Peroneal reaction time after ankle sprain: a systematic review and meta-analysis

Effects of the FIFA 11+ on ankle evertors latency time and knee muscle strength in amateur futsal players

Background: The FIFA 11+ has shown to increase muscle strength and reduce injury risk. The purpose of this study was to assess the short and long-term effects of the FIFA 11+ on knee strength, and muscle latency after sudden inversion of amateur futsal players.Methods: Seventy-one male futsal players were recruited and randomized to a FIFA 11+ (n = 37, age: 27.0 ± 5.1 years) and a control group (n = 34, age: 26.0 ± 5.1 years). The FIFA 11+ programme was executed twice a week, for 10 weeks, followed-up after 10 weeks where both groups executed regular warm-ups. Concentric and eccentric isokinetic knee muscle strength was tested and latency time of the evertor muscles after sudden inversion of the ankle was executed with a trapdoor mechanism following an EMG protocol of selected leg muscles (peroneus brevis and peroneus longus).Results: No significant difference were observed between groups for short-term changes in isokinetic strength after adjustment for baseline differences. At long-term, significant gains were obtained after adjustment for baseline differences in eccentric strength for both lower limbs as for the H/Q ratios for the dominant limb. No changes between groups were observed in the peroneus brevis and peroneus longus latency time.Conclusions: Performing FIFA 11+ did not have short-term effects on knee strength and muscle latency after sudden inversion in amateur futsal players. However, significant long-term benefits were observed for eccentric strength and H/Q ratios.

Dynamic stretching does not affect peroneal and tibial muscle reaction properties

Objectives

This study aims to investigate acute and chronic effects of dynamic stretching on peroneal and tibialis anterior reaction properties.

Patients and methods

Between September 2015 and June 2017, a total of 21 male athletes (mean age 22.6 years; range, 20 to 30 years) were included in this study. All participants were randomly divided into two groups as dynamic stretching group (n=11) and control group (n=10). The participants in the dynamic stretching group performed stretching exercises for the ankle evertor and dorsiflexor muscles five days a week for six weeks. Peroneal and tibial muscle reaction properties were evaluated at baseline (two times for acute effect) and at the end of the intervention. Electromyographic activity parameters including reaction time, reaction duration, and reaction magnitude of the muscles were measured using an ankle supination tilting platform. There were four different supination conditions: (i) ankle neutral, 15° inversion (0015), (ii) ankle neutral, 30° inversion (0030), (iii) ankle 20° plantarflexion, 15° inversion (2015), and (iv) ankle 20° plantarflexion, 30° inversion (2030).

Results

There were no significant differences in acute and chronic effects of dynamic stretching exercises for peroneal and tibial muscle reaction time, reaction duration, and muscle activity in four positions on the ankle inversion simulation platform (p>0.05).

Conclusion

Our study results suggest that dynamic stretching exercises have no positive or negative effects on muscle reaction properties and on the possible risk of ankle sprain during sudden ankle inversion. Dynamic stretching exercises may still be preferred for sports where strength and force effects are important.

Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews

BACKGROUND

Many factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary contributing factors. However, readers are now faced with several systematic reviews that present conflicting findings.

OBJECTIVE

The aim of this systematic review and meta-analysis was to establish the statistical significance and effect size of primary factors contributing to CAI and to identify likely reasons for inconsistencies in the literature.

METHODS

Relevant health databases were searched: CINAHL, MEDLINE, PubMed, Scopus and SPORTDiscus. Systematic reviews were included if they answered a focused research question, clearly defined the search strategy criteria and study selection/inclusion and completed a comprehensive search of the literature. Included reviews needed to be published in a peer-reviewed journal and needed to review observational studies of factors and/or characteristics of persons with CAI, with or without meta-analysis. There was no language restriction. Studies using a non-systematic review methodology (e.g. primary studies and narrative reviews) were excluded. Methodological quality of systematic reviews was assessed using the modified R-AMSTAR tool. Meta-analysis on included primary studies was performed.

RESULTS

Only 17% of primary studies measured a clearly defined CAI population. There is strong evidence to support the contribution of dynamic balance, peroneal reaction time and eversion strength deficits and moderate evidence for proprioception and static balance deficits to non-specific ankle instability.

CONCLUSIONS

Evidence from previous systematic reviews does not accurately reflect the CAI population. For treatment of non-specific ankle instability, clinicians should focus on dynamic balance, reaction time and strength deficits; however, these findings may not be translated to the CAI population. Research should be updated with an adequately controlled CAI population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2016, CRD42016032592.

