Clinical Scenario: Balance impairment is common in patients with chronic ankle instability (CAI), especially during dynamic tasks. Manual therapies, such as ankle joint mobilizations are known to improve clinician-oriented outcomes such as dorsiflexion range of motion, but their impact on sensorimotor outcomes such as dynamic postural control and the retention of benefits remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve dynamic postural control in patients with CAI relative to a control condition and are those benefits retained after termination of the treatment? Summary of Key Findings: Three studies quantified the immediate effect and two studies quantified the retained benefit of anterior-to-posterior ankle joint mobilizations on improving Star Excursion Balance Test (SEBT) reach distances. Two studies demonstrated large immediate improvements in SEBT reach distances and those same investigations found that those large improvements were retained. Clinical Bottom Line: Ankle joint mobilization appears to improve SEBT reach distances and those improvements are retained. Strength of Recommendation: Strength of recommendation is a B due to inconsistent moderate-quality patient-oriented evidence.
Erik A. Wikstrom, Sajad Bagherian, Gary Allen and Kyeongtak Song
Walter E. Davis, Boni Boswell, Allen W. Burton, Stephen A. Butterfield, Pat DiRocco, Susan J. Hall, Gary Kamen, Jeff McCubbin, Wayne Munson and Terry L. Rizzo
Gary Allen, Kristy Smith, Brady Tripp, Jason Zaremski and Seth Smith
We present a case of a 17-year-old White male high school American football player who was diagnosed with an anomalous left coronary artery arising from the right coronary sinus after experiencing dizziness, near-syncope, and altered mental status during a football practice. The symptoms were recognized by an on-site certified athletic trainer who activated emergency medical response. After unremarkable initial emergency evaluation, referral to a sports cardiologist unveiled an anomalous left coronary artery arising from the right coronary sinus on echocardiogram. After surgical correction and rehabilitation, the patient was able to return to exercise activity. Anomalous coronary arteries are the second most common cause of autopsy-positive episodes of sudden cardiac death among athletes and are rarely recognized with abnormal electrocardiogram (EKG) findings prior to events. This case highlights the importance of prompt recognition, evaluation, and treatment of athletes with cardiac symptoms, and contributes to an ongoing discussion on whether echocardiograms should be considered in preparticipation evaluations.