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Khazaei F, Sayyed-Hosseinian SH, Miri HH, Zeinalzadeh A, Nazary-Moghadam S. Prognostic Values of Clinical and Anthropometric Characteristics in Lateral Ankle Sprain Following Physiotherapy. J Foot Ankle Surg 2024; 63:495-501. [PMID: 38641313 DOI: 10.1053/j.jfas.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
Lateral ankle sprain (LAS) is a common injury in sports and daily activities. The present study aimed to determine the prognostic value of clinical and anthropometric parameters in predicting LAS recovery after physiotherapy. Twenty-seven patients with acute LAS were included in this cohort study. First, prognostic factors and anthropometric variables were assessed, along with the time elapsed since the injury, pain score on a visual analogue scale (VAS), navicular drop, ankle range of motion (ROM), and ambulation status. Second, patients received physiotherapy, and their recovery status was assessed using the foot and ankle outcome score (FAOS) questionnaire immediately (first evaluation) and one month after physiotherapy (second evaluation). Univariate regression analysis and stepwise regression were used to evaluate the association between prognostic factors and outcome predictability. The results of this paper have shown that ambulation status was significantly correlated with all FAOS subscales in both the first and second evaluations, except for the FAOS-symptoms (FAOS-Sx) and FAOS-quality of life (FAOS-QOL) subscales in the first evaluation. The eversion ROM was significantly correlated with the FAOS-Sx and FAOS-Sports and Recreational activities (FAOS-Sport/Rec) subscales in the first evaluation. Additionally, age, height, and VAS were significantly correlated with FAOS-activity of daily living (FAOS-ADL) in the first evaluation, so this means that ambulation status is a valuable predictor of treatment success immediately and one month after physiotherapy intervention and compared to other FAOS subscales, the FAOS-QOL subscale is a more reliable predictor of the effectiveness of physiotherapy.
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Affiliation(s)
- Farzaneh Khazaei
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kikumoto T, Kobayashi M, Omori G, Kubo M. Single-legged landing behavior of high school basketball players with chronic ankle instability. J Bodyw Mov Ther 2024; 39:454-462. [PMID: 38876668 DOI: 10.1016/j.jbmt.2024.03.054] [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: 12/21/2022] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Anterior cruciate ligament injury is one of the most serious ligamentous injuries. The purpose is to compare the impact of the ankle joint on the knee during landing between athletes with chronic instability and a control group (coper group) and to verify the effects of the kinetic chain from other joints. DESIGN Prospective study. SETTING High school basketball. PARTICIPANTS Participants were 62 female high school basketball players who had participated in team sports for >6 months. MAIN OUTCOME MEASURES Player joint angles, movements, and moments. RESULTS The knee valgus moment was significantly higher in the chronic ankle instability group than in the coper group (20%-60% [p < 0.01]; 80%-100% [p < 0.05]) during landing motion. The knee valgus moment was also significantly higher during the change from the maximum knee joint flexion position to the maximum extension (p < 0.05). In addition, the landing motions of the chronic instability group may have utilized suboptimal compensatory motor strategy on the sagittal plane, depending heavily on the knee joint's abduction moment. CONCLUSIONS Our findings indicate that the chronic ankle instability group uses a different landing strategy pattern than the coper group by changing the joint moment and joint angle during landing, which may increase the risk of anterior cruciate ligament injury.
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Affiliation(s)
- Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan.
| | - Marina Kobayashi
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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Simpson JD, Cosio Lima L, Lee Y, Chander H, Knight AC. Closed-Loop Reflex Responses of the Lateral Ankle Musculature From Various Thresholds During a Lateral Ankle Sprain Perturbation. J Sport Rehabil 2024; 33:215-219. [PMID: 38198793 DOI: 10.1123/jsr.2023-0336] [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: 09/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
CONTEXT Latency is a reliable temporal metric used to evaluate sensorimotor integration of the fibularis longus (FL) and fibularis brevis (FB) during lateral ankle sprain perturbations. Currently, no clinical recommendations exist to select appropriate thresholds to evaluate the closed-loop reflex response of the lateral ankle musculature. The purpose of this study was to assess threshold value on latency of the FL and FB during an unanticipated inversion perturbation that simulates the mechanism of a lateral ankle sprain. DESIGN Descriptive laboratory study. METHODS Twenty healthy adults with no history of lateral ankle sprain injury completed an unanticipated single-leg drop landing onto a 25° laterally inclined force platform from a height of 30 cm. Surface electromyography recorded muscle activity data from the FL and FB during the inversion perturbation. Latency was identified at points where muscle activity exceeded 2, 5, and 10 SD above the average muscle activity 200 milliseconds prior to foot contact, and compared across threshold value using a 1-way analysis of variance (P < .05). RESULTS The 2 SD threshold was significantly shorter than both 5 SD and 10 SD thresholds for the FL (P < .01) and FB (P < .01). Likewise, the 5 SD threshold was significantly shorter than the 10 SD thresholds for FL (P = .004) and FB (P = .003). CONCLUSIONS More sensitive thresholds results in a shorter closed-loop reflexive response compared to the more rigorous thresholds. We recommend that selection of the appropriate threshold to identify latency of the lateral ankle musculature should be based on the device used to simulate a lateral ankle sprain and the ankle inversion velocity produced during the ankle inversion perturbation.
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Affiliation(s)
- Jeffrey D Simpson
- Sports Medicine and Neuromechanics Laboratory, Department of Movement Sciences and Health, University of West Florida, Pensacola, FL, USA
| | - Ludmila Cosio Lima
- Sports Medicine and Neuromechanics Laboratory, Department of Movement Sciences and Health, University of West Florida, Pensacola, FL, USA
| | - Youngil Lee
- Sports Medicine and Neuromechanics Laboratory, Department of Movement Sciences and Health, University of West Florida, Pensacola, FL, USA
| | - Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
| | - Adam C Knight
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
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Sayyadi P, Minoonejad H, Seidi F, Shikhhoseini R, Arghadeh R. The effectiveness of fatigue on repositioning sense of lower extremities: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2024; 16:35. [PMID: 38311746 PMCID: PMC10840207 DOI: 10.1186/s13102-024-00820-w] [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: 01/18/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION An injury can significantly harm both individual and team performance. One of the most important risk factors for sports-related injuries, especially non-collision injuries, is fatigue. It seems that poor proprioception may play an essential role to impose athletes to further injuries. This systematic review and meta-analysis aimed to examine the effectiveness of fatigue on the repositioning sense of the lower extremity joints. METHOD The electronic databases, including PubMed, Web of Science, Scopus, and Google Scholar were systematically searched from inception to 11January 2024. The obtained records were exported to the EndNote Software version 8. Then, two investigators examined the records independently to find eligible studies based on the inclusion/exclusion criteria. In the case of disagreements, a consequence method was utilized. The quality of the eligible studies was evaluated using the Downs and Black checklist. Comprehensive Meta-Analysis (CMA) software ver. 3 software was used for statistical analysis. Q-test and I2 were employed to examine the data homogeneity. In addition, considering the risk of bias, the Funnel Plot and trim-and-fill method were used. RESULTS After reviewing the titles and abstracts of 3883 studies found in the selected databases, 43 articles were found to be eligible to include in meta-analyses. The results showed that fatigue led to a significant increase in the active absolute error of the knee (SDM = 0.524, 95% CI = 0.406-0.841), ankle in the horizontal plane (SDM = 0.541, 95% CI = 0.367-0.715), ankle in the sagittal plane (SDM = 0.443, 95% CI = 0.088-0.798), and hip (SDM = 0.988, 95% CI = 0.135-1.841). However, fatigue had no significant effects on the passive absolute error of the knee and ankle in horizontal plane and relative angular error of the knee. CONCLUSION Fatigue can diminish the active joint position sense of the lower extremities and thus may increase the risk of injury by reducing proprioception. Therefore, future research could be conducted to investigate the potential impact of integrated fatigue-mitigating exercises into athletes' training programs, with the aim of reducing the incidence of sports-related injuries.
