1. 1 Hydrotherapy for for ankle joint By : Wafa Al-Robaya’a

2. What is a sprained ankle? A sprained ankle is a common cause of ankle pain. A sprain is stretching and or tearing of ligaments (you sprain a ligament and strain a muscle). The most common is an inversion sprain (or lateral ligament sprain) where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.

3. Immediate First Aid for a sprained ankle: Aim to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible.RICE R is for rest. It is important to rest the injury to reduce pain and prevent further damage. Use crutches it necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation. I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack or similar immediately following injury for 15 minutes. Repeat this every 2 hours.cold therapy

4. C is for compression - This reduces bleeding and helps reduce swelling. A Lousiana wrap bandaging technique is excellent for providing support and compression to a recently injured ankle.Lousiana wrap E is for Elevation - Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you!

6. C M Bleakley, S M McDonough, D C MacAuley Br J Sports Med 2006

7. Background: The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known.

8. Objective : To compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains Subjects: Sportsmen (n = 44) and members of the general public (n = 45) with mild/moderate acute ankle sprains

9. Methods: Subjects were randomly allocated, under strictly controlled double blind conditions, to one of two treatment groups: standard ice application (n = 46) or intermittent ice application (n = 43). The mode of cryotherapy was standardised across groups and consisted of melting iced water (0°C) in a standardised pack. Function, pain, and swelling were recorded at baseline and one, two, three, four, and six weeks after injury.

10. Outcome measurement  The primary outcome measure was subjective ankle function, assessed using Binkley’s lower extremity functional scale.16 This scale has excellent test retest reliability and good construct validity.  Pain was assessed using a 10 cm visual analogue scale  Swelling was measured using a figure of eight method.

13. Results : Subjects treated with the intermittent protocol had significantly (p,0.05) less ankle pain on activity than those using a standard 20 minute protocol; however, one week after ankle injury, there were no significant differences between groups in terms of function, swelling, or pain at rest.

14. Conclusion: Intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury.

15. Calderon, Edjean; Salgado, Sharon; Candelaria, Yahaira; Bayron, Flavia; Seda, Carlos; Ortiz, Alexis ©2008The American College of Sports Medicine

16. PURPOSE: The purpose of this investigation was to determine if a combined aquatic and land therapy program was more effective than land therapy alone in improving lower extremity power and agility of injured athletes.

17. Subjects: Nine athletes were randomly assigned to land (n=5) and the combined (n=4) therapy rehabilitation programs. Physical therapy prescription was individualized to meet specific needs of the athlete and their injury. Treatment was offered three times per week for approximately 60 - 75 minutes each day.

18. METHODS: The follow-up measures were at four weeks after the beginning of therapy and included assessment of : Power hopping running agility A maximal vertical jump was used to measure lower extremity power and jumping performance.

19. METHODS: Dynamic stability during hopping and pivoting activities was measured by using a figure eight hop task. A zigzag run task was used to measure running agility.

20. METHODS: Symmetry indexes between the non injured and injured limb were calculated for the vertical jump and figure-eight tasks. Mann-Whitney U- test was used to compare differences between groups after the intervention for each of the variables.

21. RESULTS: Statistically significant differences were found for both vertical jump measures (p<.03), with the group receiving the combined therapy exhibiting better outcomes at four weeks compared to the land therapy group. No statistically significant differences for the figure eight and zigzag run results were found.

22. CONCLUSIONS: Aquatic therapy combined with land therapy helped improve lower extremity power and symmetry between both legs in young athletes after four week intervention. However, the results showed no differences in running, cutting, pivoting and agility for those elite athletes participating in either intervention. Perhaps the demands of these tasks or small sample size could have affected the results. Nevertheless, studies with bigger sample size are needed before conclusions can be drawn.

23. Adam Meakinsa, Tim Watsonb, ©Physical Therapy in Sport 7 (2006)

24. Aims: This study compare the thermal effects of longwave ultrasound (LWUS) and conductive heating (hot water bottle— HWB) on ankle mobility.

25. Design & setting: A crossover design was used (n = 18), with each of the interventions (LWUS or HWB) being compared with its own control condition. Functional ankle mobility was assessed using the weight bearing lunge test (WBLT).

27. Results: A repeated measures ANOVA results confirm that the application of local superficial heat to non- injured AT increases functional ankle mobility. Analysis revealed a statistically significant difference in the change of ankle mobility between the application of LWUS and its control session (5.45 mm, p < 0.0005) and between the application of HWB and its control session (7.5 mm, p < 0.0005). There was no statistically significant difference between the effects of the two treatments on changes in ankle mobility (1.77 mm, p = 0:125), though there was a trend for the HWB treatment to be more effective. Note : ANOVA : analysis of varince

29. Conclusions: Both LWUS and a conductive heating intervention have been shown to significantly increase functional ankle mobility under the conditions described. The demonstration that a local heat application (HWB), which can be self-administered, is at least as effective as LWUS, which has been applied in the treatment room, may prove advantageous to patients’ self- management under guidance.

30. Val J. Robertson, PhD, Alex R. Ward, PhD, Peter Jung, Bphysio Physical Medicine and Rehabilitation2005

31. Objective: To compare the effects of deep heating (shortwave diathermy [SWD]) and superficial heating (hydro collator packs) on tissue extensibility

32. Design: A double-blind, repeated-measures study. Possible effects of sex and intervention order were controlled. Participants: Twenty-four subjects with no neurologic or musculoskeletal pathologies affecting their lower limbs.

33. Interventions: Three intervention conditions: deep heating (SWD), superficial heating (hot packs), and no heating were applied in preallocated order to each subject at least 36 hours apart.

34. Main Outcome Measures: Ankle dorsiflexion in weight bearing was measured by using an inclinometer to ascertain changes in the extensibility of the calf muscles and associated soft tissues.

35. Results: Deep heating increased the range of ankle dorsiflexion by 1.8°1.9°. The change in ankle dorsiflexion after superficial and no heating was 0.7°1.5° and 0.1°1.0°, respectively

36. Conclusions: Deep heating, in the absence of stretching, increases tissue extensibility more than superficial heating or no heating. Superficial heating is more effective than no heating, but the difference was not statistically significant.

37. Thank You & Happy Holiday