Last week I shared the first paper I had written during chiropractic college. Turns out, that was the first final paper I wrote. For the same class, I had to complete a research paper earlier, though only a week earlier.

The topic I chose was ankle sprains. I did a literature search and wrote a summary of my findings. Not bad, for my first attempt. Though, it took me quite some time to track down the actual papers I cited, since I didn’t include a proper biography. It turns out that a couple of the papers I used were not quite what I thought they were–one was a thesis from UWS, the other was in a journal that no longer exists.

Nevertheless, it’s nice to look back and realize I wasn’t a complete idiot when it came to writing papers.

Sports Injuries: Ankle Sprain

Principles 1

UWS - 1st Quarter

Summary of Findings

Manipulation

Two of the articles I reviewed focused on the benefits of joint manipulation, both as a preventive measure and as a treatment. Köhne, et. al.,¹ assessed 30 patients with recurrent ankle sprains and compared a single ankle manipulation to multiple manipulations. Their goal was to determine whether ankle manipulations could improve proprioception which is thought to improve resistance to further sprains. The results were positive with a dose response effect – the patients receiving more adjustments had improvements in proprioceptive tests. The authors suggest that this result implies that the patients would have a decreased risk of future ankle sprain.

The second article, by Pellow,² compared a specific ankle adjustment with ultrasound treatment in a group of 15 patients and included a follow-up evaluation after 1 month. Manipulation was once again found to be an effective treatment. We will discuss ultrasound in the next section.

Ultrasound

Two articles mention the use of ultrasound as a therapy for ankle sprains. The aforementioned article by Pellow found manipulation to be more effective than ultrasound treatment, although patients treated with ultrasound did show improvement in subjective pain rating scales and ROM readings.

However, Swain & Henschke,³ in the British Journal of Sports Medicine, compared ultrasound with placebo treatment on athletes with acute ankle pain. While all of the patients improved during the 1 to 4 weeks post-treatment, those who received ultrasound had no marked improvement over those who received placebo.

Rehabilitation

Beyond preventive and palliative care, chiropractic and conservative care offers a variety of treatments to rehabilitate injured ankles. Three studies discussed post-acute treatment of such injuries. Pajaczkowski¹ evaluated progressive resistance exercises, proprioceptive challenges, plyometric exercises, and sport-specific agility drills. Snow² confirms the benefits of proprioceptive exercises, citing wobble and rocker board training specifically.

Topic researched: Sports Injury - Ankle Sprain

Search strategy

I chose gather as many related articles as I could find at first. I began in SPORTDiscus with the search term “ankle sprain” which returned way too many results, most of which were not specific to chiropractic and sports injuries. I began adding terms and settled on “chiropractic AND sports AND ankle AND (sprain OR injury)”. I added articles to a folder if I determined their title was specific enough to the information I was looking for. After searching through the first couple of pages of results, I exported that folder of articles to RefWorks into a collection for this project. I continued searching in Rehabilitation & Sports Medicine Source, Physical Therapy & Sports Medicine Collection, and AMED: Alternative and Complementary Medicine.

I then returned to RefWorks and reviewed the articles I collected. I opened each one, skimmed the abstract and determined whether it contained the specific information I was looking for. Then I printed it and read the abstract or article in more detail.

Useful Databases

I found SPORTDiscus to have a set of results that was relevant and specific to my search terms. The majority of the articles were intervention studies, whereas other databases resulted in a majority of case studies which, while interesting, do not provide clinical guidance.

Preferred Databases

I prefer to use the Cochrane Database. Systematic reviews provide the most statistically valid information. However, when limited studies are available, other databases like SPORTDiscus have relevant case studies and smaller cohort experiments.

Problems encountered

It was difficult to navigate RefWorks at first – the user interface allowed me to get confused between articles – but after experimenting with different layout views, I found one that was easier to navigate. I also struggled to find the proper links back to the actual article (in Full View, up to 3 links are provided to view the article, only one of which would actually load). Some links would only provide the citation and abstract, while others would provide another link to the full text of the article. One particular article took me over 30 minutes to find – the catalog showed it as being held locally, but after searching the shelves and seeking help from a librarian, it was found to in fact be available at the publisher’s web site. It can be frustrating to have to navigate so many levels of databases and log-in credentials, when one is used to the immediate satisfaction of finding answers on Google.

Time

I began the assignment the first week of the quarter and spend 30-60 minutes at least every other week. Most of my time was spent on the library tutorial section, with a good 1/3 of the time spent on the research portion. I have spent at least 5-6 hours on the assignment.

References

Köhne, E., Jones, A., Korporaal, C., Price, J. L., Brantingham, J. W., & Globe, G. (2007). A Prospective, Single-Blinded, Randomized, Controlled Clinical Trial of the Effects of Manipulation on Proprioception and Ankle Dorsiflexion in Chronic Recurrent Ankle Sprain. Journal of the American Chiropractic Association, 44(5), 7–17. ↩︎
Pellow, J. E., & Brantingham, J. W. (2001). The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. Journal of Manipulative and Physiological Therapeutics, 24(1), 17–24. ↩︎
Swain, M., & Henschke, N. (2012). Therapeutic ultrasound is not clinically beneficial for acute ankle sprains. British Journal of Sports Medicine, 46(4), 241–242. ↩︎
Pajaczkowski, J. A. (2007). Rehabilitation of distal tibiofibular syndesmosis sprains: a case report. The Journal of the Canadian Chiropractic Association, 51(1), 42–49. ↩︎
Snow, S. (1997). Proprioceptive rehabilitation of ankle sprain injuries. Thesis. Western States Chiropractic College. ↩︎