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Affiliation(s)
- Parisa Sayyadi
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Iran, Tehran, Iran.
| | - Foad Seidi
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Iran, Tehran, Iran
| | - Rahman Shikhhoseini
- Department of Corrective Exercise and Sports Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ramin Arghadeh
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Tehran, Iran
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Marimon X, Mengual I, López-de-Celis C, Portela A, Rodríguez-Sanz J, Herráez IA, Pérez-Bellmunt A. Kinematic Analysis of Human Gait in Healthy Young Adults Using IMU Sensors: Exploring Relevant Machine Learning Features for Clinical Applications. Bioengineering (Basel) 2024; 11:105. [PMID: 38391591 PMCID: PMC10886386 DOI: 10.3390/bioengineering11020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Gait is the manner or style of walking, involving motor control and coordination to adapt to the surrounding environment. Knowing the kinesthetic markers of normal gait is essential for the diagnosis of certain pathologies or the generation of intelligent ortho-prostheses for the treatment or prevention of gait disorders. The aim of the present study was to identify the key features of normal human gait using inertial unit (IMU) recordings in a walking test. METHODS Gait analysis was conducted on 32 healthy participants (age range 19-29 years) at speeds of 2 km/h and 4 km/h using a treadmill. Dynamic data were obtained using a microcontroller (Arduino Nano 33 BLE Sense Rev2) with IMU sensors (BMI270). The collected data were processed and analyzed using a custom script (MATLAB 2022b), including the labeling of the four relevant gait phases and events (Stance, Toe-Off, Swing, and Heel Strike), computation of statistical features (64 features), and application of machine learning techniques for classification (8 classifiers). RESULTS Spider plot analysis revealed significant differences in the four events created by the most relevant statistical features. Among the different classifiers tested, the Support Vector Machine (SVM) model using a Cubic kernel achieved an accuracy rate of 92.4% when differentiating between gait events using the computed statistical features. CONCLUSIONS This study identifies the optimal features of acceleration and gyroscope data during normal gait. The findings suggest potential applications for injury prevention and performance optimization in individuals engaged in activities involving normal gait. The creation of spider plots is proposed to obtain a personalised fingerprint of each patient's gait fingerprint that could be used as a diagnostic tool. A deviation from a normal gait pattern can be used to identify human gait disorders. Moving forward, this information has potential for use in clinical applications in the diagnosis of gait-related disorders and developing novel orthoses and prosthetics to prevent falls and ankle sprains.
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Affiliation(s)
- Xavier Marimon
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
- Automatic Control Department, Universitat Politècnica de Catalunya (UPC-BarcelonaTECH), 08034 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), 08950 Barcelona, Spain
| | - Itziar Mengual
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Carlos López-de-Celis
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), 08007 Barcelona, Spain
| | - Alejandro Portela
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Iria Andrea Herráez
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- ACTIUM Research Group, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
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Han S, Oh M, Lee H, Hopkins JT. EMG Analysis During Static Balance in Chronic Ankle Instability, Coper and Controls. Int J Sports Med 2024; 45:48-54. [PMID: 37972934 DOI: 10.1055/a-2156-2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Patients with chronic ankle instability (CAI) consistently display postural control alterations, which may result from sensorimotor dysfunction. This study aimed to compare muscle activity in the lower extremity and postural control among individuals with CAI, copers and uninjured controls during a static balance test. A total of 57 physically active participants were categorized into three groups (CAI, copers and controls) and performed a single-leg balance test with two visual conditions: eyes open and eyes closed. Muscle activity in six lower extremity muscles and center of pressure (CoP) variables were recorded and analyzed. Patients with CAI exhibited greater muscle activity in the medial gastrocnemius and gluteus maximus compared to controls or copers, regardless of the visual condition. Copers displayed increased gluteus medius activity compared to controls. Additionally, all groups demonstrated increased muscle activity and CoP variables when visual feedback was disrupted. These findings suggest that patients with CAI may have less effective recruitment of motor units during static balance. On the other hand, greater muscle activity in the gluteus medius in copers may represent a coping mechanism to avoid further ankle injuries. Further research on muscle activity during dynamic postural control is warranted to explore sensorimotor alterations in patients with CAI.
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Affiliation(s)
- Seunguk Han
- Exercise Sciences, Brigham Young University, Provo, United States
| | - Minsub Oh
- Exercise Sciences, Brigham Young University, Provo, United States
| | - Hyunwook Lee
- Exercise Sciences, Brigham Young University, Provo, United States
| | - J Ty Hopkins
- Exercise Sciences, Brigham Young University, Provo, United States
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Moisan G, Chicoine D, McBride S, Farahpour N, Isabelle PL, Dagenais C, Griffiths I. Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles. J Foot Ankle Res 2023; 16:91. [PMID: 38129924 PMCID: PMC10740238 DOI: 10.1186/s13047-023-00681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. METHODS Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. RESULTS Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). CONCLUSIONS Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Dominic Chicoine
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Sean McBride
- Department of Physical Therapy, University of Findlay, Findlay, OH, USA
| | - Nader Farahpour
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Department of Sport Biomechanics, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Pier-Luc Isabelle
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Camille Dagenais
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Han S, Lee H, Oh M, Hopkins JT. Lower Extremity Energy Dissipation and Generation During Jump Landing and Cutting in Patients With Chronic Ankle Instability. J Athl Train 2023; 58:912-919. [PMID: 36913640 PMCID: PMC10784882 DOI: 10.4085/1062-6050-0452.22] [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] [Indexed: 03/15/2023]
Abstract
CONTEXT Participants with chronic ankle instability (CAI) frequently display altered movement patterns during functional movements. However, it remains unclear how these altered joint kinematics during jump landing negatively affect ankle joint health in the CAI population. Calculating joint energetics may offer an important method to estimate the magnitude of lower extremity joint loading during functional movements in participants with CAI. OBJECTIVE To determine differences in energy dissipation and generation by the lower extremity during maximal jump landing and cutting among groups with CAI, copers, and controls. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-four participants with CAI, 44 copers, and 44 controls. MAIN OUTCOME MEASURES(S) Kinematics and kinetics of the lower extremity and ground reaction force data were collected during a maximal jump-landing and cutting task. The product of angular velocity in the sagittal plane and joint moment data represented joint power. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve. RESULTS Participants with CAI displayed reduced ankle energy dissipation (35.9% ± 10.1%) and generation (31.6% ± 12.8%; P < .01) compared with copers (dissipation = 43.6% ± 11.1%; generation = 40.4% ± 12.0%) and controls (dissipation = 41.3% ± 11.1%; generation = 39.6% ± 12.0%) during maximal jump landing and cutting. Participants with CAI also displayed greater energy dissipation at the knee (45.1% ± 9.1%) than copers (39.7% ± 9.5%) during the loading phase and greater energy generation at the hip than controls (36.6% ± 16.8% versus 28.3% ± 12.8%) during the cutting phase. However, copers displayed no differences in joint energetics compared with controls. CONCLUSIONS Participants with CAI displayed differences in both energy dissipation and generation by the lower extremity during maximal jump landing and cutting. However, copers did not show altered joint energetics, which may represent a coping mechanism to avoid further injuries.
