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Jang J, Franz JR, Pietrosimone BG, Wikstrom EA. Muscle contributions to reduced ankle joint contact force during drop vertical jumps in patients with chronic ankle instability. J Biomech 2024; 163:111926. [PMID: 38183761 DOI: 10.1016/j.jbiomech.2024.111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Chronic ankle instability is a condition linked to progressive early ankle joint degeneration. Patients with chronic ankle instability exhibit altered biomechanics during gait and jump landings and these alterations are believed to contribute to aberrant joint loading and subsequent joint degeneration. Musculoskeletal modeling has the capacity to estimate joint loads from individual muscle forces. However, the influence of chronic ankle instability on joint contact forces remains largely unknown. The objective of this study was to compare tri-axial (i.e., compressive, anterior-posterior, and medial-lateral) ankle joint contact forces between those with and without chronic ankle instability during the ground contact phase of a drop vertical jump. Fifteen individuals with and 15 individuals without chronic ankle instability completed drop vertical jump maneuvers in a research laboratory. We used those data to drive three-dimensional musculoskeletal simulations and estimate muscle forces and tri-axial joint contact force variables (i.e., peak and impulse). Compared to those without chronic ankle instability, the ankles of patients with chronic ankle instability underwent lower compressive ankle joint contact forces as well as lower anterior-posterior and medial-lateral shearing forces during the weight acceptance phase of landing (p <.05). These findings suggest that patients with chronic ankle instability exhibit lower ankle joint loading patterns than uninjured individuals during a drop vertical jump, which may be considered in rehabilitation to potentially reduce the risk of early onset of ankle joint degeneration.
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Affiliation(s)
- Jaeho Jang
- Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | - Brian G Pietrosimone
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, United States
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, United States
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2
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Hong CC, Calder J. The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact. Foot Ankle Clin 2023; 28:187-200. [PMID: 37137618 DOI: 10.1016/j.fcl.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Dai M, Liu X, Yang L, Wang J, Ye F, Zhao H, Duan D, Liu X. Morphologic evaluation of injured and contralateral uninjured ankles in patients with unilateral chronic ankle instability. Br J Radiol 2022; 95:20220155. [PMID: 35766941 PMCID: PMC10996958 DOI: 10.1259/bjr.20220155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the morphological anatomy and abnormalities of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in unilateral chronic ankle instability (CAI). METHODS 22 patients (men: women, 13:9; mean age, 28.95 ± 8.127 years) with unilateral CAI and 18 healthy volunteers (men: women, 9:9, mean age, 28.33 ± 3.678 years) were recruited. MRI scans were divided into Group 1 (22 injured ankles), Group 2 (22 contralateral uninjured ankles), and Group 3 (36 healthy volunteer ankles). The morphologic variables, MRI signal intensity (SI) values were evaluated. RESULTS The ATFL proximal, intermediate, and distal sites and the CFL proximal and distal sites in Group 3 were narrower than those in Group 1 (P <0.05). Both ATFL and CFL in Group 1 were thicker than those in Group 3 (P <0.01). The proximal and intermediate sites of the ATFL and the proximal site of the CFL in Group 3 were narrower than those in Group 2 (P <0.01). The intermediate site of the ATFL and the proximal and distal sites of the CFL in Group 2 were thicker than those in Group 3 (P <0.01). The mean SI values of the ATFL in Group 1 were higher than those in Groups 2 and 3 (P <0.01). The ATFL and CFL SI values were higher in Group 2 than those in Group 3 (P <0.05). CONCLUSION Both the injured and contralateral uninjured ankles had wider ATFL and CFL, more thickness, and higher SI values compared with those of healthy volunteer ankles. ADVANCES IN KNOWLEDGE High-resolution three-dimensional MRI provides a potential tool assisting clinical decision on the treatment and rehabilitation therapy of patients with unilateral CAI.
