Deficits in subtalar pronation and supination proprioception in subjects with chronic ankle instability

Blood flow restriction training improves the efficacy of routine intervention in patients with chronic ankle instability

As a new means of rehabilitation, blood flow restriction training (BFRT) is widely used in the field of musculoskeletal rehabilitation. To observe whether BFRT can improve the efficacy of routine rehabilitation intervention in patients with chronic ankle instability (CAI). Twenty-three patients with CAI were randomly divided into a routine rehabilitation group (RR Group) and a routine rehabilitation ​+ ​blood flow restriction training group (RR ​+ ​BFRT Group) according to the Cumberland Ankle Instability Tool (CAIT) score. The RR Group was treated with routine rehabilitation means for intervention, and the RR ​+ ​BFRT Group was treated with a tourniquet to restrict lower limb blood flow for rehabilitation training based on routine training. Before and after the intervention, the CAIT score on the affected side, standing time on one leg with eyes closed, comprehensive scores of the Y-balance test, and surface electromyography data of tibialis anterior (TA) and peroneus longus (PL) were collected to evaluate the recovery of the subjects. Patients were followed up 1 year after the intervention. After 4 weeks of intervention, the RR ​+ ​BFRT Group CAIT score was significantly higher than the RR Group (19.33 VS 16.73, p ​< ​0.05), the time of standing on one leg with eyes closed and the comprehensive score of Y-balance were improved, but there was no statistical difference between groups (p ​> ​0.05). RR ​+ ​BFRT Group increased the muscle activation of the TA with maximum exertion of the ankle dorsal extensor (p ​< ​0.05) and had no significant change in the muscle activation of the PL with maximum exertion of the ankle valgus (p ​> ​0.05). There was no significant difference in the incidence of resprains within 1 year between the groups (36.36% VS 16.67%, p ​> ​0.05). The incidence of ankle pain in the RR ​+ ​BFRT Group was lower than that in the RR Group (63.64% VS 9.09%, p ​< ​0.01). Therefore, four-weeks BFRT improves the effect of the routine intervention, and BFRT-related interventions are recommended for CAI patients with severe ankle muscle mass impairment or severe pain.

Comparison of effect of wobble board training with and without cognitive intervention on balance, ankle proprioception and jump landing kinetic parameters of men with chronic ankle instability: a randomized control trial

Background

The aim of the present study was to compare the effect of a wobble board training (WBT) course with and without cognitive intervention (CI) on balance, ankle proprioception and jump-landing kinetic parameters in active men with chronic ankle instability (CAI).

Methods

Twenty-one active men in the age range of 18–25 years with CAI were randomly divided into three groups of WBT for five weeks as follows: with CI (n = 7); without CI (n = 7); control (n = 7). In this study, balance was evaluated by Y-Balance Test and Balance Error Scoring System, proprioception was evaluated as active and passive replication of 15-degree inversion angle and Maximum inversion angle minus 5-degrees, and single-leg jump-landing test was used for measurement of kinetic variables as pre-test and post-test in similar conditions.

Results

Post-test of both groups of WBT with and without CI showed a significant improvement in all variables compared to pre-test (p ≤ 0.05); however, in post-test, there was no significant difference in any of the variables between WBT groups with and without CI (p ≥ 0.05).

Conclusions

A course of WBT with and without CI leads to a significant improvement in balance, proprioception and jump-landing kinetic parameters, including time to stabilization and center of pressure displacement in active men with CAI. Although the WBT group with CI showed a greater improvement in mean than WBT group without CI, but the difference was not significant in any of the variables.

Trial registration

Retrospectively Registered. irict.ir Identifier: IRCT20200617047818N1 on 05–02-2021.

Force sense deficits in chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Patients with chronic ankle instability (CAI) may experience ankle force sense deficits due to mechanoreceptor injury and proprioceptive deafferentation in the affected ankles. This study aimed to systematically review the literature and investigate (1) whether patients with CAI have impaired force sense when compared with uninjured contralateral sides or healthy controls, and (2) which characteristics of CAI (e.g., any measurement of CAI symptoms, clinical questionnaires, or functional tests on the injured ankles) are correlated with force sense deficits. TYPE: Systematic review and meta-analysis.

