondersoek is geloods. Deelnemers: 'n Vooraf opgestelde vraelys is deur 91 fisioterapeute in die Weskaapse metropool voltooi. Metodiek: 'n Gevalle studie is aangebied van 'n tipiese matige verstuite enkel. Die respondent moes hulle tegnieke in die hantering van die geval aandui. Volgens die klassifikasie van die “West Point Grading System” word so 'n verstuiting gekenmerk deur makroskopiese gedeeltelike skeur van die enkel ligamente, matige pyn, swelsel en tasteerheid van die area. Dit gaan gepaard met 'n effense verlies van beweging en stabiliteit van die gewrig. Die prognose vir so 'n besering om na sport terug te keer is om en by twee tot ses weke. Die insidensie van aanwending van geselekteerde metodes van behandeling gedurende die eerste week en die verhouding met die vooraf geselekteerde behandelings riglyne opgestel deur die “Koninklijk Nederlands Genootschap voor Fysiotherapie” (KNGF) is bereken en ontleed. Die “Chi-square” toets is gebruik om die verskil te bereken tussen die respons van die Fisioterapeute en die aanbevelings van die kliniese riglyne. Resultate: Oorkoepelend is die keuses van behandelings tegnieke deur die fisioterapeute in lyn met die riglyne van die 'Koninklijk Nederlands Genootschap voor Fysiotherapie' (KNGF). Verskeie sinvolle behandelings is gekies waarvoor daar positiewe aanduidings was, byvoorbeeld: lokale kompressie, ys terapie, en oefeninge. Dit is egter kommerwekkend dat 49 – 91% (n=91) van die deelnemers 'n manuele tegniek ingesluit het waar daar tans gebrekkige aanduidings voor bestaan. Verder, het meer as twee derdes van die fisioterapeute aangedui dat hulle elektroterapie sou gebruik wat nie in riglyne aanbeveel word nie. Gevolgtrekking: Fisioterapeute moet die gebruik van tegnieke waarvoor daar nie duidelike bewyse in die literatuur bestaan nie, heroorweeg, want dit mag die koste van behandeling verminder, sonder om die positiewe resultate van herstel, negatief te beinvloed.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation / M

Severe ankle injuries can result in ligament rupture or a fracture. A major problem after such injuries is limitation in mobility. Weight bearing tasks, such as walking, become a problem because of pain, deficits in joint range of motion and muscle strength. This thesis studies a key dilemma in early rehabilitation, whether to immobilise the ankle or allow joint motion to improve mobility outcomes. Studies have focused on two scenarios, severe ligament rupture, and unstable fractures managed through open reduction and internal fixation (ORIF). The analysis of gait outcomes was an important component of this thesis and a novel analytical method was developed to normalise gait velocity in the estimation of speed-dependent gait outcomes. A systematic review and meta-analysis was conducted including evidence to July 2014. The reporting and design of trials was universally poor. In the 6 weeks of recovery following ankle ORIF surgery, there was insufficient evidence that early ankle movements offered a benefit to mobility recovery compared with immobilisation in a cast. Ankle movements compared with immobilisation reduced the risk of venous thrombosis/thromboembolism. However, compared with cast immobilisation, the risk of deep and superficial surgical site infection and fixation-related complications were higher when ankle movements were permitted. To investigate the role of ankle supports in rehabilitation of walking after ORIF, two randomised cross-over studies were completed. In healthy participants with non-pathological gait, a walker boot induced gait abnormalities when compared with Tubigrip (elasticated bandage). There were no important differences in gait between a stirrup brace and Tubigrip. In people who had undergone ankle ORIF 6 weeks previously, a walker boot and to a lesser extent a stirrup brace offered improvements in gait symmetry and lower pain scores when compared with Tubigrip. Finally, a secondary analysis of the Collaborative Ankle Support Trial cohort (n=584) was conducted, which concluded that, in comparison to Tubigrip, 10 days of cast immobilisation provided greater probability of recovery of a range of mobility outcomes 4 weeks following injury. This thesis contributes evidence favouring a role for ankle immobilisation in improving mobility following severe ankle injury in adults. Clinicians should be aware of the benefits and risk of harms outlined, as well as the limitations in the current evidence base.

Title: The ankle joint injury prevention of floorball players Objectives: The main objective of this work is to determine what prevention of ankle joint and if ever floorball players use. The research is focused on players from first League and Extraleague in Czech Republic. Furthermore, what charakter of ankle joint injury is the most experienced by players , if there is a link between the injury of ankle joint and positions which are players playing, or a link between the injury of ankle joint with the length and frequency of trainings. The work deals also with the link between origins of injuries on rebound or swing leg. Methods: In the work has been used quantitative type of research using questionnaires. The results were statistically processed by programmes Microsoft Excel and Statistical Package for Social Science 17.0 (SPSS). Results: The research found that the incidence of ankle joint injuries by floorball players is high. The most common character of ankle joint injury is stretched ligaments. The link between injuries and the length and frequency of trainings, or the link between posts which players play and injuries can't be rejected. The injury of ankle joint occurs more frequently on rebound leg. Furthermore, it was found that many players are using some kind of prevention, but very...