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Affiliation(s)
- Meng Dai
- Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
- Hubei Province Key Laboratory of Molecular
Imaging, Wuhan,
China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
- Hubei Province Key Laboratory of Molecular
Imaging, Wuhan,
China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
- Hubei Province Key Laboratory of Molecular
Imaging, Wuhan,
China
| | - Jiazheng Wang
- MSC Clinical & Technical Solutions, Philips
Healthcare, Beijing,
China
| | - Fang Ye
- Department of Occupational and Environmental Health and
Ministry of Education Key Lab for Environment and Health, School of
Public Health, Tongji Medical College, Huazhong University of Science
and Technology, Wuhan,
China
| | - Hu Zhao
- Department of Human Anatomy, School of Basic Medicine, Tongji
Medical College, Huazhong University of Science and
Technology, Wuhan,
China
| | - Deyu Duan
- Department of Orthopaedics, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
| | - Xi Liu
- Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
- Hubei Province Key Laboratory of Molecular
Imaging, Wuhan,
China
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Abassi M, Whiteley R. Serial Within-Session Improvements in Ankle Dorsiflexion During Clinical Interventions Including Mobilization-With-Movement and A Novel Manipulation Intervention - A Case Series. Int J Sports Phys Ther 2021; 16:1158-1168. [PMID: 34386293 PMCID: PMC8329314 DOI: 10.26603/001c.25544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Persisting reductions in ankle dorsiflexion range of motion are commonly encountered clinically and seen to be associated with adverse outcomes after ankle and other lower extremity injuries. Accordingly improving identified deficits is a common goal for rehabilitation; however, little data exists documenting any improvement related to interventions in these patients. PURPOSE To document the change in dorsiflexion range of motion after stretching and mobilization-with-movement and exercise and a novel manipulation intervention in a population of injured athletes. DESIGN Case series in 38 consecutive injured athletes with persisting reductions in ankle dorsiflexion range of motion (42 "stiff" ankles, 34 uninjured) in an outpatient sports physiotherapy clinic. METHOD During a single treatment session, two baseline measurements of weight-bearing dorsiflexion were taken at the start of the session to establish reliability and minimum detectable change, and then the same measures were performed after stretching and a mobilization-with-movement intervention, and again after clinical exercise and a novel manipulation which was applied on both ankles. RESULTS Excellent reliability was demonstrated (ICC2,1>0.93, MDC=3.5°) for the dorsiflexion measure. Statistically significant (p<0.01), but clinically meaningless improvements were seen after stretching and the mobilization-with-movement intervention on the injured and uninjured legs (1.9° and 1.4° respectively) with greater improvements seen after exercise and the subsequent manipulation (6.9° and 4.7°). CONCLUSIONS The relatively simple clinical exercise and manipulation intervention program was associated improvement in dorsiflexion range of motion in this cohort with persisting ankle stiffness. The interventions described largely restored range of motion consistent with baseline levels of the uninjured ankles. Improvements were also seen in the uninjured ankles following intervention.
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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Maestroni L, Read P, Bishop C, Turner A. Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Sports Med 2020; 50:239-252. [PMID: 31559567 DOI: 10.1007/s40279-019-01195-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.
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Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy.
- StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
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Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med 2020; 49:601-619. [PMID: 30747379 DOI: 10.1007/s40279-019-01071-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN Systematic review and narrative synthesis. DATA SOURCES The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.
