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1.
Topical Ketoprofen Versus Placebo in Children Presenting With Ankle Sprain to the Emergency Department: A Randomized Controlled Study.
Serinken, M, Eken, C, Tünay, K, Gölcük, Y
Pediatric emergency care. 2020;(8):e447-e450
Abstract
OBJECTIVE Despite the favorable data concerning topical agents use in outpatient clinics, they are not commonly in emergency departments (EDs). The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in children presenting with ankle sprain to the ED. STUDY DESIGN Children between 7 and 18 years old presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered in a 5-cm area locally. Pain improvements at 15 and 30 minutes were measured by visual analog scale. RESULTS Median pain reductions at 15 minutes for ketoprofen and placebo groups were 27.5 (16-39) and 5 (4-10), respectively. Median changes in pain intensity at 30 minutes for ketoprofen and placebo gel groups were 48 (43-52) and 9 (6-16), respectively. When compared 2 arms for the pain improvement at 15 and 30 minutes, the differences between 2 study drugs were 20 (13-28) and 35 (29-41), respectively. There were 7 (12.7%) rescue drug needs in the placebo group and 1 (1.7%) in the ketoprofen group (difference, 10.9%; 95% confidence interval, -6% to 7%; P = 0.83). There were no adverse effects in either group. CONCLUSIONS Ketoprofen gel is superior to placebo in ceasing pain in children presenting with ankle sprain to the ED with a high safety profile.
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2.
Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review.
van Hoeve, S, Poeze, M
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2019;(4):748-754
Abstract
Since the end of the 1990s, several multisegment foot models (MSFMs) have been developed. Several models were used to describe foot and ankle kinematics in patients with foot and ankle pathologies; however, the diagnostic value for clinical practice of these models is not known. This review searched in the literature for studies describing kinematics in patients after foot and ankle trauma using an MSFM. The diagnostic value of the MSFMs in patients after foot and ankle trauma was also investigated. A search was performed on the databases PubMed/MEDLINE, Embase, and Cochrane Library. To investigate the diagnostic value of MSFMs in patients after foot and ankle trauma, studies were classified and analyzed following the diagnostic research questions formulated by Knottnerus and Buntinx. This review was based on 7 articles. All studies were published between 2010 and 2015. Five studies were retrospective studies, and 2 used an intervention. Three studies described foot and ankle kinematics in patients after fractures. Four studies described foot and ankle kinematics in patients after ankle sprain. In all included studies, altered foot and ankle kinematics were found compared with healthy subjects. No results on patient outcome using MSFMs and costs were found. Seven studies were found reporting foot and ankle kinematics in patients after foot and ankle trauma using an MSFM. Results show altered kinematics compared with healthy subjects, which cannot be seen by other diagnostic tests and add valuable data to the present literature; therefore, MSFMs seem to be promising diagnostic tools for evaluating foot and ankle kinematics. More research is needed to find the additional value for MSFMs regarding patient outcome and costs.
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3.
The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.
Sefiddashti, L, Ghotbi, N, Salavati, M, Farhadi, A, Mazaheri, M
Journal of bodywork and movement therapies. 2018;(3):805-809
Abstract
PURPOSE Hamstring strain is a common sport injury that results in pain and functional limitation. Despite its high frequency in active populations, there is no agreement regarding the best method used for early intervention of hamstring strain. The aim of the present study was to compare the effects of cryotherapy and cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. MATERIALS AND METHODS Thirty seven elite athletes with an acute grade I or II hamstring strain were randomly assigned to either cryotherapy (n = 19) or cryostretching (n = 18) group, receiving 5 sessions of supervised treatment plus home-based intervention monitored by the therapist. Pre-treatment to post-treatment changes in pain, active and passive knee extension range of motion and functional status were compared between the two groups. RESULTS Compared to cryotherapy, cryostretching resulted in larger improvement of function and passive knee extension range of motion. Changes in active knee extension range of motion and pain severity were not significantly different between the two groups. CONCLUSION A rehabilitation protocol involving gentle stretching following cryotherapy is more effective than cryotherapy alone in the improvement of function and passive knee range of motion in patients with grade I and II hamstring strain.
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4.
Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training.
Shield, AJ, Bourne, MN
Sports medicine (Auckland, N.Z.). 2018;(3):513-524
Abstract
Hamstring strain injuries are endemic in running-based sports. Given the economic and performance implications of these injuries, a significant body of research has emerged in recent years in an attempt to identify risk factors and develop or optimise injury prevention strategies. Surveys of injury prevention practices among medical and conditioning staff in elite sport suggest that many sporting clubs invest significant efforts in eccentric hamstring conditioning and lumbo-pelvic or trunk stability programmes. The purpose of this narrative review was to critically evaluate the evidence underpinning these practices. Single-exercise eccentric training interventions have proven effective in the prevention of primary and recurrent hamstring strains, when compliance is adequate. However, despite its almost universal acceptance, the authors are aware of only one, very recent, prospective risk factor study examining the effect of lumbo-pelvic motion during sprinting on hamstring injury risk. Furthermore, the interventions exploring the effect of lumbo-pelvic training on hamstring injury rates have not measured stability in any way. An improved understanding of the evidence underpinning commonly employed hamstring injury prevention practices may enable clinicians and coaches to better prioritise effective strategies in the increasingly complex environment of elite sport.
