1
|
Hu X, Feng T, Li P, Liao J, Wang L. Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:33. [PMID: 38589676 PMCID: PMC11001848 DOI: 10.1186/s40798-024-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) is manifested by sensorimotor impairments in the sprained ankle, including deficits in sensation, motor function, and central integration or processing. These impairments have a significant impact on physical activities and daily life. Recently, some studies have suggested that bilateral deficits were observed in unilateral CAI, but contradictory evidence disputes this finding. Therefore, the objective of this study was to investigate whether bilateral sensorimotor deficits presented in individuals with unilateral CAI. METHODS Without language restriction, the following databases were retrieved from database inception up until 3 November 2023, including PubMed, WOS, EMBASE, Cochrane, SPORTDiscus and CINAHL. Case-control and cross-sectional studies that investigated bilateral sensorimotor functions in individuals with unilateral CAI were included. Sensorimotor functions contained static and dynamic balance, functional performance, muscle strength and activation, as well as sensation. Outcome measures contained centre-of-pressure parameters, normalised reach distance, activation time and magnitude of muscle, sensory errors and threshold. The risk of bias and quality assessment of included studies were evaluated using a standardised tool recommended by the Cochrane Collaboration and the Epidemiological Appraisal Instrument, respectively. To explore the potential bilateral deficits associated with unilateral CAI, a comprehensive meta-analysis was conducted using Review Manager version 5.4. The analysis compared the injured limb of unilateral CAI with healthy controls and the uninjured limb with healthy controls. The main focus of this study was to investigate the differences between the uninjured limb and healthy controls. A random-effects model was employed and effect sizes were estimated using the standardised mean difference (SMD) with 95% confidence intervals (CIs). Effect sizes were deemed as weak (0.2-0.5), moderate (0.5-0.8), or large (> 0.8). RESULTS A total of 11,442 studies were found; 30 studies were contained in the systematic review and 20 studies were included in the meta-analysis. Compared with healthy controls, those with unilateral CAI presented weak to moderate impairments in their uninjured limbs in static balance with eyes open (SMD = 0.32, 95% CI: 0.08 to 0.56), functional performance (SMD = 0.37; 95% CI: 0.08 to 0.67), kinesthesia (SMD = 0.52; 95% CI: 0.09 to 0.95) and tibialis anterior activation (SMD = 0.60, 95% CI: 0.19 to 1.01). There were no significant differences in other comparisons between the uninjured limb and healthy controls. CONCLUSIONS Patients with unilateral CAI may present bilateral deficits in static balance with eyes open, functional performance and kinaesthesia. However, further evidence is required to confirm this point due to limited studies included in some analyses and small effect size. REGISTRATION The protocol was registered in the International Prospective Register of Systematic Reviews platform (CRD: 42,022,375,855).
Collapse
Affiliation(s)
- Xiaomei Hu
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Tianyi Feng
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Pan Li
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Jingjing Liao
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China.
| |
Collapse
|
2
|
Basciani S, Zampogna B, Gregori P, Shanmugasundaram S, Guelfi M, Marinozzi A. Current concepts in ankle microinstability and ankle functional instability. J Clin Orthop Trauma 2024; 51:102380. [PMID: 38577562 PMCID: PMC10988036 DOI: 10.1016/j.jcot.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Susanna Basciani
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Biagio Zampogna
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
- BIOMORF Department Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U Policlinico "G. Martino" Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Pietro Gregori
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | | | - Matteo Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy
| | - Andrea Marinozzi
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| |
Collapse
|
3
|
Kim KM, Needle AR, Kim JS, An YW, Cruz-Díaz D, Taube W. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:241-256. [PMID: 36650898 DOI: 10.1080/09638288.2022.2161643] [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: 04/04/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). MATERIALS AND METHODS Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. RESULTS Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior). CONCLUSIONS FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.
Collapse
Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
| | - Joo-Sung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
4
|
Shadegani R, Khanmohammadi R, Olyaei G. Comparison of effects of Mulligan taping and Kinesio taping on ankle neuromuscular control in response to a sudden inversion perturbation in individuals with chronic ankle instability. Phys Ther Sport 2023; 63:58-66. [PMID: 37506655 DOI: 10.1016/j.ptsp.2023.07.004] [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: 04/27/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES This study was aimed to compare the effects of Mulligan taping (MT) with Kinesio taping (KT) and the un-taped ankle on neuromuscular control during a sudden inversion perturbation in individuals with chronic ankle instability (CAI). DESIGN Randomized, single blind cross-over. SETTING Biomechanics lab. PARTICIPANTS 16 individuals with chronic ankle instability. MAIN OUTCOME MEASURES The outcome measures were the onset time and magnitude of short (SLR) and medium latency response (MLR) for peroneus brevis (PB), peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) muscles and the TA/P and SOL/TA antagonist co-activation. RESULTS In the groups of KT and MT, the onset time was significantly decreased at post-taping compared to pre-taping, such that for the onset time of PB MLR, the groups of KT and MT had an earlier onset time than the un-taped group. For the magnitude of TA SLR and PB MLR, groups exhibited different behaviors. In the KT group, the magnitude was significantly increased post-taping, however, in the MT group, it was decreased. Regarding the TA/P and SOL/TA co-activation, the groups of KT and MT showed significant changes post-taping. CONCLUSION This study suggests that KT and MT significantly affect neuromuscular control in response to a sudden perturbation in individuals with CAI, although the behavior of KT and MT appears to be somewhat different from each other.
Collapse
Affiliation(s)
- Roghaye Shadegani
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Olyaei
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Cao S, Chen Y, Zhu Y, Jiang S, Wang X, Wang C, Ma X. Functional effects of arthroscopic modified Broström procedure on lateral ankle instability: A pilot study. Foot Ankle Surg 2023; 29:261-267. [PMID: 36813592 DOI: 10.1016/j.fas.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aims to assess the mechanical and functional effects of the arthroscopic modified Broström procedure (AMBP) on patients with lateral ankle instability. METHODS Eight patients with unilateral ankle instability treated with AMBP and eight healthy subjects were recruited. Healthy subjects, preoperative and one-year postoperative patients were assessed using outcome scales and the Star Excursion Balance Test (SEBT) for dynamic postural control. One-dimensional statistical parametric mapping was performed to compare ankle angle and muscle activation curve during stair descent. RESULTS The patients with lateral ankle instability showed good clinical outcomes and increased posterior lateral reach during the SEBT after the AMBP (p = 0.046). The medial gastrocnemius activation after initial contact was reduced (p = 0.049), and the peroneal longus activation after initial contact was promoted (p = 0.014). CONCLUSION The AMBP has functional effects of promoting dynamic postural control and peroneal longus activation within one year of follow-up, which can benefit patients with functional ankle instability. However, the medial gastrocnemius activation was unexpectedly reduced post operation.
Collapse
Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yungu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunchao Zhu
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Shuyun Jiang
- Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
8
|
Clair BL, Winder ML, Neubauer EF. Open Evaluation of the Peroneal Tendons Should Be Considered in Patients With Chronic Lateral Ankle Instability Undergoing Ankle Arthroscopy With Lateral Ankle Stabilization. J Foot Ankle Surg 2022; 61:1177-1181. [PMID: 34782250 DOI: 10.1053/j.jfas.2021.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Peroneal tendon pathology is commonly associated with chronic lateral ankle instability. Foot and ankle surgeons often rely on preoperative magnetic resonance imaging (MRI) for identification of related pathology and surgical planning in these patients. The purpose of this study was to assess the ability of preoperative MRI to accurately detect peroneal tendon pathology in patients with chronic lateral ankle instability. Consecutive surgical cases involving arthroscopic evaluation and management of lateral ankle instability sequelae were evaluated retrospectively. Preoperative MRI were compared to intraoperative findings in order to determine the sensitivity, specificity, positive and negative predictive values. Eighty-two patients met inclusion criteria, 58 females and 24 males. The average age at the time of surgery was 46 years (range 13-75). Peroneal tendon pathology was identified intraoperatively in 76 (92.7%) patients and on MRI in 40 (48.8%) patients. The most commonly identified pathologies were tenosynovitis, tendinopathy and longitudinal split/tear, with the peroneus brevis tendon being most commonly involved. MRI was 38.7% specific, 50.0% sensitive, had a positive predictive value of 92.5%, and a negative predictive value of 7.1%. While MRI is a helpful study for evaluation of co-pathologies and surgical planning in patients with lateral ankle instability, procedural selection should not be solely based on MRI results, and the peroneal tendons should be evaluated intraoperatively in patients undergoing arthroscopic procedures for lateral ankle instability.