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Myoelectric Responses of Lower-Body Muscles Performing Squat and Lunge Exercise Variations Adopting Visual Feedback With a Laser Sensor. J Sport Rehabil 2020; 29:1159-1165. [PMID: 31945738 DOI: 10.1123/jsr.2019-0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/30/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Cross-over study. CONTEXT The squat, single-leg squat, forward lunge, and reverse lunge are fundamental movements often performed in activities of daily living, sports competitions, and sport-specific training. OBJECTIVE The purpose of this study was to investigate the effect of visual feedback with a laser sensor (VFLS) versus a control condition on the myoelectric activity (surface electromyography [sEMG]) of the vastus medialis oblique (VMO), vastus lateralis, gluteus medius (Gmed), and erector spinae muscles during the performance of several squat variations with bodyweight. METHODS Nineteen female college students (20 [2.5] y, 165.3 [10.2] cm, 66.4 [4.1] kg, 2 [1.2] y of resistance training experience) with a background in strength or sports training volunteered to participate in this study. Over 4 separate visits, subjects performed 2 sets of 10 repetitions of a squat variation exercise in random order (ie, squat, single-leg squat, forward lunge, and reverse lunge). The first set of a given squat variation condition was considered a control set, and then after 3-minute rest, a second set was performed with VFLS. RESULTS Significant decreases in VMO and Gmed myoelectric activity were observed during the VFLS set versus the control set for the forward lunge exercise (P = .03). No differences were observed between the control set and VFLS set in the sEMG normalized signal for all muscles analyzed for the squat and single-leg squat, respectively. However, the sample entropy of the sEMG signal for the erector spinae became more irregular during the VFLS set versus the control set for the squat exercise (P = .01), whereas the Gmed presented a more irregular sEMG signal during the VFLS set versus the control set for the single-leg squat (P = .08). CONCLUSION Laser sensor biofeedback may induce significant decreases in VMO and Gmed activation performing forward lunge exercise. Therefore, laser sensor biofeedback may induce a reduction in muscle activity of neutralizers muscles during a few squat bodyweight variations (bilateral, single-leg, forward, and reverse lunge).
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Simpson JD, Stewart EM, Turner AJ, Macias DM, Chander H, Knight AC. Lower Limb Joint Kinetics During a Side-Cutting Task in Participants With or Without Chronic Ankle Instability. J Athl Train 2020; 55:169-175. [PMID: 31895591 DOI: 10.4085/1062-6050-334-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited. OBJECTIVE To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI. DESIGN Cohort study. SETTING Motion-capture laboratory. PATIENTS OR OTHER PARTICIPANTS Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg). INTERVENTION(S) Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed. MAIN OUTCOME MEASURE(S) Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables. RESULTS The CAI group exhibited a reduced ankle-eversion moment (39%-81% of stance phase) and knee-abduction moment (52%-75% of stance phase) and a greater ankle plantar-flexion moment (3%-16% of stance phase) than the control group (P range = .009-.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t28 = 1.978, P = .03). CONCLUSIONS Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.
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Affiliation(s)
- Jeffrey D Simpson
- Department of Movement Sciences and Health, University of West Florida, Pensacola
| | - Ethan M Stewart
- Department of Kinesiology, Mississippi State University, Starkville
| | - Alana J Turner
- Department of Kinesiology, Mississippi State University, Starkville
| | - David M Macias
- Department of Orthopaedic Surgery, Columbus Orthopaedic Clinic, MS
| | - Harish Chander
- Department of Kinesiology, Mississippi State University, Starkville
| | - Adam C Knight
- Department of Kinesiology, Mississippi State University, Starkville
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Abstract
Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.