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5.
Clinical effects of Zingiber cassumunar (Plai): A systematic review.
Chongmelaxme, B, Sruamsiri, R, Dilokthornsakul, P, Dhippayom, T, Kongkaew, C, Saokaew, S, Chuthaputti, A, Chaiyakunapruk, N
Complementary therapies in medicine. 2017;:70-77
Abstract
Zingiber cassumunar Roxb. known locally as "Plai" in Thai, has been used for treating bruise, sprain and musculoskeletal pain. Several pre-clinical studies demonstrated the anti-inflammatory effect of Plai. However, current evidence of clinical effects of Plai is still unclear. This study aimed to determine the clinical efficacy and safety of Plai among all identified indications. Of the 808 articles identified by a systematic review, six studies were included. Four studies were randomized controlled trials, while two studies were quasi-experimental studies involving 178 patients in intervention group and 177 patients in control group. Duration of treatment ranged from 7days to 2 months. Our findings showed that 14% Plai cream had a strong trend of benefits in pain reduction for muscle pain and ankle sprain. However, evidence supporting the effects of Plai on acne vulgaris treatment and anti-histamine effect are still unclear.
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6.
Effect of high-speed running on hamstring strain injury risk.
Duhig, S, Shield, AJ, Opar, D, Gabbett, TJ, Ferguson, C, Williams, M
British journal of sports medicine. 2016;(24):1536-1540
Abstract
BACKGROUND Hamstring strain injuries (HSIs) are common within the Australian Football League (AFL) with most occurring during high-speed running (HSR). Therefore, this study investigated possible relationships between mean session running distances, session ratings of perceived exertion (s-RPE) and HSIs within AFL footballers. METHODS Global positioning system (GPS)-derived running distances and s-RPE for all matches and training sessions over two AFL seasons were obtained from one AFL team. All HSIs were documented and each player's running distances and s-RPE were standardised to their 2-yearly session average, then compared between injured and uninjured players in the 4 weeks (weeks -1, -2, -3 and -4) preceding each injury. RESULTS Higher than 'typical' (ie, z=0) HSR session means were associated with a greater likelihood of HSI (week -1: OR=6.44, 95% CI=2.99 to 14.41, p<0.001; summed weeks -1 and -2: OR=3.06, 95% CI=2.03 to 4.75, p<0.001; summed weeks -1, -2 and -3: OR=2.22, 95% CI=1.66 to 3.04, p<0.001; and summed weeks -1, -2, -3 and -4: OR=1.96, 95% CI=1.54 to 2.51, p<0.001). However, trivial differences were observed between injured and uninjured groups for standardised s-RPE, total distance travelled and distances covered whilst accelerating and decelerating. Increasing AFL experience was associated with a decreased HSI risk (OR=0.77, 95% CI 0.57 to 0.97, p=0.02). Furthermore, HSR data modelling indicated that reducing mean distances in week -1 may decrease the probability of HSI. CONCLUSIONS Exposing players to large and rapid increases in HSR distances above their 2-yearly session average increased the odds of HSI. However, reducing HSR in week -1 may offset HSI risk.
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7.
Topical Ketoprofen Versus Placebo in Treatment of Acute Ankle Sprain in the Emergency Department.
Serinken, M, Eken, C, Elicabuk, H
Foot & ankle international. 2016;(9):989-93
Abstract
BACKGROUND Topical agents have been shown to be effective in soft tissue injuries and commonly used in outpatient clinics. However, the data regarding topical agents in the emergency department is insufficient, and they are not used often in the emergency department setting. The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in patients presenting with ankle sprain to the emergency department. METHODS Patients presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered over a 5-cm area locally. Pain alleviation was measured by visual analog scale at 15 and 30 minutes. A total of 100 patients were included in the final analysis. RESULTS The median pain reduction in ketoprofen and placebo groups at 15 minutes was 27 (19.8-33.4) and 9 (7.6-17), respectively. The median pain reduction at 30 minutes for both groups was 42 (36-50.8) and 20 (17.6-24.4), respectively. Pain improvement either at 15 minutes (median difference: 16 [9-22]) or 30 minutes (median difference: 21 [15-27]) was better in the ketoprofen group than placebo. There were no adverse effects in either group. CONCLUSION Ketoprofen gel was superior to placebo at 30 minutes in alleviating pain secondary to ankle sprain in the ED with a high safety profile. Further studies are needed concerning the effect of ketoprofen gel for long-term effects. LEVEL OF EVIDENCE Level I, high quality prospective randomized study.
