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Xue X, Wang Y, Xu X, Li H, Li Q, Na Y, Tao W, Yu L, Jin Z, Li H, Wang R, Hua Y. Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Health 2024; 16:29-37. [PMID: 36872589 PMCID: PMC10732110 DOI: 10.1177/19417381231152490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
CONTEXT Postural control deficits arising from injured ankles are central to chronic ankle instability (CAI) and its persistent symptoms. This is usually measured by recording the center of pressure (CoP) trajectory during static single-leg stance using a stable force plate. However, existing studies have produced conflicting results on whether this mode of measurement adequately reveals the postural deficits in CAI. OBJECTIVE To determine whether postural control during static single-leg stance is impaired in CAI patients when compared with uninjured healthy controls. DATA SOURCES Literature databases, PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus, were searched from inception to April 1, 2022, using ankle-, injury-, and posture-related terms. STUDY SELECTION Two authors independently performed the step-by-step screening of article titles, abstracts, and full texts to select peer-reviewed studies investigating CoP trajectory during static single-leg stance using a stable force plate in CAI patients and healthy controls. A total of 13,637 studies were reviewed, and 38 studies (0.003%) met the selection criteria. STUDY DESIGN Meta-analyses of descriptive epidemiological study. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION CoP parameters, sway directions, visual condition, and numerical data (means and standard deviations) were extracted. RESULTS The injured ankles of CAI patients had higher standard deviations of sway amplitude in both anterior-posterior and medial-lateral directions (standardized mean difference [SMD] = 0.36 and 0.31, respectively) under conditions of open eyes than controls. Higher mean sway velocity in anterior-posterior, medial-lateral, and total directions (SMD = 0.41, 0.37, and 0.45, respectively) with closed eyes was also found. CONCLUSION CAI patients had deficits of postural control during static single-leg stance, and these deficits were identified by the CoP trajectory. Further methodological explorations of CoP parameters and corresponding test conditions are required to enhance the sensitivity and reliability of postural deficit assessments in CAI using force plates.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiran Wang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyun Xu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weichu Tao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Le Yu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ru Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, China
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Kempfert DJ, Chaconas EJ, Daugherty ML, Clark NC. Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction. Phys Ther Sport 2023; 64:63-73. [PMID: 37778110 DOI: 10.1016/j.ptsp.2023.09.007] [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: 06/20/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DESIGN Repeated measures. SETTING University. PARTICIPANTS 8 female, 4 male with unilateral autogenous ACLr. MAIN OUTCOME MEASURES Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50-0.75), good (0.75-0.90). RESULTS ACLr-side intra-rater/inter-rater ICCs ranged: LT, -0.27-0.80/-0.01-0.84; VS, 0.12-0.90/0.25-0.90; PPT, 0.49-0.98/0.86-0.99; AJPS, 0.15-0.79/0.55-0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12-0.66/-0.09-0.64; VS, 0.35-0.89/0.05-0.81; PPT, 0.65-0.99/0.45-0.95; AJPS, 0.07-0.81/0.37-0.99; ACHD, 0.99/0.98. CONCLUSIONS Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.
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Affiliation(s)
- David J Kempfert
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Eric J Chaconas
- Doctor of Science Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI, 54311, United States.
| | - Matthew L Daugherty
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, C04 3SQ, United Kingdom.
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Hu X, Liao J, Hu X, Zeng Z, Wang L. Effects of plantar-sensory treatments on postural control in chronic ankle instability: A systematic review and meta-analysis. PLoS One 2023; 18:e0287689. [PMID: 37368906 DOI: 10.1371/journal.pone.0287689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE This study aimed to examine the effects of plantar-sensory treatments on postural control in individuals with chronic ankle instability (CAI). METHODS This study was registered in PROSPERO (registration number CRD42022329985) on May 14, 2022. An extensive search was performed in Pubmed, Embase, Cochrane, Web of Science, and Scopus to identify the potential studies on plantar-sensory treatments affecting postural control before May 2022. The methodological quality of involved studies was assessed using the scale of Physiotherapy Evidence Database (PEDro). The Cochrane Tool and the Risk of Bias in Non-randomized Studies of Interventions assessment tool were used to evaluate the risk of bias in randomised controlled trials (RCTs) and non-RCTs respectively. RevMan 5.4 was utilised to calculate the standardised mean difference (SMD), with 95% confidence interval (CI). RESULTS Eight RCTs with a mean PEDro rating of 6 and four non-RCTs with a mean PEDro rating of 4.75 were included in the quantitative analysis. The types of plantar-sensory treatments included plantar massage, whole-body vibration and textured surface-stimulation treatment. A significant effect of static balance with eyes open (SMD = -0.54; 95% CI: -0.81 to -0.27; p < 0.001) was found and subgroup analysis showed that plantar massage (SMD = -0.49; 95% CI: -0.84 to -0.14; p = 0.006) and whole-body vibration (SMD = -0.66; 95% CI: -1.12 to -0.19; p = 0.005) had positive effects. In the subgroup analysis of anterior dynamic balance, whole-body vibration revealed a significant increase (SMD = 0.60; 95% CI: 0.06-1.14; p = 0.03). The pooled results or subgroup analysis including eyes-closed static balance and other directions of dynamic balance indicated no significant difference (p > 0.05). CONCLUSIONS This meta-analysis indicated that plantar-sensory treatments could improve postural control in CAI, especially the treatments of plantar massage and long-term whole-body vibration.
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Affiliation(s)
- Xiaomei Hu
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Jingjing Liao
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xiaoyue Hu
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Ziwei Zeng
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
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Heimark NE, Friedman AMH, Kitano K, Madsen LP. The role of sural nerve reflexes during drop-landing in subjects with and without chronic ankle instability. Exp Brain Res 2023; 241:1691-1705. [PMID: 37204505 DOI: 10.1007/s00221-023-06636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
The purpose of this study was to investigate the functional role of cutaneous reflexes during a single-leg drop-landing task among healthy, neurologically intact adults, and to identify whether individuals with chronic ankle instability (CAI) demonstrate altered reflexes and subsequent ankle kinematics. All subjects were physically active adults and were categorized as control (n = 10, Male = 6, Female = 4) or CAI (n = 9, Male = 4, Female = 5) depending on whether they scored a 0 or ≥ 11 on the Identification of Functional Ankle Instability questionnaire, respectively. Subjects performed 30-40 single-leg drop-landing trials from a platform set to the height of their tibial tuberosity. Muscle activity of four lower leg muscles was collected via surface electromyography, while ankle kinematics were recorded via an electrogoniometer. Non-noxious stimulations were elicited randomly to the ipsilateral sural nerve at two unique phases of the drop-landing task (takeoff and landing). Unstimulated and stimulated trials were used to calculate middle latency reflex amplitudes (80-120 ms) and net ankle kinematics (140-220 ms) post-stimulation. Mixed-factor ANOVAs were used to identify significant reflexes within groups and differences in reflex amplitudes between groups. Unlike the CAI group, the control group experienced significant facilitation of the Peroneus Longus (PL) and inhibition of the Lateral Gastrocnemius (LG) when stimulated at takeoff, resulting in eversion immediately prior to landing. When stimulated at landing, the control group experienced significantly more inhibition of the PL compared to the CAI group (p = 0.019). These results suggest lower neural excitability for individuals with CAI, which may predispose them to recurrent injury during similar functional tasks.
