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Developing and implementing a rehabilitation program is one of the most challenging patient care skills because it requires a firm grasp of the healing process and available treatment options, which must then be serially compared with the pathologic condition of the injury and the patient's progress. This cyclical problem-based approach to rehabilitation allows clinicians to most effectively individualize the rehabilitation plan to the patient's individual needs and progress. In each phase of the rehabilitation process, problems should be identified and goals developed taking into consideration the phase of healing.

ObjectiveTo provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations.BackgroundOne of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present.RecommendationsThese guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

A nonrandomized 2-group pretest-posttest design.To determine the effects of a 4-week balance training program during stance on a single leg.Individuals who have experienced multiple episodes of inversion ankle sprains often participate in balance training programs. Balance training is performed to treat existing proprioceptive deficits and to restore ankle joint stability, presumably by retraining altered afferent neuromuscular pathways. The effectiveness of such programs on individuals with functionally unstable ankles has yet to be established.Prior to and following training, subjects with self-reported functionally unstable ankles (5 women and 8 men, mean age = 21.9 +/- 3.1 years) and nonimpaired subjects (6 women and 7 men, mean age = 21.2 +/- 2.5 years) completed a static balance assessment for both limbs as well as the ankle joint functional assessment tool questionnaire (AJFAT). The subjects from both groups participated in a unilateral, multilevel, static and dynamic balance training program 3 times a week for 4 weeks. Subjects from the experimental group trained only the involved limb, and the nonimpaired group trained a randomly selected limb. A stability index (SI) was calculated during the balance assessment to indicate the amount of platform motion. Compared to low stability indices, high stability indices indicate greater platform motion during stance and therefore less stability.Following training, subjects from both groups demonstrated significant improvements in balance ability. When balance was assessed at a low resistance to platform tilt (stability level 2), the posttraining scores of both the subjects with unstable ankles (mean SI = 2.63 +/- 1.92) and the nonimpaired subjects (mean SI = 2.69 +/- 2.32) were significantly better than their pretraining scores (mean SIs = 5.93 +/- 3.65 and 4.67 +/- 3.43, respectively). Assessed at a high resistance to platform tilt (stability level 6), the posttraining scores of both subjects with unstable ankles (mean SI = 1.27 +/- 0.66) and the nonimpaired subjects (mean SI = 1.37 +/- 0.66) were significantly better than their pretraining scores (mean SIs = 2.30 +/- 1.88 and 2.04 +/- 1.43, respectively). Additionally, the posttraining AJFAT scores of subjects with unstable ankles (25.78 +/- 3.80) and the nonimpaired subjects (29.15 +/- 5.27) were significantly greater than their pretraining scores (17.11 +/- 3.44 and 22.92 +/- 5.22, respectively), indicating an overall improvement in perceived ankle joint functional stability.This study suggests that balance training is an effective means of improving joint proprioception and single-leg standing ability in subjects with unstable and nonimpaired ankles.

Anterior cruciate ligament injuries are occurring at a higher rate in female athletes compared with their male counterparts. Research in the area of anterior cruciate ligament injury has increasingly focused on the role of joint proprioception and muscle activity in promoting knee joint stability. We measured knee joint laxity, joint kinesthesia, lower extremity balance, the amount of time required to generate peak torque of the knee flexor and extensor musculature, and electromyographically assessed muscle activity in 34 healthy, collegiate-level athletes (average age, 19.6 1.5 years) who played soccer or basketball or both. Independent t-tests were used to determine significant sex differences. Results revealed that women inherently possess significantly greater knee joint laxity values, demonstrate a significantly longer time to detect the knee joint motion moving into extension, possess significantly superior single-legged balance ability, and produce significantly greater electromyographic peak amplitude and area of the lateral hamstring muscle subsequent to landing a jump. The excessive joint laxity of women appears to contribute to diminished joint proprioception, rendering the knee less sensitive to potentially damaging forces and possibly at risk for injury. Unable to rely on ligamentous structures, healthy female athletes appear to have adopted compensatory mechanisms of increased hamstring activity to achieve functional joint stabilization.

The purpose of this study was to determine the proprioceptive effects of ankle bracing and taping. Proprioception was assessed in 26 subjects by evaluating ankle joint position sense, which was determined by the subjects' ability to actively reproduce a passively positioned joint angle. Testing was performed at positions of 30° of plantar flexion and 15° of inversion. Each subject underwent four trials at each test angle under three conditions: braced, taped, and control. For the plantar flexion test, both the braced condition and the taped condition significantly enhanced joint position sense when compared to the control condition. There was no significant difference between the braced and taped conditions. For the inversion test, the taped condition significantly enhanced joint position sense compared to the control condition. There was no significant difference between the braced and the control conditions or between the braced and the taped conditions. This study demonstrates that ankle bracing and taping improve joint position sense in the stable ankle.

Proprioception and accompanying neuromuscular feedback mechanisms provide an important component for the establishment and maintenance of functional joint stability. Neuromuscular control and joint stabilisation is mediated primarily by the central nervous system. Multisite sensory input, originating from the somatosensory, visual and vestibular systems, is received and processed by the brain and spinal cord. The culmination of gathered and processed information results in conscious awareness of joint position and motion, unconscious joint stabilisation through protective spinal-mediated reflexes and the maintenance of posture and balance. Clinical research aimed at determining the effects of articular musculoskeletal injury, surgery and rehabilitation, on joint proprioception, neuromuscular control and balance has focused on the knee and ankle joints. Such studies have demonstrated alterations in proprioception subsequent to capsulo-ligamentous injury, partial restoration of proprioceptive acuity following ligamentous reconstruction, and have suggested beneficial proprioceptive changes resulting from comprehensive rehabilitation programmes.