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Diane Madras and J. Bradley Barr

Objective:

The article presents a focused review of the literature surrounding training methods for addressing the proprioceptive loss and subsequent balance problems that result from inversion ankle sprains.

Data Sources:

The authors searched the MEDLINE and CINAHL databases for the period 1985 through December 2001 using the key words ankle, ankle sprain, and rehabilitation.

Study Selection:

Any study investigating a rehabilitation or prevention program for the proprioceptive or balance aspects of ankle instability was included.

Data Synthesis:

Key components of the training regimen used in each study are described, and major findings are summarized.

Conclusions:

Based on the literature reviewed, there is evidence to suggest that training programs for individuals with ankle instability that include ankle-disk or wobble-board activities help improve single-leg-stance balance and might decrease the likelihood of future sprains.

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Kevin E. Wilk, James R. Andrews, William G. Clancy Jr., Heber C. Crockett and James W. O'Mara Jr.

Treatment of posterior cruciate ligament (PCL) injuries has changed considerably in recent years. This article discusses current rehabilitation for PCL disruptions in athletes. The treatment of PCL injuries varies somewhat based on the chronicity (acute vs. chronic) of injury and associated pathologies. The authors provide their treatment algorithm for the acute and chronic PCL-injured-knee patient. Nonoperative rehabilitation is discussed with a focus on immediate motion, quadriceps muscle strengthening, and functional rehabilitation. A discussion of the biomechanics of exercise is provided, with a focus on tibiofemoral shear forces and PCL strains. Surgical treatment is also discussed, with the current surgical approach being either the two-tunnel or the one-tunnel patellar tendon autograft procedure. The rehabilitation program after surgery is based on the healing constraints, surgical technique, biomechanics of the PCL during functional activities, and exercise. With the new changes in surgical technique and in the rehabilitation process, the authors believe that the outcome after PCL reconstruction will be enhanced.

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Ailsa Niven

Context:

Athlete’s adherence behavior can influence the outcome of a rehabilitation program.

Objective:

To draw on sport physiotherapists’ expert knowledge to increase understanding of adherence issues in practice and identify factors that influence adherence and strategies that can be used to enhance adherence.

Design:

An interview design with inductive content analysis.

Participants:

Nine (6 women and 3 men) experienced sports physiotherapists.

Results:

Under-adherence and over-adherence were issues in practice for some practitioners, and adherence was viewed as important for successful recovery from injury. Three higher order themes emerged relating to the influence of athlete characteristics, situational characteristics, and characteristics of the injury and rehabilitation on both facilitating and preventing rehabilitation adherence. Strategies to improve adherence in practice emerged from the data and broadly addressed the key determinants of adherence.

Conclusion:

Adherence to rehabilitation is influenced by a number of factors and strategies to enhance adherence are identified.

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Kelly L. Adler, P. Christopher Cook and Brian D. Giordano

Injury to the rectus femoris (RF) myotendinous complex is the most common location of quadriceps injury, due to combined loads of stretch and eccentric muscular activation. To our knowledge, open proximal RF repair has been reported, but a thorough description of postoperative rehabilitation and functional progression of athletic activity has not been described. This case report outlines the rehabilitation of a 30-year-old female following open proximal RF repair after 15 months of failed conservative treatment. Six months postoperatively she returned to competitive recreational soccer with no complaints.

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Andrew R. Levy, Remco C.J. Polman, Peter J. Clough, David C. Marchant and Keith Earle

Objective:

To investigate the relationship between mental toughness, sport injury beliefs, pain, and adherence toward a sport injury rehabilitation program.

Design:

A prospective design was employed that evaluated adherence over the entire rehabilitation period.

Participants:

70 patients undertaking a sport injury rehabilitation program for a tendonitis related injury.

Main Outcome Measures:

Adherence was measured using self report measures of clinic and home based rehabilitation alongside attendance.

Results:

No association was found between mental toughness and coping appraisals, although high mentally tough individuals displayed more positive threat appraisals and were better able to cope with pain than their less mentally tough counterparts. Greater attendance at rehabilitation sessions was displayed by more mentally tough individuals; however, more positive behavior during clinic rehabilitation was characterized by low mental toughness.

Conclusions:

Despite the 0benefits of being mentally tough, sports medicine providers need to be aware that a high degree of mental toughness may have negative consequences upon rehabilitation behavior and subsequently recovery outcomes.

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Kelly Copperthite Ranalli

Total talar dislocations without associated fractures are extremely rare traumatic events that are described sparingly in research and are currently without a standardized treatment protocol. This report highlights rehabilitation for this injury following a fall from a great height with eventual return to prior level of function and with minimal complications.

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Laura Desveaux, Roger Goldstein, Sunita Mathur and Dina Brooks

Nonadherence to exercise is a main cause of reduced function for older adults with chronic disease following completion of rehabilitation. This quantitative study used a questionnaire to evaluate the barriers and facilitators to community-based exercise following rehabilitation, from the perspectives of older adults with chronic diseases and their healthcare professionals (HCPs). Questionnaires were administered one-on-one to 83 older adults and 35 HCPs. Those with chronic disease perceived cost (43%), travel time (43%), and physical symptoms (39%) as primary barriers to program participation, with similar perceptions across all chronic conditions. Access to a case manager (82%), a supported transition following rehabilitation (78%), and a condition-specific program (78%) were the primary facilitators. Significant between group differences were found between HCPs and older adults with chronic disease across all barriers (p < .001), with a greater number of HCPs perceiving barriers to exercise participation. There were no between-group differences in the perception of factors that facilitate participation in exercise.

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Rachel E. Brinkman-Majewski and Windee M. Weiss

Although injury prevention is one of the primary goals for athletic trainers, the nature of physical activity and sport participation dictates that some individuals will ultimately become injured and undergo injury treatment and rehabilitation. 1 Until the 1990s, athletic trainers and other

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Karen M. Griffin, Cindy O. Henry and J. W. Thomas Byrd

Objective:

To explain the basic fundamentals of patient assessment after hip arthroscopy, formulation of a treatment plan, and detailed essentials of postoperative rehabilitation.

Data Sources:

Established literature and the evolution of a protocol developed in treating over 150 hip-arthroscopy patients and numerous patients with symptomatic hip disease.

Data Synthesis:

Although the pathological process being addressed and the surgical technique employed in its management influence the protocol, the common goals of rehabilitation are to reduce discomfort and improve function. These common goals, first realized in the postoperative rehabilitation process, have been found to have similar application in the conservative management of patients with symptomatic hip disease.

Conclusions:

Arthroscopy has necessitated the development of a postoperative rehabilitation protocol. Principles previously employed in other joints are now finding application in the hip.