Antagonist co-activation during short and medium latency responses in subjects with chronic ankle instability

PURPOSE

This study aims to evaluate bilateral ankle antagonist co-activation during compensatory postural responses, including short latency responses (SLR) and medium latency responses (MLR), in response to a unilateral sudden ankle inversion in subjects with chronic ankle instability (CAI).

METHODS

Twenty-four participants with CAI and 20 controls participated in the present study. Bilateral eletromyography of peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA) and soleus (SOL) muscles was collected during a unilateral sudden inversion perturbation (30°) to assess antagonist co-activation of SOL/TA and TA/P pairs during SLR and MLR in both support and perturbed positions.

RESULTS

Compared to control group, participants with CAI presented: (1) bilateral increased antagonist co-activation of SOL/TA MLR in the support position; and (2) decreased antagonist co-activation of TA/P MLR of uninjured limb in the support position and of injured limb in the perturbed position.

CONCLUSIONS

CAI involves deregulation of ankle antagonist co-activation of MLR in both injured and uninjured limbs.

The Effect of Static Stretching of Peroneal and Tibialis Anterior Muscles on Reaction Time: A Randomized Controlled Study

OBJECTIVE

The aim of this study was to investigate the acute and chronic effects of static stretching on peroneal and tibialis anterior reaction characteristics.

DESIGN

All 23 participants who volunteered for this study were randomly divided into static (n = 12) and control (n = 11) groups. The subjects in the static stretching group performed stretching exercises for the ankle evertor and dorsiflexor muscles 5 days a week for 6 wks. Peroneal and tibialis anterior muscle reaction characteristics were evaluated at the beginning (2 times for acute effect) and end of this period. Electromyographic activity parameters of the muscles were measured using an ankle inversion tilting platform that simulated a sudden ankle inversion. The following were the four different ankle inversion conditions: (a) ankle-neutral, 15-degree inversion; (b) ankle-neutral, 30-degree inversion; (c) ankle-20-degree plantarflexion, 15-degree inversion; and (d) ankle-20-degree plantarflexion, 30-degree inversion.

RESULTS

Either in terms of acute or chronic effects, no significant differences were found after static stretching exercises for peroneal and tibialis anterior muscle reaction time, reaction duration, and muscle activity evaluated in four positions on the ankle inversion simulation platform (P > 0.05).

CONCLUSIONS

In light of these results, it is possible to state that the short duration of static stretching exercises can still be applied before sports activities.

Bilateral compensatory postural adjustments to a unilateral perturbation in subjects with chronic ankle instability

BACKGROUND

To evaluate the magnitude of bilateral compensatory postural adjustments in response to a unilateral sudden inversion perturbation in subjects with chronic ankle instability.

METHODS

24 athletes with chronic ankle instability (14 with functional ankle instability, 10 with mechanical ankle instability) and twenty controls participated in this study. The bilateral electromyography of ankle muscles was collected during a unilateral sudden ankle inversion to assess the magnitude of subcortical and voluntary compensatory postural adjustments in both the perturbed and the contralateral limb (support limb).

FINDINGS

In the support position, compared to the control group, the group with functional ankle instability presented decreased compensatory postural adjustments of the tibialis anterior in both the injured and the uninjured limbs in the support position and of the soleus in the uninjured limb. In the side of the perturbation, participants with functional ankle instability presented decreased soleus compensatory postural adjustments in the uninjured limb when compared to the control group. Increased values of soleus and peroneal brevis compensatory postural adjustments were observed in the group with mechanical instability when compared to the control group and to the group with functional ankle instability.

INTERPRETATION

Subjects with functional ankle instability present bilateral impairment of compensatory postural adjustments of the tibialis anterior in a support position and of the soleus of the uninjured limb regardless of the position. Subjects with mechanical instability present bilateral increase of these adjustments in the peroneal brevis regardless of the position and in the soleus muscle in the side of the perturbation.

Predictors of chronic ankle instability: Analysis of peroneal reaction time, dynamic balance and isokinetic strength

BACKGROUND

Previous studies have reported the factors contributing to chronic ankle instability, which could lead to more effective treatments. However, factors such as the reflex response and ankle muscle strength have not been taken into account in previous investigations.

METHODS

Fifty recreational athletes with chronic ankle instability and 55 healthy controls were recruited. Peroneal reaction time in response to sudden inversion, isokinetic evertor muscle strength and dynamic balance with the Star Excursion Balance Test and the Biodex Stability System were measured. The relationship between the Cumberland Ankle Instability Tool score and performance on each test was assessed and a backward multiple linear regression analysis was conducted.

