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Berkiye Kirmizigil, Jeffry Roy Chauchat, Omer Yalciner, Gozde Iyigun, Ender Angin and Gul Baltaci

literature, we noticed that the KT inhibition technique was not used on rectus femoris muscle. This study aims to investigate whether the application of rectus femoris KT inhibition technique after DOMS enhances recovery of muscle soreness, edema, and physical performance. Thus, we hypothesized that the

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Andrew L. McDonough and Joseph P. Weir

The purpose of this case study was to investigate reflex inhibition of the quadriceps femoris in a subject with postsurgical edema of the left knee. The subject was a 45-year-old male with a traumatic knee injury with resultant edema who underwent elective arthroscopic surgery. Reflex inhibition was assessed by H-reflex elicitation in the femoral nerve and surface electromyography of the quadriceps. To assess the degree of edema, direct circumferential measurements were taken. On the first presurgical visit, the left knee demonstrated mild edema with a decrease in H-reflex amplitudes. Two days after surgery, a further reduction in amplitudes and more swelling were demonstrated followed by an increase in amplitudes and a reduction in edema on the 28th postoperative day. These findings document a relationship between reflex inhibition and joint swelling that was previously described in experimental models where joint edema was simulated.

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Alison R. Snyder, April L. Perotti, Kenneth C. Lam and R. Curtis Bay


Electrical stimulation is often used to control edema formation after acute injury. However, it is unknown whether its theoretical benefits translate to benefits in clinical practice.


To systematically review the basic-science literature regarding the effects of high-voltage pulsed stimulation (HVPS) for edema control.

Evidence Acquisition:

CINAHL (1982 to February 2010), PubMed (1966 to February 2010), Medline (1966 to February 2010), and SPORTDiscus (1980 to February 2010) databases were searched for relevant studies using the following keywords: edema, electrical stimulation, high-volt electrical stimulation, and combinations of these terms. Reference sections of relevant studies were hand-searched. Included studies investigated HVPS and its effect on acute edema formation and included outcome measures specific to edema. Eleven studies met the inclusion criteria. Methodological quality and level of evidence were assessed for each included study. Effect sizes were calculated for primary edema outcomes.

Evidence Synthesis:

Studies were critiqued by electrical stimulation treatment parameters: mode of stimulation, polarity, frequency, duration of treatment, voltage, intensity, number of treatments, and overall time of treatments. The available evidence indicates that HVPS administered using negative polarity, pulse frequency of 120 pulses/s, and intensity of 90% visual motor contraction may be effective at curbing edema formation. In addition, the evidence suggests that treatment should be administered in either four 30-min treatment sessions (30-min treatment, 30-min rest cycle for 4 h) or a single, continuous180-min session to achieve the edemasuppressing effects.


These findings suggest that the basic-science literature provides a general list of treatment parameters that have been shown to successfully manage the formation of edema after acute injury in animal subjects. These treatment parameters may facilitate future research related to the effects of HVPS on edema formation in humans and guide practical clinical use.

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Guilherme S. Nunes, Igor Yamashitafuji, Bruna Wageck, Guilherme Garcia Teixeira, Manuela Karloh and Marcos de Noronha

Context: The treatment of edema after a knee injury is usually 1 of the main objectives during rehabilitation. To assess the success of treatment, 2 methods are commonly used in clinical practice: volumetry and perimetry. Objective: To investigate the intra- and interassessor reliability of volumetry and perimetry to assess knee volume. Design: Cross-sectional. Setting: Laboratory. Participants: 45 health participants (26 women) with mean age of 22.4 ± 2.8 y. Main Outcome Measures: Knee volume was assessed by 3 assessors (A, B, and C) with 3 methods (lower-limb volumetry [LLV], knee volumetry [KV], and knee perimetry [KP]). Assessor A was the most-experienced assessor, and assessor C, the least experienced. LLV and KV were performed with participants in the orthostatic position, while KP was performed with participants in supine. Results: For the interassessor analysis, the ICC2,1 was high (.82) for KV and very high for LLV (.99) and KP (.99). For the intra-assessor analysis, ICC2,1 ranged from moderate to high for KV (.69-.83) and was very high for LLV (.99) and KP (.97-.99). Conclusion: KV, LLV, and KP are reliable methods, both intra- and interassessor, to measure knee volume.

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Jennifer A. Stone

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John A. Norwig

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James W. Youdas, Timothy J. McLean, David A. Krause and John H. Hollman


Posterior calf stretching is believed to improve active ankle dorsiflexion range of motion (AADFROM) after acute ankle-inversion sprain.


To describe AADFROM at baseline (postinjury) and at 2-wk time periods for 6 wk after acute inversion sprain.


Randomized trial.


Sports clinic.


11 men and 11 women (age range 11–54 y) with acute inversion sprain.


Standardized home exercise program for acute inversion sprain.

Main Outcome Measure:

AADFROM with the knee extended.


Time main effect on AADFROM was significant (F 3,57 = 108, P < .001). At baseline, mean active sagittal-plane motion of the ankle was 6° of plantar flexion, whereas at 2, 4, and 6 wk AADFROM was 7°, 11°, and 11°, respectively.


AADFROM increased significantly from baseline to week 2 and from week 2 to week 4. Normal AADFROM was restored within 4 wk after acute inversion sprain.

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Thilo Hotfiel, Marion Kellermann, Bernd Swoboda, Dane Wildner, Tobias Golditz, Casper Grim, Martin Raithel, Michael Uder and Rafael Heiss

kinase (CK) analysis, and a clinical assessment, each before and 60 hours after the eccentric exercise training. The main dependent variables in the study were absolute values of ARFI parameters represented as intramuscular SWVs. The MRI was performed as reference standard to confirm intramuscular edema

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Tricia Majewski-Schrage and Kelli Snyder

Clinical Scenario:

Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements.

Focused Clinical Question:

Does MLD improve patient- and disease-oriented outcomes for patients with orthopedic injuries?