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Michael G. Dolan and Frank C. Mendel

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Graig R. Denegar, Jay Hertel and Sayers John Miller

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

Context:

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.

Objectives:

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.

Conclusions:

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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Frank C. Mendel, Michael G. Dolan, Dale R. Fish, John Marzo and Gregory E. Wilding

Context:

High-voltage pulsed current (HVPC), a form of electrical stimulation, is known to curb edema formation in laboratory animals and is commonly applied for ankle sprains, but the clinical effects remain undocumented.

Objective:

To determine whether, as an adjunct to routine acute and subacute care, subsensory HVPC applied nearly continuously for the first 72 h after lateral ankle sprains affected time lost to injury.

Design:

Multicenter, randomized, double-blind, placebo-controlled trial.

Setting:

Data were collected at 9 colleges and universities and 1 professional training site.

Participants:

50 intercollegiate and professional athletes.

Interventions:

Near-continuous live or placebo HVPC for 72 h postinjury in addition to routine acute and subacute care.

Main Outcome Measure:

Time lost to injury measured from time of injury until declared fit to play.

Results:

Overall, time lost to injury was not different between treated and control groups (P = .55). However, grade of injury was a significant factor. Time lost to injury after grade I lateral ankle sprains was greater for athletes receiving live HVPC than for those receiving placebo HVPC (P = .049), but no differences were found between groups for grade II sprains (P = .079).

Conclusions:

Application of subsensory HVPC had no clinically meaningful effect on return to play after lateral ankle sprain.

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3 3 6 6 From the Editor Jimmy’s Right Joe Godek 11 1998 3 3 6 6 3 3 3 3 10.1123/att.3.6.3 Research Electrotherapy and the Athletic Therapist: Theme Intmduction Douglas M. Kleiner PhD, ATC 11 1998 3 3 6 6 5 5 5 5 10.1123/att.3.6.5 Guidelines to Enhance Therapeutic Ultrasound Treatment Outcomes

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Michael J Higgins PhD, ATC/PT Carl O. Eaton MS, ATC/PT 9 2004 9 9 5 5 6 6 10 10 10.1123/att.9.5.6 Clinical Application of Electrotherapy Michael G. Dolan MA, ATC, CSCS Frank C. Mendel PhD 9 2004 9 9 5 5 11 11 16 16 10.1123/att.9.5.11 Low-Level Laser Therapy in Athletic Training Ian A. Mcleod MEd

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Fatemeh Ehsani, Rozita Hedayati, Rasool Bagheri and Shapour Jaberzadeh

of the participants in each group are shown in Table  1 . The SE group received supervised progressive SE program plus electrotherapy, and the control group received GE program plus electrotherapy. The examiner who evaluated the outcomes was blinded to group assignment completely, and the patients in

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Mohamed Abdelmegeed, Everett Lohman, Noha Daher, June Kume and Hasan M. Syed

motion. During the remodeling phase, therapists can progress to use serial splints, active and active assistive exercises, with heat, stretching, and electrotherapy modalities when appropriate. 2 Conservative management of TFCC injuries may include protective bracing and strengthening (if tolerated). 2