FINDINGS

Participants with chronic ankle instability showed prolonged peroneal reaction time, poor performance in the Biodex Stability System and decreased reach distance in the Star Excursion Balance Test. No significant differences were found in eversion and inversion peak torque. Moderate correlations were found between the Cumberland Ankle Instability Tool score and the peroneal reaction time and performance on the Star Excursion Balance Test. Peroneus brevis reaction time and the posteromedial and lateral directions of the Star Excursion Balance Test accounted for 36% of the variance in the Cumberland Ankle Instability Tool.

INTERPRETATION

Dynamic balance deficits and delayed peroneal reaction time are present in participants with chronic ankle instability. Peroneus brevis reaction time and the posteromedial and lateral directions of the Star Excursion Balance Test were the main contributing factors to the Cumberland Ankle Instability Tool score. No clear strength impairments were reported in unstable ankles.

Comparison of dynamic postural stability scores between athletes with and without chronic ankle instability during lateral jump landing

BACKGROUNDS

Many ankle injuries occur while participating in sports that require jumping and landing such as basketball, volleyball and soccer. Most recent studies have investigated dynamic postural stability of patients with chronic ankle instability after landing from a forward jump. The present study aimed to investigate the dynamic postural stability of the athletes who suffer from chronic ankle sprain while landing from a lateral jump.

METHODS

Twelve athletes with self-reported unilateral chronic ankle instability (4 females and 8 males) and 12 matched controls (3 females and 9 males) voluntarily participated in the study. Dynamic postural stability index and its directional indices were measured while performing lateral jump landing test.

RESULTS

No differences were found between athletes with and without chronic ankle instability during our landing protocol by means of the dynamic postural stability index and its directional indices. Findings showed that in each group, medial/lateral stability index is significantly higher than anterior/posterior and vertical stability indexes.

CONCLUSION

Findings showed that dynamic postural stability was not significantly different between the two groups. Future studies should examine chronic ankle instability patients with more severe disabilities and expose them to more challenging dynamic balance conditions to further explore postural stability.

LEVEL OF EVIDENCE

IIIa.

Evidence of a different landing strategy in subjects with chronic ankle instability

The purpose of the study is to evaluate the discriminative validity of the multiple hop test (MHT) for chronic ankle instability (CAI). The dynamic postural control of 51 CAI subjects and 52 uninjured controls was assessed using the MHT. To evaluate dynamic postural control, the type and number of balance errors were analysed and the time to complete the MHT was measured. Between-group differences of time scores and balance errors, identified as being change-in-support strategy errors (CSS) or fixed-support strategy errors (FSS), were assessed. The area under curve of the outcomes was determined and likelihood ratios (LRs) were calculated based upon their most optimal cut off point. When compared to uninjured controls, CAI subjects needed significantly more time to perform the test (p<0.001) and made significantly more CSS errors (p<0.001). When 1 positive outcome (time score or CSS errors) was considered as a criterion, the LR⁺ was 2 and the LR^- 0.08. In the case of 2 positive outcomes (time score and CSS errors), the LR⁺ was 7.1 and the LR^- 0.49. CAI subjects have an impaired dynamic postural control and rely on a different postural strategy to restore balance. The MHT has good discriminative validity for CAI.

Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability

INTRODUCTION

Deficient sensory input from damaged ankle ligament receptors is thought to contribute to sensorimotor deficits in those with chronic ankle instability (CAI). Targeting other viable sensory receptors may then enhance sensorimotor control in these patients. The purpose of this randomized controlled trial was to evaluate the effects of 2 wk of sensory-targeted ankle rehabilitation strategies (STARS) on patient- and clinician-oriented outcomes in those with CAI.

METHODS

Eighty patients with self-reported CAI participated. All patients completed patient-oriented questionnaires capturing self-reported function as well as the weight-bearing lunge test and an eyes-closed single-limb balance test. After baseline testing, patients were randomly allocated to four STARS groups: joint mobilization, plantar massage, triceps surae stretching, or control. Each patient in the intervention groups received six 5-min treatments of their respective STARS over 2 wk. All subjects were reassessed on patient- and clinician-oriented measures immediately after the intervention and completed a 1-month follow-up that consisted of patient-oriented measures. Change scores of the three STARS groups were compared with the control using independent t-tests and Hedges' g effect sizes with 95% confidence intervals.