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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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.
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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
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Abbasi L, Panahi F, Zarei-Kurdshooli Z, Yazdi Yahya-Abadi F. The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain. J Bodyw Mov Ther 2023; 35:233-237. [PMID: 37330775 DOI: 10.1016/j.jbmt.2023.04.044] [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: 12/11/2021] [Revised: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN Randomized clinical trial; assessor-blind; before and after comparison. SETTING Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S) Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.
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Affiliation(s)
- Leila Abbasi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Panahi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Zarei-Kurdshooli
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Yazdi Yahya-Abadi
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Kunugi S, Hirono T, Yoshimura A, Holobar A, Watanabe K. Association between force fluctuation during isometric ankle abduction and variability of neural drive in peroneus muscles. J Electromyogr Kinesiol 2023; 70:102780. [PMID: 37126978 DOI: 10.1016/j.jelekin.2023.102780] [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: 01/22/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023] Open
Abstract
Analyzing motor unit (MU) activities of peroneus muscles may reveal the causes of force control deficits of ankle eversion. This study aimed to examine peroneus muscles' MU discharge characteristics and associations between force fluctuation and variability of the neural drive in healthy participants. Thirty-one healthy males participated in this study. MU activities were identified from high-density surface electromyography of peroneus muscles during ankle eversion at 15 and 30% of maximal voluntary contraction (MVC). Participants increased the contraction level until reaching the target and held it for 15 s. The central 10 s of the hold phase were used for analysis. A cumulative spike train (CST) was calculated using MU firings. Variabilities of the force and CST are represented by the coefficient of variation (CoV). Spearman's rank correlation coefficient was used to assess the association between CoV of force and CoV of CST. For 15 and 30 % MVC trials, CoV of force was 1.86 ± 1.59 and 1.57 ± 1.26%, and CoV of CST was 5.01 ± 3.24 and 4.51 ± 2.78%, respectively. The correlation was significant at 15% (rho = 0.27, p < 0.001) and 30% (rho = 0.32, p < 0.001) MVC. Our findings suggest that in peroneus muscles, force fluctuation weakly to moderately correlates with neural drive variability.
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Affiliation(s)
- Shun Kunugi
- Center for General Education, Aichi Institute of Technology, 1247 Yachigusa, Yakusa-cho, Toyota-shi, Aichi 470-0392, Japan; Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan.
| | - Tetsuya Hirono
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| | - Akane Yoshimura
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| | - Aleš Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000 Maribor, Slovenia
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
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13
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Wagemans J, Bleakley C, Taeymans J, Kuppens K, Schurz AP, Baur H, Vissers D. Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review. Phys Ther Sport 2023; 60:75-83. [PMID: 36716507 DOI: 10.1016/j.ptsp.2023.01.008] [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: 10/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES 1) determine the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients with an acute ankle sprain; 2) Determine whether prescribed exercises incorporate complex tasks associated with ankle sprain injury mechanisms? METHODS We searched databases CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar for RCT's including patients with acute ankle sprains, managed through exercise-based rehabilitation. Risk of bias was assessed by the Risk of Bias 2 tool. Exercises were analysed based on: the primary impairment(s) addressed; direction of movement; base of support; weightbearing status; flight phase. (PROSPERO: CRD42020210858) RESULTS: We included fourteen RCT's comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises incorporated a flight phase. CONCLUSIONS Rehabilitation after LAS comprises simple exercises in the sagittal plane that do not reflect mechanisms of re-injury. Future interventions should incorporate more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. https://twitter.com/jentewagemans
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; SOMT University of Physiotherpy Education, Amersfort, the Netherlands
| | | | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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14
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Kawabata S, Murata K, Iijima H, Nakao K, Kawabata R, Terada H, Kojima T, Takasu C, Kano T, Kanemura N. Ankle instability as a prognostic factor associated with the recurrence of ankle sprain: A systematic review. Foot (Edinb) 2023; 54:101963. [PMID: 36709590 DOI: 10.1016/j.foot.2023.101963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
DESIGN Systematic review using PRISMA guidelines. PURPOSE To explore Relationship between ankle instability and ankle sprain recurrence in preventing recurrence of ankle sprains and to provide appropriate treatment. METHODS MEDLINE (the Cochrane Library) and the Physiotherapy Evidence Database (PEDro) were explored using key words related to ankle instability and ankle sprains in for April 2022. According to the inclusion criteria, studies that 1) targeted patients with ankle sprains, 2) assessed ankle instability, and 3) investigated ankle sprain recurrence rates, were extracted. The author names, publication year, patient characteristics, comparison groups, intervention methods, and outcome data (ankle instability and recurrence) were extracted. A correlation analysis between recurrence rate and ankle instability was conducted. In addition, A meta-analysis was performed on the correlation coefficients within each article. RESULTS Eight studies were extracted from 149 studies. A correlation analysis was conducted on five studies and meta-analysis was on three studies with the same post-intervention follow-up period and the same assessment methods for ankle instability and recurrence rate. Strong positive correlations were found for the same follow-up periods (r = 0.95: 95%CI [0.62-0.99]; 3-month, r = 0.97: 95%CI [0.75-0.10]; 1 year, p < .05). The correlation became stronger as the follow-up period increased. Furthermore, the meta-analysis showed that ankle instability as well as the main symptoms of sprain, such as pain and swelling, tended to be positively correlated with the recurrent rate of ankle sprains. These results suggest that ankle instability is strongly related to recurrence, and the longer the time since onset, the stronger the relationship. CONCLUSIONS Ankle instability was a prognostic factor associated with recurrence of ankle sprains in patients with ankle sprains. Therefore, ankle instability is one of important factor in preventing recurrence of ankle sprains.