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Affiliation(s)
| | | | - Koichi Kitano
- Indiana University, 1025 E 7th St, Bloomington, IN, 47405, USA
| | - Leif P Madsen
- Indiana University, 1025 E 7th St, Bloomington, IN, 47405, USA
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Hoch MC, Hertel J, Gribble PA, Heebner NR, Hoch JM, Kosik KB, Long D, Sessoms PH, Silder A, Torp DM, Thompson KL, Fraser JJ. Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol. BMC Sports Sci Med Rehabil 2023; 15:54. [PMID: 37032355 PMCID: PMC10084629 DOI: 10.1186/s13102-023-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).
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Grants
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
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Affiliation(s)
- Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.
| | - Jay Hertel
- Sports Medicine and Chair, Department of Kinesiology, University of Virginia, 550 Brandon Avenue, Charlottesville, VA, 22904-4407, USA
| | - Phillip A Gribble
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Johanna M Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Kyle B Kosik
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Doug Long
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY, 40536-0200, USA
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Danielle M Torp
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Katherine L Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, USA
| | - John J Fraser
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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Narciso FV, Dâmaso AR, Barela JA, Carvalho ANS, Ruiz F, de Queiroz SS, Lemos VS, de-Andrade AGP, Tufik S, De-Mello MT. Overweight Impairs Postural Control of Female Night Workers. Sleep Sci 2023; 16:29-37. [PMID: 37151773 PMCID: PMC10157823 DOI: 10.1055/s-0043-1767746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/20/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives To verify the relationships between sleep duration (Total Sleep Time - TST) and postural control of female night workers before and after shift. As well as, to verify if there is an influence of the body mass index (BMI) on the postural control of these female workers before and after shift. Methods A total of 14 female night workers (mean age: 35.0 ± 7.7 years) were evaluated. An actigraph was placed on the wrist to evaluate the sleep-wake cycle. The body mass and height were measured, and BMI was calculated. Postural control was evaluated by means of a force platform, with eyes opened and eyes closed before and after the 12-hour workday. Results There was an effect of the BMI on the velocity and the center of pressure path with eyes opened before ( t = 2.55, p = 0.02) and after ( t = 4.10, p < 0.01) night work. The BMI impaired the velocity and the center of pressure path with eyes closed before ( t = 3.05, p = 0.01; t = 3.04, p = 0.01) and after ( t = 2.95, p = 0.01; t = 2.94, p = 0.01) night work. Furthermore, high BMI is associated with female workers' postural sway ( p < 0.05). Conclusion Therefore, high BMI impairs the postural control of female night workers, indicating postural instability before and after night work.
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Affiliation(s)
- Fernanda Veruska Narciso
- Centro Universitário Mário Palmério (UNIFUCAMP), Physioterapy, Monte Carmelo, MG, Brazil
- Address for correspondence Fernanda Veruska Narciso
| | - Ana R. Dâmaso
- Universidade Federal de São Paulo, Nutrition, São Paulo, SP, Brazil
| | - Jose A. Barela
- Universidade Estadual Paulista, Physical Education, Rio Claro, SP, Brazil
| | | | - Francieli Ruiz
- Universidade Federal de São Paulo, Psychobiology, São Paulo, SP, Brazil
| | | | | | - Andre Gustavo P. de-Andrade
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Belo Horizonte, MG, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo, Psychobiology, São Paulo, SP, Brazil
| | - Marco Túlio De-Mello
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Belo Horizonte, MG, Brazil
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Lempke LB, Hoch MC, Call JA, Schmidt JD, Lynall RC. Lower Extremity Somatosensory Function Throughout Concussion Recovery: A Prospective Cohort Study. J Head Trauma Rehabil 2023; 38:E156-E166. [PMID: 35687895 DOI: 10.1097/htr.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being symptom-free) time points. SETTING Laboratory. PARTICIPANTS Participants with a concussion and matched controls ( n = 24; 58% male, age: 19.3 ± 1.1 years, mass: 70.3 ± 16.4 kg, height: 177.3 ± 12.7 cm). DESIGN Prospective cohort. MAIN MEASURES Somatosensory assessments on the dominant limb at both time points included: (1) plantar touch sensation threshold via Semmes-Weinstein monofilaments, (2) plantar pressure pain threshold via algometry, and (3) knee absolute passive joint repositioning (PJR) error via Biodex across 3 arcs (105°-75°, 30°-60°, 90°-45° knee-flexion). We used mixed-model analyses of variance, post hoc Tukey honestly significant difference t tests with mean difference, 95% CI, and Hedges' g effect sizes to examine outcomes. RESULTS Touch sensation had a group effect with the concussion cohort needing 0.95 grams of force (gf) more relative to controls (95% CI: 0.03 to 1.87; P = .043). No touch sensation interaction was present, but medium and large effects were observed for greater gf needed among the concussed cohort at the acute (1.11 gf; 95% CI: 0.17 to 2.05; g = 0.96) and asymptomatic time points (0.79 gf; 95% CI: -0.15 to 1.73; g = 0.73). No plantar pressure pain threshold effects were observed ( P ≥ .311), with negligible pressure difference magnitudes at the acute (0.26 pound force [lbf]/cm 2 ; 95% CI: -1.54 to 2.06; g = 0.13) and medium magnitudes at the asymptomatic time points (0.99 lbf/cm 2 ; 95% CI: -0.81 to 2.80; g = 0.42) for the concussed cohort needing more pressure to detect pain. The 30° to 60° PJR had a time effect, with asymptomatic time point having 3.12° better accuracy (95% CI: 1.23° to 5.02; P = .002). The concussed cohort had small-to-medium magnitude differences relative to controls at the acute time point for PJR during 105° to 75° (0.89°; g = 0.30) and 90° to 45° (0.62°; g = 0.17), but not 30° to 60° (-1.75°; g = -0.40). CONCLUSIONS Individuals with a concussion exhibited large effects for diminished plantar touch sensation and small to medium effects for inhibited plantar pressure pain sensation compared with controls, which may indicate altered somatosensory function. Negligible PJR differences suggest knee joint position sense is not altered post-concussion. Pre- and postconcussion examination is warranted to understand causal somatosensory mechanisms.
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Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, University of Georgia, Athens (Drs Lempke, Schmidt, and Lynall); Department of Kinesiology, University of Georgia, Athens (Drs Lempke, Call, Schmidt, and Lynall); Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, and Micheli Center for Sports Injury Prevention, Waltham, Massachusetts (Dr Lempke); Sports Medicine Research Institute, University of Kentucky, Lexington (Dr Hoch); and Skeletal Muscle Dysfunction Laboratory, University of Georgia, Athens (Dr Call)
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Lalevée M, Anderson DD, Wilken JM. Current Challenges in Chronic Ankle Instability: Review and Perspective. Foot Ankle Clin 2023; 28:129-143. [PMID: 36822682 DOI: 10.1016/j.fcl.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic ankle instability (CAI) is common, disabling, and represents a significant socioeconomic burden. Current treatment options are not adequately efficacious. CAI is multifaceted, yet it is commonly addressed in terms of either mechanical instability or functional impairment. Both are inherently linked. Basic research must be conducted to foster reliable translational research encompassing both mechanical and functional aspects. A review was conducted to identify CAI risk factors for inclusion in future studies, and we offer here opinions and perspectives for future research.
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Affiliation(s)
- Matthieu Lalevée
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France; Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, Rouen 76000, France
| | - Donald D Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242, USA; Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, 500 Newton Road, 1-249 Medical Education Building, Iowa City, IA 52242-1089, USA.
