Ankle sprain injuries are the most common injury sustained during sporting activities. One-sixth of all sports injury loss time is from ankle sprains. Each year, an estimated 1 million persons, present to physicians with acute ankle injuries. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. The diagnosis of a sprain relies on the medical history including symptoms, as well as making a differential diagnosis mainly in distinguishing it from strains or bone fractures. Despite their prevalence in society, ankle sprains still remain a difficult diagnostic and therapeutic challenge in the athlete, as well as in society in general. The high incidence of ligamentous ankle injuries requires clearly defined acute care and a broad knowledge of new methods in rehabilitation. In addition to rapid pain relief, the main objective of treatment is to quickly restore the range of motion of the ankle without any major loss of proprioception, thereby restoring full activity as soon as possible. The purpose of this article is to review the anatomy, pathomechanics, investigation, diagnosis, management of lateral ankle sprains.

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Background: Present study aimed to compare and scientifically understanding the importance of visual and auditory reaction time in basketball players. Reaction is purposeful voluntary response to different stimuli as auditory or visual stimuli. In simple reaction time stimulus and response are one, while in choice reaction time stimulus and response are multiple. Materials and Methods: The visual and auditory reaction time was measured by the multiple choice apparatus in subjects. Simple reaction time and choice reaction time measured. Reaction time was measured in two sessions. In first session visual reaction time was measured and in second session auditory reaction time was measured. The results were statistically analyzed and were recorded as mean ± standard deviation (SD) and Student's paired t-test was applied to check the level of significance. Result and Conclusion: In the present study we found that auditory reaction time was less as compared to visual reaction time for both simple and choice visual reaction time tasks in basketball players. Since the auditory stimulus reaches the cortex faster than the visual stimulus; the auditory reaction time is faster than the visual reaction time. Reaction time is good indicator of quickness in sports. Faster reaction times are significant for better performance of athletes. Reaction time decreases by practice. Skills can be improved by practice. Sports person can practice regularly to improve their reaction time and ultimately their performance.

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Pectoralis major muscle rupture is a rare type of injury that has become more prevalent in the past 3 decades. It is most commonly associated with weightlifting particularly bench press maneuver although it has been reported to occur in various strenuous sports activities participated in by recreational and professional athletes. This paper is a review of literature which contains description of the anatomy and mechanisms of the injury, presenting signs and symptoms, initial investigations, classification of injury, management and rehabilitation.

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This report describes a rare intra-articular benign tumor, lipoma arborescens (LA), of the knee joint in a 35-year-old male. The patient suffered from left knee joint swelling for 3 years with occasional pain. Swelling was soft and boggy in the suprapatellar area. Motion of the joint was complete. No abnormality was detected in any laboratory tests. Magnetic resonance imaging (MRI) showed a large soft-tissue density in the suprapatellar area with high signal intensity on T1- and T2-weighted images. Operative arthroscopy revealed a creamy brown hypertrophied synovium with diffuse papillary processes characterized by villous proliferation of the synovium infiltrated by mature fat tissue, chronic inflammatory cells and vessels as seen in the pathologic slides. LA should be considered in patients with painless, slowly progressive swelling of a joint, especially the knee. MRI should be considered to exclude this pathology as well as other uncommon intra-articular pathology. Treatment with synovectomy is frequently curative.

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The purpose of this study was to evaluate the efficacy of hamstring stretch in a patient with a painful flatback. A twenty-five-year old female patient was referred by an orthopedist, with a complaint of backache and difficulty in bending forward since one and one-half months. She experienced pain severity of 9 on a visual analogue scale (VAS), difficulty in bending forward to touch her toes, and the range of lumbar flexion was 35 cm as per the sliding ruler arrangement method. Hence, an attempt was made to explore the efficacy of a hamstring stretch in a case of flatback. The patient was given bilateral hamstring stretch twice a day for four weeks along with initial short wave diathermy for pain relief. At the end of the fourth week, pain was nearly normal on the numeric scale, and lumbar flexion range of motion was 9 cm, indicating marked improvement. It is concluded that bilateral hamstring stretch can be used as a prime intervention for relief of pain and to obtain lumbar flexibility in patients with painful flatback to prevent flatback deformity.

