JOURNAL WATCH

EFFECT OF UNSUPERVISED HOME-BASED PROPRIOCEPTIVE TRAINING ON RECURRENCES OF ANKLE SPRAIN: A RANDOMISED CONTROLLED TRIAL. Hupperets MD, Verhagen EALM, van Mechelen W. British Medical Journal 2009;339:b2684.

A cohort of 522 athletes, aged 12–70, who had

sustained a lateral ankle sprain up to 2 months before inclusion were split into an intervention group (120 females and 136 males) who received treatment plus an 8-week home-based proprioceptive training programme and a control group (128 females and 138 males) who did not undergo the extra proprioceptive exercise programme. The main outcome measure was a self-reported recurrence of ankle sprain. At a one-year follow-up, 145 of the athletes

reported recurrent ankle sprain: 56 (22%) were in the intervention group and 89 (33%) were in the control group. Nine athletes needed to be treated to prevent one recurrence. The intervention programme was associated with a 35% reduction in the risk of recurrence. Analysis showed significantly fewer recurrent ankle sprains in the intervention group compared with the control group. Some of the athletes were not medically treated at the time of injury and only started treatment at the start of the study. No significant differences were found between the medically treated athletes in the intervention

group and the medically treated controls. The athletes in the intervention group who were not medically treated had a significantly lower risk of recurrence than controls who were not medically treated.

sportEX comment

This is quite a large study and it demonstrates that this proprioceptive training programme had benefits especially in the study participants whose original sprains were not medically treated. In other words, up to two months post-injury is not too late to start treatment. There will be an article on proprioception training in sportEX Dynamics later in the year.

UNDERSTANDING THE PROCESS OF FASCIAL UNWINDING. Minasny B. International Journal of Therapeutic Massage and Bodywork 2009;2(3).

Myofascial unwinding is a popular technique in massage therapy in which a client undergoes a spontaneous reaction in response to the therapist’s

touch. It can be induced by using specific techniques that encourage a client’s body to move into positions of ease. However the science behind the mechanism behind it is not known. This paper proposes a model for the effect. During fascial unwinding, the therapist stimulates mechanoreceptors in the fascia by applying gentle touch and stretching. The touching and stretching induce relaxation and activate the parasympathetic nervous system. They also activate the central nervous system, which is involved in the modulation of muscle tone as well as movement. In this way, the central nervous system is aroused and responds by encouraging muscles to find an easier (or more relaxed) position, introducing an ideomotor action. The ideomotor action is generated via normal voluntary motor control systems, but in fascial unwinding it is altered and experienced as an involuntary response. It is therefore a neurobiological process that employs the self-regulation dynamic system theory.

sportEX comment The clinical experience of many practitioners is that myofascial unwinding

works. This model proposes a reason why. It would be nice to have examples written up as case studies to support the theory. If you have one, send it to us please.

sportEX comment Greater rest equals greater

work. Simple really.

Seventy patients were included who had lateral elbow

tendinopathy (LET) for at least 4 weeks. They were sequentially allocated to receive either a home exercise programme or a supervised exercise

programme five times a week for 12 weeks. Both programmes consisted of slow progressive eccentric exercises of the wrist extensors and static stretching of the extensor carpi radialis brevis tendon. Outcome measures were pain (visual analogue scale), function (visual analogue scale) and pain-free grip strength. Patients

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COMPARISON OF EFFECTS OF A HOME EXERCISE PROGRAMME AND A SUPERVISED EXERCISE PROGRAMME FOR THE MANAGEMENT OF LATERAL ELBOW TENDINOPATHY. Stasinopoulos D, Stasinopoulou K, et al. British Journal of Sports Medicine 3 November 2009 (e-Pub doi:10.1136/bjsm.2008.049759).

were evaluated at baseline, at the end of treatment (week 12), and 3 months (week 24) after the end of treatment. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline. There were significant differences in pain and function improvement between the groups at the end of treatment and at the 3-month follow-up. The supervised exercise programme produced the largest effect.

sportEX comment

The supervised exercise programme is superior to the home-based one both for reducing pain and improving function in patients with LET at the end of the treatment and at follow-up. Of course it is. Don’t underestimate the power of having a therapist on hand to motivate and correct and generally give reassurance.

sportEX dynamics 2010;23(Jan):4-6

EFFECT OF REST INTERVAL LENGTH ON THE VOLUME COMPLETED DURING UPPER BODY RESISTANCE EXERCISE. Humberto M, Simão R. Journal of Sports Science and Medicine 2009;8:388–392.

Twelve trained men completed two experimental sessions that consisted of five upper-body exercises: barbell bench press, incline barbell bench press, pec-deck flye, barbell lying triceps extension, and triceps pushdown. These were performed for three sets with an 8-RM load. The two experimental sessions differed only in the length of the rest interval between the sets and exercises; one session had a 1-minute interval and the other had a 3-minute rest interval. The results showed that for each exercise a significantly greater workout volume was completed when resting three minutes between sets and exercises.