Better Functional Results of Conservative Treatment in Fresh Lateral Ligament Injuries of the Ankle with Additional Deep Oscillation

Abstract

Background and Aim: 25% of all injuries of musculoskeletal injuries involve the ankle. 85% concern the lateral ligament structures, 10% the anterior syndesmosis and 5% the medial ligament structures, accompanied by edema and hematoma in the respective regions. Very good results were already achieved with deep oscillation therapy for several indications, including trauma. The aim of this study was the evaluation of conservative treatment with the Aircast? brace for fresh exterior ligament injuries with an additional electro-mechanical treatment, i.?e. deep oscillation, and optimalisation of this novel combination of treatments. Methods: 43 patients were treated for acute ligament injuries of the fibular ankle with distorsion or laceration of the medial ligament, hematoma and contusion. They received a complex functional conservative treatment with the Aircast? brace with additional deep oscillation therapy. 25 of these injuries of the ankle occurred during sports and 18 during everyday activities. A questionnaire, a clinical and radiological examination of the upper ankle joint were used for evaluation. At the beginning and end of treatment, symptoms were assessed subjectively by the patients with the numerical rating scale (NRS) and by the physician with a modified 4-step rating scale. The study compares the effect of additional deep oscillation with a control group of 25 patients receiving standard treatment. Results: 30 (70%) of the 43 patients were female and 13 (30%) male. The average age was 26 years. 14 (33%) patients had a very good, 22 (51%) good, 3 (7%) satisfactory, and 4 (9%), insufficient outcome. Thus, 39 (91%) were satisfied and 4 (9%) dissatisfied. The subjective assessment of symptoms (NRS) improved significantly (p <?0.001) from 9.1 (baseline) to 2.1 points after treatment. Objective assessment by the attending physician based on various clinical parameters was good or very good in 80% of the cases. Conclusions: The study shows that the conservative functional treatment described here with an Aircast? brace with the integration of deep oscillation is a very good treatment for fresh lateral ligament injuries. Based on this study, an additional positive effect of deep oscillation is observed in terms of reduction of edema and hematoma, detumescence, pain and inflammation. Also, the high patient satisfaction supports this conclusion. The treatment is gentle and thus, unlike other electrical and mechanical therapies, not contraindicated in the acute phase. It is effective, easy to apply and patients perceive it consistently as positive.

The Effectiveness of Deep Oscillation Therapy on Reducing Swelling and Pain in Athletes With Acute Lateral Ankle Sprains

“…Three relevant studies [2][3][4] were located and categorized as shown in Table 1 (based on levels of evidence, Centre for Evidence Based Medicine). 5…”

“…6,7 However, the results of the current CAT do not support the use of deep oscillation therapy for the purpose of reducing pain and swelling following an acute lateral ankle sprain. Each of the 3 reviewed articles only included patients with low-grade acute lateral ankle sprain, within 48 to 72 hours 2,3 and up to 1 week 3 following injury, meaning these results are generalizable to a specific patient population. Of the 3 studies reviewed in this CAT, only 1 study 3 described statistically significant reduction in swelling and pain after acute ankle sprains in the deep oscillation therapy condition compared with the standard of care.…”

Effect of deep oscillation as a recovery method after fatiguing soccer training: A randomized cross-over study

“…Like lymphatic drainage, DO also focuses on the lymphatic system. In randomized controlled studies it showed excellent results in reducing oedema and hematoma 16 , 17 . One study reported that the effect of classical manual lymphatic drainage on pain and swelling is enhanced when performed under DO 17 .…”

“…The effect of deep oscillation has been investigated for various indications. In randomized controlled trials, DO was reported to be effective in reducing oedema and hematoma, 16 , 17 reducing inflammation 15 and pain,16, 17, 18 or increasing healing of sports traumata 16 . In one study DO showed a relaxing effect on the hamstrings muscles, which was expressed in an extension of the range of movement directly after the application 19 .…”

Randomisierte Pilotstudie zur Quantifizierung des patientenseitigen Nutzens der Beeinflussung primärer Wundheilungsprozesse durch Tiefenoszillation

“…Sie stellt daher eine adjuvante Behandlungsmöglichkeit dar, die etwa in die akute OP-Nachsorge nach Mastektomie bereits vor 1991 Eingang fand [9]. Die Therapie erwies sich zuvor in Studien bei Lymphödemen, Traumata und Fibromyalgie jeweils als signifikant schmerzreduzierend [10,11,[13][14][15]. Bei Raynaudʼs sekundärer bis systemischer Sklerose hingegen erwies sich TO (n = 10) versus Kontrolle (n = 10) mit p = 0,055 im Gegensatz zu Feedbacktraining (n = 8) versus Kontrolle nur als tendenziell schmerzverbessernd (VAS) [12].…”