Proprioceptive postural control strategies differ among non-injured athletes

Lack of Proprioceptive Strategy Modulation Leads to At-Risk Biomechanics for Anterior Cruciate Ligament in Healthy Athletes

INTRODUCTION

Anterior cruciate ligament (ACL) injuries are frequent in handball, and altered sensory integration may contribute to increased injury risk. Recent evidence showed that proprioceptive postural control strategies differ among athletes. The aim of this study was to evaluate the relationship between proprioceptive strategy and biomechanics during side-cutting maneuvers.

METHODS

A total of 47 handball players performed anticipated and unanticipated cutting tasks. Their postural proprioceptive strategy was then characterized according to the perturbation of the center of pressure displacement generated by the muscle vibration on a firm and foam surface. Individuals able to reweight proprioception from ankle to lumbar signals according to the stability of the support were defined as flexible. Conversely, athletes maintaining an ankle-steered strategy on foam surface were characterized as rigid. Statistical parametric mapping analysis was used to compare pelvic and lower limb side-cutting kinematics, kinetics, and EMG activity from seven muscles 200 ms before and after initial contact (IC) using a two-way ANOVA (group-condition).

RESULTS

Twenty athletes (11 females and 9 males, 18.5 yr) were characterized as flexible and 20 athletes (12 females and 8 males, 18.9 yr) as rigid. No interaction between condition and proprioceptive profile was observed. More ipsilateral pelvic tilt before IC and lower vastus lateralis (VL) activity immediately after IC was observed during CUT ant . When comparing proprioceptive strategy, rigid individuals exhibited less preactivity of the semitendinosus ( P < 0.001) and higher VL activity ( P = 0.032). Conversely, rigid showed higher gluteus medius preactivity ( P < 0.05) and higher VL activity 100 ms after IC ( P < 0.001). Ankle was also more internally rotated before and during the stance phase ( P < 0.05) among rigid athletes.

CONCLUSIONS

Rigid handball players exhibited at-risk determinants for anterior cruciate ligament injuries during side-cutting maneuvers.

Postural control in gymnasts: anisotropic fractal scaling reveals proprioceptive reintegration in vestibular perturbation

Dexterous postural control subtly complements movement variability with sensory correlations at many scales. The expressive poise of gymnasts exemplifies this lyrical punctuation of release with constraint, from coarse grain to fine scales. Dexterous postural control upon a 2D support surface might collapse the variation of center of pressure (CoP) to a relatively 1D orientation-a direction often oriented towards the focal point of a visual task. Sensory corrections in dexterous postural control might manifest in temporal correlations, specifically as fractional Brownian motions whose differences are more and less correlated with fractional Gaussian noises (fGns) with progressively larger and smaller Hurst exponent H. Traditional empirical work examines this arrangement of lower-dimensional compression of CoP along two orthogonal axes, anteroposterior (AP) and mediolateral (ML). Eyes-open and face-forward orientations cultivate greater variability along AP than ML axes, and the orthogonal distribution of spatial variability has so far gone hand in hand with an orthogonal distribution of H, for example, larger in AP and lower in ML. However, perturbing the orientation of task focus might destabilize the postural synergy away from its 1D distribution and homogenize the temporal correlations across the 2D support surface, resulting in narrower angles between the directions of the largest and smallest H. We used oriented fractal scaling component analysis (OFSCA) to investigate whether sensory corrections in postural control might thus become suborthogonal. OFSCA models raw 2D CoP trajectory by decomposing it in all directions along the 2D support surface and fits the directions with the largest and smallest H. We studied a sample of gymnasts in eyes-open and face-forward quiet posture, and results from OFSCA confirm that such posture exhibits the classic orthogonal distribution of temporal correlations. Head-turning resulted in a simultaneous decrease in this angle Δθ, which promptly reversed once gymnasts reoriented their heads forward. However, when vision was absent, there was only a discernible negative trend in Δθ, indicating a shift in the angle's direction but not a statistically significant one. Thus, the narrowing of Δθ may signify an adaptive strategy in postural control. The swift recovery of Δθ upon returning to a forward-facing posture suggests that the temporary reduction is specific to head-turning and does not impose a lasting burden on postural control. Turning the head reduced the angle between these two orientations, facilitating the release of postural degrees of freedom towards a more uniform spread of the CoP across both dimensions of the support surface. The innovative aspect of this work is that it shows how fractality might serve as a control parameter of adaptive mechanisms of dexterous postural control.

Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review

BACKGROUND

Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking.

OBJECTIVE

The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability.

METHODS

PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956.

RESULTS

Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability.

DISCUSSION

The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.

The impact of unexpected platform perturbation on ankle proprioception ability in static and dynamic starting positions

AIMS

To examine the relationship between ankle proprioception and the ability to maintain balance with increased magnitudes of unexpected perturbations; and to compare the participants' ability to maintain balance following perturbations when starting from static and dynamic positions.

METHODS

Sixty physical education students (average 24.6 years) were tested for proprioception ability (AUC scores) and balance challenges presented on a perturbation treadmill. The degree at which participants lost postural balance was recorded in seven starting positions: standing-eyes-open (SO), standing-eyes-closed (SC), tandem-dominant (TD), tandem non-dominant, (TND) single-leg lateral side perturbation (SLP), single-leg medial side perturbation (SMP), and walking. Perturbation scores were analysed divided by tertiles. Multidimensional Unfolding SPSS Statistics 25 (PREFSCAL) was used to examine the relationships between data sets.

RESULTS

AUC scores of both dominant and non-dominant legs were significantly correlated with SO (r = 0.316; r = 0.445), SC (r = 0.364; r = 0.413), TD (r = 0.346; r = 0.308), and walking (r = 0.265; r = 0.439), respectively. In the dominant-leg, AUC scores of individuals with below-median SO scores were significantly worse compared to those with median SO scores (p = .046). In the non-dominant leg, individuals with above-median SC had significantly better AUC scores compared to those with lower-than-median SC (p = .008). Those with median and above-median SO and walking achieved better AUC scores than those with below-median (SO: p = .049, p = .004; walking: p = .016, p < .001, respectively). In dimension I, the SLP and SMP were located opposite one another; in dimension II, the TD and TND were located at the upper side, whereas SC, SO and walking were at the lowest side.

CONCLUSIONS

AUC scores were significantly correlated with the level at which postural balance was lost, whereby the better the proprioception ability, the better the ability to maintain balance. As such, the ability to maintain balance is harder in tandem positions than in standing and walking positions. This ability differed when perturbations were to the lateral or medial sides.

Hip Abductor Muscle Fatigue Induces Different Strategies During Disrupted Postural Control

Background

Ankle sprain is one of the most common injuries in sport, and hip abductor muscle weakness has recently been reported as a predisposing factor. Currently, the influence of hip abductor muscle fatigue on ankle joint control has not been elucidated during an ankle disturbed balance exercise. This study aimed to determine the influence of hip abductor muscle fatigue on ankle joint control during a disturbed balance task, and to consider inter-individual variability in the kinematic and neuromuscular reorganizations implemented.

Methods

Twenty-six healthy subjects (13 males; 13 females) performed a unipedal postural balance task with eyes closed before and after a fatiguing exercise (up to a 50% decrease in strength) of the hip abductor muscles. Subjects completed balance task while equipped with an ankle destabilization device that allows inversion/eversion movements. Electromyographic (EMG) activity of the gastrocnemius lateralis (GastL), peroneus longus (PL) and brevis, tibialis anterior, and gluteus medius were recorded during task. Kinematics (e.g., frontal foot angulation) of the ankle complex were determined using inertial measurement units.

Results

In the overall group, no significant time, sex or interaction effect was observed for kinematic and EMG variables. However, when considering individual responses to hip fatigue, 14 subjects decreased the standard deviation of frontal angulation (−30%) suggesting enhancement of ankle joint control, while 12 subjects increased it (+46%). Normalized EMG for PL and GastL muscles changed with fatigue for both these groups. However, variations were significantly different between groups (p = 0.027 for PL and p = 0.006 for GastL). Indeed, the contribution of ankle muscles increased for the enhanced-stability group while no change for the impaired-stability group.

Conclusion

These results highlight that subject adopt different neuromuscular and kinematic ankle strategies to control ankle destabilization in response to hip abductor muscle fatigue. Frontal foot angulation variability seemed to be a valuable marker to detect the type of strategy employed. The strategy adopted by the impaired-stability group might have important implications when analyzing risk factors for ankle sprains. Further studies should consider individual responses to fatigue, to understand which factor could predispose athletes to use of one or other strategy.