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Original research
Abstract
Objectives: To determine the efficacy of ultrasound treatment in the management of acute lateral ligament sprains of the ankle joint.
Design: Single-blind randomized controlled trial.
Setting: Physiotherapy Department of St Lukes Hospital, Malta.
Participants: Thirty-four patients with acute lateral ligament sprains of the ankle joint presenting to the Accident and Emergency Department
of St Lukes Hospital, Malta were randomly assigned to one of three treatment groups: active ultrasound treatment group (nZ12); placebo
ultrasound treatment group (nZ10); no ultrasound treatment group (nZ12).
Main outcome measures: Pain (visual analogue scale), swelling (tape measure), range of motion during dorsiflexion and plantarflexion
(universal 3608 goniometer), and postural stability (balance error scoring system) were measured on days 1 (baseline), 8, 15 and 22.
Results: No statistically significant differences (aZ0.05) between treatment groups were detected in any outcome measure. Within treatment
groups, statistically significant differences (aZ0.05) were detected in pain, swelling, range of motion during dorsiflexion and plantarflexion,
and postural stability.
Conclusions: At the dose and duration used, ultrasound treatment does not increase the effectiveness of management of acute lateral ligament
sprains of the ankle joint, with respect to the following outcomes: pain, swelling, range of motion during dorsiflexion and plantarflexion, and
postural stability.
q 2005 Elsevier Ltd. All rights reserved.
Keywords: Ultrasound therapy; Ankle injuries; Lateral ligament sprains; Inversion injuries
1. Introduction
Ankle injuries are one of the commonest causes of
referral to the Accident and Emergency Department
(Packer, Goring, Gayner, & Craxford, 1991), with lateral
sprains accounting for up to 95% of all ankle injuries
(Gooch, Geiringer, & Akau, 1993) and 12% of all injuries
(Garrick & Requa, 1988). Despite their importance, there is
still debate regarding the management of acute ankle sprains
(Van der Windt et al., 2003). Standard treatment usually
comprises of rest, ice, compression and leg elevation, but
* Corresponding author. Tel.: C44 1 61 295 2326; fax: C44 1 61 295
2395.
E-mail address: l.c.herrington@salford.ac.uk (L. Herrington).
1466-853X/$ - see front matter q 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ptsp.2005.05.002
2. Methods
2.1. Participants
Thirty-four patients with acute lateral ligament sprains of
the ankle joint presenting to the Accident and Emergency
Department of St Lukes Hospital, Malta met the criteria
(Tables 1 and 2) and were selected to participate in the
study. Informed written consent was obtained from all
participants. Ethical approval for the study was granted
117
Table 1
Inclusion criteria
Grade 1 & 2 inversion injuries of the ankle joint
Duration since, injury: O24 and !96 h
Ranging in age from 20 to 50 years
First distortion ever
118
Table 3
Demographic database
Males
Females
Age in years
Grade 1 injury
Grade 2 injury
Duration since,
injury (hours)
a
Active
ultrasound
Placebo
ultrasound
No ultrasound
4
6
29G11a
6
4
60G26a
5
5
33G12a
6
4
60G26a
5
4
30G11a
5
4
61G27a
MeanGstandard deviation.
119
Table 5
Results of pilot work
Swelling (cm)
Dorsiflexion (8)
Plantarflexion (8)
Assessment 1
Assessment 2
Assessment 3
Assessment 4
52G4.0
5.8G6.1
50G11
52G4.0
6.2G6.5
50G11
52G3.9
6.0G7.0
50G10
51G4.0
5.4G6.3
50G12
3. Results
4. Discussion
120
5. Conclusions
At the dose and duration used in this study, ultrasound
therapy is not effective in the management of acute lateral
ligament sprains of the ankle joint, with respect to the
following outcomes: pain, swelling, range of motion during
dorsiflexion and plantarflexion, and postural stability.
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