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Affiliation(s)
- Sora Kawabata
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kouki Nakao
- Department of Rehabilitation, Amakusa Rehabilitation Hospital, Saitama, Japan
| | - Riku Kawabata
- Department of Rehabilitation, Minami-Koshigaya Hospital, Saitama, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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15
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Peroneal muscle activity during stable and unstable load exercises. A cross-sectional study. Phys Ther Sport 2023; 60:84-90. [PMID: 36738669 DOI: 10.1016/j.ptsp.2023.01.010] [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: 12/01/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the muscle activity of the peroneus longus during the execution of different unstable load exercises compared to stable load exercises. DESIGN Cross-sectional study. SETTING Functional Anatomy Laboratory. PARTICIPANTS 28 healthy athletes. MAIN OUTCOME MEASURES Surface electromyography (sEMG), unstable load (water tank), Stable Load (Sandbag), type of exercise (Isometric single leg stance, single-leg Romanian deadlift, front rack forward lunge and lateral lunge). RESULTS The repeated measures ANOVA revealed significant Group ∗ Time interaction in Root Mean Square (RMS) (F = 51.307, P < 0.001, ŋ2 = 0.70). In the between-group analysis there were statistically significant differences in RMS isometric single leg stance in favor to unstable load (P < 0.001, ŋ2 = 0.07). In the within-group analysis of RMS statistically significant differences were found in the stable load group between isometric single leg stance and single-leg Romanian deadlift (P < 0.001, ŋ2 = 0.05). CONCLUSIONS Single leg stance exercise with unstable load showed higher peroneus muscle activity than stable load. However, no peroneus muscle activity differences were found between unstable and stable loads for single-leg Romanian deadlift, frontal rack forward lunge and lateral lunge. Single-leg Romanian deadlift with stable load showed higher peroneus muscle activity than isometric single leg stance with stable load.
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16
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Asgari M, Nazari B, Bizzini M, Jaitner T. Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:226-235. [PMID: 35659964 PMCID: PMC10105015 DOI: 10.1016/j.jshs.2022.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/12/2022] [Accepted: 04/22/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The side effects of the FIFA 11+ program on performance have not been generally reviewed. The objective of this study was to synthesize the literature on the effects of the 11+ on players' performance. METHODS Five online databases (PubMed, Scopus, ScienceDirect, Springer, and Google Scholar) were searched (from April 2006 to March 2022) using predefined keywords and sub-keywords. The potential references were primarily recorded through Endnote and imported to Covidence. Out of the 123 references screened by 2 blinded researchers through the software, 59 full texts were assessed for eligibility, 33 of which were ultimately included. The quality of the studies and the risk of bias were then assessed. Study ID, title, place, aim, design, start/end dates, population description, study criteria, statistical analysis, and outcomes were extracted. RESULTS Studies were conducted on male and female players aged 10-32 years old. The quality of the studies was moderate to high, and except for unclear bias for blinding outcome assessment, the risk of bias for all domains was low. Long-term application of the 11+ improved most biomechanical measures and physiological responses except for lower extremity stability, ankle evertors time latency, ankle dorsiflexion, and proprioception. Conversely, the 11+ showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities. CONCLUSION Mid-to-long-term implementation of the 11+ improved the majority of biomechanical and a couple of physical measures but showed no effects on technical skills. Precaution must be observed for using the 11+ before competitions, as it could acutely decrease physical/technical performance. Given the contradictory nature of the literature, further studies should evaluate the short-to-mid-term effects of the 11+. Further studies are required to address ankle responses to the 11+ intervention.
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Affiliation(s)
- Mojtaba Asgari
- Institute for Sport and Sports Science, TU Dortmund University, Dortmund 44221, Germany.
| | - Bahareh Nazari
- Faculty of Physical Education and Sports Science, University of Tehran, Kish Island branch, Kish Island 79416, Iran
| | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic Lengghalde, Zürich 8008, Switzerland
| | - Thomas Jaitner
- Institute for Sport and Sports Science, TU Dortmund University, Dortmund 44221, Germany
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17
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Santos LDD, Pereira CAM, Bolligner Neto R, Alonso AC, Greve JMD. EVALUATION OF ANKLE MOVEMENTS ON A SUDDEN INVERSION PLATFORM. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0139i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
ABSTRACT Introduction: Ankle sprains are frequent in sports activities and can lead to joint instability with clinical and performance consequences. Sudden ankle inversion platforms have been used to study the mechanism of ankle sprain. Objectives: To test a static platform that simulates the movement of ankle sprain (sudden inversion) in soccer players. Methods: A platform was developed to perform the sudden movement of an ankle sprain dissociated in three axes: inversion, plantar flexion, and medial rotation. A computer program was also created to read the angular velocity and the time to reach the maximum amplitude of the three axes of movement, synchronized with the platform movements. Thirty soccer players without ankle sprains were evaluated on the sudden inversion platform. Each athlete performed 10 randomly initiated tests, with five per leg. Results: There was no statistical difference in angular velocity or time to reach maximum range of motion of plantar flexion and medial rotation between the tests. During the tests, the angular velocity of the inversion increased. Conclusion: The sudden static platform evaluated the movements performed by the ankle during the sprain reliably in the 10 tests with no difference in the mechanical behavior. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.
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Affiliation(s)
- Leandro Dias dos Santos
- Universidade de São Paulo, Brazil; Physical Therapy Department of the São Bernardo Futebol Clube, Brazil
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18
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Santos LDD, Pereira CAM, Bolligner Neto R, Alonso AC, Greve JMD. AVALIAÇÃO DOS MOVIMENTOS DO TORNOZELO NA PLATAFORMA DE INVERSÃO SÚBITA. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0139p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RESUMO Introdução: A entorse do tornozelo é frequente nas atividades esportivas, podendo levar à instabilidade articular com consequências clínicas e de desempenho. As plataformas de inversão súbita do tornozelo têm sido usadas para estudar o mecanismo de entorse do tornozelo. Objetivos: Testar uma plataforma estática que simule o movimento de entorse do tornozelo (inversão súbita) em jogadores de futebol. Métodos: A plataforma foi desenvolvida para realizar o movimento súbito da entorse de tornozelo dissociado em três eixos: inversão, flexão plantar e rotação medial. Também foi criado um programa de computador para leitura da velocidade angular e do tempo para atingir a amplitude máxima dos três eixos de movimento, sincronizados com os movimentos da plataforma. Trinta jogadores de futebol sem entorse de tornozelo foram avaliados na plataforma súbita. Cada atleta fez 10 testes, iniciados de forma aleatória, sendo cinco em cada perna. Resultados: Entre os testes, não houve diferença estatística das velocidades angulares e tempo para atingir a amplitude máxima do movimento de flexão plantar e rotação medial. Durante os testes, a velocidade angular da inversão aumentou. Conclusão: A plataforma estática súbita, avaliada em 10 tentativas, foi confiável para avaliar os movimentos executados pelo tornozelo durante a entorse, e não houve diferença de comportamento mecânico. Nível de evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.
