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Logo of brjsmedBritish Journal of Sports MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Br J Sports Med. 2007 July; 41(7): 465–466.
PMCID: PMC2465362


Knee joint effusion and cryotherapy alter lower chain kinetics and muscle activity

HopkinsJT. J Athl Train 2006;41:177–84

Professor Martin P Schwellnus, University of Cape Town, South Africa

BackgroundFollowing a joint effusion, muscle inhibition takes place. It has been shown that cryotherapy can disinhibit the quadriceps muscle after a joint effusion by a resting measure (Hoffmann reflex) of motor recruitment.

Research question/sDoes cryotherapy, when applied after a joint effusion, alter quadriceps muscle recruitment and restore muscle function?

MethodologySubjects: 45 healthy subjects (26 male, 19 female, 21 ± 2 yrs).

Experimental procedure: Subjects were randomly assigned to one of three groups: control (CON, no ice and no effusion), effusion (EFF, 55 ml effusion in the knee joint and sham ice bag) or effusion/cryotherapy (EFFICE, effusion and ice pack). Measures of muscle function and electromyographic (EMG) activity during knee extension were taken pre‐injection, post‐injection, and 30 and 60 minutes post‐injection.

Measures of outcome: Muscle function (knee, hip and ankle peak joint torque, peak and average power) and EMG activity (average and peak vastus medialis, vastus lateralis, medial hamstrings and gastrocnemius muscle normalised EMG activity).

Main finding/s

Muscle function: There were significant decreases in knee peak torque (30 min) and peak power (30 and 60 min) in the EFF group, but not in the CON or EFFICE groups after the injection.

Conclusion/sFollowing an experimentally induced knee joint effusion, the application of ice (cryotherapy) restores muscle function (peak torque and power) and quadriceps muscle EMG activity.

Evidence based rating7.5/10

Clinical interest rating7/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study, effect of pain inhibition not investigated, testing position may not be functional

Keywordsjoint, effusion, inhibition, cryotherapy

Oxidative stress response to aerobic exercise: comparison of antioxidant supplements

Bloomer RJ, Goldfarb AH, McKenzie MJ.Med Sci Sports 2006;38:1098–105

BackgroundHigh‐intensity and prolonged exercise can increase the production of reactive oxygen/nitrogen species, which have been associated with the development of a variety of medical conditions.

Research question/sDo two antioxidant formulas (vitamin C and E supplement or fruit and vegetable juice) reduce oxidative stress (as measured by biomarkers) before and after endurance exercise?

MethodologySubjects: 48 healthy endurance‐trained athletes (25 male, 23 female).

Experimental procedure: Subjects were randomly assigned to one of three 14‐day treatment groups: a vitamin E and C supplement group (VITCE  = 15; 400 IU vitamin E and 1 g vitamin C), a fruit and vegetable juice powder concentrate group (FRVEG  = 16) or a placebo (CON  = 17). All the subjects performed an exercise test (running 30 min at 80% VO2max) before, after 2 weeks of supplementation, and after a 1 week washout period. Blood samples were taken before and immediately after exercise and analysed for biomarkers of oxidative stress (protein carbonyls (PC), malondialdehyde (MDA) and 8‐hydroxydeoxyguanosine (8OhdG)), and vitamins C and E.

Measures of outcome: PC, MDA, 8OhdG, vitamin C and vitamin E.

Main finding/s

• There was a significant increase in post‐exercise PC values for all treatments after all exercise bouts (p<0.0001).

• MDA was not affected by exercise and treatment, and observed changes in 8OhdG were not attributed to the supplementation.

Conclusion/sTwo weeks' treatment using either a combined vitamin C and E supplement, or a fruit and vegetable juice supplement, reduces some (but not all) biomarkers of oxidative stress following a bout of acute exercise.

Evidence based rating7.5/10

Clinical interest rating7.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study

Keywordsantioxidants, exercise, oxidative stress, dietary supplements, free radicals

A prospective, randomized clinical investigation of the treatment of first‐time ankle sprains

Beynnon BD, Renstrom PA, Haugh L, et al. Am J Sports Med 2006;34:1401–12

BackgroundExternal protective support for the ankle is commonly used in the treatment of acute ankle sprains; however, the optimal type of support that is to be used has not been well researched.

Research question/sDoes elastic wrapping, bracing, bracing combined with elastic wrapping, or casting result in earlier return to normal function following an acute, first‐time ankle ligament sprain?

MethodologySubjects: 126 patients with ankle sprains (<72 hrs after injury: grade 1 (30), grade 2 (74) or grade 3 (22)).

Experimental procedure: Patients were stratified according to the grade and then randomised to undergo functional treatment with different types of external supports: grade 1 (elastic wrap (EW), air‐stirrup (AS) or EW+AS), grade 2 (EW, AS, EW+AS, or a cast for 10 days) and grade 3 (AS or cast for 10 days). Subjects completed daily logs until they returned to normal function and were followed up at 6 months.

Measures of outcome: Main measure of outcome (days to normal pre‐injury walking, and stair climbing).

Main finding/sAt 6 months follow‐up there were no differences between the treatments for frequency of re‐injury, ankle motion and function in each sprain severity group.

Conclusion/sAn air‐stirrup brace, combined with an elastic wrap, results in earlier return to pre‐injury function after first‐time grade I and II ankle ligament sprains compared with use of an air‐stirrup brace alone, an elastic wrap alone or a walking cast for 10 days.

Evidence based rating8/10

Clinical interest rating8.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study

Keywordsankle injuries, ligament injuries, sprains, rehabilitation

Cardiac rehabilitation vs. home exercise after coronary artery bypass graft surgery: a comparison of heart rate recovery

Wu S‐K, Lin Y‐W, Chen C‐L, et al. Am J Phys Med Rehabil 2006;85:711–17

BackgroundIt is well known that the autonomic dysfunction can adversely affect clinical outcome in patients with cardiovascular disease; exercise training may modify this response.

Research question/sDoes formal cardiac rehabilitation or a home‐based exercise programme improve heart rate recovery in patients who underwent coronary artery bypass grafting (CABG)?

MethodologySubjects: 54 male patients who underwent CABG.

Experimental procedure: Subjects were randomly assigned to either a 12‐week cardiac rehabilitation exercise programme (REHAB  = 18), a home‐based exercise programme (HOME  = 18) or a control group (CON  = 18). Heart rate recovery [decrease in heart rate (beats/min) in the first min following a maximal exercise test] was assessed before and after the 12‐week period.period.

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Measures of outcome: Heart rate recovery (beats/min).

Main finding/s

Conclusion/s• In patients who underwent CABG, a 12‐week formal cardiac rehabilitation programme results in significant improvements in 1 min heart rate recovery compared with a control group.

• The home‐based exercise group had comparable efficacy to that demonstrated in the cardiac rehabilitation group.

Evidence based rating7.5/10

Clinical interest rating7.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study, small sample size, no other measures of outcome

Keywordscardiac rehabilitation, coronary artery disease, home‐based exercise, coronary artery bypass graft

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