Collapse
|
9
|
Seo JH, Lee MY. Effects of quarter heel raising exercise on balance and ankle strength in functional ankle instability subjects. Medicine (Baltimore) 2022; 101:e30672. [PMID: 36197155 PMCID: PMC9509092 DOI: 10.1097/md.0000000000030672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Functional ankle instability (FAI) is defined as the subjective sensation of instability or "giving way" after an ankle sprain and occurs in approximately 40% of patients with lateral ankle instability. As an ankle joint rehabilitation intervention, heel raising exercises, toe jumping exercises, ankle joint proprioceptive exercises, as well as orthosis and taping are commonly applied to prevent the recurrence of an ankle joint injury. So this study was evaluated effect of quarter heel raising exercise (QHR) on balance and peroneus longus muscle strength in FAI subjects. METHODS Among 26 FAI subjects, 13 with FAI were assigned to the QHR group, and 13 with FAI were assigned to the control group which was no intervention. All of 30 subjects were evaluated Teskscan included static balance ability, Y balance test included dynamic balance ability with three directions which is anterior, posterolateral, posteromedial direction. Commander muscle testing included eversion/inversion strength ratio at pre- and post-intervention. RESULTS There was a significant interaction between group and time in static, dynamic balance, and strength. In QHR group, there was simple effect on static, dynamic balance, and strength. But control group showed no simple effect on static, dynamic balance, and strength. In the pre- and post-intervention differences between the groups. There was a significant difference in pre-intervention condition between the groups, but no significant difference between the groups in post-intervention in all conditions. CONCLUSIONS QHR exercise is useful for improving the balance ability and muscle strength of the peroneus longus muscle in FAI subjects.
Collapse
Affiliation(s)
- Joon Ho Seo
- Department of Rehabilitation, Gyeongbuk Regional Rehabilitation Hospital, Gyeongsan, Republic of Korea
| | - Mi Young Lee
- Department of Physical Therapy, College of Biomedical Science, Daegu Haany University, Gyeongsan, Republic of Korea
- *Correspondence: Mi Young Lee, Department of Physical Therapy, College of Biomedical Science, Daegu Haany University, Gyeongsan 38609, Republic of Korea (e-mail: )
| |
Collapse
|
10
|
Lee I, Ha S, Chae S, Jeong HS, Lee SY. Altered Biomechanics in Individuals With Chronic Ankle Instability Compared With Copers and Controls During Gait. J Athl Train 2022; 57:760-770. [PMID: 34404090 PMCID: PMC9661934 DOI: 10.4085/1062-6050-0605.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Given that motions of 1 segment affect those of an adjacent segment, the authors of biomechanical studies must thoroughly investigate the kinematics and kinetics of the proximal joints (hip and knee) as well as the ankle joints in patients with chronic ankle instability (CAI). However, few researchers have investigated the altered movement strategies of the lower extremities of patients with CAI compared with lateral ankle-sprain (LAS) copers and control participants throughout the full gait cycle of walking and jogging. OBJECTIVE To evaluate lower extremity biomechanical differences in patients with CAI, LAS copers, and control individuals during gait. DESIGN Case-control study. SETTING Controlled laboratory setting. PATIENTS OR OTHER PARTICIPANTS A total of 54 participants, consisting of 18 patients with CAI (age = 24.6 ± 2.8 years, height = 173.0 ± 8.0 cm, mass = 67.8 ± 14.6 kg), 18 LAS copers (age = 26.0 ± 4.6 years, height = 173.4 ± 7.5 cm, mass = 66.9 ± 10.3 kg), and 18 control individuals (age = 26.2 ± 2.3 years, height = 172.2 ± 8.2 cm, mass = 63.3 ± 11.2 kg). MAIN OUTCOME MEASURE(S) Three-dimensional kinematics and kinetics of the lower extremity during walking and jogging. RESULTS The CAI group exhibited dorsiflexion deficits and more inverted ankles compared with the LAS coper and control groups during walking and jogging. In addition, the LAS coper group generated greater knee internal-rotation moments than did the CAI group during jogging. The other variables did not differ among groups. CONCLUSIONS Participants with CAI demonstrated altered biomechanics, which need to be addressed via intervention programs.
Collapse
Affiliation(s)
- Inje Lee
- Department of Sports Rehabilitation Medicine, Kyungil University, Gyeongsan, Republic of Korea
,International Olympic Committee Research Centre Korea, Seoul, Republic of Korea
| | - Sunghe Ha
- International Olympic Committee Research Centre Korea, Seoul, Republic of Korea
,Department of Physical Education, Yonsei University, Seoul, Republic of Korea
| | - Seongok Chae
- Department of Physical Education, Yonsei University, Seoul, Republic of Korea
| | - Hee Seong Jeong
- International Olympic Committee Research Centre Korea, Seoul, Republic of Korea
,Department of Sports and Health Management, Mokwon University, Daejeon, Republic of Korea
| | - Sae Yong Lee
- International Olympic Committee Research Centre Korea, Seoul, Republic of Korea
,Department of Physical Education, Yonsei University, Seoul, Republic of Korea
,Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
11
|
Cao S, Wang C, Jiang S, Yu Y, Zhang C, Huang J, Wang X, Ma X. Concomitant osteochondral lesions of the talus affect the stair descent biomechanics of patients with chronic ankle instability: A pilot study. Gait Posture 2022; 96:306-313. [PMID: 35772346 DOI: 10.1016/j.gaitpost.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/28/2022] [Accepted: 06/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies on the kinematics of patients with chronic ankle instability (CAI) that did not incorporate MRI and arthroscopic assessment could not differentiate between patients with CAI without osteochondral lesion of the talus (OLT) and patients with CAI and OLT and have thus presented contradictory results. RESEARCH QUESTION This study aimed to investigate the kinematic and electromyographic differences between patients with and without OLT. METHODS Sixteen subjects with CAI (eight without OLT and eight with OLT confirmed through MRI and arthroscopic assessment) and eight healthy subjects underwent gait analysis in a stair descent setting. The three groups' patient-reported outcomes; ankle joint range of motion in flexion, inversion and rotation; and muscle activation of the peroneus, tibialis anterior, and gastrocnemius during a gait cycle were analyzed and compared. A curve analysis, namely, one-dimensional statistical parametric mapping, was performed to compare the dynamic ankle kinematics and muscle activation curves over the entire normalized time series. RESULTS The patients with and without OLT had no difference in patient-reported outcomes. The maximal ankle plantarflexion of the patients without OLT and the healthy subjects was significantly larger than that of patients with OLT (p = 0.005). The maximal ankle internal rotation of patients without OLT was significantly larger than that of patients with OLT (p = 0.048). The peroneal activation during 0-6% of the gait cycle of patients with OLT was reduced compared with the healthy subjects. SIGNIFICANCE Patients with CAI and OLT and patients with CAI without OLT have no difference in patient-reported outcomes, but patients with OLT can be differentiated using the post-initial-contact peroneal activation deficit and the restriction of ankle plantarflexion and internal rotation during stair descent. These variables can be utilized to monitor the function of patients with CAI and their possibility of developing OLT.
Collapse
Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuyun Jiang
- Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Yu
- Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
12
|
Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability. Healthcare (Basel) 2022; 10:healthcare10071171. [PMID: 35885698 PMCID: PMC9315602 DOI: 10.3390/healthcare10071171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 12/22/2022] Open
Abstract
Neural changes in the ankle stabilizing muscles following ankle sprains are thought to be one contributing factor to persistent ankle dysfunction. However, empirical evidence is limited. Therefore, we aimed to examine spinal reflex excitability of lower leg muscles following acute ankle sprains (AAS). We performed a case-control study with 2 groups consisting of 30 young adults with AAS and 30 aged-matched uninjured controls. Hoffmann reflex (H-reflex) testing was performed to estimate spinal reflex excitability of lower leg muscles: soleus, fibularis longus (FL), tibialis anterior (TA). Maximal H-reflex (Hmax) and motor responses (Mmax) were determined by delivering a series of electrical stimuli at the sciatic nerve. Hmax/Mmax ratios were calculated to represent normalized spinal reflex excitability. Separate group-by-limb analyses of variance (ANOVA) with repeated measures found there were no significant interactions for any of the muscles (SL: F1,56 = 0.95, p = 0.33, FL: F1,51 = 0.65, p = 0.42, TA: F1,51 = 1.87, p = 0.18), but there was a significant main effect of group in the soleus (F1,56 = 6.56, p = 0.013), indicating the Hmax/Mmax ratio of soleus in the AAS group was significantly lower bilaterally (AAS = 0.56 ± 0.19, control = 0.68 ± 0.17, p = 0.013), with no significant group differences in the other muscles (FL: F1,51 = 0.26, p = 0.61, TA: F1,51 = 0.93, p = 0.34). The bilateral inhibition of the soleus spinal reflex excitability following AAS may be significant in that it may explain bilateral sensorimotor deficits (postural control deficits) following unilateral injury, and provide insights into additional therapies aimed at the neural change.
