Ankle sprain : Subjective and objective measures of functional impairment and treatment
Sammanfattning: This thesis is based upon a series of studies were performed in order to provide more informationabout the etiology of late symptoms after ankle sprain, most often referred to as functional instabilityof the ankle joint. In a retrospective study of basketball players, the incidence of ankle sprains and theprevalence of late symptoms after such an injury were investigated. The injury incidence was cal-culated to 5.5 ankle injuries /1000 activity hours, which is three to four times higher than in Swedishelite basketball, soccer and orienteering. 52% reported late symptoms after ankle sprain. Impaired proprioception is a suggested cause of chronic symptoms after ankle sprain. Weregistered increased postural sway in basketball players with previous ankle sprain by stabilometricrecordings as a sign of a proprioceptional deficit. The active dorsiflexion angle was smaller in thebasketball players than in the controls and may contribute to the high incidence of ankle sprains inbasketball players. Postural sway was registered in classical ballet dancers. During the study six dancers sustainedan ankle sprain and for this group recordings before and after the injury were obtained. Followingankle sprain, postural sway was increased for several weeks. During rehabilitation postural stabilitygradually improved, also after professional dancing had been resumed. In a prospective study of 73 patients we studied the influence of an ankle sprain on objectivemodalities of ankle joint function. We also studied if treatment with an Air-Stirrup¨ ankle brace couldenhance the restoration of function compared to a traditionally used compression bandage. Anklesprain resulted in a decreased active range of motion in eversion-inversion during the ten weekfollow-up period. We registered increased postural sway standing on the injured foot up to fourweeks after the injury, a deficit in evertor muscle peak torque and a evertor-invertor muscle imbalanceat ten weeks. A longer curve running time with the injured ankle in outside of the curve was notedduring the follow-up. The group treated with Air-Stirrup¨ ankle brace was more mobile as measured with SicknessImpact Profile self-rating questionnaire, showed a larger range of motion in the initial phase of therehabilitation and a shorter sick leave. Ankle brace treatment resulted in socioeconomic savings. A late follow-up two years after the ankle sprain was performed. 33% reported late symptoms,30% in the ankle brace group and 38% in the control group. In the group with no symptoms, arestoration of evertor muscle torque was registered, which had not occurred in the subjects with latesymptoms of instability, leading to a manifest evertor-invertor muscle imbalance. The effect of taping of the ankle on postural sway at perturbation was studied in subjects withchronic ankle instability, using a specially designed pelturbation device. Taping of the ankle resultedin a decreased postural sway at perturbation before but not after a training session, indicating that theprophylactic effect of laping is most important during the first part of a practice session or a game.With untaped ankle, the postural sway decreased after the training session. The results could beexplained by a faster neuromuscular response to dysequilibrium with the tape applied and also awarm-up effect from exercise. In summary, subjective and objective measures of ankle joint function are used in subjects withacute and chronic instability. The presented results and methods could be used when designing andevaluating a rehabilitation program in patients with ankle sprain or symptoms of chronic instability inorder lo prevent reinjuries.Key words: Ankle sprain, epidemiology, postural sway, muscle torque, muscle imbalance,proprioception, joint position sense, figure-of-eight running, sick leave, ankle brace treatment,functional instability, basketball, ballet, soccer, taping, Sickness Impact Profile, Karlsson scoreISBN 91-628-2052-4
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