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Misencoding of ankle joint angle control system via cutaneous afferents reflex pathway in chronic ankle instability. Exp Brain Res 2022; 240:2327-2337. [PMID: 35764722 DOI: 10.1007/s00221-022-06406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
This study aimed to investigate how the cutaneous reflexes in the peroneus longus (PL) muscle are affected by changing the ankle joint position in patients with chronic ankle instability (CAI). We also investigated the correlation between the degree of reflex modulation and angle position sense of the ankle joint. The participants were 19 patients with CAI and 20 age-matched controls. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve at the ankle joint in the neutral standing and eversion/inversion standing positions. The suppressive middle latency cutaneous reflex (MLR; ~ 70-120 ms) and angle position sense of the ankle joint were assessed. During neutral standing, the gain of the suppressive MLR was more prominent in the CAI patients than in controls, although no significant difference was seen during 30° inversion standing. In addition, the ratios of the suppressive MLR and background electromyography in a neutral position were significantly larger than those at the 15°, 25°, and 30° inversion positions in CAI patients. No such difference was seen in control individuals. Furthermore, the correlations between reflex modulation degree and position sense error were quite different in CAI patients compared to controls. These findings suggest that the sensory-motor system was deteriorated in CAI patients due to changes in the PL cutaneous reflex pathway excitability and position sense of the ankle joint.
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Wikstrom EA, Song K, Tennant JN, Pietrosimone B. Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability. Med Sci Sports Exerc 2022; 54:1013-1019. [PMID: 35576137 DOI: 10.1249/mss.0000000000002867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI). METHODS Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes. RESULTS Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697). CONCLUSIONS In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.
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Affiliation(s)
- Erik A Wikstrom
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kyeongtak Song
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Song K, Franz JR, Wikstrom EA. Optical flow balance perturbations alter gait kinematics and variability in chronic ankle instability patients. Gait Posture 2022; 92:271-276. [PMID: 34896838 DOI: 10.1016/j.gaitpost.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) have known balance impairments thought to be the result of an inability to reweight sensory information. CAI patients place greater emphasis on visual information during single-limb stance than healthy controls but this evidence is based on removing visual information during static conditions. RESEARCH QUESTION Does perturbed optical flow effect step kinematics and variability in those with CAI differently than healthy controls? What is the relationship among ankle laxity, plantar cutaneous sensation, and susceptibility to perturbed optical flow in those with CAI? METHODS 17 CAI patients and 17 healthy individuals participated in a crossover experimental study. Participants walked on a treadmill at 1.25 m/s while watching a speed-matched virtual hallway with and without continuous mediolateral (ML) optical flow perturbations. Three-dimensional pelvic and foot kinematics were recorded at 100 Hz for at least 300 consecutive steps in each condition. Step width (SW) and step length (SL) values were calculated from consecutive heel positions. Gait variability was characterized as the standard deviation of step width (SWV), step length (SLV), and ML sacrum motion (SMV) across all steps performed in each condition. RESULTS The CAI group exhibited a greater change in SWV (p = 0.037), SLV (p = 0.040), and ML SMV (p = 0.047) from the perturbed to unperturbed conditions relative to the healthy controls. A condition main effect was also noted for SW (p < 0.001) and SL (p < 0.001) as ML optical flow perturbations resulted in significant changes in SW and SL relative to the normal walking condition. SIGNIFICANCE Walking with ML optical flow perturbations induced greater variability changes in those with CAI relative to controls. When combined with the existing literature, this finding suggests that CAI individuals have a greater reliance on visual information in both static and dynamic (i.e. walking gait) conditions relative to healthy individuals.
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Affiliation(s)
- Kyeongtak Song
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA; MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
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12
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Terada M, Kosik KB, McCann RS, Drinkard C, Gribble PA. Corticospinal activity during a single-leg stance in people with chronic ankle instability. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:58-66. [PMID: 32866712 PMCID: PMC8847849 DOI: 10.1016/j.jshs.2020.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/22/2020] [Accepted: 07/22/2020] [Indexed: 05/25/2023]
Abstract
PURPOSE The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. METHODS Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task. RESULTS Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to lateral ankle sprain copers (CSP100%: p = 0.003; MEP120%: p = 0.044) and controls (CSP100%: p = 0.041; MEP120%: p = 0.006). CONCLUSION This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI. Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.
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Affiliation(s)
- Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Kyle B Kosik
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY 40536-0200, USA
| | - Ryan S McCann
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | | | - Phillip A Gribble
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY 40536-0200, USA
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13
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Song K, Hoch JM, Quintana C, Heebner NR, Hoch MC. Slower visuomotor reaction time in division-I collegiate athletes with a history of ankle sprain. Res Sports Med 2021:1-9. [PMID: 34711090 DOI: 10.1080/15438627.2021.1996361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to compare visuomotor reaction time (VMRT) in collegiate athletes based on ankle sprain history. Participants included athletes with ankle sprain history (n = 18) and athletes with no ankle sprain history (n = 33). Participants completed an upper-extremity VMRT task which was comprised of eight wireless light-emitting diode sensors. The difference between reaction time (sec) and the number of "Hits" and "Misses" were compared between groups. The ankle sprain history group had significantly slower VMRT compared to the no ankle sprain history group with moderate effect sizes. However, there was no difference in the number of "Hits" or "Misses" between groups, despite observing moderate effect sizes. This result suggests that VMRT may be a potential target for prevention and rehabilitation strategies in individuals with ankle sprains. However, further research is needed to better understand the role of VMRT on the risk of ankle sprains.
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Affiliation(s)
- Kyeongtak Song
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Johanna M Hoch
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Carolina Quintana
- Department of Kinesiology, California State University Fresno, Fresno, CA, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
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14
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The Effects of Acute and Long-Term Whole-Body Vibration Training on the Postural Control During Cognitive Task in Patients With Chronic Ankle Instability. J Sport Rehabil 2021; 30:1121-1128. [PMID: 34214989 DOI: 10.1123/jsr.2021-0034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
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.
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15
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Mullins JF, Hoch MC, Kosik KB, Heebner NR, Gribble PA, Westgate PM, Nitz AJ. Effect of Dry Needling on Spinal Reflex Excitability and Postural Control in Individuals With Chronic Ankle Instability. J Manipulative Physiol Ther 2020; 44:25-34. [PMID: 33248750 DOI: 10.1016/j.jmpt.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 03/25/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group. METHODS This quasi-experimental university-laboratory study included 50 adult volunteers-25 with CAI (16 female, 9 male; age: 26 ± 9.42 years; height: 173.12 ± 9.85 cm; weight: 79.27 ± 18 kg) and 25 healthy controls (15 female, 10 male; age: 25.8 ± 5.45 years; height: 169.47 ± 9.43 cm; weight: 68.47 ± 13 kg). Participants completed the Star Excursion Balance Test (SEBT), single-leg balance, and assessment of spinal reflex excitability before and after a single treatment of dry needling to the fibularis longus. The anterior, posterolateral, and posteromedial directions of the SEBT were randomized, and reach distances were normalized to a percentage of leg length. A composite SEBT score was calculated by averaging the normalized scores. Postural control was assessed in single-limb stance on a force plate through time-to-boundary measurements in eyes-open and eyes-closed conditions. Fibularis longus and soleus spinal reflexes were obtained by providing electrical stimulation to the common fibular and tibial nerves with participants lying prone. A Group × Time analysis examined changes in performance, and effect sizes were calculated to assess significance. RESULTS Significant group × time interactions were identified for composite (P = .006) and posteromedial (P = .017) SEBT scores. Significant time effects for all directions of the SEBT, time to boundary with eyes open, and the mediolateral direction with eyes closed indicate improved postural control following treatment (P < .008). Within-group effect sizes for significant time effects ranged from small to large, indicating potential clinical utility. CONCLUSION Dry needling demonstrated immediate short-term improvement in measures of static and postural control in individuals with CAI as well as healthy controls.
