Journal of Dr. NTR University of Health Sciences

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 6  |  Issue : 2  |  Page : 92--97

Effects of ultrasound therapy with taping PNF training and PNF training with taping in treatment and rehabilitation of sports injuries of high ankle sprain


DL Charly Daniel 
 Principal, Kasturi College of Physiotherapy, Anantapur, Andhra Pradesh, India

Correspondence Address:
D L Charly Daniel
11/949, Opp Post Office, Aravindanagar, Anantapur - 515 001, Andhra Pradesh
India

Abstract

Context: Ligamentous injuries around the ankle joint are among the most common sporting injuries, especially in jumping sports (e.g., basketball, volleyball). They are not always well-managed. Associated injuries are frequently not diagnosed and the rehabilitation of ligamentous injuries is often inadequate, leading to a high rate of recurrence. Aims: The aim of this study was to find out effects of ultrasound therapy (UT), UT with taping, proprioceptive neuromuscular facilitation (PNF) training, PNF training with taping in treatment, and rehabilitation of high ankle sprain injury. Settings and Design: The experimental design used in this study was random group design. Of the total population with ligament injuries of the ankle, 50 suffering from high ankle sprain injury were randomly selected. Materials and Methods: Fifty subjects suffering from high ankle sprain injury were randomly selected and divided into five groups consisting of 10 subjects in each. Group I underwent UT, Group II underwent UT with taping, Group III underwent PNF training, Group IV underwent PNF training with taping, and Group V was considered as the control group, which was managed with RICE protocol and did not receive any specialized treatment. Statistical Analysis Used: To find out the significance of the difference among the five different treatments on a particular dependent variable, analysis of covariance (ANCOVA) was used. Results: It was concluded that combining ultrasound with taping and PNF training with taping were found to be more beneficial in the treatment and rehabilitation of high ankle sprain injury. Conclusions: It was concluded that combining ultrasound with taping and PNF training with taping were found to be more beneficial in the treatment and rehabilitation of high ankle sprain injury. The combined effect of UT, PNF training, and taping may be explored by future researchers.



How to cite this article:
Charly Daniel D L. Effects of ultrasound therapy with taping PNF training and PNF training with taping in treatment and rehabilitation of sports injuries of high ankle sprain.J NTR Univ Health Sci 2017;6:92-97


How to cite this URL:
Charly Daniel D L. Effects of ultrasound therapy with taping PNF training and PNF training with taping in treatment and rehabilitation of sports injuries of high ankle sprain. J NTR Univ Health Sci [serial online] 2017 [cited 2020 May 25 ];6:92-97
Available from: http://www.jdrntruhs.org/text.asp?2017/6/2/92/208003


Full Text



 Introduction



The medical community is playing an increasingly active role in encouraging fitness enhancement whether by threats [the dangers of high cholesterol or low-density lipoprotein (LDL), osteoporosis, or cardiovascular disease] or promises (enhanced competitive performance or lowered body fat) (Ried 1992).[1] At least some portion of organized medicine appears to be encouraging the fitness movement. At the same time, such support might be applied more thoughtfully if it were possible to better predict the injury consequences of participation. It is useful to attempt to identify the risk factors and suggest what might be done to cater these factors (Baumhauer et al. 1995).[2] Approximately 14% of all sport injuries are sprains to the ankle, representing one ankle injury each season for every 17 participants. In high-risk sports such as jumping and running this percentage is even higher, at 25% of all lost time injuries. Ankle sprain has been shown to be 24 times more common in the dominant leg, and to have a high (73.5%) prevalence of recurrence (Churchill and Donley 1998).[3] Ligamentous injuries around the ankle joint are among the most common sporting injuries, especially in jumping sports (e.g., basketball, volleyball). They are not always well-managed. The associated injuries are frequently not diagnosed and the rehabilitation of ligamentous injuries is often inadequate, leading to a high rate of recurrence (Khan and Bruker 1998).[4]

The two types of therapeutic ultrasound effects are: Thermal and nonthermal effects. Thermal effects are due to the absorption of the sound waves. Nonthermal effects are from cavitation, microstreaming, and acoustic streaming (Mo et al. 2012).[5] Cavitational effects result from the vibration of the tissue, causing the formation of microscopic bubbles, which transmit the vibrations in a way that directly stimulates cell membranes. This physical stimulation appears to enhance the cell repair effects of the inflammatory response (Wilkin et al. 2004).[6] The effectiveness of therapeutic ultrasound for pain, musculoskeletal injuries, and soft tissue lesions remains questionable. Studies have proven that ultrasound helps in enhancing the metabolic activities of cells. Thus, ultrasound treatment helps in tissue repair, especially in soft tissue injuries (Baker et al. 2001).[7]