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Background: Zarda is a widely used form of smokeless tobacco in India. Cigarette smoking has extensive effects on cardiovascular functions. Zarda is prepared by the user by mixing tobacco with lime in the palm and gives the user the choice to change the combination. This study aims to determine the effect of Zarda on the cardiovascular system adaptability to exercise. There are conflicting opinions about the degree of adaptability of the cardiovascular system in delivering the physiological needs in case of severe exercise. Role of the normal cardiovascular system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. The effect of Zarda usage on this phenomenon is studied here. Materials and Methods: Cardiovascular functions were assessed after maximal exercise testing by recording parameters such as maximum heart rate (HR), delta HR, recovery HR and maximum oxygen pulse in two groups' viz., Zarda users and non-user controls. Results: On studying the differences in cardiovascular functions in users and controls, there was a significant difference in maximum HR. The other parameters such as delta HR and maximum oxygen pulse were on the higher side in controls while the recovery HR was significantly lower in the control group, which was consistently maintained after exercise testing. Based on these findings it is suggested that there is a higher adaptability of the cardiovascular system to the exercise stimulus in the form of better VO ₂ max, faster recovery of the exercise HR and a lesser risk for cardiovascular mortality as suggested by the higher delta HR in non-Zarda users.

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The study of Biomechanics of walking provides us with reference data needed to distinguish between normal and abnormal walking. The purpose of this study was to determine the normal values of some walking biomechanical variables of Saudi Arabian children between the ages of 7 and 11 years. The present study was also aimed at exploring the differences between age groups in walking biomechanical variables. The study sample consisted of 50 healthy Saudi children without any structural deformities and with a body mass index (BMI) of less than overweight (BMI <20). Before collecting data, reflective markers were attached to joints of the right side in order to help in digitizing and locating three-dimensional coordinates using Motus 8 program. Then, subjects walked on a raised walkway with an AMTI force plate (500 Hz) in its middle and filmed by two cameras (50 Hz) one to the right side and the other to the backside of the subject. Results indicated that there were no significant differences in kinematic variables between groups except in stride and step lengths. In addition, there were no significant differences in kinetic variables between groups except in push of force (Y1). Results also indicated a strong relationship between walking velocity and most of the kinematic variables and the three peaks of vertical force. In conclusion, the results of this study showed clear differences between Saudi children and children of other countries. It is recommended that the values of this study be used as normal values for evaluation of walking of Saudi children between the ages 7 and 11.

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Background: The Suryanamaskara (SN) exercise is a comprehensive yoga technique which incorporates physical activity, breath regulation, relaxation and awareness. Apart from improving physical stamina and endurance, SN has been shown to influence an individual's perception and performance. But its immediate effect on sustained attention was not reported adequately. Objective: The study was designed to assess the immediate effect of 108 SN on sustained attention, efficiency and speed of visual scanning in subjects participated in Rathasapthami day (the seventh day following the Sun's northerly movement). Materials and Methods: In this single and mixed group pre-post study, 96 subjects with mean age 33.15 ± 13.61 years participated. The Six Letter Cancellation Test (SLCT) and Digit Letter Substitution Test (DLST) data were collected immediately before and after 108 SN. Statistical Analysis: Means, Standard Deviations, Kolmogorov-Smirnov test and Wilcoxon Signed Ranks Test were used for analyzing the data with the help of SPSS-16. Results: When compare with predata analysis, the SLCT showed 30.61% increase (P < 0.001) in Total Attempted (TA), 81.58% decrease (P < 0.01) in Wrongly Attempted (WA) and 31.87% increase (P < 0.001) in Net Score (NS). Similarly, the DLST showed 38.71% increase (P < 0.001) in TA, 13.64% decrease (P = 0.001) in WA and 35.44% increase (P < 0.001) in NA. Thus, the analysis of SLCT and DLST scores shows that SN was associated with increase in TA and NS and decrease in WA scores. Conclusion: When compared with pre data analysis, the post analysis of SLCT and DLST scores showed that the SN was associated with increase in TA and NS and decrease in WA scores. Thus, the SN holds great promise in enhancing sustained attention in healthy individuals. Well-designed studies are needed before a strong recommendation can be made.

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Objective: Anterior cruciate ligament (ACL) injuries are common among athletes and active individuals participating in sports. ACL reconstruction using the single-bundle technique can be performed through transtibial or anteromedial portals. The transtibial technique carries the theoretical risk of vertical placement of the femoral tunnel in the intercondylar notch. The aim of this study is to assess the efficacy of a free-hand drilled-transtibial technique in achieving optimal graft positioning. Materials and Methods: We analyzed a retrospective series of post-operative knee radiographs in 52 consecutive patients who underwent a single-bundle ACL reconstruction by a single surgeon using this transtibial method, from June 2009 to January 2010. Tunnel positioning was radiographically assessed by an independent single observer, who was not involved in the management of patients. The graft inclination angle, the coronal and the sagittal femoral and tibial tunnel placements were evaluated. Results: Post-operative radiographs of 40 patients (40 knees) were retrospectively evaluated for femoral and tibial tunnel positioning. In the coronal plane, the mean graft inclination angle was 21°, the femoral tunnel was positioned at a mean of 43% lateral to the lateral femoral condyle and the tibial tunnel at a mean of 46% lateral to the medial border of the medial tibial plateau. In the sagittal plane, the femoral tunnel was placed at 84% posteriorly across Blumensaat's line and the tibial tunnel at a mean of 43% along the length of the tibial plateau. The results were consistent with optimal tunnel positioning according to anatomic and clinical studies. Conclusion: The transtibial technique described in this series can achieve optimal tunnel positioning for single-bundle ACL reconstruction.