Collapse
|
13
|
Werasirirat P, Yimlamai T. Effect of supervised rehabilitation combined with blood flow restriction training in athletes with chronic ankle instability: a randomized placebo-controlled trial. J Exerc Rehabil 2022; 18:123-132. [PMID: 35582686 PMCID: PMC9081407 DOI: 10.12965/jer.2244018.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/05/2022] [Indexed: 11/24/2022] Open
Abstract
Blood flow restriction (BFR) resistance exercise has been advocated as an alternative approach for improving muscle strength in patients undergoing musculoskeletal rehabilitation. The present study aimed to evaluate the effectiveness of a 4-week supervised rehabilitation (R) with and without BFR on muscle strength, cross-sectional area (CSA), dynamic balance, and functional performance in athletes with chronic ankle instability (CAI). A total of 16 collegiate athletes with CAI participated in this study. They were randomly assigned to the BFR+R group (n=8) or the R group (n=8). Both groups underwent supervised rehabilitation 3 times weekly for 4 consecutive weeks. Additionally, the BFR+R group was applied with a cuff around the proximal thigh at 80% arterial occlusion pressure in addition to the traditional rehabilitation program, whereas the R group received the sham BFR only. Before and after 4 weeks of intervention, isokinetic muscle strength, CSA, Y-balance test, and side hop test (SHT) were measured. Following a 4-week intervention, the BFR+R group exhibited significant improvements in muscle strength of ankle plantarflexor and evertor, CSA of fibularis longus, and SHT timed performance compared with prior training and the R group (all, P<0.05). However, no significant difference was observed on dynamic balance among the groups. The present finding indicated that a 4-week supervised rehabilitation combined with BFR is more effective in improving muscle strength and size and functional performance compared with the traditional rehabilitation alone. This information could have implications for physical therapists and clinician in developing and designing a rehabilitation program for athletes with CAI.
Collapse
Affiliation(s)
| | - Tossaporn Yimlamai
- Corresponding author: Tossaporn Yimlamai, Department of Sports Science, Faculty of Sports Science, Chulalongkorn University, Rama I Road, Pathumwan District, Bangkok 10330, Thailand,
| |
Collapse
|
14
|
Watabe T, Takabayashi T, Tokunaga Y, Watanabe T, Kubo M. Copers exhibit altered ankle and trunk kinematics compared to the individuals with chronic ankle instability during single-leg landing. Sports Biomech 2022:1-13. [PMID: 35435154 DOI: 10.1080/14763141.2022.2058989] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Copers are individuals who have had a lateral ankle sprain but have no history of recurrent lateral ankle sprain, residual symptoms, or functional disability. Copers have shown no significant difference in lower limb kinematics in landing for proactive conditions compared with a control (CTR) group. However, the copers (CPR) group has shown differences compared to CTR and chronic ankle instability (CAI) groups for dynamic balance conditions, suggesting that the trunk may compensate for foot instability during shock absorption. This study aimed to examine the differences in the kinematics and kinetics among CPR, CAI and CTR groups in reactive and proactive single-leg landing tasks. Participants were physically active adults with CAI (n = 14), CPR (n = 14), and CTR (n = 14), who performed proactive and reactive single-leg landings. The lower limb, trunk kinematics, vertical ground reaction force (vGRF) peak value, and the time to minimum peak vGRF were analysed. It might be conceivable that the CPR group could absorb vGRF efficiently by increasing the trunk flexion angle and increasing the time to reach the minimum peak vGRF regardless of landing condition. The results suggest that evaluating the movements of the entire body, including the ankle and trunk, is essential.
Collapse
Affiliation(s)
- Takaya Watabe
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa 920-8641, Japan
| | - Tomoya Takabayashi
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Yuta Tokunaga
- Terrabyte Corporation, 3-10-7 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan
| | - Takahiro Watanabe
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Masayoshi Kubo
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| |
Collapse
|
15
|
Eraktas İ, Ayhan C, Hayran M, Soylu AR. Alterations in forearm muscle activation patterns after scapholunate interosseous ligament injury: A dynamic electromyography study. J Hand Ther 2021; 34:384-395. [PMID: 32620427 DOI: 10.1016/j.jht.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case control. PURPOSE OF THE STUDY This study aimed to investigate the alterations seen in the activation patterns of the forearm muscles and to demonstrate the associated functional outcomes, in patients with scapholunate interosseous ligament (SLIL) injury. METHODS The study involved 15 patients with SLIL injury (instability group) and 11 healthy participants (control group). Both groups were evaluated with regard to their pain, grip strength, and upper extremity functional level (disabilities of the arm, shoulder and hand and patient-rated wrist evaluation questionnaires), and they also underwent a dynamic electromyography analysis of their forearm muscle activity. The activation patterns of the extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), flexor carpi ulnaris, and flexor carpi radialis muscles during wrist extension and flexion were recorded by means of surface electromyography. RESULTS In the instability group, the pain severity was higher and the functional level was worse than in the control group (P < .05). Furthermore, during wrist extension, the ECR activity was lower and the ECU activity was higher in the instability group than in the control group (P < .05). CONCLUSION Dynamic stabilization of the wrist, flexor carpi ulnaris, and flexor carpi radialis muscles have been shown to play an active role with ECU and ECR. Increased ECU and decreased ECR activation may pose a potential risk in terms of enhancing the scapholunate gap. We, therefore, propose that appropriate preventive neuromuscular exercise strategies implemented as part of a physiotherapy program for patients with SLIL lesions might increase the contribution of the dynamic stability effect of the relevant muscles.
Collapse
Affiliation(s)
- İrem Eraktas
- Bolu Physical Therapy and Rehabilitation Hospital, Bolu, Turkey
| | - Cigdem Ayhan
- Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Mutlu Hayran
- School of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- School of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
| |
Collapse
|
16
|
Plangtaisong P, Shen W, Wheeler PC, Fong DT. Effect of exercise interventions and prophylactic devices on reducing peroneal muscle reaction time by sudden ankle perturbation: A systematic review and meta-analysis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Pereira BS, Andrade R, Espregueira-Mendes J, Marano RPC, Oliva XM, Karlsson J. Current Concepts on Subtalar Instability. Orthop J Sports Med 2021; 9:23259671211021352. [PMID: 34435065 PMCID: PMC8381447 DOI: 10.1177/23259671211021352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
Collapse
Affiliation(s)
- Bruno S. Pereira
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Hospital Privado de Braga, Lugar da Igreja Nogueira, Braga,
Portugal
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports,
University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto,
Porto, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, Minho University, Braga, Portugal
- 3B’s–PT Government Associate Laboratory, Braga/Guimarães,
Portugal
- 3B’s Research Group– Biomaterials, Biodegradables and Biomimetics,
University of Minho, Headquarters of the European Institute of Excellence on Tissue
Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
| | | | - Xavier Martin Oliva
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei,
Barcelona, Spain
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
18
|
The Role of Peroneal Tendinopathy and the Cavovarus Foot and Ankle. Clin Podiatr Med Surg 2021; 38:445-460. [PMID: 34053654 DOI: 10.1016/j.cpm.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Peroneal tendon pathology is often an overlooked and underdiagnosed condition. It is often confused with chronic ankle instability. It is important when surgically managed to assess the condition of the tendons, muscle viability and strength, and associated cavovarus deformity. Complex reconstruction may be needed, including 2-stage procedures with a silicone rod and tendon transfer.
Collapse
|
19
|
Willegger M, Hirtler L, Schwarz GM, Windhager RH, Chiari C. [Peroneal tendon pathologies : From the diagnosis to treatment]. DER ORTHOPADE 2021; 50:589-604. [PMID: 34160639 PMCID: PMC8241798 DOI: 10.1007/s00132-021-04116-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
Peronealsehnenpathologien sind selten, jedoch häufig unterdiagnostiziert. Eine Assoziation mit einer chronisch lateralen Sprunggelenkinstabilität sowie mit einer varischen Rückfußachse kann bestehen. Pathologien der Sehnen lassen sich in 3 Kategorien einteilen: Tendinitis und Tenosynovitis, Sehnenrisse und Rupturen sowie Sehnensubluxation und Sehnenluxation. Die Magnetresonanztomographie ist die Standardmethode zur radiologischen Beurteilung. Die Diagnose und Behandlung basieren jedoch in erster Linie auf Anamnese und klinischer Untersuchung. Eine primär konservative Therapie kann versucht werden, ausgenommen bei Peronealsehnenluxationen des professionellen Sportlers. Die chirurgische Therapie sollte gezielt auf die zugrunde liegende Pathologie abgestimmt werden und kann dementsprechend divers von der tendoskopischen Synovektomie bis zur anatomischen Reparatur des superioren peronealen Retinakulums mit Vertiefung der retromalleolären Rinne ausfallen. Die postoperativen Ergebnisse zeigen eine hohe Patientenzufriedenheit und niedrige Reluxationsraten.