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Affiliation(s)
- Jennifer F Mullins
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky.
| | - Matthew C Hoch
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Kyle B Kosik
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Nicholas R Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Phillip A Gribble
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Arthur J Nitz
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
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16
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Gokeler A, McKeon PO, Hoch MC. Shaping the Functional Task Environment in Sports Injury Rehabilitation: A Framework to Integrate Perceptual-Cognitive Training in Rehabilitation. ACTA ACUST UNITED AC 2020. [DOI: 10.3928/19425864-20201016-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Walking Gait Mechanics and Gaze Fixation in Individuals With Chronic Ankle Instability. J Sport Rehabil 2020; 30:286-292. [PMID: 32788415 DOI: 10.1123/jsr.2019-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Many individuals who suffer a lateral ankle sprain will develop chronic ankle instability (CAI). Individuals with CAI demonstrate kinematic differences in walking gait, as well as somatosensory alterations compared with healthy individuals. However, the role of vision during walking gait in this population remains unclear. OBJECTIVE To evaluate ankle kinematics, gaze deviations, and gaze velocity between participants with CAI and healthy controls while walking on a treadmill during 3 separate visual conditions (no target, fixed target, and moving target). DESIGN Case-control study. SETTING Laboratory. Patients (or Other Participants): Ten CAI participants and 10 healthy matched controls participated. MAIN OUTCOME MEASURES Ankle sagittal and frontal plane kinematics were analyzed for the entire gait cycle. Average and standard deviation (SD) for gaze deviation and gaze velocity were calculated in the horizontal (X) and vertical (Y) planes. RESULTS No significant differences were found between groups for either ankle kinematics or gaze variables; however, large effect sizes were found in the no target condition for average deviation of X (healthy 0.05 [0.02], CAI 0.12 [0.11]). Moderate effect sizes were identified in the no target condition for SD of Y (healthy 0.04 [0.03], CAI 0.11 [0.15]) and the moving target condition for average velocity of X (healthy 1.56 [0.73], CAI 2.27 [1.15]) and Y (healthy 1.07 [0.51], CAI 1.47 [0.52]). CONCLUSIONS Although no significant differences were found between groups, it is possible that the role of vision in individuals with CAI may be altered with a more difficult task.
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18
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The evalaution of the foot core system in individuals with plantar heel pain. Phys Ther Sport 2020; 42:75-81. [PMID: 31951848 DOI: 10.1016/j.ptsp.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP). DESIGN Cross-Sectional. SETTING Laboratory. PARTICIPANTS Sixteen individuals with PHP and sixteen matched healthy participants. MAIN OUTCOME MEASURES Static foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences. RESULTS Individuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance. CONCLUSIONS Individuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.
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19
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Song K, Wikstrom EA. Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review. PHYSICIAN SPORTSMED 2019; 47:275-283. [PMID: 30739572 DOI: 10.1080/00913847.2019.1581511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.
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Affiliation(s)
- Kyeongtak Song
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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20
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Jamali A, Forghany S, Bapirzadeh K, Nester C. The Effect of Three Different Insoles on Ankle Movement Variability during Walking in Athletes with Functional Ankle Instability. Adv Biomed Res 2019; 8:42. [PMID: 31360683 PMCID: PMC6621341 DOI: 10.4103/abr.abr_69_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Increased ankle movement variability has been reported in people with functional ankle instability (FAI). The purpose of this study was to investigate the effect of textured insole, lateral wedge, and textured lateral wedge insole on ankle movement variability during walking in athletes with FAI. Materials and Methods Twenty-one athletes diagnosed with FAI participated in this before-after study. Kinematic data were collected during four conditions (5 repeated trials per condition): (1) flat ethylene-vinyl acetate (EVA) insole, (2) textured flat EVA insole, (3) prefabricated lateral heel and sole wedge insole, and (4) textured lateral heel and sole wedge. The analysis of ankle movement variability was conducted during stance phase and 200 ms before initial contact to 200 ms after initial contact. The coefficient of multiple correlations (CMC) was calculated to investigate pattern variability and intraclass correlation (ICC) was used to investigate variability at the points of interest. Results In terms of pattern variability, wearing textured lateral wedge increased CMC compared to other insoles. However, statistically significant differences were observed only in the frontal plane during stance phase (P < 0.05). In terms of variability at the points of interest, in the frontal plane and in all points of interest, wearing textured lateral wedge increased ICC compared to other insoles. The effects of other insoles on ankle movement variability were inconsistent. Conclusions The results of this study showed that textured insole has the potential to decrease variability and the use of texture with lateral wedge may more improve variability in athletes with FAI.
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Affiliation(s)
- Akram Jamali
- Musculoskeletal Research Centre, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Forghany
- Musculoskeletal Research Centre, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Health Sciences, University of Salford, Salford, UK
| | - Khadijeh Bapirzadeh
- Musculoskeletal Research Centre, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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21
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Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability. Physiother Theory Pract 2019; 37:672-681. [PMID: 31311365 DOI: 10.1080/09593985.2019.1641870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with chronic ankle instability (CAI) experience a dynamic interplay between impaired mechanical structures and sensorimotor deficiencies that contribute to recurrent sprains and sensations of instability. Concomitantly, muscular trigger points (MTrPs) are known to occur following trauma, maximal or submaximal concentric contractions, and unaccustomed eccentric loads. Additionally, MTrPs are theorized to be exacerbated in low-load and repetitive strain activities. MTrPs located within a muscle are associated with altered motor control, reaction delay, and decreased strength, deficits also found among those with CAI. Dry needling (DN) is reported to improve muscle range of motion, motor control, and pain in a myriad of neuromusculoskeletal conditions by decreasing spontaneous electrical activity and stiffness of taut muscle bands while improving filament overlap. Building on evidence supporting neuromechanical decoupling in chronic ligamentous injury with what is known about the development of MTrPs, this paper proposes a centrally mediated mechanism for improved sensorimotor function following DN for individuals with CAI. Dry needling equilibration theory (DNET) states that proprioception is improved following DN in the lower extremity by changing the muscle's length-tension relationship and leveraging minor acute discomfort to improve muscle spindle afferent information via the gamma motor system. The application of DNET for individuals with CAI may provide a mechanistic explanation for improved descending cortical output, resulting in enhanced sensorimotor function.
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22
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Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train 2019; 54:589-602. [PMID: 31184957 DOI: 10.4085/1062-6050-472-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
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Affiliation(s)
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington
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23
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Abstract
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.