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Background: The role of hormones on lung function tests was well-known in the normal course of the menstrual cycle. Significant increase in both progesterone (37%) and estradiol (13.5%), whereas no change in plasma follicle-stimulating hormone and luteinizing hormone was observed in exercising women in previous studies. Therefore, this study was intended to see the limitations of the respiratory system in adaptability to exercise in proliferative phase of the menstrual cycle in perimenopausal obese homemakers. Materials and Methods: Healthy young adult females between 42 and 45 years who regularly undergo training and participate in competitive middle distance running events for at least past 3 years were considered in the control, whereas the study group did not have any such regular exercise program were obese homemakers. The two groups were in perimenopausal age group. They were made to undergo computerized spirometry after undergoing maximal exercise testing on a motorized treadmill. Results: It was observed that exercise per se does not cause a statistically significant change in dynamic lung function parameters maximum mid-expiratory flow, peak expiratory flow rate, mid-expiratory flow 25-75% in either of the groups. Discussion: This finding supports the hypothesis that the respiratory system is not normally the most limiting factor in the delivery of oxygen even under the predominant influence of estrogen in proliferative phase, which is further accentuated by exercise.

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Background: Sedentary life-style is a modern day reality. Various physiological parameters are likely to be affected due to physical inactivity. Pulmonary function tests are likely to be compromised to varying degrees in these individuals. It is thus important to study the pattern of ventilatory studies in these subjects as compared with a physically active group. This study was conducted to compare these two groups of people in order to find out the importance of physical activity in the pulmonary function. Materials and Methods: A total of 30 male subjects between 45 and 60 years of age with a desk job and no regular exercise habit free from diabetes and hypertension, non-smokers were selected as study subjects and a similar number of male subjects otherwise comparable anthropometrically with a physically active life-style like a morning walk for at least 1 h as controls were randomly selected. Flow-volume loop, forced expiratory volume in the first second (FEV ₁ ), forced vital capacity (FVC) and FEV ₁ / FVC were recorded using the computerized spirometer. Results: FEV ₁ , FVC and FEV ₁ / FVC ratio measured in sedentary subjects were significantly reduced (P < 0.05) when compared with physically active individuals. Conclusion: The incidence of restrictive tendency is more in the sedentary as compared to controls. As changes in respiratory mechanics due to inactivity are almost completely reversible, early intervention in such patients will ensure lesser chance of complications later in life. With the advent of computerized spirometry analysis of flow-volume loops is indeed of great help to the early prediction of respiratory morbidity.

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As psychologic and physical stress is more common in competitive sports, it is important to know the relation between the associated stress factors with the pathogenesis of periodontal disease. There are various risk factors associated with the outcome of periodontal disease. The triggering agents like, increase in the prevalence of periodontal pathogens, behavioral changes in nutrition, oral hygiene maintenance, biochemical parameters and associated stress factors are important in causing the periodontal disease. This review highlights the importance of periodontal health in the competitive athletes and sports persons. In order to achieve the high performance standards in the competition, one should have the complete periodontal health along with the overall well being of an individual.

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Objective : To determine whether hip-strengthening exercise or combination exercise may relieve pain better than quadriceps-strengthening exercise in adult patellofemoral pain syndrome patients. Materials and Methods: Literature search was performed using PubMed and EMBASE database. Studies were appraised by using the center of evidence-based medicine therapeutic study appraisal sheet. The visual analog scale (VAS) reduction was measured and plotted into forest plot using excel program. Results: Two studies showed better result of hip-quadriceps-strengthening exercise to quadriceps-strengthening exercise [3.31 ± 3.12 vs. 1.5 ± 3.04 and 3.6 ± 2.6 vs. 1.5 ± 2.8], while the other one compared hip-strengthening therapy to quadriceps-strengthening exercise [2.2 ± 4.5 vs. 0.1 ± 4.8]. Conclusion: Hip-quadriceps strengthening exercise gives better result in reducing pain perception in Patellofemoral pain syndrome (PFPS) patients compared with hip-strengthening exercise or quadriceps-strengthening exercise.

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