The literature regarding proprioceptive neuromuscular facilitation (PNF) training has made the technique the optimal stretching method when the aim is to increase the range of motion, especially in short-term changes. Generally, an active PNF stretch involves a shortening contraction of the opposing muscle to place the target muscle on stretch. This is followed by an isometric contraction of the target muscle. PNF can be used to supplement daily stretching and is employed to make quick gains in the range of motion to help athletes improve performance (Westwater-Wood et al. 2010).[8] Apart from being safe and time-efficient, the dramatic gains in the range of motion seen in a short period of time may also promote compliance with the exercise and rehabilitation program (Kisner and Colby 2012).[9] PNF stretching was originally developed as a form of rehabilitation and to that effect, it is very effective. It is also excellent for targeting specific muscle groups as well as increasing flexibility; it also improves muscular strength. Pain reduction is essential but improvement of any loss of motion, strength, and/or proprioception is equally important (DeLee and Drez 1994, Singer and Jones 1995, Windsor et al. 1994).[10],[11],[12]

Tape is often applied to manage symptoms of chronic injuries such as medial tibial stress syndrome (or shin splints), patellaofemoral syndrome, and turf-toe (McConnell 2000, Specchiulli and Cofano 2001, Ugalde and Batt 2001).[13],[14],[15] Athletic tape can be applied to ease pain symptoms as well. Taping along the nerve tract of irritated or inflamed tissue can shorten the inflamed region and reduce pain (Heidt et al. 1996, McConnell 2002).[16],[17] Ankle taping can increase ankle stability by at least two mechanisms: Limitation of motion and proprioception (Lephart et al. 1998).[18] For a single treatment, ankle taping is less expensive than either a brace or an athletic shoe. Initially, the effectiveness of ankle taping is similar to bracing (Quinn, et al. 2000, Arnold and Docherty 2004)[19],[20] However, studies have demonstrated a significant loss of effectiveness after 24 min of activity (Lohrer et al.1999).[21] Moreover, ankle taping becomes virtually ineffective after periods as short as 40 min (Manfroy et al.1997).[22]

Thus, there are different physiotherapy methods being used to treat the ankle ligament injuries of the players. They are ultrasound therapy (UT), cryotherapy, massage, PNF training, taping, electrotherapy such as short wave diathermy, transcutaneous electrical stimulation (TENS), etc. To facilitate speedy recovery from the injury, it is very essential to select the right treatment. In this research, the researcher is interested to find out effects of UT, UT with taping, PNF training, PNF training with taping in the treatment, and rehabilitation of ligament injuries in the ankle. Even though there are different ankle injuries, the investigator selected high ankle sprain for this study. To test the effect of these different treatments on the injured players, the researcher selected swelling as a dependent variable.

 Materials and Methods



The experimental design used in this study was random group design. Of the total population with ligament injuries of the ankle, 50 suffering from high ankle sprain injury were randomly selected. The 50 injured selected subjects were further randomly divided into five groups consisting of 10 in each group. Group I underwent UT, group II underwent UT with taping, group III underwent PNF training, group IV underwent PNF stretching with taping, and group V was considered as the control group, which was managed with rest, ice, compression, and elevation (RICE) protocol and did not receive any specialized treatment. Prior to the experimental treatments, the swellings in all the subjects were measured with a measuring tape and the scores were recorded in centimeters. The experimental treatments were given to the subjects as per the description and supervision of the experienced physiotherapist for 15 days continuously. All the subjects were tested prior to treatment and after completion of 15 days of treatment on the selected dependent variable, swelling. The differences between the initial and final means of swelling were considered as the effect of the selected treatment on selected injury. To find out the significance of the difference among the five different treatments on a particular dependent variable, analysis of covariance (ANCOVA) was used. In all the cases, 0.05 level was fixed to test the hypothesis.

 Results



The descriptive statistics on obtained data on high ankle sprain injury swelling of the ankle due to UT, UT with taping (UT&T), PNF training (PNFT), PNF training with taping (PNFT&T), and the control group (CG) are presented in [Table 1].{Table 1}

[Table 1] shows that the pretest mean on high ankle sprain injury swelling of the UT group was 66.3 with standard deviation ±1.16, the pretest mean of ultrasound therapy with the taping (UT&T) group was 66.75 with standard deviation ±0.75, the pretest mean of PNFT group was 65.75 with standard deviation ±1.38, the pretest mean of proprioceptive neuromuscular facilitation training with taping (PNFT&T) group was 66.35 with standard deviation ±1.11, and the pretest mean of the control group was 65.75 with standard deviation ±1.38.

As seen in the results presented in [Table 1], the posttest mean on high ankle sprain injury swelling of the UT group was 64.2 with standard deviation ±1.14, posttest mean of the UT&T group was 64.2 with standard deviation ±0.86, the posttest mean of the PNFT group was 63.5 with standard deviation ±1.38, the posttest mean of the PNFT group and T group was 64.2 with standard deviation ±0.95, and the posttest mean of the control group was 64.55 with standard deviation ±1.5.