RESULTS

The joint mobilization group had the greatest weight-bearing lunge test improvement. Plantar massage had the most meaningful single-limb balance improvement. All STARS groups improved patient-oriented outcomes with joint mobilization having the most meaningful effect immediately after the intervention and plantar massage at the 1-month follow-up.

CONCLUSION

Each STARS treatment offers unique contributions to the patient- and clinician-oriented rehabilitation outcomes of those with CAI. Both joint mobilization and plantar massage appear to demonstrate the greatest potential to improve sensorimotor function in those with CAI.

Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis

Context:

Lateral ankle ligamentous sprain (LAS) is one of the most common injuries in recreational activities and competitive sports. Many studies have attempted to determine whether there are certain intrinsic factors that can predict LAS. However, no consensus has been reached on the predictive intrinsic factors.

Objective:

To identify the intrinsic risk factors of LAS by meta-analysis from data in randomized control trials and prospective cohort studies.

Data Sources:

A systematic computerized literature search of MEDLINE, CINAHL, ScienceDirect, SPORTDiscus, and Cochrane Register of Clinical Trials was performed.

Study Selection:

A computerized literature search from inception to January 2015 resulted in 1133 studies of the LAS intrinsic risk factors written in English.

Study Design:

Systematic review.

Level of Evidence:

Level 4.

Data Extraction:

The modified quality index was used to assess the quality of the design of the papers and the standardized mean difference was used as an index to pool included study outcomes.

Results:

Eight articles were included in this systematic review. Meta-analysis results showed that body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and peroneus brevis reaction time correlated with LAS.

Conclusion:

Body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and the reaction time of the peroneus brevis were associated with significantly increased risk of LAS.

Factors contributing to chronic ankle instability: a protocol for a systematic review of systematic reviews

BACKGROUND

Ankle sprains are a significant clinical problem. Researchers have identified a multitude of factors contributing to the presence of recurrent ankle sprains including deficits in balance, postural control, kinematics, muscle activity, strength, range of motion, ligament laxity and bone/joint characteristics. Unfortunately, the literature examining the presence of these factors in chronic ankle instability (CAI) is conflicting. As a result, researchers have attempted to integrate this evidence using systematic reviews to reach conclusions; however, readers are now faced with an increasing number of systematic review findings that are also conflicting. The overall aim of this review is to critically appraise the methodological quality of previous systematic reviews and pool this evidence to identify contributing factors to CAI.

METHODS

A systematic review will be conducted on systematic reviews that investigate the presence of various deficits identified in CAI. Databases will be searched using pre-determined search terms. Reviews will then be assessed for inclusion based on the set eligibility criteria. Two independent reviewers will assess the articles for inclusion before evaluating the methodological quality and presence of bias of the included studies; any disagreements will be resolved by discussion between reviewers to reach consensus or by a third reviewer. Data concerning the specific research question, search strategy, inclusion/exclusion criteria, population, method and outcomes will be extracted. Findings will be analysed with respect to the methodological quality of the included reviews.

DISCUSSION

It is expected that this review will clarify the cause of contradicting findings in the literature and facilitate future research directions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016032592 .

Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study

Single limb stance instability is a risk factor for lower extremity injuries. Therefore, the development of proprioception may play an important role in injury prevention. This investigation considered a professional basketball team for 6 years, integrating systematic proprioceptive activity in the training routine. The purpose was to assess the effectiveness of proprioceptive training programs based on quantifiable instability, to reduce ankle sprains, knee sprains, and low back pain through developing refined and long-lasting proprioceptive control. Fifty-five subjects were studied. In the first biennium (2004-2006), the preventive program consisted of classic proprioceptive exercises. In the second biennium (2006-2008), the proprioceptive training became quantifiable and interactive by means of electronic proprioceptive stations. In the third biennium (2008-2010), the intensity and the training volume increased while the session duration became shorter. Analysis of variance was used to analyze the differences in proprioceptive control between groups, years, and bienniums. Injury rates and rate ratios of injury during practices and games were estimated. The results showed a statistically significant reduction in the occurrence of ankle sprains by 81% from the first to the third biennium (p < 0.001). Low back pain showed similar results with a reduction of 77.8% (p < 0.005). The reduction in knee sprains was 64.5% (not significant). Comparing the third biennium with the level of all new entry players, proprioceptive control improved significantly by 72.2% (p < 0.001). These findings indicate that improvements in proprioceptive control in single stance may be a key factor for an effective reduction in ankle sprains, knee sprains, and low back pain.