Collapse
Affiliation(s)
- Madeleine Willegger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Lena Hirtler
- Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Gilbert M Schwarz
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Zentrum für Anatomie und Zellbiologie, Abteilung für Anatomie, Medizinische Universität Wien, Wien, Österreich
| | - Rein Hard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| |
Collapse
|
20
|
Watabe T, Takabayashi T, Tokunaga Y, Yoshida T, Kubo M. Copers adopt an altered movement pattern compared to individuals with chronic ankle instability and control groups in unexpected single-leg landing and cutting task. J Electromyogr Kinesiol 2021; 57:102529. [PMID: 33588176 DOI: 10.1016/j.jelekin.2021.102529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
Individuals with chronic ankle instability (CAI) demonstrate altered ankle kinematics during landing compared to uninjured individuals. However, if copers may have adopted unique movement strategy to prevent repeated ankle sprains is unclear. The purpose of this study compares the lower-extremity joint kinematics and muscle activities of CAI (N = 8), coper (COP) (N = 8), and control (CON) (N = 8) groups in unexpected single-leg landing and cutting. Performance time (from initial contact to toe-off), number of mistakes in the jumping direction, low-extremity joint angle are assessed. Muscle activities were recorded from the tibialis anterior, medial gastrocnemius, and peroneus longus (PL), and mean muscle activity, co-contraction index (CI), and PL latency were analyzed. Results of performance time and CI are not significant. Significantly less number of mistakes in the jumping direction and a shorter PL latency were discovered in the COP and CON compared with the CAI group (P < 0.05). The peak hip joint flexion angle is significantly smaller in the COP than in the CON (P = 0.04). In dynamic tasks requiring quick judgments of ankle inclination, the COP may be able to accurately sense the inclination of the foot. Additionally, movement strategies differed between the COP and CON groups in an unexpected single-leg landing and cutting.
Collapse
Affiliation(s)
- Takaya Watabe
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan.
| | - Tomoya Takabayashi
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan.
| | - Yuta Tokunaga
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan.
| | | | - Masayoshi Kubo
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan.
| |
Collapse
|
21
|
Wattananon P, Sungnak P, Songjaroen S, Kantha P, Hsu WL, Wang HK. Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit. Musculoskelet Sci Pract 2020; 50:102215. [PMID: 33220931 DOI: 10.1016/j.msksp.2020.102215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/25/2020] [Indexed: 02/08/2023]
Abstract
Lumbar multifidus muscle (LM) activation deficit has been proposed as a potential underlying mechanism responsible for recurrence episode of low back pain (LBP). The quantification of voluntary LM activation can provide a better understanding of the role of muscle activation deficit in LBP. The objective of this technical report is to propose a new approach using neuromuscular electrical stimulation (NMES) in combination with the ultrasound imaging technique (USI) to investigate the ability of individual to voluntarily activate the LM. We recruited ten participants with a recurrent LBP (rLBP) and twelve participants with no history of LBP (NoLBP). Theoretically, the superimposition of NMES on the LM during maximum voluntary isometric contraction (MVIC) should activate all motor units available in the LM. The percentage of LM activation (%LM) can be calculated by the changes of LM thickness during MVIC, divided by the changes of LM thickness during the combination of MVIC and NMES. This %LM was used to compare between groups. The individuals with rLBP had significantly lower %LM (p < 0.05) compared with the NoLBP counterpart (%LM = 72.4 and 92.9, respectively). Results demonstrate that this new approach can potentially differentiate %LM among individuals with rLBP and NoLBP. This new approach can be potentially used to 1) determine the extent of LM activation deficit, 2) identify the existence of muscle activation deficit in the LM, and 3) objectively measure the effect of the intervention designed to address the LM activation deficit.
Collapse
Affiliation(s)
- Peemongkon Wattananon
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Panakorn Sungnak
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Sranya Songjaroen
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No.17, Xuzhou Rd., Zhongzheng District, Taipei City, 100, Taiwan.
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No.17, Xuzhou Rd., Zhongzheng District, Taipei City, 100, Taiwan.
| | - Hsing-Kuo Wang
- Sports Physiotherapy Lab, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, No.17, Xuzhou Rd., Zhongzheng District, Taipei City, 100, Taiwan.
| |
Collapse
|
22
|
Suttmiller AM, McCann RS. Neural excitability of lower extremity musculature in individuals with and without chronic ankle instability: A systematic review and meta-analysis. J Electromyogr Kinesiol 2020; 53:102436. [DOI: 10.1016/j.jelekin.2020.102436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/23/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
|
23
|
Novel application of dry needling for neuropathic myofascial ankle pain and dysfunction following insidious integumentary infection: A case report. J Bodyw Mov Ther 2020; 24:138-143. [PMID: 32507139 DOI: 10.1016/j.jbmt.2019.10.017] [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: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dry needling (DN) was effectively applied to a patient whose primary complaint was hyperalgesia and decreased ankle function meeting criteria for neuropathic myofascial pain following an integumentary infection, skin grafting and immobilization. CASE DESCRIPTION A 33-year-old male serving on active duty in the United States Air Force was referred to physical therapy for decreased ankle range of motion and pain, eight weeks after an integumentary infection on his ankle. The infection was complicated by tissue loss requiring skin grafting for closure. Two months of traditional rehabilitation was unsuccessful and this patient was referred for DN treatment. OUTCOMES Clinically relevant improvements were achieved after one treatment. After 48 hours, the patient's reported Pain Quality Assessment Scale (PQAS) dropped from a baseline 67 to 34 and Lower Extremity Functional Scale (LEFS) increased from 44 to 56. Plantarflexion and dorsiflexion improved by 15° and inversion and eversion by five degrees. After one year and 11 DN treatments, function continued to improve as demonstrated by single leg stance time improvement from 4 s to more than 60 seconds, without pain, a final LEFS of 72 and a return to unrestricted full duty. CONCLUSION DN is an increasingly utilized treatment option for myofascial pain. This case report represents a unique application of DN to an atypical patient presenting with neuropathic myofascial pain syndrome that demonstrated improvement with DN as the sole intervention. Further research regarding the application of DN as a treatment option for neuropathic myofascial pain syndromes is needed.
Collapse
|
24
|
Motoneuron Function Does not Change Following Whole-Body Vibration in Individuals With Chronic Ankle Instability. J Sport Rehabil 2019; 28:614-622. [PMID: 30222478 DOI: 10.1123/jsr.2017-0364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/20/2018] [Accepted: 07/22/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Following a lateral ankle sprain, ∼40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and, therefore, possibly prevent reinjury. OBJECTIVE To determine if an acute bout of WBV can improve AMI and proprioception in individuals with CAI. DESIGN AND PARTICIPANTS The authors examined if an acute bout of WBV can improve AMI and proprioception in individuals with CAI with a repeated-measures design. A total of 10 young adults with CAI and 10 age-matched healthy controls underwent a control, sham, and WBV condition in randomized order. SETTING Biomechanics laboratory. INTERVENTION WBV. MAIN OUTCOME MEASURES Motoneuron pool recruitment was assessed via Hoffmann reflex (H-reflex) in the soleus. Proprioception was evaluated using ankle joint position sense at 15° and 20° of inversion. Both were assessed prior to, immediately following, and 30 minutes after the intervention (pretest, posttest, and 30mPost, respectively). RESULTS Soleus maximum H-reflex:M-response (H:M) ratios were 25% lower in the CAI group compared with the control group (P = .03). Joint position sense mean constant error did not differ between groups (P = .45). Error at 15° in the CAI (pretest 0.8 [1.6], posttest 2.0 [2.8], 30mPost 2.0 [1.9]) and control group (pretest 0.8 [2.0], posttest 0.6 [2.9], 30mPost 0.5 [2.1]) did not improve post-WBV. Error at 20° did not change post-WBV in the CAI (pretest 1.3 [1.7], posttest 1.0 [2.4], 30mPost 1.5 [2.2]) or control group (pretest -0.3 [3.0], posttest 0.8 [2.1], 30mPost 0.6 [1.8]). CONCLUSION AMI is present in the involved limb of individuals with CAI. The acute response following a single bout of WBV did not ameliorate the presence of AMI nor improve proprioception in those with CAI.
