STUDY DESIGN: Prospective cohort study. OBJECTIVES: To examine the natural recovery from grade I and II ankle injuries over a 1-month period. BACKGROUND: There is a high rate of injury recurrence and persistence of symptoms following ankle sprains, suggesting that these injuries may not be adequately managed. However, little is known about the recovery process after discharge from emergency departments. METHODS AND MEASURES: Clinical assessment of ankle swelling, strength, and joint mobility and laboratory assessment of peak torque and joint range of motion (ROM) were performed 4 and 30 days following initial clinical assessment in the emergency department. Analyses for repeated measures determined change over time and differences between injured and noninjured ankles. Self-assessed ankle function was evaluated on day 4 and day 30, and its relationship to clinical and laboratory assessments determined. RESULTS: Forty-six subjects entered the study and complete datasets were obtained from 28. Significant swelling, weakness, and mobility restrictions were evident on initial assessment. Symptoms improved over time and, while clinical variables were normal by day 30, laboratory assessment indicated weakness of plantar flexors and limited active and passive ROM at 1 month. Swelling and reduced passive ROM were associated with overall function and limitations in sports and recreation activities, as well as quality of life 1 month postinjury. CONCLUSION: Clinically assessed strength and ankle dorsiflexion mobility suggested full recovery at 1 month post injury, yet more sensitive measures of ankle impairment and performance detected residual deficits. Persistent impairment and incomplete recovery of self-assessed function suggest the need for management beyond standard emergency department care. Associations between impairment measures and function may provide guidance for treatment intervention.

J Orthop Sports Phys Ther. 2008;38(9):566-571, published online 29 May 2008. doi:10.2519/jospt.2008.2811

KEY WORDS: function, impairment, injury, soft tissue, strength

Strengthening of the vastus medialis oblique (VMO) has been advocated as a treatment for patellofemoral pain syndrome (PFPS), as weakness of this component of the quadriceps is postulated to contribute to malalignment of the patella. This study investigated the surface electromyographic activity (EMG) of the VMO relative to the vastus lateralis (VL) during 5 isometric exercises in 8 PFPS female subjects and 19 controls. The area under the EMG curve of each muscle was normalized to the EMG area acquired while subjects performed a submaximal isometric contraction (50% of maximum voluntary contraction), and the "normalized" outcome measure was expressed as a proportion (VMO:VL) A 2-factor repeated measures analysis of variance indicated no differences in the VMO:VL proportion between the control group and PFPS participants across the 5 exercises (p > .05). The VMO:VL proportions for medial tibial rotation and knee extension combined and knee extension alone were significantly greater than for the other 3 exercises (p < 0.005). Hip adduction or the combination of hip adduction and knee extension did not result in greater recruitment of the VMO compared with the VL.

J Orthop Sports Phys Ther. 1998;27(3):197-204.

Key Words: quadriceps, vastus medialis, patellofemoral pain, exercise