Two different methods for the prevention of ankle joint injuries in soccer were tested. Coordination training on an ankle disk improves functional stabilty and postural control, whereas an orthosis provides mechanical sup port. Both techniques reduce the frequency of ankle sprains in soccer players with previous ankle problems. The orthosis is an alternative to taping, and can be used during the rehabilitation period after injury or when playing on uneven ground. Coordination training on an ankle disk ought to be included in the rehabilitation of ankle injuries to prevent functional instability. It may also be done prophylactically by players with previous ankle problems in order to break the vicious circle of recurrent sprains and feeling of giving way.

Prevention of ankle sprains

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines’ version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation “I” and level of evidence “II”. Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.

/pdf/2016-sosort-guidelines-orthopaedic-and-rehabilitation-wd47whqefo.pdf

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.

The origins of cerebral lateralization in humans are traced to the asymmetric prenatal development of the ear and labyrinth. Aural lateralization is hypothesized to result from an asymmetry in craniofacial development, whereas vestibular dominance is traced to the position of the fetus during the final trimester. A right-ear sensitivity advantage may contribute to a left-hemispheric advantage in speech perception and language functions, whereas left-otolithic dominance may independently promote right-sided motoric dominance and a right-hemispheric superiority in most visuospatial functions. The emergence of handedness is linked to the assumption of an upright posture in the early hominids, whereas the failure to develop clear vestibular asymmetry may underlie the poor motoric lateralization found in several neurodevelopmental disorders.

A general theory concerning the prenatal origins of cerebral lateralization in humans.

Current population studies characterize idiopathic scoliosis as a single-gene disorder that follows the patterns of mendelian genetics, including variable penetrance and heterogeneity. The role of melatonin and calmodulin in the development of idiopathic scoliosis is likely secondary, with indirect effects on growth mechanisms. Reported abnormalities of connective tissue, skeletal muscle, platelets, the spinal column, and the rib cage are all thought to be secondary to the deformity itself. Although no consistent neurological abnormalities have been identified in patients with idiopathic scoliosis, it is possible that a defect in processing by the central nervous system affects the growing spine. The true etiology of idiopathic scoliosis remains unknown; however, it appears to be multifactorial.

Etiology of idiopathic scoliosis: current trends in research.

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

/pdf/2011-sosort-guidelines-orthopaedic-and-rehabilitation-19z0wik8ea.pdf

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

Postural equilibrium has been quantified by stabilometry in 57 patients with adolescent idiopathic scoliosis aged 10-16 years. Treatment was required in 39 cases whereof 18 were placed under observation only. The control group comprised 32 healthy children of the same age. An experimental design was made to vary the degree of difficulty of upright standing in four different test situations. The postural sway was analysed in the sagittal and lateral direction as well as in the area of total sway. The scoliotic patients had a significantly poorer postural control compared with the healthy children in all the tests. The difference was most pronounced in tests in which the proprioceptive functions were most important for maintaining the postural equilibrium. The left convex patients had quantitatively more pronounced reactions than the right convex patients. Patients with small curvatures, i.e., patients placed under observation only, had significantly increased postural sway compared with patients with more severe deformity. This fact, together with findings in patients with double primary curvatures, and the results of the study of brace effects, indirectly indicate the possibility of a postural disequilibrium as a contributory causative factor in adolescent idiopathic scoliosis.

https://www.tandfonline.com/doi/pdf/10.3109/17453677809050088

Postural equilibrium in adolescent idiopathic scoliosis.

An electro-nystagmographic study of labyrinthine function was performed in 56 patients with adolescent idiopathic scoliosis (AIS)aged from 10 to 16 years. Forty-seven patients had major structural single curvatures, and nine patients had double-primary scoliosis and were analysed separately. Treatment was required in 36 cases while 20 were being observed only. Thirty healthy children of the same ages constituted a control group. Spontaneous nystagmus (SN) and positional nystagmus (PN) were found in 24 out of the 47 patients with single curvatures and in only one subject in the control group (P less than 0.001). No significant correlation was noted between direction of convexity and nystagmus. Neither did the frequency of SN or PN differ significantly between patients requiring treatment and patients submitted to observation only. Significant differences were observed in the caloric response between right and left scoliotic patients (P less than 0.05). The right convex patients had a sensitivity dominance in the right labyrinth and the left convex patients in the left labyrinth. There were no significant differences between right- and left-beating nystagmus. A dysrhythmic nystagmus occurred in the scoliotic patients with significantly increased frequency (P less than 0.05). The results are discussed with special reference to aetiology in AIS. It was difficult, however, to draw any definite conclusion as to whether the findings may indicate a causative factor in relation to the idiopathic curvature or whether they might be a feed-back effect from the deformed spine.

A study of labyrinthine function in patients with adolescent idiopathic scoliosis. I. An electro-nystagmographic study.

The etiology of idiopathic scoliosis is still unsolved, despite extensive research. This paper analyzes the different factors of relevance. Recent investigations have convincingly demonstrated the hereditary traits of idiopathic scoliosis. In the adolescent group a specific growth pattern has also been demonstrated, while muscular factors and biochemical changes of connective tissues are somewhat more uncertain. A significant number of patients demonstrate asymmetries in the vestibular apparatus and electroencephalographic abnormalities. Because of the essential role of the vestibular and central nervous systems in the postural equilibrium, functional asymmetries or minor pathologic changes in these structures might also be factors of importance. It is our view that adolescent idiopathic scoliosis should be regarded as a multifactorial disease. Combining the findings in recent investigations, a possible model for the pathogenesis of the disease is outlined.

Etiologic Factors in Adolescent Idiopathic Scoliosis

Postural sway has been quantified with stabilometry during caloric labyrinthine stimulation in an erect posture in 49 patients, aged 10--16 years, with adolescent idiopathic scoliosis. Thirty-two healthy children of the same age constituted a control group. The scoliotic patients tended to have an increased postural sway during labyrinthine stimulation on the convex side compared to the effects on the concave side. Significant differences were observed when left and right scoliotic patients were compared with the controls. The results can be explained by an asymmetric sensitivity in the labyrinth or by a dysfunction in the postural control mechanisms at the brain stem level.

https://www.tandfonline.com/doi/pdf/10.3109/17453677908989768

Vestibulospinal reflex activity in patients with adolescent idiopathic scoliosis. Postural effects during caloric labyrinthine stimulation recorded by stabilometry.

(1974). The Richards Compression and Sliding Hip Screw System in the Treatment of Intertrochanteric Fractures. Acta Orthopaedica Scandinavica: Vol. 45, No. 1-4, pp. 213-219.

Tage Sahlstrand

Papers

Postural equilibrium in adolescent idiopathic scoliosis.

A study of labyrinthine function in patients with adolescent idiopathic scoliosis. I. An electro-nystagmographic study.

Etiologic Factors in Adolescent Idiopathic Scoliosis

Vestibulospinal reflex activity in patients with adolescent idiopathic scoliosis. Postural effects during caloric labyrinthine stimulation recorded by stabilometry.

The Richards compression and sliding hip screw system in the treatment of intertrochanteric fractures.