Taking into consideration the pretest means and posttest means, the adjusted posttest means were determined and ANCOVA was done. The adjusted mean on high ankle sprain injury swelling in the UT group was 64.09, in the UT&T group was 63.69, in the PNFT group was 63.88, in the PNFT&T group was 64.05, and in the control group was 64.93.

The statistical analysis comparing the initial and final means of HAS injury swelling due to the UT group, UT&T group, PNFT group, PNFT&T group, and control group (CG) is presented in [Table 2].{Table 2}

The obtained F ratio of 1.33 on the pretest means of the groups was not significant at 0.05 level. This shows that there was no significant difference in the means of the groups at the initial stage.

The obtained F ratio of 1.01 on posttest means of the groups was not significant at 0.05 level. This shows that there was no significant difference in the means of the groups at the initial stage.

The obtained F value on adjusted means was 5.92. The obtained F value was greater than the required value of 2.58 and hence, it was accepted that there were significant differences among the adjusted means on the swellings of the subjects.

Since significant improvements were recorded, the results were subjected to post hoc analysis using Scheffe's confidence interval test. The results are presented in [Table 3].{Table 3}

The post hoc analysis of obtained ordered adjusted means showed that the paired mean differences between the UT group and control group 0.84, UT&T group and control group 1.24, PNFT group and control group 1.05, and PNFT&T group and control group 0.88 were higher than the confidence interval. It shows significant difference between the above paired means. Further, the observation of the means reveal that the means of training protocol groups were significantly less than the control group.

The post hoc analysis of obtained ordered adjusted means also state that the paired mean differences between the UT group and UT&T group 0.4, UT group and PNFT group 0.21, UT group and PNFT&T group 0.04, UT&T group and PNFT group 0.19, UT&T group and PNFT&T group 0.36, PNFT group, and PNFT&T group 0.17 were lesser than required confidence interval, 0.84. It indicates insignificant difference between the above paired means. The above analysis reveals that the swelling was significantly reduced due to the treatment protocols when compared to the control group and there was an insignificant difference among the treatment groups.

The pretest, posttest, and ordered adjusted means are presented through line graph for a better understanding of the results of this study in [Figure 1].{Figure 1}

Line graph showing pre-, post-, and adjusted means on high ankle sprain injury swelling

 Discussion



The results presented in [Table 1], [Table 2], and [Table 3] show the descriptive statistics, ANCOVA results, and postanalysis, respectively, on high ankle sprain injury swelling treatment and rehabilitation due to UT, UT with taping, PNF training, PNF training with taping, and controls. The results proved that all the four treatment groups were able to reduce swelling of high ankle sprain significantly. Though there were differences among the different groups in reducing swelling on high ankle sprain injury, these differences were not significant at 0.05 level. And the formulated hypothesis No. 1 that UT, UT with taping, PNF training, and PNF training with taping would significantly reduce swelling was accepted at the 0.05 level. Since there was no significant difference among the treatment groups in reducing swelling on high ankle sprain injury, the formulated hypothesis No. 4 that there would be no significant difference among the different physiotherapy modalities tested, namely, UT, UT with taping, PNF training, and PNF with taping in altering swelling was accepted at the 0.05 level.

The findings of this study were in agreement with the findings of Mo et al. in 2012[5] who found that therapeutic ultrasound effects were due to the absorption of the sound waves and Wilkin et al. 2004[6] who found that cavitational effects result from the vibration of the tissue, causing the formation of microscopic bubbles, which transmit the vibrations in a way that directly stimulate cell membranes. This physical stimulation appears to enhance the cell repair effects of the inflammatory response. Baker et al. 2001[7] found that the effectiveness of therapeutic ultrasound for pain, musculoskeletal injuries, and soft tissue lesions remains questionable. The study has proven that ultrasound helps in enhancing the metabolic activities of cells. Thus, ultrasound treatment helps in tissue repair, especially in soft tissue injuries, which result in an improved range of motion as found in this study compared to the control group.

Westwater-Wood et al. in 2010[8] reported that PNF can be used to supplement daily stretching and is employed to make quick gains in the range of motion to help athletes improve performance. Kisner and Colby 2012[9] found that apart from being safe and time-efficient, the dramatic gains in range of motion seen in a short period of time may also promote compliance with the exercise and rehabilitation program. de Vries JS et al. in 2011 reported based on a meta-analysis that neuromuscular rehabilitation results in more rapid improvements in function. The findings of this study are in agreement with these findings.

McConnell (2002)[17] found that the athletic tape can be applied to ease pain symptoms as well. Lephart et al. (1998)[18] found that ankle taping can increase ankle stability by at least two mechanisms: Limitation of motion and proprioception. The findings of this study proved that the range of motion increased significantly compared to the control group while applying taping with UT and PNF training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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