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Affiliation(s)
- Jay Hertel
- Department of * Kinesiology, University of Virginia, Charlottesville.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Revay O Corbett
- Department of * Kinesiology, University of Virginia, Charlottesville
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TERADA MASAFUMI, JOHNSON NATHAN, KOSIK KYLE, GRIBBLE PHILLIP. Quantifying Brain White Matter Microstructure of People with Lateral Ankle Sprain. Med Sci Sports Exerc 2019; 51:640-646. [DOI: 10.1249/mss.0000000000001848] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Fazeli SH, Amiri A, Jamshidi AA, Sanjari MA, Bagheri R, Rahimi F, Akbari M. Effect of ankle taping on postural control measures during grasp and release task in patients with chronic ankle instability. J Back Musculoskelet Rehabil 2019; 31:881-887. [PMID: 29889059 DOI: 10.3233/bmr-171067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of Mulligan ankle taping on center of pressure (COP) parameters during performance of a functional upper limb task in patients with chronic ankle instability (CAI). METHODS A clinical controlled trial study designed between 4 ankle conditions: untaped and taped, CAI and healthy subjects. Fifteen subjects with CAI and 15 healthy controls were asked to grasp an object at their waist level and release it above shoulder level in an oblique pattern during performance of single-leg stance balance test. All the subjects performed 3 trials of single-leg stance with eyes opened before and after Mulligan taping on a force plate during performance of functional upper limb task. The mean displacement (mdCOP), range of COP excursion (rangeCOP) and average speed of COP (velCOP) in anteroposterior (AP) and mediolateral (ML) directions were analysed for differences between groups. RESULTS mdCOP and rangeCOP in AP direction were significantly increased (P= 0.04 and 0.03, respectively) in the CAI group. Mulligan taping significantly reduced velCOP in AP and ML directions (P= 0.02). CONCLUSION In CAI patients Mulligan ankle taping can improve postural control by decreasing velCOP, therefore Mulligan taping can have immediate positive effects on postural parameters and maintenance of dynamic postural control.
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Affiliation(s)
- Sayyed Hamed Fazeli
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amiri
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Ashraf Jamshidi
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Rehabilitation Research Center, School of Rehabilitation Sciences, Department of Rehabilitation Basic Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Bagheri
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Akbari
- Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran
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Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews. Sports Med 2018; 48:189-205. [PMID: 28887759 DOI: 10.1007/s40279-017-0781-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Nonlinear Dynamic Measures for Evaluating Postural Control in Individuals With and Without Chronic Ankle Instability. Motor Control 2018; 23:243-261. [PMID: 30318988 DOI: 10.1123/mc.2017-0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to compare time-to-boundary and sample entropy during a single-leg balance task between individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Twenty-two participants with CAI, 20 lateral ankle sprain copers, and 24 healthy controls performed a single-leg balance task during an eyes-closed condition. Participants with CAI exhibited lower time-to-boundary values compared with lateral ankle sprain copers and healthy controls. However, we did not find differences in sample entropy variables between cohorts. A decrease in time-to-boundary values in participants with CAI indicated that CAI may constrain the ability of the sensorimotor system to maintain the center of pressure within the boundaries of the base of support. However, the regularity of the center of pressure velocity time series appears not to be altered in the CAI cohort in this study.
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Wikstrom EA, Song K, Lea A, Brown N. Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability. J Athl Train 2018; 52:629-635. [PMID: 28722491 DOI: 10.4085/1062-6050-52.4.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT One of the major concerns after an acute lateral ankle sprain is the potential for development of chronic ankle instability (CAI). The existing research has determined that clinician-delivered plantar massage improves postural control in those with CAI. However, the effectiveness of self-administered treatments and the underlying cause of any improvements remain unclear. OBJECTIVES To determine (1) the effectiveness of a self-administered plantar-massage treatment in those with CAI and (2) whether the postural-control improvements were due to the stimulation of the plantar cutaneous receptors. DESIGN Crossover study. SETTING University setting. PATIENTS OR OTHER PARTICIPANTS A total of 20 physically active individuals (6 men and 14 women) with self-reported CAI. INTERVENTION(S) All participants completed 3 test sessions involving 3 treatments: a clinician-delivered manual plantar massage, a patient-delivered self-massage with a ball, and a clinician-delivered sensory brush massage. MAIN OUTCOME MEASURE(S) Postural control was assessed using single-legged balance with eyes open and the Star Excursion Balance Test. RESULTS Static postural control improved (P ≤ .014) after each of the interventions. However, no changes in dynamic postural control after any of the interventions were observed (P > .05). No differences were observed between a clinician-delivered manual plantar massage and either a patient-delivered self-massage with a ball or a clinician-delivered sensory brush massage in any postural-control outcome. CONCLUSIONS In those with CAI, single 5-minute sessions of traditional plantar massage, self-administered massage, and sensory brush massage each resulted in comparable static postural-control improvements. The results also provide empirical evidence suggesting that the mechanism for the postural-control improvements is the stimulation of the plantar cutaneous receptors.
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The Examination of Patient-Reported Outcomes and Postural Control Measures in Patients With and Without a History of ACL Reconstruction: A Case Control Study. J Sport Rehabil 2018; 27:170-176. [DOI: 10.1123/jsr.2016-0105] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. Objective: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Design: Case control. Setting: Laboratory. Participants: A total of 20 post-ACLR and 40 healthy control participants. Main Outcome Measures: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. Results: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Conclusions: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.
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Terada M, Kosik K, Johnson N, Gribble P. Altered postural control variability in older-aged individuals with a history of lateral ankle sprain. Gait Posture 2018; 60:88-92. [PMID: 29169097 DOI: 10.1016/j.gaitpost.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/27/2017] [Accepted: 11/10/2017] [Indexed: 02/02/2023]
Abstract
The current study aimed to examine postural control performance during a single-leg balance task in elderly individuals with and without a previous history of lateral ankle sprain (LAS). Eighteen adults with a previous history of LAS (mean age = 66 years old) and 12 healthy controls (mean age = 65 years old) were included in the study. Participants performed three trials of a single-leg balance task during an eyes-opened condition for 20-s. Center of pressure (COP) trajectories in the anteroposterior (AP) and mediolateral (ML) directions were collected with a force plate. The following postural control measures were calculated in the AP and ML directions: 1) Sample Entropy (SampEn); 2) Approximate Entropy (ApEn); 3) mean of Time-to-Boundary minima (mean TTB); and 4) COP velocity (COPV). Older-age participants with a history LAS exhibited lower ApEn-AP, SampEn-AP, and SampEn-ML values compared to healthy controls (p < 0.05). The information gained from this investigation indicates more rigid postural control patterns, less adaptability, and more difficulty maintaining COP during a single-leg balance task in adults with a previous history of LAS. Our data suggest that there is a need to consider history of musculoskeletal injury when evaluating factors for postural control and fall risk in the elderly. Future investigations are needed to assess the effect of LAS on age-related declines in postural control and discern associations between potential risk factors of fall-related injuries and LAS in an elderly population.
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Affiliation(s)
- Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan.