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Affiliation(s)
- Leandro Dias dos Santos
- Universidade de São Paulo, Brazil; Physical Therapy Department of the São Bernardo Futebol Clube, Brazil
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Conduction Velocity of Spinal Reflex in Patients with Acute Lateral Ankle Sprain. Healthcare (Basel) 2022; 10:healthcare10091794. [PMID: 36141406 PMCID: PMC9498455 DOI: 10.3390/healthcare10091794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Recent literature has highlighted altered spinal-reflex excitability following acute lateral ankle sprain (ALAS), yet there is little information on the conduction velocity of spinal reflex pathways (CV-SRP) in these patients. Therefore, we aimed to investigate the effects of ALAS on the CV-SRP. We employed a cross-sectional study with two groups: ALAS (n = 30) and healthy controls (n = 30). The CV-SRP of the soleus, fibularis longus, and tibialis anterior was assessed using the H-index method. As secondary outcomes, H-reflex and M-wave latencies were assessed as well as acute symptoms including ankle swelling, pain, and self-reported ankle function. Separate group-by-limb ANOVA with repeated measures revealed a significant interaction for soleus CV-SRP (p < 0.001) and H-reflex latency (p < 0.001), showing significant slower CV-SRP and longer H-reflex latency in the involved limb of the ALAS group compared with both limbs in the control group. However, there was no significant interaction or main effect in any other ankle muscles (p > 0.05). A further correlation analysis showed a significant relationship between CV-SRP and acute symptoms, including ankle swelling (r = −0.37, p = 0.048) and self-reported ankle function (r = 0.44, p = 0.017) in ALAS patients. These results suggest a disrupted functionality of the afferent pathway and/or synaptic transmission following ALAS. Level of Evidence: 4.
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20
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A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4438. [PMID: 35983544 PMCID: PMC9377677 DOI: 10.1097/gox.0000000000004438] [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: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
Functional lower extremity reconstruction primarily aims to restore independent ambulation. We sought to define the synergies recruited during a walking gait to inform donor selection for various motor deficits. With these findings, we discuss the functional neuromuscular components of independent gait with the goal of informing lower extremity reconstruction.
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Lee JH, Jung HW, Jang WY. Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Broström procedure. Sci Rep 2022; 12:610. [PMID: 35022508 PMCID: PMC8755731 DOI: 10.1038/s41598-021-04567-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/24/2021] [Indexed: 12/25/2022] Open
Abstract
The modified Broström procedure (MBP) is an initial treatment for symptomatic chronic ankle instability (CAI) patients. This study aimed to compare the proprioception and neuromuscular control ability of both affected and unaffected ankles at the time of return to sports after MBP for patients with scores of normal controls. 75 individuals (40 who underwent MBP, 35 normal controls) participated. The dynamic balance test scores were significantly higher in the affected ankle of the patients than in the controls (1.5 ± 0.6° vs. 1.1 ± 0.4°, p < 0.003). The time to peak torque for dorsiflexion (60.8 ± 13.9 ms vs. 52.2 ± 17.5 ms, p < 0.022) and eversion (68.9 ± 19.1 ms vs. 59.3 ± 21.1 ms, p < 0.043) was significantly delayed in the affected ankle of the patients than in the controls. The dynamic balance test and time to peak torque in CAI patients remained significantly reduced at the time of return-to-sport after MBP. Clinicians and therapists should be aware of potential deficits in proprioception and neuromuscular control when determining the timing of return to sports after MBP.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Woo Young Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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22
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McCreadie J, Whyte O, Greig M. A critical appraisal of ankle rehabilitative interventions. Res Sports Med 2021:1-9. [PMID: 34779324 DOI: 10.1080/15438627.2021.2001648] [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: 10/19/2022]
Abstract
Introduction Lateral ankle sprain is a common musculoskeletal pathology. Functional exercise progression is vital to restore full function. Aim The aim of this study was to compare the electromyographical response to a standard balance task on one stable and four unstable surfaces. Participants Twenty subjects (5 male, 15 females; age at 23 ± 7.1 years) were recruited to participate in the study. Methods A gym-based single session cross over design was used to compare peak and mean surface EMG (sEMG) activity of the Peroneus Longus, Tibilais Anterior and medial head of the gastrocnemius muscles whilst performing a standardized balance task on one stable surface and four unstable surfaces stable surface. Results A significant main effect for surface was found. Post-hoc testing revealed that the Floor and Trampoline (Trampet) elicited similar mean sEMG response. Discussion The results of the study propose a safe and stepwise progressive rehabilitation regime following ankle injury whilst considering the healing process of the injured structure.
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Affiliation(s)
- John McCreadie
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
| | - Olivia Whyte
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
| | - Matt Greig
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
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23
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Disrupted somatosensory input alters postural control strategies during the Star Excursion Balance Test (SEBT) in healthy people. Gait Posture 2021; 90:141-147. [PMID: 34481264 PMCID: PMC9278490 DOI: 10.1016/j.gaitpost.2021.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic adaptations, including persistent sensorimotor deficits, remain in individuals with a history of ankle instability, resulting in altered postural control strategies during functional tasks such as gait, running, or landing. However, we do not know the contribution of the altered somatosensory input on postural control strategies during a dynamic balance task such as the Star Excursion Balance Test (SEBT). RESEARCH QUESTION The purpose of this study was to characterize postural control strategies with and without disrupted somatosensory input during a dynamic balance task in people without chronic ankle sprain. METHODS This study was a crossover study design. Twenty healthy young adults (10 men, 10 women; age = 23.9 ± 3.0 years, height = 174.2 ± 7.4 cm, mass = 71.2 ± 16.7 kg) performed the posteromedial reach test during the SEBT while standing on the ground and on foam. We measured the maximum reach distance (MRD); joint angles of the ankle, knee, hip, and trunk in the sagittal, frontal, and transverse planes; and position and displacement of the center of mass (COM) and center of pressure (COP) during the posteromedial reach task. RESULTS The MRD was shorter when standing on the foam than on the ground (p < 0.001). There was a condition by phase interaction for ankle dorsiflexion; tibia internal rotation; and trunk flexion (p < 0.001; p = 0.03; p = 0.01, respectively). The COM and COP were positioned more laterally on the foam (p < 0.001). The COM and COP anterior-posterior displacements were more anterior during the foam condition (p = 0.017). SIGNIFICANCE By using a foam pad to disrupt somatosensory information, participants demonstrated altered strategies to control the joint kinematics, COM, and COP, as a function of posteromedial distance. Ankle and trunk movement strategies may influence the posteromedial reach distance. This model may simulate changes that occur with chronic ankle instability.
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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
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25
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Postural Control and Functional Ankle Stability in Professional and Amateur Skateboarders. Healthcare (Basel) 2021; 9:healthcare9081009. [PMID: 34442146 PMCID: PMC8392589 DOI: 10.3390/healthcare9081009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Basic maneuvers in skateboarding, such as the ollie, put the player at high risk for ankle injuries because of the position of the feet required to perform the maneuvers. This study investigated ankle stability and reaction time for the tibialis anterior, fibularis longus, and fibularis brevis in professional and amateur skateboarders. In total, 16 professional and 16 amateur skateboarders were recruited as participants and underwent range of motion assessments, balance testing, and muscle reaction time measurements. The results revealed that professional skateboarders had a significantly smaller inversion angle compared to amateur players, which suggested better joint control and hence greater safety in the former. Balance testing results indicated better balance in professional skateboarders, and healthy skateboarders had better balance than did injured professional and amateur skateboarders. No significant difference in muscle reaction time was observed between amateur and professional skateboarders.