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Affiliation(s)
- Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington
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Kunugi S, Masunari A, Koumura T, Fujimoto A, Yoshida N, Miyakawa S. Altered lower limb kinematics and muscle activities in soccer players with chronic ankle instability. Phys Ther Sport 2018; 34:28-35. [DOI: 10.1016/j.ptsp.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
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Knee Frontal Plane Projection Angle: A Comparison Study Between Drop Vertical Jump and Step-Down Tests With Young Volleyball Athletes. J Sport Rehabil 2018; 28:153-158. [PMID: 29091512 DOI: 10.1123/jsr.2017-0204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Observational study. CONTEXT Altered frontal plane knee mechanics during dynamic tasks have been often associated with lower-extremity injuries. Strategies to decrease these risk factors and improve knee joint stability are often applied in rehabilitation and training environments. OBJECTIVE The purpose of this study was to compare knee joint frontal plane projection angles (FPPA) via 2-dimensional video analysis during drop vertical jump (DVJ) and step-down test (SDT) tasks in the preferred and nonpreferred limbs of young male and female volleyball players. METHODS A total of 60 young male (n = 29) and female (n = 31) volleyball players (13.6 [1.1] y, 62.2 [11.2] kg, and 170.8 [10] cm) participated in this study. Once the athletes were screened for inclusion and exclusion criteria, limb preference was operationally defined as the preferred kicking leg or the foot used for stair climbing. In a randomized study design, participants were asked to perform a bilateral DVJ and unilateral step-down landing tasks for both preferred and nonpreferred limb. Kinematic analysis was performed via a 2-dimensional video recording of knee joint FPPA alignment. RESULTS No difference was noted in FFPA during DVJ and SDT tasks between preferred and nonpreferred limbs in both male and female groups (P > .05). The FFPA was significantly higher for both limbs during DVJ versus SDT in both groups (P ≤ .05), but it was not different between male and female athletes. CONCLUSIONS Based on these findings, clinicians may expect young male and female volleyball athletes to demonstrate similar and symmetrical lower-extremity 2-dimensional knee joint FPPA values across screening tests intended to identify lower-extremity injury risk factors. However, greater FPPA values should be expected during the more dynamic DVJ task.
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Malliaropoulos N, Bikos G, Meke M, Vasileios K, Valle X, Lohrer H, Maffulli N, Padhiar N. Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle - a 17 years observational cohort study. J Foot Ankle Res 2018; 11:7. [PMID: 29492109 PMCID: PMC5828071 DOI: 10.1186/s13047-018-0247-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/22/2018] [Indexed: 12/26/2022] Open
Abstract
Background Inversion injury to the ankle and hamstring injuries are common problems in most sports. It is not known whether these injuries constitute a predisposing factor or a precursor of injury or re-injury of these anatomical locations. Therefore, we wished to test the hypothesis that a previous inversion ankle injury exerted a significant effect on the chance of an athlete suffering from a subsequent ipsilateral hamstring injury and vice versa. Methods In an observational cohort study over 17 years (1998–2015), 367 elite track and field athletes, were grouped according to their first traumatic isolated ankle or hamstring injury. Fifty athletes experienced both injuries. The Mann-Whitney U and Chi-square tests (p < 0.05) were performed to test possible associations of ankle and hamstring injury with age, gender, athletics discipline, grade, and type of antecedent injury. Results Athletes with a preceding ankle injury had a statistically significantly higher chance of experiencing a subsequent hamstring injury compared with athletes who had experienced a hamstring injury as their first traumatic event (x2 = 4.245, p = 0.039). The proportion of both ankle and hamstring injury events was not statistically different between female (18%) and male (11%) athletes. Age and grade of injury did not influence the proportion of ankle and/or hamstring injury events. Conclusion There is a statistically significantly higher frequency of hamstring injuries in elite track and field athletes having experienced a previous ankle ligament injury.