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8.
Hamstring strength and flexibility after hamstring strain injury: a systematic review and meta-analysis.
Maniar, N, Shield, AJ, Williams, MD, Timmins, RG, Opar, DA
British journal of sports medicine. 2016;(15):909-20
Abstract
OBJECTIVE To systematically review the evidence base related to hamstring strength and flexibility in previously injured hamstrings. DESIGN Systematic review and meta-analysis. DATA SOURCES A systematic literature search was conducted of PubMed, CINAHL, SPORTDiscus, Cochrane Library, Web of Science and EMBASE from inception to August 2015. INCLUSION CRITERIA Full-text English articles which included studies which assessed at least one measure of hamstring strength or flexibility in men and women with prior hamstring strain injury within 24 months of the testing date. RESULTS Twenty-eight studies were included in the review. Previously injured legs demonstrated deficits across several variables. Lower isometric strength was found <7 days postinjury (d=-1.72), but this did not persist beyond 7 days after injury. The passive straight leg raise was restricted at multiple time points after injury (<10 days, d=-1.12; 10-20 days, d=-0.74; 20-30 days, d=-0.40), but not after 40-50 days postinjury. Deficits remained after return to play in isokinetically measured concentric (60°/s, d=-0.33) and Nordic eccentric knee flexor strength (d=-0.39). The conventional hamstring to quadricep strength ratios were also reduced well after return to play (60:60°/s, d=-0.32; 240:240°/s, d=-0.43) and functional (30:240°/s, d=-0.88), but these effects were inconsistent across measurement methods. CONCLUSIONS After hamstring strain, acute isometric and passive straight leg raise deficits resolve within 20-50 days. Deficits in eccentric and concentric strength and strength ratios persist after return to play, but this effect was inconsistent across measurement methods. Flexibility and isometric strength should be monitored throughout rehabilitation, but dynamic strength should be assessed at and following return to play.
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9.
Diclofenac patch for the treatment of acute pain caused by soft tissue injuries of limbs: a randomized, placebo-controlled clinical trial.
Predel, HG, Pabst, H, Schäfer, A, Voss, D, Giordan, N
The Journal of sports medicine and physical fitness. 2016;(1-2):92-9
Abstract
BACKGROUND This study aimed to assess the efficacy and the safety of a newly-developed patch containing diclofenac sodium 140 mg in patients affected by acute soft tissue sport injuries, such as contusion, strain and sprain with a randomised, double-blind, placebo-controlled trial. METHODS One hundred and sixty-four subjects were recruited within 3 hours of a soft-tissue sport injury and were equally assigned to receive diclofenac or placebo patch applied twice a day for 7 days. The primary study endpoint was reduction in severity of pain on movement from baseline to 48 hours measured by Visual Analogue Scale. Secondary outcomes were reduction of pain on movement and at rest, reduction of pain on pressure, time to efficacy onset, global efficacy assessment and use of rescue analgesics. RESULTS The reduction of pain on movement from baseline to day 2 was markedly greater in the diclofenac group compared with placebo (treatment effect: -24.25 mm, P<0.001 between groups). Statistically significant improvements were also observed in the diclofenac group compared to placebo for the secondary variables of pain on movement and at rest, pain on pressure, time to efficacy onset and global patient and investigator efficacy assessment. Local adverse reactions at the application site were reported in comparable rates in the two groups. CONCLUSIONS The diclofenac patch could be a safe and effective alternative to the oral administration of non-steroidal anti-inflammatory drugs in the treatment of minor sport injuries.
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10.
Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival.
Opar, DA, Drezner, J, Shield, A, Williams, M, Webner, D, Sennett, B, Kapur, R, Cohen, M, Ulager, J, Cafengiu, A, et al
Scandinavian journal of medicine & science in sports. 2014;(4):e254-9
Abstract
This study aimed to observe the incidence rates of hamstring strain injuries (HSIs) across different competition levels and ages during the Penn Relays Carnival. Over a 3-year period, all injuries treated by the medical staff were recorded. The type of injury, anatomic location, event in which the injury occurred, competition level, and demographic data were documented. Absolute and relative HSI (per 1000 participants) were determined, and odds ratios (ORs) were calculated between sexes, competition levels, and events. Throughout the study period 48,473 athletes registered to participate in the Penn Relays Carnival, with 118 HSIs treated by the medical team. High school girls displayed lesser risk of HSI than high school boys (OR = 0.55, P = 0.021), and masters athletes were more likely than high school- (OR = 4.26, P < 0.001) and college-level (OR = 3.55, P = 0.001) athletes to suffer HSI. The 4 × 400-m relay displayed a greater likelihood of HSI compared with the 4 × 100-m relay (OR = 1.77, P = 0.008). High school boys and masters-level athletes are most likely to suffer HSI, and there is higher risk in 400-m events compared with 100-m events.