| | - Kyle Kosik
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, United States
| | - Nathan Johnson
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, United States
| | - Phillip Gribble
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, United States
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Balance Training Does Not Alter Reliance on Visual Information during Static Stance in Those with Chronic Ankle Instability: A Systematic Review with Meta-Analysis. Sports Med 2017; 48:893-905. [DOI: 10.1007/s40279-017-0850-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Cruz-Montecinos C, Maas H, Pellegrin-Friedmann C, Tapia C. The importance of cutaneous feedback on neural activation during maximal voluntary contraction. Eur J Appl Physiol 2017; 117:2469-2477. [PMID: 29018954 DOI: 10.1007/s00421-017-3734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the importance of cutaneous feedback on neural activation during maximal voluntary contraction (MVC) of the ankle plantar flexors. METHODS The effects of cutaneous plantar anaesthesia were assessed in 15 subjects and compared to 15 controls, using a one-day pre/post-repeated measures design. Cutaneous plantar anaesthesia was induced by lidocaine injection at the centre of forefoot, lateral midfoot, and heel. Each subject performed isometric MVCs of the ankle plantar flexors. During each isometric ramp contraction, the following variables were assessed: maximal isometric torque; surface electromyography (EMG) activity of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles; and co-contraction index (CCI) between the MG and TA. RESULTS For ankle torque, two-way ANOVA showed no significant interaction between the pre/post-measurements × group (p = 0.166). However, MG activity presented significant interactions between the pre/post-measurements × group (p = 0.014). Post hoc comparisons indicated a decrease of MG activity in the experimental group, from 85.9 ± 11.9 to 62.7 ± 30.8% (p = 0.016). Additionally, the post-anaesthesia MG activity of the experimental group differed statistically with pre- and post-MG activity of the control group (p = 0.027 and p = 0.008, respectively). For TA activity and CCI, two-way ANOVA detected no significant interactions between the pre/post-measurements × group (p = 0.605 and p = 0.332, respectively). CONCLUSION Our results indicate that during MVC, cutaneous feedback modulates neural activity to MG muscle, without changing the extent of MG-TA co-contraction.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Programa de Magister en Kinesiología y Biomecánica Clínica, Departamento de Kinesiología, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | | | - Claudio Tapia
- Facultad de Ciencias de la Rehabilitacion, Universidad Andres Bello, Fernandez Concha 700, Las Condes, Santiago, Chile. .,Department of Electrical Engineering, Universidad de Chile, Santiago, Chile.
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Song K, Burcal CJ, Hertel J, Wikstrom EA. Increased Visual Use in Chronic Ankle Instability: A Meta-analysis. Med Sci Sports Exerc 2017; 48:2046-56. [PMID: 27635773 DOI: 10.1249/mss.0000000000000992] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The underlying cause of balance impairments in chronic ankle instability (CAI) patients remains unknown, but an altered use of sensory information has been hypothesized as a potential cause. The purpose of this systematic review with meta-analysis was to determine whether CAI patients use somatosensory information to the same extent as uninjured controls during static single limb stance. METHODS We searched PubMed, CINAHL, SPORTDiscus, and Scopus databases from origin to March 2016 using the combination of key words, including postural control, postural stability, single limb stance, single leg stance, single leg balance, single limb balance, and time to boundary (TTB). Eligible studies had to include instrumented single leg stance with both eyes open and eyes closed in healthy, CAI, or both groups as well as report TTB mean and SD values. RESULTS A total of 11 articles were identified. Effect sizes using eyes closed to eyes open standardized mean differences and 95% confidence intervals were calculated for all studies that were included in this investigation. Similarly, pooled estimates for each TTB outcome were compared between the CAI and the uninjured control groups. The mean (95% confidence interval) of the mediolateral TTB (control: -1.50 [-1.71 to -1.29]; CAI: -2.04 [-2.31 to -1.77]), anterioposterior mean (control: -2.19 [-2.43 to -1.96]; CAI: -2.82 [-3.13 to -2.52]), and anterioposterior SD (control: -1.81 [-2.03 to -1.58]; CAI: -2.50 [-2.79 to -2.22]) did not overlap, indicating significant differences between two groups. CONCLUSION On the basis of our systematic review with meta-analysis, it appears that CAI patients do not use somatosensory information to the same extent as uninjured controls and instead upregulate the use of visual information during single limb stance.
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Affiliation(s)
- Kyeongtak Song
- 1Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC; 3Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC; and 4Department of Kinesiology, University of Virginia, Charlottesville, VA
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Wikstrom EA, McKeon PO. Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function. J Athl Train 2017; 52:325-331. [PMID: 28290704 DOI: 10.4085/1062-6050-52.2.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)-associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. OBJECTIVE To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. DESIGN Secondary analysis of a randomized controlled clinical trial. SETTING Sports medicine research laboratories. PATIENTS OR OTHER PARTICIPANTS Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. INTERVENTION(S) Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. MAIN OUTCOME MEASURE(S) Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S). RESULTS Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients <22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made ≥2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with ≤53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS. CONCLUSIONS Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and <5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.
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Affiliation(s)
- Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Kosik KB, McCann RS, Terada M, Gribble PA. Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review. Br J Sports Med 2016; 51:105-112. [PMID: 27806951 DOI: 10.1136/bjsports-2016-096534] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify which therapeutic intervention may be most effective for improving self-reported function in patients with chronic ankle instability (CAI). DESIGN Systematic literature review. Articles were appraised using the Downs and Black Checklist by 3 reviewers. DATA SOURCES PubMed along with CINAHL, MEDLINE and SPORTDiscus within EBSCOhost for pertinent articles from their inception through August 2016. ELIGIBILITY CRITERIA FOR SELECTED STUDIES Articles included were required to (1) be written in English, (2) report adequate data to calculate effect sizes, (3) identify patients with CAI, (4) use some form of therapeutic intervention and (5) use a self-reported questionnaire as a main outcome measurement. RESULTS A broad spectrum of therapeutic interventions were identified related to balance training, multimodal rehabilitation, joint mobilisation, resistive training, soft-tissue mobilisation, passive calf stretching and orthotics. All of the articles included in the balance training category had moderate-to-strong Hedges g with none of the 95% CIs crossing 0. Hedges g effect sizes ranged from -0.67 to -2.31 and -0.51 to -1.43 for activities of daily living and physical activity, respectively. The multimodal rehabilitation category also produced moderate-to-strong Hedges g effect sizes but with large CIs crossing 0. Hedges g effect sizes ranged from -0.47 to -9.29 and -0.62 to -24.29 for activities of daily living and physical activity, respectively. CONCLUSIONS The main findings from this systematic review were balance training provided the most consistent improvements in self-reported function for patients with CAI.
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Affiliation(s)
- Kyle B Kosik
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Ryan S McCann
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Masafumi Terada
- College of Sport and Health Sciences, Ritsumeikan University, Kyoto, Japan
| | - Phillip A Gribble
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
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Hoch JM, Perkins WO, Hartman JR, Hoch MC. Somatosensory deficits in post‐ACL reconstruction patients: A case–control study. Muscle Nerve 2016; 55:5-8. [DOI: 10.1002/mus.25167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/20/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Johanna M. Hoch
- School of Physical Therapy and Athletic TrainingOld Dominion UniversityNorfolk Virginia USA
| | - William O. Perkins
- School of Physical Therapy and Athletic TrainingOld Dominion UniversityNorfolk Virginia USA
| | - Jonathan R. Hartman
- School of Physical Therapy and Athletic TrainingOld Dominion UniversityNorfolk Virginia USA
| | - Matthew C. Hoch
- School of Physical Therapy and Athletic TrainingOld Dominion UniversityNorfolk Virginia USA
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Wikstrom EA, Allen G. Reliability of two-point discrimination thresholds using a 4-2-1 stepping algorithm. Somatosens Mot Res 2016; 33:156-160. [PMID: 27595313 DOI: 10.1080/08990220.2016.1227313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE A 4-2-1 stepping algorithm reliably captures light touch thresholds but has not been used to assess two-point discrimination (TPD) thresholds. Therefore, the purpose of this investigation was to determine the intra- and inter-rater reliability of a 4-2-1 stepping algorithm at determining TPD thresholds. MATERIALS AND METHODS Fifteen healthy, physically active young adults were assessed twice over a 1-week period using digital calipers and a 4-2-1 stepping algorithm. TPD thresholds were assessed by an expert and a novice examiner at each time point. Reliability was assessed on the plantar surface of the foot at the head of the first and base of the fifth metatarsal. RESULTS Three intra-rater intraclass correlation coefficient (ICC) values exceeded 0.75 and were interpreted as good. The inter-rater reliability was good with ICC values ranging from 0.76 to 0.93 at both sites during both test sessions. CONCLUSIONS The 4-2-1 stepping algorithm demonstrates good intra- and inter-tester reliability at determining TPD thresholds on the plantar surface of the foot at the head of the first and base of the fifth metatarsal in young healthy adults.