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Affiliation(s)
- Nikolaos Malliaropoulos
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece.,National Track & Field Centre, Sports Medicine Clinic, Thessaloniki, Greece.,European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health Trust, London, UK.,5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Georgios Bikos
- National Track & Field Centre, Sports Medicine Clinic, Thessaloniki, Greece.,Euromedica Arogi Rehabilitation Clinic, Thessaloniki, Greece
| | - Maria Meke
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece
| | - Korakakis Vasileios
- 7Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Hellenic Orthopaedic Manipulative Therapy Diploma, Athens, Greece
| | - Xavier Valle
- Football Club Barcelona, Medical Department, Barcelona, Spain.,10Sports Medicine School (Universitat de Barcelona), Barcelona, Spain.,Mapfre Centre for Tennis Medicine, Barcelona, Spain.,12Department de Cirurgia de la Facultat de Medicina at the Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Heinz Lohrer
- European SportsCare Network, Frankfurt am Main, Germany.,Department of Sport and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nicola Maffulli
- 5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.,15Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nat Padhiar
- European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health Trust, London, UK.,5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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Coordination and Symmetry Patterns During the Drop Vertical Jump in People With Chronic Ankle Instability and Lateral Ankle Sprain Copers. Phys Ther 2016; 96:1152-61. [PMID: 26893510 DOI: 10.2522/ptj.20150160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 02/04/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The drop vertical jump (DVJ) task has previously been used to identify movement patterns associated with a number of injury types. However, no current research exists evaluating people with chronic ankle instability (CAI) compared with people coping with lateral ankle sprain (LAS) (referred to as "LAS copers") during this task. OBJECTIVE The aim of this study was to identify the coping movement and motor control patterns of LAS copers in comparison with individuals with CAI during the DVJ task. DESIGN This was a case-control study. METHODS Seventy individuals were recruited at convenience within 2-weeks of sustaining a first-time acute LAS injury. One year following recruitment, these individuals were stratified into 2 groups: 28 with CAI and 42 LAS copers. They attended the testing laboratory to complete a DVJ task. Three-dimensional kinematic and sagittal-plane kinetic profiles were plotted for the lower extremity joints of both limbs for the drop jump phase (phase 1) and drop landing phase (phase 2) of the DVJ. The rate of impact modulation relative to body weight during both phases of the DVJ also was determined. RESULTS Compared with LAS copers, participants with CAI displayed significant increases in hip flexion on their "involved" limb during phase 1 of the DVJ (23° vs 18°) and bilaterally during phase 2 (15° vs 10°). These movement patterns coincided with altered moment-of-force patterns at the hip on the "uninvolved" limb. LIMITATIONS It is unknown whether these movement and motor control patterns preceded or occurred as a result of the initial LAS injury. CONCLUSIONS Participants with CAI displayed hip-centered changes in movement and motor control patterns during a DVJ task compared with LAS copers. The findings of this study may give an indication of the coping mechanism underlying outcome following initial LAS injury.
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Allet L, Zumstein F, Eichelberger P, Armand S, Punt IM. Neuromuscular Control Mechanisms During Single-Leg Jump Landing in Subacute Ankle Sprain Patients: A Case Control Study. PM R 2016; 9:241-250. [PMID: 27457519 DOI: 10.1016/j.pmrj.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/30/2016] [Accepted: 07/15/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Optimal neuromuscular control mechanisms are essential for preparing, maintaining, and restoring functional joint stability during jump landing and to prevent ankle injuries. In subacute ankle sprain patients, neither muscle activity nor kinematics during jump landing has previously been assessed. OBJECTIVE To compare neuromuscular control mechanisms and kinematics between subacute ankle sprain patients and healthy persons before and during the initial contact phase of a 25-cm single-leg jump. DESIGN Case-control study. SETTING University hospital. PATIENTS Fifteen patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. METHODS Subjects performed alternately 3 single-leg forward jumps of 25 cm (toe-to-heel distance) barefoot. Their results were compared with the data of 15 healthy subjects. MAIN OUTCOME MEASUREMENTS Electromyographic (EMG) activity of the musculus (m.) gastrocnemius lateralis, m. tibialis anterior, and m. peroneus longus as well as kinematics for ankle, knee, and hip joint were recorded for pre-initial contact (IC) phase, post-initial contact phase, and reflex-induced phase. RESULTS The results showed that EMG activity of the 3 muscles did not differ between ankle sprain patients (n = 15) and healthy persons (n = 15) for any of the analyzed time intervals (all P > .05). However, during the pre-IC phase, ankle sprain patients presented less plantar flexion, as well as during the post-IC phase after jump landing, compared to healthy persons (P < .05). CONCLUSION Taken together, these kinematic alterations of the ankle joint can lead to neuromuscular control mechanism disturbances through which functional instability might arise. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lara Allet
- University of Applied Sciences of Western Switzerland, HES-SO, Geneva, Switzerland; Geneva University Hospitals and University of Geneva, Geneva, Switzerland∗
| | | | - Patric Eichelberger
- Health, Research and Development Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland(‡)
| | - Stéphane Armand
- Geneva University Hospitals and University of Geneva, Geneva, Switzerland(§)
| | - Ilona M Punt
- University of Applied Sciences of Western Switzerland, HES-SO, Geneva, Switzerland; Department of Physical Therapy, University of Applied Sciences of Western Switzerland, 25 rue des Caroubiers, CH-1227 Carouge, Switzerland; Geneva University Hospitals and University of Geneva, Geneva, Switzerland(‖).