1 Abstract Title Ankle sprain, conservative versus operational treatment: A literature review Aim The main purpose of this thesis is to assess and review the efficacy of main types of conservative and surgical interventions applied on ankle sprain injuries, as also the factors that influence the clinical outcomes in patients undergoing the selected treatment procedures. Method This thesis is a literary research, reviewing articles from relevant journals and books. Information and data sources were retrieved from English, released between 1980 and 2016, using electronic databases and reference lists of articles. The following databases were searched for the highest possible amount of relevant articles, with an attempt to reduce publication and/or selection bias: PubMed, EMBASE, CINAHL, The Cochrane Library (Cochrane Database of Systematic Reviews), Web of science and Medline. Preliminary searches began at the inception of the project, and the full search was concluded in October 10th , 2016. A restriction for the type of publication (meta-analysis, systematic review, clinical trials, comparative trials, practice guidelines and case studies) was applied when allowed by the databases research tools. Results The analysis of the reviewed studies resulted that conservative treatment approaches is the main...

As doenças cerebrovasculares, incluindo o acidente vascular encefálico (AVE), são a segunda causa de morte no mundo, e o principal causador das incapacidades na população adulta. Devido à reorganização cortical, quanto mais precoce a reabilitação é realizada, melhores são os resultados. Desta forma, novos tratamentos e soluções tecnológicas foram desenvolvidos para enfrentar os desafios da reabilitação pós AVE, por exemplo, aumento da intensidade e duração da terapia incluindo manipulação externa, treinamento do movimento bilateral, e reabilitação robótica. Os dispositivos robóticos possibilitam a realização de tarefas específicas repetidas vezes, de forma controlada e confiável, fator determinante para a facilitação da reorganização cortical, com aumento da habilidade motora e melhora do desempenho das atividades funcionais. O objetivo principal deste trabalho foi verificar a adequação e usabilidade da Plataforma Robótica de Reabilitação de Tornozelo - PRRT em indivíduos que precisam de reabilitação de tornozelo decorrente de sequela de AVE, a fim de realizar eventuais ajustes antes que o equipamento seja incorporado na prática clínica. A metodologia consistiu em verificar a adequação ergonômica e técnica do equipamento, e avaliar a satisfação do usuário após o seu uso por meio de questionário. O aparelho foi avaliado tanto em pacientes com déficit motor de hemiparesia, como em indivíduos sem deficiências. Os resultados experimentais mostram que o equipamento é adequado como um recurso auxiliar na avaliação da amplitude de movimento articular do tornozelo e da força muscular, beneficiando os terapeutas na avaliação dos ganhos reais obtidos com as terapias. A partir das respostas ao questionário, verifica-se que os indivíduos sentiram-se satisfeitos com o recurso. Portanto, conclui-se que a PRRT é um recurso auxiliar promissor no tratamento do tornozelo de indivíduos que sofreram lesão neurológica, podendo trazer benefícios em relação à amplitude de movimento e ganho de força, além de proporcionar uma terapia prazerosa e estimulante aos pacientes. / Cerebrovascular diseases, including stroke, are the second leading cause of death worldwide and the leading cause of disability in the adult population. Due to cortical reorganization, the earlier rehabilitation is performed, the better the results. In this way, new treatments and technological solutions were developed to meet the challenges of rehabilitation after stroke, for example, increase of intensity and duration of therapy including external manipulation, bilateral movement training, and rehabilitation robotics. Robotic devices allow performing specific tasks repeatedly in a controlled and reliable way, a key factor for cortical reorganization, with increase of motor skills and improvement of functional activities performance. The main objective of this work was to verify the adequacy and usability of the Robotic Platform for Ankle Rehabilitation in post-stroke patients who need ankle rehabilitation, in order to make any necessary adjustments before the equipment be incorporated into clinical practice. The methodology consisted in verifying ergonomic and technical adequacy, and evaluates user satisfaction after use through a questionnaire. The device was evaluated in patients with motor deficit of hemiparesis, as well as in individuals without disabilities. Experimental results show the proposed equipment is suitable as an auxiliary resource in evaluating the range of motion and muscle strength of the ankle, assisting therapists in the evaluation of real gains obtained with the therapies. From the questionnaire responses, the individuals said they were satisfied with the resource. Therefore, it is concluded that the PRRT is a promising auxiliary resource in the treatment of individuals who have suffered neurological damage, bringing benefits with relation to range of motion and muscle strength, as well as providing pleasurable and stimulating therapy to patients.