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Affiliation(s)
- Erik A Wikstrom
- a Department of Exercise & Sport Science , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Gary Allen
- a Department of Exercise & Sport Science , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Burcal CJ, Hoch MC, Wikstrom EA. Effects of a stocking on plantar sensation in individuals with and without ankle instability. Muscle Nerve 2016; 55:513-519. [PMID: 27490972 DOI: 10.1002/mus.25362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022]
Abstract
INTRODUCTION It is unknown whether footwear has a beneficial or deleterious effect on cutaneous sensitivity. We aimed to test a preliminary model of footwear and its effect on tactile perception among groups of controls, copers, and chronic ankle instability participants. METHODS Light-touch thresholds were obtained for 45 participants (age: 20.2 ± 2.8 years; height: 167.6 ± 9.8 cm; mass: 66.3 ± 14.7 kg) using Semmes-Weinstein monofilaments at the head of the first metatarsal (1MT), base of the fifth metatarsal (5MT), and calcaneus (CAL). Baseline measurements were compared with those taken after wearing a nylon stocking for 5 min. RESULTS Thresholds were increased at all 3 sites when the stocking was worn (P < 0.05). Controls had an increase at 1MT, copers had an increase at 5MT and CAL, and chronic ankle instability had an increase at CAL. CONCLUSIONS Cutaneous thresholds increase when subjects wear a nylon stocking, a model for the sensory effects of footwear. A history of ankle injury appears to influence which sites have altered sensibility. Muscle Nerve, 2016. Muscle Nerve 55: 513-519, 2017.
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Affiliation(s)
- Christopher J Burcal
- Department of Kinesiology, University of North Carolina at Charlotte, 209 Belk Gym, 9201 University City Blvd., Charlotte, North Carolina, USA
| | - Matthew C Hoch
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kirby JL, Houston MN, Gabriner ML, Hoch MC. Relationships between mechanical joint stability and somatosensory function in individuals with chronic ankle instability. Foot (Edinb) 2016; 28:1-6. [PMID: 27322958 DOI: 10.1016/j.foot.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 12/01/2015] [Accepted: 04/15/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) have demonstrated alterations in ankle mechanics and deficits in sensory function. However, relationships between mechanical stability and somatosensory function have not been examined, nor have those between somatosensory function and injury history characteristics. Therefore, the objective of this study was to examine relationships between (1) somatosensory function and mechanical stability and (2) somatosensory function and injury history characteristics. METHODS Forty adults with CAI volunteered to participate. In a single testing session, participants completed mechanical and sensory assessments in a counterbalanced order. Dependent variables included anterior/posterior displacement (mm), inversion/eversion rotation (°), SWM index values, JPS absolute error (°), number of previous ankle sprains, and number of "giving way" episodes in the previous 3 months. Spearman's Rho correlations examined the relationships between somatosensory function and (1) mechanical stability and (2) injury history characteristics (p<0.05). RESULTS No significant correlations were identified between any variables (p>0.11), and all r-values were considered weak. CONCLUSIONS These results revealed somatosensory function was not significantly correlated to mechanical stability or injury history characteristics. This indicates peripheral sensory impairments associated with CAI are likely caused by factors other than mechanical stability and injury history characteristics.
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Affiliation(s)
- Jessica L Kirby
- Human Movement Sciences, Old Dominion University, Norfolk, VA, United States.
| | - Megan N Houston
- Human Movement Sciences, Old Dominion University, Norfolk, VA, United States.
| | - Michael L Gabriner
- Human Movement Sciences, Old Dominion University, Norfolk, VA, United States.
| | - Matthew C Hoch
- School of Physical Therapy & Athletic Training, Old Dominion University, Norfolk, VA, United States.
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Song K, Kang TK, Wikstrom EA, Jun HP, Lee SY. Effects of reduced plantar cutaneous sensation on static postural control in individuals with and without chronic ankle instability. J Sci Med Sport 2016; 20:910-914. [PMID: 28571626 DOI: 10.1016/j.jsams.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 04/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to determine how reduced plantar cutaneous sensation influences static postural control in individuals with and without CAI. DESIGN A case-control study design. METHODS Twenty-six individuals with self-reported CAI and 26 matched healthy controls participated in this study. The plantar aspect of the participants' foot was then submersed in ice water (0°C) for 10min to reduce plantar sensation. Before and after the cooling procedure, plantar cutaneous sensation thresholds and single leg balance with eyes open and closed were assessed. RESULTS Significantly, higher scores were observed in both groups after ice water submersion (p<0.001) indicating a significant reduction in the plantar cutaneous sensitivity after the cooling procedure. In single limb balance with eyes open, there were significant intervention main effects for the TTB ML mean (p<0.001), TTB AP mean (p=0.035) and TTB ML SD (p=0.021); indicating postural control improvement in both groups post-cooling. In single limb balance with eyes closed, Group×Intervention interactions were observed for the TTB AP mean (p=0.003) and TTB AP SD (p=0.017); indicating postural control deficits in CAI group post-cooling, but no changes in the control group. CONCLUSIONS The main finding of this study was that reduced plantar cutaneous sensation induced by an ice submersion procedure caused eyes closed postural control impairments in those with CAI but not healthy controls. The present investigation demonstrated that the ability to dynamically reweight among sensory inputs to maintain postural stability appears to be diminished in CAI patients compared to healthy controls.
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Affiliation(s)
- Kyeongtak Song
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, USA
| | - Tae Kyu Kang
- Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Republic of Korea
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - Hyung-Pil Jun
- Department of Movement Sciences, University of Idaho, USA
| | - Sae Yong Lee
- Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Republic of Korea.
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Bowker S, Terada M, Thomas AC, Pietrosimone BG, Hiller CE, Gribble PA. Neural Excitability and Joint Laxity in Chronic Ankle Instability, Coper, and Control Groups. J Athl Train 2016; 51:336-43. [PMID: 27065189 DOI: 10.4085/1062-6050-51.5.05] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy control group. OBJECTIVE To determine if differences exist in spinal reflex excitability and ankle laxity among participants with CAI, copers, and healthy controls. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-seven participants with CAI, 30 participants categorized as copers, and 26 healthy control participants. MAIN OUTCOME MEASURE(S) We assessed spinal reflex excitability of the soleus using the Hoffmann reflex protocol. Participants' ankle laxity was measured with an instrumented ankle arthrometer. The maximum Hoffmann reflex : maximal muscle response ratio was calculated. Ankle laxity was measured as the total displacement in the anterior-posterior directions (mm) and total rotation in the inversion and eversion directions (°). RESULTS Spinal reflex excitability was diminished in participants with CAI compared with copers and control participants (P = .01). No differences were observed among any of the groups for ankle laxity. CONCLUSION Changes in the spinal reflex excitability of the soleus that likely affect ankle stability were seen only in the CAI group, yet no mechanical differences were noted across the groups. These findings support the importance of finding effective ways to increase spinal reflex excitability for the purpose of treating neural excitability dysfunction in patients with CAI.