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Tashiro T, Maeda N, Sasadai J, Kotoshiba S, Sakai S, Suzuki Y, Fujishita H, Urabe Y. Tensiomyographic Neuromuscular Response of the Peroneus Longus and Tibialis Anterior with Chronic Ankle Instability. Healthcare (Basel) 2021; 9:healthcare9060707. [PMID: 34200684 PMCID: PMC8230383 DOI: 10.3390/healthcare9060707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the muscle contractile response of the peroneus longus (PL) and tibialis anterior (TA) in groups with and without chronic ankle instability (CAI) using tensiomyography. Twenty-three adults, 12 with CAI and 11 healthy participants, participated in this study. All subjects underwent a tensiomyographic assessment of the PL and TA to measure delay time, contraction time and maximal displacement. The ankle evertor and invertor normalized peak torques, maximum work done and muscle thickness of the PL and TA were calculated. The delay time and contraction time of the PL in the CAI side were significantly higher than those in the healthy group (p < 0.05); however, no significant difference could be detected in the TA between groups. Furthermore, there was no significant difference in the normalized peak torques, maximum work done and muscle thickness of the PL and TA between groups. The CAI side demonstrated a delayed muscle contractile response of the PL when compared with the healthy group although there was no difference in muscle strength and muscle size. Clinicians should consider the muscle contractile response of the PL for rehabilitation of the ankle evertor with CAI.
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Affiliation(s)
- Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (T.T.); (N.M.); (S.K.); (S.S.)
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (T.T.); (N.M.); (S.K.); (S.S.)
| | - Junpei Sasadai
- Sports Medical Center, Japan Institute of Sports Sciences, Tokyo 115-0056, Japan;
| | - Somu Kotoshiba
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (T.T.); (N.M.); (S.K.); (S.S.)
| | - Shogo Sakai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (T.T.); (N.M.); (S.K.); (S.S.)
| | - Yuta Suzuki
- Department of Rehabilitation, Matterhorn Rehabilitation Hospital, Hiroshima 737-0046, Japan;
| | - Hironori Fujishita
- Sports Medical Center, Hiroshima University Hospital, Hiroshima University, Hiroshima 734-8551, Japan;
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (T.T.); (N.M.); (S.K.); (S.S.)
- Correspondence:
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Lorenzo-Sánchez-Aguilera C, Rodríguez-Sanz D, Gallego-Izquierdo T, Lázaro-Navas I, Plaza-Rodríguez J, Navarro-Santana M, Pecos-Martín D. Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study. PAIN MEDICINE 2021; 21:1991-1998. [PMID: 30649506 DOI: 10.1093/pm/pny299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability. OBJECTIVE Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables. METHODS A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer. RESULTS Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs. CONCLUSIONS Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease.
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Bamber ZA, Sun W, Menon RS, Wheeler PC, Swain ID, Fong DTP. Functional Electrical Stimulation of Peroneal Muscles on Balance in Healthy Females. CYBORG AND BIONIC SYSTEMS 2021; 2021:9801097. [PMID: 36285134 PMCID: PMC9494702 DOI: 10.34133/2021/9801097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/11/2021] [Indexed: 12/26/2022] Open
Abstract
Balance improvement could contribute to ankle stability for the prevention of ankle sprains. Functional electrical stimulation (FES) is an effective way of augmenting muscle activity and improving balance. This study investigated the effect of FES of peroneal muscles on single-and double-leg balance. Fifteen healthy females (age = 23.1 ± 1.6 years, height = 1.63 ± 0.07 m, and weight = 63.7 ± 9.9 kg) performed single- and double-leg standing balance tests with eyes open and closed before and after 15-minute FES intervention during treadmill running at a comfortable, self-selected pace. FES of peroneal muscles was provided bilaterally, using an Odstock Dropped Foot Stimulator. The total excursion of the centre of pressure (COP) was calculated to assess the standing balance control ability. The total excursion of COP in single- and double-leg stance with eyes open reduced significantly after FES intervention by 14.7% (p < 0.001) and 5.9% (p = 0.031), respectively. The eyes-closed condition exhibited a 12.7% (p = 0.002) reduction in single-leg stance but did not significantly change in double-leg stance (p > 0.05). Limb preference did not account for balance postintervention. No significant difference in total excursion of COP was found between preferred and less preferred limbs with both visual conditions (p > 0.05). FES of peroneal muscles improved standing balance control with eyes open in double-leg and single-leg stance and with eyes closed in double-leg stance. The improvements in balance control with FES treatment did not vary concerning limb preference.
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Affiliation(s)
- Zoe A. Bamber
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Division of Orthopaedics, Trauma and Sports Medicine, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Wei Sun
- Shandong Sport University, Jinan, Shandong, China
| | - Rhea S. Menon
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick C. Wheeler
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ian D. Swain
- The Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - Daniel T. P. Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Moisan G, Mainville C, Descarreaux M, Cantin V. Lower limb biomechanics in individuals with chronic ankle instability during gait: a case-control study. J Foot Ankle Res 2021; 14:36. [PMID: 33941223 PMCID: PMC8091674 DOI: 10.1186/s13047-021-00476-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background Individuals with chronic ankle instability (CAI) exhibit many biomechanical changes to lower limbs during walking. However, only a few studies have investigated the differences in lower limb biomechanics of individuals with CAI compared to healthy controls using a comprehensive approach including kinematic, kinetic and electromyography (EMG) measures. Consequently, the theoretical framework explaining the biomechanical adaptations in individuals with CAI is mostly based on the results of studies including heterogenous methods and participants’ specificities (e.g., level of disability). More studies using a comprehensive approach are needed to better understand the biomechanical adaptations associated with CAI. The objective of this case-control study was to identify the kinematic, kinetic and EMG differences between individuals with CAI and healthy controls during walking. Methods Twenty-eight individuals with CAI and 26 healthy controls were recruited to walk at a self-selected speed during which lower limb kinematics, kinetics and EMG were analysed. Ankle and knee angles and moments as well as gluteus medius, vastus lateralis, gastrocnemius lateralis, peroneus longus and tibialis anterior muscles activity were compared between the CAI and control groups using one-dimensional statistical parametric mapping. Results The CAI group exhibited greater ankle inversion angles from 14 to 48% of the stance phase (%SP) (p = 0.008), ankle eversion moments from 40 to 78%SP (p < 0.001), knee abduction moments from 3 to 6%SP and peroneus longus muscle activity from 0 to 15%SP (p = 0.003) and 60 to 76%SP (p = 0.003) compared to the control group. No significant between-group differences in ankle sagittal and transverse angles and moments, knee angles, knee sagittal and transverse moments as well as gluteus medius, vastus lateralis, gastrocnemius lateralis and tibialis anterior muscles activity were found. Conclusions During the first half of the stance phase, individuals with CAI could be at more risk of sustaining recurrent LAS mostly due to greater ankle inversion angles. However, the greater ankle eversion moments and peroneus longus muscle activity during the second half of the stance phase were an efficient mechanism to correct this maladaptive gait pattern and allowed to attenuate the faulty ankle movements during the pre-swing phase. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00476-6.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada. .,Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
| | - Camille Mainville
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Vincent Cantin
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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Rogan S, Taeymans J, Eggertswyler B, Zuber S, Eichelberger P. Effect of finding-oriented manual therapy techniques on muscle activity and postural control in patients with chronic ankle instability - A randomized controlled feasibility study. J Bodyw Mov Ther 2021; 27:402-409. [PMID: 34391263 DOI: 10.1016/j.jbmt.2021.03.018] [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: 08/01/2019] [Revised: 12/19/2020] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Previous studies have analyzed the effects of manual therapy techniques (MTT) in patients with chronic ankle instability (CAI). Clinicians treat patients according the finding-oriented MTT approach. This approach is seldom pursued in research. The purpose of this study was to evaluate the feasibility and efficacy of finding-oriented MTT applications in patients with CAI. METHOD In this randomized controlled, blinded assessor crossover feasibility trial, participants were randomized to receive nine finding-oriented MTT treatments or no treatment during a three-week period, followed by a six-day washout period after which participants were crossed-over. Criteria under evaluation were adherence and attrition rates, safety (adverse events (AEs)) and acceptability and preliminary effects of finding-oriented MTT on muscular activity (measured by surface Electromyography (sEMG)) and on dynamic balance (measured by time to stabilization (TTS) and the modified Star Excursion Balance Test (modified STBT)). RESULTS Seven women and two men (mean age: 26 ± 6.1 years) with CAI enrolled in this feasibility study. Success criteria showed a high adherence (90%) and low attrition rate (10%). All data could be used for analysis. AEs such as tingling in the foot during a short time frame were reported after four finding-oriented MTT interventions. Preliminary effect sizes showed divergence and few statistically significant results for sEMG. CONCLUSION The participants were adherent to the finding-oriented MTT intervention. The acceptability of data recording and data analysis was good. In addition, the study protocol should be adapted by adding a 10-min warm up period, a participant familiarization to TTS and modified STBT, and test repetitions.