A entorse de tornozelo pode ocorrer pela amplitude exagerada de inversão e flexão plantar. Lacuna importante no controle postural é a ação do ajuste postural antecipatório (APA) e compensatório (APC) para estabilizar a articulação do tornozelo. O reflexo de estiramento (M1) e as reações pré-programadas (M2 e M3) foram pouco exploradas em pessoas com instabilidade crônica de tornozelo (CAI). A co-ativação e inibição são fenômenos modulados em nível medular por neurônios excitatórios e inibitórios, mas as informações sobre esses fenômenos atuam na CAI são escassas. A fadiga muscular afeta negativamente as pessoas na condição de CAI. Logo, qual é a relação entre APA e APC no movimento de entorse de tornozelo? A CAI pode alterar as respostas M1, M2 e M3 por lesões osteomioarticulares do tornozelo? A fadiga pode alterar todas estas variáveis em pessoas com CAI? Esta dissertação de mestrado teve por objetivo geral analisar o sinal EMG no movimento simulado da inversão de tornozelo em atletas universitárias de futsal que possuem e que não possuem a CAI. A amostra foi composta por 24 atletas de futsal feminino universitário e foram divididos em dois grupos: controle e instabilidade. A simulação do movimento de entorse do tornozelo foi feita por meio de uma plataforma mecânica que simula o movimento de inversão de tornozelo. Foi utilizado um sistema de aquisição de sinais de 8 canais, onde foram utilizados 4 canais para registro EMG e 3 canais para o registro do sinal do acelerômetro. Para determinar o início e final do movimento da plataforma foi fixado um acelerômetro 3D em uma das bordas da plataforma de inversão. Foram realizar quedas aleatórias na plataforma de inversão antes e depois do protocolo de fadiga. Foram monitorados os músculos tibial anterior, fibular longo e curto e gastrocnêmio lateral. Os períodos analisados foram os APA, APC, reflexo de estiramento muscular e reações pré-programadas. Parece que durante os períodos M1, M2 e M3 há um fator de desproteção no grupo instabilidade, apesar de haver em alguns pares de músculos uma maior coerência, comparado com o grupo controle. Durante o APA os músculos eversores não foram alterados no grupo instabilidade, mas no APC os eversores foram menores comparados com o grupo controle, sugerindo um fator de desproteção. Na correlação cruzada, todos os pares de músculos foram maiores no grupo controle, uma forma de se opor ao movimento de inversão maior que o grupo instabilidade. A co-ativação e inibição recíproca foram alteradas com a fadiga, aumentando após a fadiga, mas a inibição recíproca foi maior somente no grupo controle, podendo mover a articulação do tornozelo de uma forma mais facilitada que o grupo instabilidade. A coerência de pares de músculos foi diferente somente nos grupos, sendo que durante o APC os músculos não sincronizaram de forma satisfatória no grupo instabilidade, somente durante APA e período M / Ankle sprain is an injury associated with sports and exercise and may be used for the exaggerated amplitude of inversion and plantar flexion. An important gap in postural control is the anticipatory (APA) and compensatory (CPA) postural adjustments to stabilize the ankle joint. The stretch reflex (M1) and the pre-programmed reactions (M2 and M3) were poorly explored in people with chronic ankle instability (CAI). Coactivation and recíprocal inhibition are phenomena modulated at the spinal level by excitatory and inhibitory neurons, but the information about these phenomena in CAI is scarce. Negative effects of muscular fatigue affect persons with CAI. Therefore, What is the relationship between APA and CPA in the movement of ankle sprain? Can CAI change the M1, M2 and M3 responses due to osteomyoarticular ankle injuries? Can fatigue change all these variables in people with CAI? This dissertation aimed at analysing the EMG signal in the simulated ankle inversion movement task in female indoor soccer university athletes who have and do not have the CAI. Participants were 24 female indoor soccer college athletes divided in two groups: control and instability. Simulation of ankle sprain was performed with a mechanical platform that simulated the ankle inversion movement. An 8-channel signal acquisition system was used, which 4 channels were used for EMG recording and 3 channels to record accelerometer signal. For determine the beginning and end of the movement of the inversion platform a 3D accelerometer was fixed to one of the edges of the inversion platform. We performed random falls on the inversion platform before and after the fatigue protocol. Muscles monitored were mm. tibialis anterior, fibularis longus, fibularis brevis and gastrocnemius lateralis. Data epochs were APA, CPA, muscle stretching reflex and preprogramed reactions. During M1, M2 and M3 epochs, there was an unprotection factor for instability group, although in some muscle pairs there were more coherence compared to control group. The eversor muscles were not changed in instability group compared with control group during APA epoch, it suggests an unprotect factor. All pair of muscles, the cross correlation were greater in control group to oppose the inversion movement greater in control group than instability group. Coactivation and reciprocal inhibition were changed with fatigue, increasing after fatigue, but reciprocal inhibition was greater only in control group, and could move the ankle joint more easily than for instability group. Coherence of muscle pairs was different only between groups, and during CPA the muscles did not synchronize satisfactorily for instability group, only during APA and M epochs