LITERATURE SURVEY

PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus were searched for ankle-related, injury-related, and force sense-related terms from inception to February 2, 2022.

METHODOLOGY

The following information was extracted from included articles: demographic data, sample size, selection criteria, methodology, force reproduction test outcomes, and correlations between force sense and other characteristics of CAI. Meta-analyses were conducted for the force sense outcomes, and a narrative review was undertaken for the correlation between force sense deficits and other characteristics of CAI.

SYNTHESIS

Eight studies were included. The meta-analyses revealed eversion force sense deficits of the injured ankles in absolute error (magnitude of force reproduction error) at 20% maximal voluntary isometric contractions (MVIC) (standardized mean difference [SMD] = 0.67, 95% confidence interval [CI] 0.23-1.11) and variable error (consistency of force reproduction) at 30% MVIC (SMD = 0.46, 95% CI 0.07-0.85), as compared with healthy controls. None of the included studies reported a significant correlation between these two deficits and other characteristics of CAI.

CONCLUSIONS

Patients with CAI have eversion force sense deficits in the magnitude of force reproduction error at 20% MVIC and the consistency of force reproduction at 30% MVIC.

Current Concepts on Subtalar Instability

Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.

The Effects of Acute and Long-Term Whole-Body Vibration Training on the Postural Control During Cognitive Task in Patients With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) is a common problem associated with impaired postural stability. Whole-body vibration (WBV) has been developed to improve muscle function and reportedly improves postural stability. The aim of this study was to evaluate the effect of 12 sessions of WBV on postural control during standing postural task in participants with CAI.

DESIGN

A controlled clinical trial study.

METHODS

Sixteen participants with CAI and 16 healthy participants aged between 20 and 40 years included in this study. They received WBV (30-Hz frequency, 3 series of four 45-s exercises with a 45-s rest) for a total of 12 sessions, 2 session per week for 6 weeks. Postural control was assessed by center of pressure (COP) parameters, including mean and SD in the anterior-posterior and medial-lateral displacement during single-leg standing. Assessments were done before and immediately after the first session and after the 12th session of WBV, with opened and closed eyes associated with easy and difficult cognitive tasks.

RESULTS

The results showed that the SD of COP displacement in the x-axis was significant in eyes opened and SD of COP displacement in the x- and y-axes were significant between groups in the eyes-opened, and eyes-closed conditions (P < .05). Analysis of variance indicated that the effect of WBV training was significant for the mean of COP displacement in the y-axis. Post hoc indicated that the effect of 12 sessions of WBV on the mean of COP displacement was significant in the CAI group (P < .05). However, the acute effect of WBV was not significant on the COP displacement in all axes (P > .05).

CONCLUSION

Higher postural sway associated with postural cognitive interactions might be considered in the rehabilitation of CAI. Twelve sessions of WBV might induce some improvement in postural control with the method of WBV used in this study.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

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.

An Updated Model of Chronic Ankle Instability

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

Internal mechanical work and maximum subtalar joint pronation in different gradients

Abstract Introduction: Some authors have described the importance of physiological intensity in the behavior of the biomechanical aspects of running (for example, subtalar pronation), but the complex relationships between these variables are not yet well understood. Objective: This study investigated the influence of positive gradients on internal mechanical work (Wint) and maximum subtalar pronation at a submaximal running speed. Method: Sixteen male, trained long-distance runners (age: 29 ± 7 yr; stature: 1.72 ± 0.07 m; body mass: 72.1 ± 10.6 kg), performed four running economy tests (gradients: +1%, +5%, +10% and +15%, respectively) for four minutes at a same submaximal running speed to quantify the maximum values of subtalar pronation and predict the Wint values. Data were analyzed using descriptive statistics, Student’s T-test, and one-way repeated-measures (ANOVA) along with the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Wint increased according to the gradient (p < 0.05). However, no significant differences were observed in the maximum values of maximum subtalar pronation corresponding to each gradient. Conclusion: Results show the maximum subtalar pronation during submaximal running depends on the speed rather than intensity of effort.