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Affiliation(s)
- Slavko Rogan
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Akademie für Integrative Physiotherapie und Trainingslehre, Grenzach-Wyhlen, Germany; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Jan Taeymans
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Beatrice Eggertswyler
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Stefan Zuber
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Patric Eichelberger
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
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López-González L, Falla D, Lázaro-Navas I, Lorenzo-Sánchez-Aguilera C, Rodríguez-Costa I, Pecos-Martín D, Gallego-Izquierdo T. Effects of Dry Needling on Neuromuscular Control of Ankle Stabilizer Muscles and Center of Pressure Displacement in Basketball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042092. [PMID: 33669979 PMCID: PMC7924825 DOI: 10.3390/ijerph18042092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to compare the effects of dry needling (DN) versus placebo DN applied to the peroneus longus (PL) and tibialis anterior (TA) on neuromuscular control and static postural control in basketball players with chronic ankle instability (CAI). A single-blinded randomized controlled trial was conducted. Thirty-two male and female basketball players with CAI were randomly assigned to receive either DN (n = 16) or placebo DN (n = 16). Pre-activation amplitudes of PL and TA were assessed with surface electromyography (EMG) during a dynamic landing test. Center of pressure (CoP) displacement and sway variability in anterior-posterior (AP) and medio-lateral (ML) directions were measured with a force platform during a single leg balance test (SLBT). Measures were obtained prior to a single DN intervention, immediately after, at 48 h, and 1 month after. The DN group displayed a significant increase in PL and TA pre-activation values, which were maintained 1 month later. Significant reductions in the ML and AP displacements and sway variability of CoP were found for the DN group. These results showed improvements in feedback/feed-forward strategies following DN, including enhanced neuromuscular control and static postural control, with the potential to become a convenient and accessible preventive treatment in CAI subjects.
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Affiliation(s)
- Luis López-González
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
- Department of Physical Therapy, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham B15 2TT, UK;
| | - Irene Lázaro-Navas
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
- Department of Physical Therapy, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Cristina Lorenzo-Sánchez-Aguilera
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
| | - Isabel Rodríguez-Costa
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
| | - Daniel Pecos-Martín
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
- Correspondence: ; Tel.: +34-918-854-719
| | - Tomás Gallego-Izquierdo
- Department of Physical Therapy, University of Alcalá, 28805 Alcalá de Henares, Spain; (L.L.-G.); (I.L.-N.); (C.L.-S.-A.); (I.R.-C.); (T.G.-I.)
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Svorai Band S, Pantanowitz M, Funk S, Waddington G, Steinberg N. Factors associated with musculoskeletal injuries in an infantry commanders course. PHYSICIAN SPORTSMED 2021; 49:81-91. [PMID: 32511050 DOI: 10.1080/00913847.2020.1780098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the prevalence of injuries among young combat soldiers as assessed and reported by the military physicians, and to investigate whether parameters such as anthropometric measures, postural balance, proprioceptive ability, and chronic ankle instability are related to injuries during and following an infantry commanders course. METHODS In this cross-sectional study, 165 soldiers were tested for anthropometric measurements, proprioceptive ability, and dynamic postural balance (DPB), as well as for their responses to an ankle stability questionnaire (CAIT), on three occasions: pre-course, middle-course, and end-course testing. All musculoskeletal injuries were assessed and recorded in the digital medical file of each participant by specialist military physicians before and during/following the course. RESULTS Ninety-eight soldiers (59.4%) were injured before the course. Forty soldiers (24.2%) incurred an injury during/following the course (with 33 out of the 40 [82.5%] soldiers that were injured during/following the course having also been injured before the course). Sixty soldiers had no injury before/during/following the course. A survival curve showed that half of the soldiers who were injured during/following the course (20 soldiers) were recorded as injured in the first half of the course (during the first 46 days of the 92-day course). Logistic regression showed that the pre-course parameters that were significant among injured soldiers compared with the non-injured soldiers were: low CAIT results (OR = 2.736, 95% CI = 1.178-6.354), high BMI (OR = 1.234, 95% CI = 1.082-1.406) and reduced proprioceptive ability (OR =.858, 95% CI =.797-.924). CONCLUSION With a high prevalence of soldiers injured during and following a commanders course, a somatosensory intervention program should be generalized into the practical daily preparation and training routines of the soldiers for improving somatosensory abilities, optimizing military physical readiness, and for preventing future musculoskeletal injuries.