Collapse
|
25
|
Fereydounnia S, Shadmehr A, Attarbashi Moghadam B, Talebian Moghadam S, Mir SM, Salemi S, Pourkazemi F. Improvements in strength and functional performance after Kinesio taping in semi-professional male soccer players with and without functional ankle instability. Foot (Edinb) 2019; 41:12-18. [PMID: 31675595 DOI: 10.1016/j.foot.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objectives of this study were to compare the immediate effects of two methods of Kinesio taping on muscle strength, functional performance, and balance in athletes with and without functional ankle instability (FAI). METHODS The present study investigated the effects of distal taping (muscle application over peroneus longus) and proximal- distal taping (muscle application over gluteus medius and peroneus longus) on the strength of evertor and hip abductor muscles, side hop test, figure of 8 hop test, and star excursion balance test in semi-professional male soccer players with and without FAI (n=15 in each group). A Multifactorial repeated measure ANOVA was used for comparison. RESULTS There were significant differences for factor effect in all outcome measures (P<0.05), except for the figure of 8 hop test. No significant differences for group effects and group by factor interaction effects (P>0.05) was observed except for the side hop test. CONCLUSION Kinesio taping had immediate effects on improving strength, performance and balance. However, there were no differences on the method of application. Clinicians can consider the application Kinesio taping during the rehabilitation process of athletes with FAI, to improve balance and strength. The long-term impacts of taping on the functional, balance and strength measures should be investigated in future studies.
Collapse
Affiliation(s)
- Sara Fereydounnia
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Shadmehr
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Saeed Talebian Moghadam
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohsen Mir
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saba Salemi
- Rehabilitation Faculty, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | |
Collapse
|
26
|
Rosen AB, Needle AR, Ko J. Ability of Functional Performance Tests to Identify Individuals With Chronic Ankle Instability: A Systematic Review With Meta-Analysis. Clin J Sport Med 2019; 29:509-522. [PMID: 31688183 DOI: 10.1097/jsm.0000000000000535] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review with meta-analysis was to determine the effectiveness of functional performance tests (FPTs) in differentiating between individuals with chronic ankle instability (CAI) and healthy controls. DATA SOURCES The National Library of Medicine Catalog (PubMed), the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the SPORTDiscus, from inception to June 2017 were searched. Search terms consisted of: "Functional Performance Test*" OR "Dynamic Balance Test*" OR "Postural Stability Test*" OR "Star Excursion Balance Test*" OR "Hop Test*" AND "Ankle Instability" OR "Ankle Sprain." Included articles assessed differences in FPTs in patients with CAI compared with a control group. MAIN RESULTS Included studies were assessed for methodological quality and level of evidence. Individual and mean effect sizes were also calculated for FPTs from the included articles. Twenty-nine studies met the criteria and were analyzed. The most common FPTs were timed-hop tests, side-hop, multiple-hop test, single-hop for distance, foot-lift test, and the Star Excursion Balance Tests (SEBTs). The side-hop (g = -1.056, P = 0.009, n = 7), timed-hop tests (g = -0.958, P = 0.002, n = 9), multiple-hop test (g = 1.399, P < 0.001, n = 3), and foot-lift tests (g = -0.761, P = 0.020, n = 3) demonstrated the best utility with large mean effect sizes, whereas the SEBT anteromedial (g = 0.326, P = 0.022, n = 7), medial (g = 0.369, P = 0.006, n = 7), and posteromedial (g = 0.374, P < 0.001, n = 13) directions had moderate effects. CONCLUSIONS The side-hop, timed-hopping, multiple-hop, and foot-lift seem the best FPTs to evaluate individuals with CAI. There was a large degree of heterogeneity and inconsistent reporting, potentially limiting the clinical implementation of these FPTs. These tests are cheap, effective, alternatives compared with instrumented measures.
Collapse
Affiliation(s)
- Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Alan R Needle
- Department of Health & Exercise Science, Appalachian State University, Boone, North Carolina
| | - Jupil Ko
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Flagstaff, Arizona
| |
Collapse
|
27
|
Zellers JA, Parker S, Marmon A, Silbernagel KG. Muscle activation during maximum voluntary contraction and m-wave related in healthy but not in injured conditions: Implications when normalizing electromyography. Clin Biomech (Bristol, Avon) 2019; 69:104-108. [PMID: 31326725 PMCID: PMC6823141 DOI: 10.1016/j.clinbiomech.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electromyography signal amplitude is influenced by a variety of factors. Normalization strategies aimed at decreasing signal variability include using peak electromyography signal during a maximum voluntary contraction and peak-to-peak M-wave amplitude. However, whether these normalization methods are comparable has not been investigated in injured populations. This study investigated the relationship between peak signal during maximum voluntary contraction and M-wave amplitude in individuals with a unilateral Achilles tendon rupture. Secondarily, we observed whether the two normalizations strategies would yield similar results when evaluating between limb differences in muscle activity during a jump task. METHODS Eleven individuals 1-3 years after a unilateral Achilles tendon rupture were included in this study. Surface electromyography was used on the medial and lateral gastrocnemii bilaterally. Peak maximum voluntary contraction, M-wave amplitude, and electromyography during a jumping task were collected. FINDINGS A strong relationship was observed between peak maximum voluntary contraction and M-wave amplitude on the uninjured (r = 0.71-0.88, P < 0.05) but not on the ruptured side (r = 0.41-0.44, P > 0.05). The two normalization techniques did not produce different results when comparing the uninjured and ruptured sides. INTERPRETATION The findings of this study suggest that M-wave normalization yields similar results as peak maximum voluntary contraction-normalized electromyography in uninjured conditions. M-wave normalization may be a useful strategy in an injured population where a maximal muscle contraction is unsafe or impaired.
Collapse
Affiliation(s)
- Jennifer A. Zellers
- Department of Physical Therapy, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
| | - Sheridan Parker
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE, 68182, USA,Department of Biomedical Engineering, 540 S. College Ave, University of Delaware, Newark, DE, 19713, USA
| | - Adam Marmon
- Department of Physical Therapy, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
| | | |
Collapse
|
28
|
Rodrigues KA, Soares RJ, Tomazini JE. The influence of fatigue in evertor muscles during lateral ankle sprain. Foot (Edinb) 2019; 40:98-104. [PMID: 31229793 DOI: 10.1016/j.foot.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 02/04/2023]
Abstract
Ankle sprain in plantarflexion and inversion is one of the most common injuries occurring in daily activities and sports. Although acute symptoms may resolve quickly, many individuals have reported persistent pain and instability. Thus, understanding the factors that contribute to the occurrence of this type of injury is extremely important. Although sprains are multifactorial, a relationship can be established between sprain and fatigue. Therefore, the present study examined the latency and intensity of activation of the peroneus longus and brevis muscles under conditions of fatigue. Twenty-three women participated in the study, including 12 with functional instability of the ankle and 11 without a history of sprain. To induce fatigue, the volunteers maintained the force of eversion and plantarflexion at 70% of the maximum voluntary isometric contraction for as long as possible until a 10% decline in the rated force occurred. Ten simulations of ankle sprains were performed before and after fatigue at random for each side, with simultaneous recordings of the electromyographic signals, using a simulator platform for inversion sprain and plantarflexion. As a result, after fatigue, no change in latency was observed. However, a reduction in the intensity of contraction of the muscles analyzed in both groups was observed. Neuromuscular control was concluded to be compromised in situations of fatigue, while differences in muscle behavior were not observed between stable and unstable ankles.
Collapse
Affiliation(s)
- Karina A Rodrigues
- State University of São Paulo - UNESP, Avenida Dr. Ariberto Pereira da Cunha, Department of Mechanical Engineering, no 333, Portal das Colinas, Guaratinguetá, SP 12516-410, Brazil.
| | - Renato J Soares
- University of Taubaté - UNITAU, Rua Marechal Arthur da Costa e Silva, Department of Physical Therapy, Biomechanics Laboratory, no 1055, Taubaté, SP 12010-490, Brazil.
| | - José E Tomazini
- State University of São Paulo - UNESP, Avenida Dr. Ariberto Pereira da Cunha, Department of Mechanical Engineering, no 333, Portal das Colinas, Guaratinguetá, SP 12516-410, Brazil.
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis. J Clin Med 2019; 8:jcm8071037. [PMID: 31315231 PMCID: PMC6678466 DOI: 10.3390/jcm8071037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022] Open
Abstract
The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.
Collapse
|
31
|
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.