Prevention of Lower Extremity Injuries in Basketball: A Systematic Review and Meta-Analysis

Context:

Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates.

Objective:

To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears.

Data Sources:

PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015.

Study Selection:

Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis.

Study Design:

Systematic review and meta-analysis.

Level of Evidence:

Level 2.

Data Extraction:

Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture).

Results:

Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P < 0.001) and ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P < 0.001), yet not ACL ruptures (OR, 1.09; 95% CI, 0.36-3.29; P = 0.87) in basketball athletes.

Conclusion:

In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries.

Contributing factors to star excursion balance test performance in individuals with chronic ankle instability

The purpose of this study was to determine the contributions of strength, dorsiflexion range of motion (DFROM), plantar cutaneous sensation (PCS), and static postural control to Star Excursion Balance Test (SEBT) performance in individuals with chronic ankle instability (CAI). Forty individuals with CAI completed isometric strength, weight-bearing DFROM, PCS, static and dynamic balance assessments. Three separate backward multiple linear regression models were calculated to determine how strength, DFROM, PCS, and static postural control contributed to each reach direction of the SEBT. Explanatory variables included dorsiflexion, inversion, and eversion strength, DFROM, PCS, and time-to-boundary mean minima (TTBMM) and standard deviation (TTBSD) in the medial-lateral (ML) and anterior-posterior (AP) directions. Criterion variables included SEBT-anterior, posteromedial, and posterolateral directions. The strength of each model was determined by the R2-value and Cohen's f2 effect size. Regression models with an effect size ≥0.15 were considered clinically relevant. All three SEBT directions produced clinically relevant regression models. DFROM and PCS accounted for 16% of the variance in SEBT-anterior reach (f2=0.19, p=0.04). Eversion strength and TTBMM-ML accounted for 28% of the variance in SEBT-posteromedial reach (f2=0.39, p<0.01). Eversion strength and TTBSD-ML accounted for 14% of the variance in SEBT-posterolateral reach (f2=0.16, p=0.06). DFROM and PCS explained a clinically relevant proportion of the variance associated with SEBT-anterior reach. Eversion strength and TTB ML explained a clinically relevant proportion of the variance in SEBT-posteromedial and posterolateral reach distances. Therefore, rehabilitation strategies should emphasize DFROM, PCS, eversion strength, and static balance to enhance dynamic postural control in patients with CAI.

Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial

Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

Muscle-Activation Onset Times With Shoes and Foot Orthoses in Participants With Chronic Ankle Instability

CONTEXT

Participants with chronic ankle instability (CAI) use an altered neuromuscular strategy to shift weight from double-legged to single-legged stance. Shoes and foot orthoses may influence these muscle-activation patterns.

OBJECTIVE

To evaluate the influence of shoes and foot orthoses on onset times of lower extremity muscle activity in participants with CAI during the transition from double-legged to single-legged stance.

DESIGN

Cross-sectional study.

SETTING

Musculoskeletal laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 15 people (9 men, 6 women; age = 21.8 ± 3.0 years, height = 177.7 ± 9.6 cm, mass = 72.0 ± 14.6 kg) who had CAI and wore foot orthoses were recruited.

INTERVENTION(S)

A transition task from double-legged to single-legged stance was performed with eyes open and with eyes closed. Both limbs were tested in 4 experimental conditions: (1) barefoot (BF), (2) shoes only, (3) shoes with standard foot orthoses, and (4) shoes with custom foot orthoses (SCFO).

MAIN OUTCOME MEASURE(S)

The onset of activity of 9 lower extremity muscles was recorded using surface electromyography and a single force plate.

RESULTS

Based on a full-factorial (condition, region, limb, vision) linear model for repeated measures, we found a condition effect (F(3,91.8) = 9.39, P < .001). Differences among experimental conditions did not depend on limb or vision condition. Based on a 2-way (condition, muscle) linear model within each region (ankle, knee, hip), earlier muscle-activation onset times were observed in the SCFO than in the BF condition for the peroneus longus (P < .001), tibialis anterior (P = .003), vastus medialis obliquus (P = .04), and vastus lateralis (P = .005). Furthermore, the peroneus longus was activated earlier in the shoes-only (P = .02) and shoes-with-standard-foot-orthoses (P = .03) conditions than in the BF condition. No differences were observed for the hip muscles.

CONCLUSIONS

Earlier onset of muscle activity was most apparent in the SCFO condition for ankle and knee muscles but not for hip muscles during the transition from double-legged to single-legged stance. These findings might help clinicians understand how shoes and foot orthoses can influence neuromuscular control in participants with CAI.