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Plantar Cutaneous Sensitivity With and Without Cognitive Loading in People With Chronic Ankle Instability, Copers, and Uninjured Controls. J Orthop Sports Phys Ther 2016; 46:270-6. [PMID: 26813754 DOI: 10.2519/jospt.2016.6351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. BACKGROUND Deficits in light touch have recently been identified on the plantar surface of the foot in those with chronic ankle instability (CAI) but not in uninjured controls. It is unknown whether copers display similar deficits. Similarly, cognitive loading has been shown to impact postural control in different populations, but it is unclear how it may impact sensory perception. OBJECTIVES To evaluate the difference in cutaneous sensation thresholds at rest and under cognitive loading, using Semmes-Weinstein monofilaments (SWMs), among uninjured controls, copers, and those with CAI. METHODS A total of 45 participants (mean ± SD age, 20.2 ± 2.8 years; height, 167.6 ± 9.9 cm; mass, 66.3 ± 14.7 kg) were recruited and categorized to a CAI, coper, or control group, based on Ankle Instability Instrument scores. Participants were assessed with SWMs for cutaneous thresholds using a 4-2-1 stepping algorithm at the head of the first metatarsal, base of the fifth metatarsal, calcaneus, and sinus tarsi. Each participant was then retested while generating random digits to the beat of a metronome in order to simulate cognitive loading. RESULTS Participants with CAI displayed significantly higher SWM thresholds at the head of the first metatarsal, base of the fifth metatarsal, and sinus tarsi than those of the control participants, and significantly higher thresholds at the base of the fifth metatarsal and calcaneus than those of copers (all, P<.05). Copers showed higher thresholds than those of controls at the sinus tarsi only (P<.05). A main effect of cognitive loading was identified at all 4 sites (P<.05). CONCLUSION People with CAI have deficits in plantar sensation relative to controls and copers. Cognitive loading increases plantar cutaneous sensation thresholds irrespective of CAI status.
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Snyder BA, Munter AD, Houston MN, Hoch JM, Hoch MC. Interrater and intrarater reliability of the semmes-weinstein monofilament 4-2-1 stepping algorithm. Muscle Nerve 2016; 53:918-24. [PMID: 26474392 DOI: 10.1002/mus.24944] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Semmes-Weinstein Monofilaments (SWM) are used to examine light touch sensation of the skin. Reliability of the 4-2-1 stepping algorithm approach for determining light touch detection thresholds has not been examined. The purpose of this study was to determine the interrater and intrarater reliability of the SWM 4-2-1 stepping algorithm on the plantar surface of the foot. METHODS Four raters with varying levels of SWM assessment experience tested light touch sensation over the plantar aspect of the first metatarsal head in 14 healthy adults. During the initial session, all raters performed the 4-2-1 stepping algorithm technique on each subject to determine interrater reliability. One week later, subjects were reassessed by 2 raters to determine intrarater reliability. RESULTS Interrater reliability ranged from moderate-to-good (ICC2,1 = 0.62-0.92). Intrarater reliability also ranged from moderate-to-good (ICC2,1 = 0.61-0.85). CONCLUSIONS The 4-2-1 stepping algorithm demonstrated acceptable interrater and intrarater reliability when measured in healthy adults. Muscle Nerve 53: 918-924, 2016.
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Affiliation(s)
- Brice A Snyder
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia, USA
| | - Alexander D Munter
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY
| | - Johanna M Hoch
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia, USA
| | - Matthew C Hoch
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, Virginia, USA
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Hoch MC, Russell DM. Plantar cooling does not affect standing balance: A systematic review and meta-analysis. Gait Posture 2016; 43:1-8. [PMID: 26669944 DOI: 10.1016/j.gaitpost.2015.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/29/2015] [Accepted: 10/06/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this systematic review with meta-analysis was to critically appraise and synthesize the literature to determine if cooling the plantar surface of the foot is an effective method of inducing postural control alterations in healthy individuals. Specific variables that were evaluated within the meta-analysis included (1) the duration of the plantar cooling intervention, (2) the stance type during postural control assessment, and (3) the role of visual input. A computerized search of four electronic databases from inception to March 2015 was performed to identify studies which examined the effects of plantar cooling on postural control in healthy individuals. A critical appraisal of the methodological quality of the included studies was performed using an appraisal criteria instrument previously used for assessing biomechanics studies. The literature search yielded 88 references of which 7 were deemed relevant and included in the systematic review and meta-analysis. A single, overall random-effects model meta-analysis of all study variables were performed; as well as, separate meta-analyses for each study variable. Across the 7 studies, the overall effect was 0.028 (95% CI=-0.177, 0.234; p=0.78) indicating that cooling the plantar surface had a very small effect on postural control. Similar results were obtained when data were examined based on study quality, plantar cooling intervention duration, stance type during postural control assessment, and the presence of visual input. Therefore, cooling the plantar surface of the foot had a very weak, non-significant effect on standing balance despite the anesthetic effects identified in each study.
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Affiliation(s)
- Matthew C Hoch
- School of Physical Therapy & Athletic Training, Old Dominion University, 3118 Health Sciences Building, Norfolk, VA 23529, USA.
| | - Daniel M Russell
- School of Physical Therapy & Athletic Training, Old Dominion University, 3118 Health Sciences Building, Norfolk, VA 23529, USA.
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Gabriner ML, Houston MN, Kirby JL, Hoch MC. Contributing factors to star excursion balance test performance in individuals with chronic ankle instability. Gait Posture 2015; 41:912-6. [PMID: 25845724 DOI: 10.1016/j.gaitpost.2015.03.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Michael L Gabriner
- The Steadman Clinic, 181 W. Meadow Dr. Suite 400, Vail, CO 81657, United States.
| | - Megan N Houston
- Department of Interdisciplinary Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, United States.
| | - Jessica L Kirby
- School of Physical Education, Sport, and Exercise Science, Ball State University, 2000 W University Ave, Muncie, IN 47306, United States.
| | - Matthew C Hoch
- School of Physical Therapy & Athletic Training, Old Dominion University, 102 Health Sciences Annex, Norfolk, VA 23529, United States.
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Wu X, Madigan ML. Impaired plantar sensitivity among the obese is associated with increased postural sway. Neurosci Lett 2014; 583:49-54. [PMID: 25242449 DOI: 10.1016/j.neulet.2014.09.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/25/2014] [Accepted: 09/10/2014] [Indexed: 12/16/2022]
Abstract
Impaired foot plantar sensitivity has been hypothesized among individuals who are obese, and may contribute to their impaired balanced during quiet standing. The objective of this study was to investigate the effects of obesity on plantar sensitivity, and explore the relationship between plantar sensitivity and balance during quiet standing. Thirty-nine young adults from the university population participated in the study including 19 obese and 20 non-obese adults. Plantar sensitivity was measured as the force threshold at which an increasing force applied to the plantar surface of the foot was first perceived, and the force threshold at which a decreasing force was last perceived. Measurements were obtained while standing, and at two locations on the plantar surface of the dominant foot. Postural sway during quiet standing was then measured under three different sensory conditions. Results indicated less sensitive plantar sensitivity and increased postural sway among the obese, and statistically significant correlations between plantar sensitivity and postural sway that were characterized as weak to moderate in strength. As such, impaired plantar sensitivity among individuals who are obese may be a mechanism by which obesity degrades standing balance among these individuals.
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Affiliation(s)
- Xuefang Wu
- Virginia Tech, Grado Department of Industrial and Systems Engineering (0118), Blacksburg, VA 24061, United States.
| | - Michael L Madigan
- Texas A&M University, Department of Biomedical Engineering (3120), College Station, TX 77843-3120, United States.
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