The purpose of this study was to determine whether 8 weeks of ankle disk training alters ankle muscle onset latency of patients with a history of lateral ankle sprain. The training was completed by eight minimally symptomatic subjects with a history of nonrehabilitated, unilateral, inversion ankle sprain sustained between 6 and 16 months before entry into the study. Ankle inversion perturbations monitored by fine-wire electromyography were performed in four lower extremity muscles (anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus) of all subjects on both the injured (experimental) and noninjured (control) legs. Testing was performed at study entry and after 8 weeks of ankle disk training on the previously injured ankle. Results revealed a statistically significant decrease in the anterior tibialis onset latency in both the experimental (67.6 +/- 20.3 to 51.7 +/- 17.6) and control (65.5 +/- 9.8 to 53.8 +/- 23.7) ankles after the training period. These findings indicate that muscle onset latency decreases in specific ankle muscle groups after ankle disk training in previously injured ankles. Both the experimental and control ankles demonstrated a significant change, which raises the question as to whether a proprioceptive cross-training effect occurred.

Introduction: The ankle sprain is one of the most common injuries in athletes. Direct evaluation of the ligament laxity can be obtained through the objective measurement of extreme passive inversion and eversion movements, but there are few studies on the use of the evaluation of the passive re-sistive torque of the ankle to assess the capsule and ligaments resistance. Objective: The aim of this study was to compare the inversion and eversion passive torque in athletes with and without ankle sprains history. Method: 32 female basketball and volleyball athletes (16.06 ± 0.8 years old; 67.63 ± 8.17 kg; 177.8 ± 6.47 cm) participated in this study. Their ankles were divided into two groups: control group (29), composed of symptom-free ankles, and ankle sprain group, composed of ankles which have suffered injury (29). The resistive torque at maximum passive ankle movement was measured by the isokinetic dynamometer and the muscular activity by electromyography system. The athletes performed 2 repetitions of inversion and eversion movement at 5, 10 and 20°/s and the same protocol only at maximum inversion movement. Results: The resistive passive torque during the inversion and eversion was lower in the ankle sprain group. This group also showed lower torques at the maximum inversion movement. No differences were observed between inversion and eversion movement. Conclusions: Ankle sprain leads to lower passive torque, indicating reduction of the resistance of the lateral ankle ligaments and mechanical laxity.

H yponatremia in exercise is a potentially dangerous clinical scenario previously thought to be limited to exercise bouts of long duration and associated with excessive water intake. We report the case of a healthy young athlete with hyponatremia after moderate-duration exercise and only moderate water intake. CASE REPORTA 19-year-old female novice triathlete presented with abrupt onset of dull, bioccipital headache associated with mild photophobia; nausea with clear, watery emesis; and generalized malaise 90 minutes after completing a sprint distance event (0.4-km swim, 17-km bike, and 5-km run) in 1 hour 33 minutes. The outdoor ambient temperature at the race's completion at approximately 9 AM was 32°C. She reported hydration with 3 L of water the evening before the race, approximately 500 mL during the race, and 700 mL after the race. Her food intake was minimal on the morning of the race.Although she was an inexperienced triathlete, she was physically fit (weight, 57 kg; height, 160 cm; body mass index, 22 kg/m 2 ) and finished the race first among female novices. The patient's medical history included exercise-induced bronchospasm and a seizure disorder that had been asymptomatic for years. For seizure prophylaxis, she was taking carbamazepine and lamotrigine, tapering down her carbamazepine while increasing her lamotrigine. Serum levels of carbamazepine and sodium drawn 3 days before the race were 5.7 mg/mL (therapeutic range, 4-10 mg/mL) and 142 mmol/L, respectively.Physical examination revealed an oral temperature 36.1°C, heart rate of 70 beats/min, blood pressure of 128/82 mm Hg without orthostatic change, and respiratory rate of 12 breaths/min. She was alert and oriented, with equal and reactive pupils, intact extraocular motion, and a noticeable tearing mechanism. Her oral mucus membranes were moist, her skin was cool and moist, and she had no detectable edema. Findings on cardiac, pulmonary, abdominal, and neurologic examinations were all normal, as was her mental status. Possible hyponatremia was diagnosed, and she was transported to a local emergency department for further evaluation and management.Laboratory studies in the emergency department confirmed the diagnosis: sodium, 127 mmol/L; potassium, 3.5 mmol/L; chloride, 97 mmol/L; bicarbonate, 21 mmol/L; glucose, 4.8 mmol/L; creatinine, 88.4 mmol/L; urea nitrogen, 3.6 mmol/L; and serum osmolality, 254 mOsm/kg.

Intensive, interdisciplinary pain rehabilitation provides an effective therapeutic modality for patients with post-laminectomy syndrome who have failed spinal cord stimulation by decreasing pain levels and by increasing functional status and self-efficacy.