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Madsen LP, Kitano K, Koceja DM, Zehr EP, Docherty CL. Effects of chronic ankle instability on cutaneous reflex modulation during walking. Exp Brain Res 2019; 237:1959-1971. [DOI: 10.1007/s00221-019-05565-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/21/2019] [Indexed: 12/26/2022]
|
34
|
Park KN, Park SY. Description and Intrarater Test-Retest Reliability of a Reverse-Action Method to Assess Ankle Evertor Muscle Performance: The I-to-V Test. Physiother Can 2019; 70:306-313. [PMID: 30745715 DOI: 10.3138/ptc.2016-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Reverse action (RA) of the ankle evertor muscle is when the proximal attachment moves toward the distal attachment, moving the lower leg in the frontal plane when the foot and ankle are fixed on the ground and inducing ankle eversion. The purpose of this study was to describe an RA method for measuring ankle evertor muscle performance. Method: Eighteen healthy individuals were recruited for this study. To assess the RA of their ankle evertors, the participants sat with their knees together and their feet firmly planted on the floor, then spread their knees as far apart as possible. A tester used a measuring tape to measured the distance (in cm) between the medial tibial tuberosity of the tested side and that of the non-tested side. In the end range position of the RA, ankle evertor electromyographic activity was recorded simultaneously. The intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were calculated to establish the intrarater test-retest reliability. The correlation between each performance value and muscle activity was assessed using a linear correlation model. Results: The proposed method of assessing RA performance was highly reliable (ICC=0.95) and had a low SEM (1.63 cm); in addition, the performance value showed a strong positive correlation with ankle evertor muscle activity (ρ=0.90; 95% CI: 0.79, 0.95; p=0.01). Conclusions: The proposed RA method of assessing the ankle evertor muscles can be used as a simple, reliable, economical performance test. It can also be used as an alternate method of testing the peroneal muscles rather than selectively measuring ankle evertor performance because hip external rotation occurs when performing RA.
Collapse
Affiliation(s)
- Kyue-Nam Park
- Department of Physical Therapy, College of Medical Science, Jeonju University, Jeonju
| | - So-Yeon Park
- Department of Physical Therapy, Sangji University, Wonju, South Korea
| |
Collapse
|
35
|
Sakai S, Urabe Y, Morikawa M, Fujishita H, Komiya M, Sasadai J, Fujishita H, Maeda N. Quantity and quality of the peroneus longus assessed using ultrasonography in leg with chronic ankle instability. J Phys Ther Sci 2018; 30:1396-1400. [PMID: 30568323 PMCID: PMC6279707 DOI: 10.1589/jpts.30.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/12/2018] [Indexed: 12/25/2022] Open
Abstract
[Purpose] Muscle quantity (e.g., cross-sectional area) and quality (e.g., muscle adipose
tissue), which are muscle strength determinants, can be assessed using ultrasonography.
The study aimed to investigate the changes in the quantity and quality of the peroneus
longus and evaluate evertor strength in legs with chronic ankle instability (CAI).
Furthermore, the associations among cross-sectional area, echogenicity, evertor strength,
and frequency of ankle sprain were examined. [Participants and Methods] Nine males with
CAI in unilateral legs were the voluntary participants in this study. The cross-sectional
area of the peroneus longus, echogenicity, and evertor strength were measured for all the
participants on the sides with CAI and that without. [Results] No significant difference
in cross-sectional area was observed between the sides. Significant differences in
echogenicity (higher on the CAI side) and evertor strength (lower on the CAI side) were
observed between the sides. In addition, a moderate correlation was observed between
echogenicity and increased sprain frequency on both sides. [Conclusion] Muscle adipose
tissue increased, evertor strength decreased, and the cross-sectional area remained
unchanged on the CAI side. The study results suggested that muscle adipose tissue
increases with increasing frequency of ankle sprain.
Collapse
Affiliation(s)
- Shogo Sakai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Masanori Morikawa
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Hironori Fujishita
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Makoto Komiya
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Junpei Sasadai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Hironori Fujishita
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University: 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| |
Collapse
|
36
|
Sousa ASP. Antagonist co-activation during short and medium latency responses in subjects with chronic ankle instability. J Electromyogr Kinesiol 2018; 43:168-173. [PMID: 30352387 DOI: 10.1016/j.jelekin.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/27/2018] [Accepted: 10/14/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE This study aims to evaluate bilateral ankle antagonist co-activation during compensatory postural responses, including short latency responses (SLR) and medium latency responses (MLR), in response to a unilateral sudden ankle inversion in subjects with chronic ankle instability (CAI). METHODS Twenty-four participants with CAI and 20 controls participated in the present study. Bilateral eletromyography of peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA) and soleus (SOL) muscles was collected during a unilateral sudden inversion perturbation (30°) to assess antagonist co-activation of SOL/TA and TA/P pairs during SLR and MLR in both support and perturbed positions. RESULTS Compared to control group, participants with CAI presented: (1) bilateral increased antagonist co-activation of SOL/TA MLR in the support position; and (2) decreased antagonist co-activation of TA/P MLR of uninjured limb in the support position and of injured limb in the perturbed position. CONCLUSIONS CAI involves deregulation of ankle antagonist co-activation of MLR in both injured and uninjured limbs.
Collapse
Affiliation(s)
- Andreia S P Sousa
- Área Científica de Fisioterapia, Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Centro de Investigação em Reabilitação - Centro de Estudos de Movimento e Atividade Humana, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal.
| |
Collapse
|
37
|
Sousa ASP, Silva M, Gonzalez S, Santos R. Bilateral compensatory postural adjustments to a unilateral perturbation in subjects with chronic ankle instability. Clin Biomech (Bristol, Avon) 2018; 57:99-106. [PMID: 29966961 DOI: 10.1016/j.clinbiomech.2018.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/03/2018] [Accepted: 06/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate the magnitude of bilateral compensatory postural adjustments in response to a unilateral sudden inversion perturbation in subjects with chronic ankle instability. METHODS 24 athletes with chronic ankle instability (14 with functional ankle instability, 10 with mechanical ankle instability) and twenty controls participated in this study. The bilateral electromyography of ankle muscles was collected during a unilateral sudden ankle inversion to assess the magnitude of subcortical and voluntary compensatory postural adjustments in both the perturbed and the contralateral limb (support limb). FINDINGS In the support position, compared to the control group, the group with functional ankle instability presented decreased compensatory postural adjustments of the tibialis anterior in both the injured and the uninjured limbs in the support position and of the soleus in the uninjured limb. In the side of the perturbation, participants with functional ankle instability presented decreased soleus compensatory postural adjustments in the uninjured limb when compared to the control group. Increased values of soleus and peroneal brevis compensatory postural adjustments were observed in the group with mechanical instability when compared to the control group and to the group with functional ankle instability. INTERPRETATION Subjects with functional ankle instability present bilateral impairment of compensatory postural adjustments of the tibialis anterior in a support position and of the soleus of the uninjured limb regardless of the position. Subjects with mechanical instability present bilateral increase of these adjustments in the peroneal brevis regardless of the position and in the soleus muscle in the side of the perturbation.
Collapse
Affiliation(s)
- Andreia S P Sousa
- Área Científica de Fisioterapia, Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Centro de Investigação em Reabilitação - Centro de Estudos de Movimento e Atividade Humana, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal.
| | - Márcia Silva
- Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Centro de Investigação em Reabilitação - Centro de Estudos de Movimento e Atividade Humana, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Samuel Gonzalez
- Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Centro de Investigação em Reabilitação - Centro de Estudos de Movimento e Atividade Humana, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Rubim Santos
- Área Científica de Física, Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Centro de Investigação em Reabilitação - Centro de Estudos de Movimento e Atividade Humana, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal.
| |
Collapse
|
38
|
The effect of additional joint mobilization on neuromuscular performance in individuals with functional ankle instability. Phys Ther Sport 2017; 30:22-28. [PMID: 29310055 DOI: 10.1016/j.ptsp.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/23/2017] [Accepted: 12/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the effects of joint mobilization and exercise training on neuromuscular performance in individuals with functional ankle instability (FAI). DESIGN A cross-sectional study. PARTICIPANTS Forty five subjects with FAI were randomized into three groups: control (CG, n = 15, 27.9 ± 6.6yr), training (TG, n = 15, 26.9 ± 5.8yr) and mobilization with training group (MTG, n = 15, 26.5 ± 4.8yr). INTERVENTION Four weeks of neuromuscular training for TG; neuromuscular training and joint mobilization for MTG. MAIN OUTCOME MEASURES Electromyography of the peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) and the reaching distance of the Y balance test (YBT), dorsiflexion range of motion (DFROM), Cumberland ankle instability tool (CAIT), and global rating scale (GRS). Two-way repeated measures MANOVA were used with the significance level p < .05. RESULTS MANOVA found significant group by time interactions on posterolateral reaching distance (p = .032), PL activation (p = .006-.03), DFROM (p < .001), CAIT (p < .001) and GRS (p < .001). The post hoc tests indicated significantly improved PL muscle activity and posterolateral reaching distance for MTG compared to TG (p = .004) and CG (p = .006). CONCLUSION Joint mobilization resulted in additional benefits on self-reported ankle instability severity, dorsiflexion mobility, and posterolateral balance performance in individuals with FAI, but its effects on general improvement, muscle activation, and other balance tasks remained uncertain.
