title: The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
abstract: BACKGROUND
  Soft tissue injuries of the leg, ankle, or foot are common and often treated by exercise. The purpose of this study was to determine the effectiveness of exercise for the management of soft tissue injuries of the leg, ankle, or foot.
  
  
  METHODS
  A systematic review of the literature was conducted. We searched five databases from 1990 to 2015. Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria. The evidence from studies with low risk of bias was synthesized using the best-evidence synthesis methodology.
  
  
  RESULTS
  We screened 7946 articles. We critically appraised ten randomized trials and six had a low risk of bias. The evidence suggests that for recent lateral ankle sprain: 1) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury; and 2) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise. Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration. Finally, for plantar heel pain, static stretching of the calf muscles and sham ultrasound lead to similar outcomes, while static plantar fascia stretching provides short-term benefits compared to shockwave therapy.
  
  
  CONCLUSIONS
  We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains. Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain.
authors.affiliation: Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Woitzik
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Clinical Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada. Electronic address: cjacobs@cmcc.ca.
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1H 7K4, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1H 7K4, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sutton
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: Department of Emergency Medicine, Queen's University at Kingston, Kingston General Hospital and Hotel Dieu Hospital, c/o 76 Stuart St., Kingston, Ontario K7L 2V7, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brison
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College Street, Toronto, Ontario M5S 3M2, Canada; Faculty of Pharmacy, University of Toronto, Leslie Dan Pharmacy Building, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada; Institute for Work and Health, 481 University Ave., Toronto, Ontario M5G 2E9, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: van der Velde
authors.affiliation: Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Stern
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.affiliation: Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1H 7K4, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, Alberta T6G 1C9, Canada.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D016512:Ankle Injuries / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018409:Foot Injuries / Q000534:rehabilitation; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000534:rehabilitation; D008297:Male; D009864:Ontario; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D020127:Recovery of Function / Q000502:physiology*; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome
keywords: Achilles tendinopathy; Ankle sprain; Exercise; Plantar fasciitis; Systematic review