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Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DTP, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Verhagen EA, Vicenzino BT, Wikstrom EA, Delahunt E. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016; 50:1496-1505. [PMID: 27259753 DOI: 10.1136/bjsports-2016-096189] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 02/06/2023]
Abstract
Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.
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Affiliation(s)
- Phillip A Gribble
- University of Kentucky, College of Health Sciences, Lexington, Kentucky, USA
| | - Chris M Bleakley
- Department of Life and Health Sciences, Ulster University, Jordanstown, Carrickfergus, UK
| | - Brian M Caulfield
- University College Dublin, Insight Centre for Data Analytics, Dublin, Ireland
| | - Carrie L Docherty
- Indiana University, School of Public Health, Bloomington, Indiana, USA
| | | | - Daniel Tik-Pui Fong
- National Centre for Sport and Exercise Medicine-East Midlands, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Jay Hertel
- Departments of Kinesiology and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Claire E Hiller
- University of Sydney, College of Health, Sydney, New South Wales, Australia
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Patrick O McKeon
- Department of Exercise and Sport Sciences, Ithaca College, Ithaca, New York, USA
| | | | - Evert A Verhagen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Bill T Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Queensland, Australia
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eamonn Delahunt
- University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
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18
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Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. Am J Sports Med 2016; 44:995-1003. [PMID: 26912285 DOI: 10.1177/0363546516628870] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impairments in motor control may predicate the paradigm of chronic ankle instability (CAI) that can develop in the year after an acute lateral ankle sprain (LAS) injury. No prospective analysis is currently available identifying the mechanisms by which these impairments develop and contribute to long-term outcome after LAS. PURPOSE To identify the motor control deficits predicating CAI outcome after a first-time LAS injury. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Eighty-two individuals were recruited after sustaining a first-time LAS injury. Several biomechanical analyses were performed for these individuals, who completed 5 movement tasks at 3 time points: (1) 2 weeks, (2) 6 months, and (3) 12 months after LAS occurrence. A logistic regression analysis of several "salient" biomechanical parameters identified from the movement tasks, in addition to scores from the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure (FAAM) recorded at the 2-week and 6-month time points, were used as predictors of 12-month outcome. RESULTS At the 2-week time point, an inability to complete 2 of the movement tasks (a single-leg drop landing and a drop vertical jump) was predictive of CAI outcome and correctly classified 67.6% of cases (sensitivity, 83%; specificity, 55%; P = .004). At the 6-month time point, several deficits exhibited by the CAI group during 1 of the movement tasks (reach distances and sagittal plane joint positions at the hip, knee and ankle during the posterior reach directions of the Star Excursion Balance Test) and their scores on the activities of daily living subscale of the FAAM were predictive of outcome and correctly classified 84.8% of cases (sensitivity, 75%; specificity, 91%; P < .001). CONCLUSION An inability to complete jumping and landing tasks within 2 weeks of a first-time LAS and poorer dynamic postural control and lower self-reported function 6 months after a first-time LAS were predictive of eventual CAI outcome.
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Affiliation(s)
- Cailbhe Doherty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Chris Bleakley
- Sport and Exercise Sciences Research Institute, Ulster Sports Academy, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - John Ryan
- St Vincent's University Hospital, Dublin, Ireland
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, University College Dublin, Dublin, Ireland
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