Collapse
|
39
|
Kosik KB, Terada M, Drinkard CP, McCann RS, Gribble PA. Potential Corticomotor Plasticity in Those with and without Chronic Ankle Instability. Med Sci Sports Exerc 2017; 49:141-149. [PMID: 27501358 DOI: 10.1249/mss.0000000000001066] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Quantifying corticomotor alterations is important to understand the neurophysiological mechanisms that likely contribute to the neuromuscular control deficits observed in patients with chronic ankle instability (CAI). Corticomotor output mapping provides further insight into the changes within the motor cortex and identifies potential changes in the area of the motor cortex associated with selected muscles. Therefore, this investigation compared the corticomotor map output for the fibularis longus (FL) muscle in patients with and without CAI. METHODS Eighteen CAI patients and 16 healthy controls (HC) volunteered. Transcranial magnetic stimulation was used to map the motor cortex's representation of the FL. The normalized average of three motor evoked potentials at 100% of active motor threshold intensity was recorded for each scalp site on a 6 × 6 cm grid. Corticomotor output map was compared between groups through 1) the size of the corticomotor map area, 2) the volume of the corticomotor map, and 3) the location of cortical representation. Independent t-tests were used to assess group differences in each mapping outcome variable. Cohen's d effect sizes along with 95% confidence intervals were calculated using the pooled SD values. RESULTS CAI patients exhibited less map volume (P = 0.018, CAI = 8.2 ± 3.2 cm mV vs HC = 11.3 ± 3.9 cm mV) and map area (P = 0.046, CAI = 12.8 ± 6.0 cm vs HC: 17.4 ± 6.9 cm) compared with HC. CONCLUSIONS The smaller map area and volume suggest a more concentrated area of neurons communicating with the FL muscle in patients with CAI. Consequently, motor cortical cells on the border of the FL excitation area are less committed to the proper function of the FL muscle and may be recruited by other surrounding areas. This may explain altered movement strategies that lead to ankle reinjury.
Collapse
Affiliation(s)
- Kyle B Kosik
- 1Department of Rehabilitation Sciences, Division of Athletic Training, University of Kentucky, Lexington, KY; and 2College of Sport and Health Sciences Ritsumeikan University, Kusatsu, Shiga-ken, JAPAN
| | | | | | | | | |
Collapse
|
40
|
Akuzawa H, Imai A, Iizuka S, Matsunaga N, Kaneoka K. The influence of foot position on lower leg muscle activity during a heel raise exercise measured with fine-wire and surface EMG. Phys Ther Sport 2017; 28:23-28. [PMID: 28950148 DOI: 10.1016/j.ptsp.2017.08.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/05/2017] [Accepted: 08/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exercises for lower leg muscles are important to improve function. To examine the influence of foot position on lower leg muscle activity during heel raises. DESIGN Cross-sectional laboratory study. SETTING Laboratory. PARTICIPANTS Fourteen healthy men participated in this study. MAIN OUTCOME MEASURES The muscle activity levels of the tibialis posterior (TP), peroneus longus (PL), flexor digitorum longus (FDL) and medial gastrocnemius (MG) were measured. The heel raises consisted of three foot positions: 1) neutral, 2) 30° abduction, and 3) 30° adduction. The EMG data for five repetitions of each foot position were normalized to maximum voluntary contraction. One-way repeated measure ANOVA was employed for statistical analysis. RESULTS The muscle activity level of TP, PL and FDL was significantly different between the three foot positions during the heel raises. TP and FDL showed the highest activity level in 30° foot adduction while PL demonstrated the highest activity level in 30° foot abduction. CONCLUSIONS Heel raises with 30° foot adduction and abduction positions can change lower leg muscle activity; These findings suggest that altering foot posture during the heel raise exercise may benefit patients with impaired TP, PL or FDL function.
Collapse
Affiliation(s)
- Hiroshi Akuzawa
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Atsushi Imai
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Satoshi Iizuka
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Naoto Matsunaga
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan.
| |
Collapse
|
41
|
Abstract
Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers. Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears. These can be associated with ankle instability, hindfoot deformity and anomalous anatomy such as a low lying peroneus brevis or peroneus quartus. A thorough clinical examination should include an assessment of foot type (cavus or planovalgus), palpation of the peronei in the retromalleolar groove on resisted ankle dorsiflexion and eversion as well as testing of lateral ankle ligaments. Imaging including radiographs, ultrasound and MRI will help determine the diagnosis. Treatment recommendations for these disorders are primarily based on case series and expert opinion. The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions.
Cite this article: EFORT Open Rev 2017;2:281-292. DOI: 10.1302/2058-5241.2.160047
Collapse
Affiliation(s)
- Kinner Davda
- Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Karan Malhotra
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Paul O'Donnell
- Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dishan Singh
- Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Nicholas Cullen
- Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| |
Collapse
|
42
|
Kunugi S, Masunari A, Yoshida N, Miyakawa S. Postural stability and lower leg muscle activity during a diagonal single-leg landing differs in male collegiate soccer players with and without functional ankle instability. JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2017. [DOI: 10.7600/jpfsm.6.257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Shun Kunugi
- Faculty of Health and Sport Sciences, University of Tsukuba
| | - Akihiko Masunari
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences
| | | | | |
Collapse
|
43
|
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: 39] [Impact Index Per Article: 4.9] [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.
Collapse
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
| |
Collapse
|
44
|
The effect of repetitive ankle perturbations on muscle reaction time and muscle activity. J Electromyogr Kinesiol 2016; 30:184-90. [PMID: 27471780 DOI: 10.1016/j.jelekin.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/17/2016] [Accepted: 07/10/2016] [Indexed: 12/26/2022] Open
Abstract
The use of a tilt platform to simulate a lateral ankle sprain and record muscle reaction time is a well-established procedure. However, a potential caveat is that repetitive ankle perturbation may cause a natural attenuation of the reflex latency and amplitude. This is an important area to investigate as many researchers examine the effect of an intervention on muscle reaction time. Muscle reaction time, peak and average amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain (combined inversion and plantar flexion movement) were calculated in twenty-two physically active participants. The 40 perturbations were divided into 4 even groups of 10 dominant limb perturbations. Within-participants repeated measures analysis of variance (ANOVA) tests were conducted to assess the effect of habituation over time for each variable. There was a significant reduction in the peroneus longus average amplitude between the aggregated first and last 10 consecutive ankle perturbations (F2.15,45.09=3.90, P=0.03, ɳp(2)=0.16). Authors should implement no more than a maximum of 30 consecutive ankle perturbations (inclusive of practice perturbations) in future protocols simulating a lateral ankle sprain in an effort to avoid significant attenuation of muscle activity.
Collapse
|
45
|
Feger MA, Snell S, Handsfield GG, Blemker SS, Wombacher E, Fry R, Hart JM, Saliba SA, Park JS, Hertel J. Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability. Orthop J Sports Med 2016; 4:2325967116653719. [PMID: 27570782 PMCID: PMC4999538 DOI: 10.1177/2325967116653719] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Patients with chronic ankle instability (CAI) have demonstrated altered neuromuscular function and decreased muscle strength when compared with healthy counterparts without a history of ankle sprain. Up to this point, muscle volumes have not been analyzed in patients with CAI to determine whether deficits in muscle size are present following recurrent sprain. Purpose: To analyze intrinsic and extrinsic foot and ankle muscle volumes and 4-way ankle strength in young adults with and without CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Five patients with CAI (mean age, 23.0 ± 4 years; 1 male, 4 females) and 5 healthy controls (mean age, 23.8 ± 4.5 years; 1 male, 4 females) volunteered for this study. Novel fast-acquisition magnetic resonance imaging (MRI) was used to scan from above the femoral condyles through the foot and ankle. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate the muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a handheld dynamometer. Patients with CAI were compared with healthy controls on all measures of muscle volume and strength. Extrinsic muscle volumes of patients with CAI were also compared with a normative database of healthy controls (n = 24) by calculating z scores for each muscle individually for each CAI subject. Results: The CAI group had smaller total shank, superficial posterior compartment, soleus, adductor hallucis obliqus, and flexor hallucis brevis muscle volumes compared with healthy controls as indicated by group means and associated 90% CIs that did not overlap. Cohen d effect sizes for the significant group differences were all large and ranged from 1.46 to 3.52, with 90% CIs that did not cross zero. The CAI group had lower eversion, dorsiflexion, and 4-way composite ankle strength, all with group means and associated 90% CIs that did not overlap. No other significant differences were identified. Conclusion: Patients with CAI demonstrate atrophy of intrinsic and extrinsic foot and ankle musculature accompanied by lower ankle strength. Clinical Relevance: Clinicians should be aware of the muscle atrophy and strength deficits when prescribing rehabilitation for patients with lateral ankle sprain or CAI.