Plantar cutaneous sensitivity and balance in individuals with and without chronic ankle instability

OBJECTIVE

To determine if plantar cutaneous sensation and postural control differ between individuals with and without chronic ankle instability (CAI).

DESIGN

Case-control.

SETTING

Laboratory.

PARTICIPANTS

Ten subjects with CAI and 10 subjects with no ankle sprain history participated.

INTERVENTIONS

Light touch was evaluated at 3 sites (heel, base of fifth metatarsal, and head of first metatarsal) on the plantar aspect of the foot using Semmes-Weinstein Monofilaments (SWMs). Postural control was assessed using the single leg firm and foam conditions of the Balance Error Scoring System (BESS) and during eyes open and eyes closed static postural control on a force plate.

MAIN OUTCOME MEASURES

Semmes-Weinstein Monofilament detection thresholds, BESS errors, and the mean of time-to-boundary (TTB) minima (TTB-mean) and the SD of TTB minima (TTB-SD) in the anterior-posterior (AP) and medial-lateral directions were evaluated for each subject.

RESULTS

Subjects with CAI demonstrated increased SWM detection thresholds at the heel (P = 0.009), head of the first (P = 0.01), and base of the fifth metatarsal (P < 0.001) and postural control deficits on the BESS firm (P = 0.04) and foam (P = 0.001) conditions and with eyes open TTB-mean AP (P = 0.007) and TTB-SD AP (P = 0.02). When combining groups, a negative moderate correlation was observed between the base of the fifth metatarsal detection threshold and eyes open TTB-mean AP (r = -0.50; P = 0.03).

CONCLUSIONS

Light touch and postural control deficits were observed in individuals with CAI. The correlation between light touch over the base of the fifth metatarsal and eyes open TTB-mean AP suggests that there may be a relevant relationship between these measures.

CLINICAL RELEVANCE

Individuals with CAI demonstrated deficits in light touch over the plantar aspect of the foot. The relationship between base of the fifth metatarsal sensation and TTB-mean AP may provide a starting point to link plantar cutaneous sensory deficits to changes in other aspects of sensorimotor function.

The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis

The aim of this systematic review was to synthesize the evidence for changes for proprioceptive variables consisting of movement and position sense in participants with glenohumeral musculoskeletal disorders. Five databases were searched until 13th August 2013. Methodological quality was assessed and meta-analyses were performed for active and passive joint reposition sense (AJPS and PJPS) and movement sense, determined with threshold to detection of passive motion (TTDPM). The search yielded 17 studies, four of which were classified as having high methodological quality, seven as moderate and six as low quality. For participants with post-traumatic glenohumeral instability, pooled findings indicate moderate evidence for higher TTDPM for involved shoulders compared to control groups and the contralateral uninvolved side, indicating decreased movement sense. For AJPS and PJPS there was moderate to limited evidence for significant increased errors for involved compared to uninvovled shoulders, but not when compared to the control groups. Limited evidence was found for decreased AJPS acuity for patients with chronic rotator cuff pain and for patients with unspecified shoulder pain compared to healthy controls. Movement sense is most likely to be impaired after shoulder injury involving post-traumatic instability when compared to the contralateral shoulder and to controls, while deficits for AJPS and PJPS are more likely to be evident compared to the contralateral shoulder in participants with glenohumeral musculoskeletal disorders.

Lateral Ankle Sprain and Chronic Ankle Instability: A Critical Review

Many studies investigated the contributing factors of chronic ankle instability, but a consensus has not yet been obtained. The objective of this critical review is to provide recent scientific evidence on chronic ankle instability, including the epidemiology and pathology of lateral ankle sprain as well as the causative factors of chronic ankle instability. We searched MEDLINE from 1964 to December 2013 using the terms ankle, sprain, ligament, injury, chronic, functional, mechanical, and instability. Lateral ankle sprain shows a very high recurrence rate and causes considerable economic loss due to medical care, prevention, and secondary disability. During the acute phase, patients with ankle sprain demonstrate symptoms such as pain, range of motion deficit, postural control deficit, and muscle weakness, and these symptoms may persist, leading to chronic ankle instability. Although some agreement regarding the effects of chronic ankle instability with deficits in postural control and/or concentric eversion strength exists, the cause of chronic ankle instability remains controversial.

LEVELS OF EVIDENCE

Therapeutic Level IV: Review of Level IV studies.