Collapse
Affiliation(s)
- Mark A Feger
- University of Virginia, Charlottesville, Virginia, USA
| | - Shannon Snell
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | | | - Rachel Fry
- University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Joseph S Park
- University of Virginia, Charlottesville, Virginia, USA
| | - Jay Hertel
- University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
46
|
Hall EA, Simon JE, Docherty CL. Using Ankle Bracing and Taping to Decrease Range of Motion and Velocity During Inversion Perturbation While Walking. J Athl Train 2016; 51:283-90. [PMID: 27111586 DOI: 10.4085/1062-6050-51.5.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Prophylactic ankle supports are commonly used. However, the effectiveness of external supports in preventing an inversion stress has been debated. OBJECTIVE To evaluate how ankle bracing and taping affect inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability compared with a control condition during a dynamic inversion perturbation while walking. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 42 physically active participants (16 men, 26 women; age = 21.2 ± 3.3 years, height = 168.9 ± 8.9 cm, mass = 66.1 ± 11.4 kg) volunteered. INTERVENTION(S) Participants walked on a custom-built walkway that suddenly inverted their ankles to 30° in 3 conditions: brace, tape, and control (no external support). We used an ASO ankle brace for the brace condition and a closed basketweave technique for the tape condition. Three trials were completed for each condition. Main Outcome Measure(s) Maximum inversion (degrees), time to maximum inversion (milliseconds), and inversion velocity (degrees per second) were measured using an electrogoniometer, and perceived stability (centimeters) was measured using a visual analog scale. RESULTS Maximum inversion decreased more in the brace condition (20.1°) than in the control (25.3°) or tape (22.3°) conditions (both P values = .001), and the tape condition restricted inversion more than the control condition (P = .001). Time to maximum inversion was greater in the brace condition (143.5 milliseconds) than in the control (123.7 milliseconds; P = .001) or tape (130.7 milliseconds; P = .009) conditions and greater in the tape than in the control condition (P = .02). Inversion velocity was slower in the brace condition (142.6°/s) than in the control (209.1°/s) or tape (174.3°/s) conditions (both P values = .001) and slower in the tape than in the control condition (P = .001). Both the brace and tape conditions provided more perceived stability (0.98 cm and 0.94 cm, respectively) than the control condition (2.38 cm; both P values = .001). CONCLUSIONS Both prophylactic conditions affected inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability. However, bracing provided more restriction at a slower rate than taping.
Collapse
Affiliation(s)
- Emily A Hall
- Department of Kinesiology, Indiana University, Bloomington
| | - Janet E Simon
- Division of Athletic Training, Ohio University, Athens
| | | |
Collapse
|
47
|
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.
Collapse
|
48
|
Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surg Sports Traumatol Arthrosc 2016; 24:1175-9. [PMID: 25786820 DOI: 10.1007/s00167-015-3562-3] [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: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE A painful episode in the region of the peroneal tendons, within the retromalleolar groove, is a common precipitating event of an acute lateral ankle sprain. A forefoot striking pattern is suspected to cause peroneal tendinosis. The aim of this study is to analyse the role of peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners. METHODS Fifty-eight runners who had experienced acute ankle sprain trauma, with pre-existing pain episodes for up to 4 weeks in the region of the peroneal tendons, were assessed clinically. Fractures were excluded by conventional radiography. An magnetic resonance imaging (MRI) scan had been performed within 14 days after the traumatic event and was subsequently evaluated by two experienced radiologists. RESULTS MRI revealed peroneal tendinosis in 55 patients (95% of the total study population). Peroneus brevis (PB) tendinosis was found in 48 patients (87% of all patients with peroneal tendinosis), and peroneus longus (PL) tendinosis was observed in 42 cases (76%). Thirty-five patients (64%) had combined PB and PL tendinosis. A lesion of the anterior talofibular ligament was found to be the most common ligament injury associated with peroneal tendinosis (29 cases; 53%), followed by a lesion of the calcaneofibular ligament (16 cases; 29%) and a lesion of the posterior tibiofibular ligament (13 cases; 24%). CONCLUSION The results of this study reflect the correlation between peroneal tendinosis and ankle sprain trauma. Injuries of one or more ligaments are associated with further complications. A period of rest or forbearance of sports as well as adequate treatment of the peroneal tendinosis is essential to prevent subsequent ankle injuries, especially in runners. Modification of the running technique would also be beneficial. LEVEL OF EVIDENCE IV.
Collapse
|
49
|
Futatsubashi G, Sasada S, Ohtsuka H, Suzuki S, Komiyama T. History-dependent changes in the recovery process of the middle latency cutaneous reflex gain after ankle sprain injury. Eur J Appl Physiol 2015; 116:459-70. [PMID: 26560108 DOI: 10.1007/s00421-015-3292-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/01/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE We previously reported that suppressive middle latency cutaneous reflexes (MLRs) in the peroneus longus (PL) are exaggerated in subjects with chronic ankle instability, and the changes are related to functional instability. However, the time-varying history of these neurophysiological changes after an ankle sprain is yet to be elucidated. Therefore, in the present study, we investigated the time course of the changes in the PL MLR after an ankle sprain in relation to the number of sprain recurrences. METHODS Twenty-three subjects with ankle sprain were classified into 3 groups according to their history of ankle sprain: first ankle sprain, 2-3 ankle sprains, and ≥4 ankle sprains. Twenty-three age-matched control subjects also participated. The PL MLRs were elicited by stimulating the sural nerve while the subjects performed different levels of isometric ankle eversion. Gain of MLR was estimated using linear regression analysis (slope value) of the amplitude modulation of MLRs obtained from graded isometric contractions. RESULT The gain of MLRs first increased 4 weeks after the injury. In subjects with their first ankle sprain, the MLRs returned to almost baseline levels after 3 months. In contrast, the increase in MLR gain persisted even after 3 months in subjects with recurrent ankle sprains. In addition, the MLR gains were closely related to functional recovery of the ankle joint. CONCLUSIONS Our findings suggest that the recovery process of MLR gains were strongly affected by the history of ankle sprains as well as the functional recovery of the ankle joint.
Collapse
Affiliation(s)
- Genki Futatsubashi
- The United Graduate School of Education, Tokyo Gakugei University, Koganei, Tokyo, Japan. .,Faculty of Business and Information Sciences, Jobu University, 634-1 Toyatsukamachi, Isesaki, Gunma, 372-8588, Japan.
| | - Syusaku Sasada
- Department of Food and Nutrition Science, Sagami Women's University, Sagamihara, Kanagawa, Japan
| | - Hiroyuki Ohtsuka
- Department of Physical Therapy, Health Sciences University of Hokkaido, Sapporo, Hokkaido, Japan
| | - Shinya Suzuki
- The United Graduate School of Education, Tokyo Gakugei University, Koganei, Tokyo, Japan.,Department of Integrative Physiology, Kyorin University, School of Medicine, Mitaka, Tokyo, Japan
| | - Tomoyoshi Komiyama
- The United Graduate School of Education, Tokyo Gakugei University, Koganei, Tokyo, Japan.,Faculty of Education, Chiba University, Chiba, Chiba, Japan
| |
Collapse
|
50
|
The Consequence of a Medial Ankle Sprain on Physical and Self-reported Functional Limitations: A Case Study Over a 5-Month Period. J Orthop Sports Phys Ther 2015; 45:756-64. [PMID: 26304642 DOI: 10.2519/jospt.2015.6097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Little evidence exists about impairments and perceived disability following eversion injury to the deltoid ligament. This case study prospectively examined the neuromuscular, biomechanical, and psychological consequences of a case of a medial ankle sprain. CASE DESCRIPTION A recreationally active man with a history of a lateral ankle sprain (grade I) was participating in a university Institutional Review Board-approved research study examining the neuromuscular and mechanical characteristics associated with chronic ankle instability. Twenty-two days after the testing session, the participant sustained an eversion injury to his left ankle while playing basketball. Outcomes The outcomes of this case are presented using the International Classification of Functioning, Disability and Health model. Outcome variables were assessed at preinjury (medial ankle sprain), 3 months postinjury, and 5 months postinjury. Measurements included neural excitability of the soleus, balance assessment, joint stability, and psychological assessments. Data from this case study revealed that a medial ankle sprain reduces joint mobility and alters neural excitability of the soleus, with concurrent deficits in balance and self-reported function. These impairments forced the participant to downgrade his physical activity lifestyle up to 5 months postinjury. DISCUSSION These data suggest the need for the development of intervention strategies to address impairments in neural excitability and joint mobility at the ankle to help patients meet the goal of maintaining long-term joint health. LEVEL OF EVIDENCE Prognosis, level 4.
Collapse
|