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Affiliation(s)
| | - Michal Pantanowitz
- Wingate College of Physical Education and Sports Sciences, Wingate Institute , Netanya, Israel
| | - Shany Funk
- Combat Fitness Department, Doctrine and Research Branch, Israel Defense Forces , Israel
| | | | - Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, Wingate Institute , Netanya, Israel
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Sun W, Chan ECH, Fong DTP. Delayed peroneal muscle reaction time in male amateur footballers during a simulated prolonged football protocol. Res Sports Med 2020; 29:364-372. [PMID: 33371739 DOI: 10.1080/15438627.2020.1868467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Peroneal muscle fatigue could result in ankle inversion sprain injuries. This study investigated the peroneal muscle reaction time during a simulated prolonged football protocol. Nine male footballers completed a 105-minute simulated prolonged football protocol. The peroneal muscle reaction time to an ankle inversion perturbation was measured every 15 minutes by a surface electromyography system sampling at 1000 Hz. One-way repeated ANOVA with post-hoc paired t-test showed a steady upward trend starting from 48.9 ms at baseline to 57.1 ms at the end of the first half, followed by a recovery back to 50.9 ms at the start of the second half and a further delay in the last 30 minutes to 60.2 ms at the end of the protocol. Delayed peroneal muscle reaction was found after 30 minutes of the first half and 15 minutes of the second half of a football match. The risk of ankle sprain could increase in the latter minutes in each half protocol. Thus, prevention injury training strategies should focus on these specific durations in football matches.
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Affiliation(s)
- Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, Shandong, China
| | - Edwin C H Chan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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35
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Huang Z, Shan W, Ding J, Sun W, Fong DTP. Peroneal reaction time delayed but dynamic single-legged stability retained in collegiate footballers during a simulated prolonged football protocol. Res Sports Med 2020; 29:557-570. [PMID: 33297786 DOI: 10.1080/15438627.2020.1857251] [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: 10/22/2022]
Abstract
Delayed peroneal reaction time and impaired single-legged dynamic stability were risk factors of lateral ankle sprain (LAS), yet no study explored the change of them during a football match. The aim is to explore the change of peroneal reaction time and single-legged dynamic stability during a football simulation protocol. Twelve collegiate football players voluntarily completed a 105-min football match simulation protocol in which peroneal reaction time, root-mean-square of mediolateral ground reaction force in first 0.4 s (RMS ML 0.4), and the mean mediolateral ground reaction force in the late stage (late dynamic MLGRF), were measured for both legs at 15-min intervals during the protocol. Peroneal reaction time was tested using an electromyography (EMG) system. The ground reaction force variables were measured from GRF data after a single-legged drop-jump landing. Repeated measures one-way MANOVA was conducted to evaluate variables over time and leg dominance. Statistical significance was set at p < 0.05 level. Peroneal reaction time significantly increased for both legs at 45 minutes and after 60 minutes. RMS ML 0.4 of both legs and late dynamic MLGRF for dominant leg remained unchanged throughout the protocol and late dynamic MLGRF for non-dominant leg significantly reduced at the 90th minute.
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Affiliation(s)
- Zhanyu Huang
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wei Shan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junyuan Ding
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Mullins JF, Hoch MC, Kosik KB, Heebner NR, Gribble PA, Westgate PM, Nitz AJ. Effect of Dry Needling on Spinal Reflex Excitability and Postural Control in Individuals With Chronic Ankle Instability. J Manipulative Physiol Ther 2020; 44:25-34. [PMID: 33248750 DOI: 10.1016/j.jmpt.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 03/25/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group. METHODS This quasi-experimental university-laboratory study included 50 adult volunteers-25 with CAI (16 female, 9 male; age: 26 ± 9.42 years; height: 173.12 ± 9.85 cm; weight: 79.27 ± 18 kg) and 25 healthy controls (15 female, 10 male; age: 25.8 ± 5.45 years; height: 169.47 ± 9.43 cm; weight: 68.47 ± 13 kg). Participants completed the Star Excursion Balance Test (SEBT), single-leg balance, and assessment of spinal reflex excitability before and after a single treatment of dry needling to the fibularis longus. The anterior, posterolateral, and posteromedial directions of the SEBT were randomized, and reach distances were normalized to a percentage of leg length. A composite SEBT score was calculated by averaging the normalized scores. Postural control was assessed in single-limb stance on a force plate through time-to-boundary measurements in eyes-open and eyes-closed conditions. Fibularis longus and soleus spinal reflexes were obtained by providing electrical stimulation to the common fibular and tibial nerves with participants lying prone. A Group × Time analysis examined changes in performance, and effect sizes were calculated to assess significance. RESULTS Significant group × time interactions were identified for composite (P = .006) and posteromedial (P = .017) SEBT scores. Significant time effects for all directions of the SEBT, time to boundary with eyes open, and the mediolateral direction with eyes closed indicate improved postural control following treatment (P < .008). Within-group effect sizes for significant time effects ranged from small to large, indicating potential clinical utility. CONCLUSION Dry needling demonstrated immediate short-term improvement in measures of static and postural control in individuals with CAI as well as healthy controls.
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Affiliation(s)
- Jennifer F Mullins
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky.
| | - Matthew C Hoch
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Kyle B Kosik
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Nicholas R Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Phillip A Gribble
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Arthur J Nitz
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky
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Thompson T, Suttmiller AMB, Ringle B, McCann RS. Corticomotor excitability of the gluteus maximus in individuals with chronic ankle instability: A pilot study. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lai JHC, Ling SKK, Cacho P, Mok SW, Yung PSH. The effects of shoe collar height on ankle sprain mechanics in athletes: A review of literature. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720950325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Our aim was to conduct a review to summarize the existing information regarding the effects of shoe collar height in altering ankle sprain mechanics in athletes. Methods: A systematic literature search of PubMed, Embase, MEDLINE, and SPORTDiscus was conducted in September 2019. Results: There were 10 studies published from 1993 to 2019 that were included. Most studies showed high-top shoes limited ankle sprain kinematics and increased resistance to inversion moment in static but not dynamic testing. High-top shoes were associated with delayed pre-landing ankle evertor muscle activation and smaller electromyography amplitudes. Conclusions: There is currently weak evidence to support that high-top shoes can limit ankle sprain kinematics in dynamic testing. Further studies with more consistent study interventions and outcome variables are needed to definitively establish the effects of shoe collar height on ankle sprain mechanics in athletes. The Translational Potential of this Article: Multiple studies on the effects of shoe collar height and ankle sprain mechanics have been performed but there is a lack of consistency in terms of study design, intervention, and outcome measures. A formal systematic review and meta-analysis were not applicable due to the heterogeneity of studies, and mixed results from these studies can be confusing to interpret, making further research on this topic difficult as a result of lack of future direction. We summarized the existing literature on this topic to provide a clearer picture and guide future research on this controversial matter.
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Affiliation(s)
- Jojo Hoi-Ching Lai
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Samuel KK Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Patrick Cacho
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - SW Mok
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Patrick SH Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
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Wenning M, Gehring D, Mauch M, Schmal H, Ritzmann R, Paul J. Functional deficits in chronic mechanical ankle instability. J Orthop Surg Res 2020; 15:304. [PMID: 32762704 PMCID: PMC7412640 DOI: 10.1186/s13018-020-01847-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization. METHODS We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles. RESULTS Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20° vs. 14° of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02). CONCLUSIONS This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Kriegackerstr 100, CH-4132 Muttenz, Basel, Switzerland.
- Department of Orthopedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Dominic Gehring
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany
| | - Marlene Mauch
- Rennbahnklinik, Kriegackerstr 100, CH-4132 Muttenz, Basel, Switzerland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
- Department of Orthopaedic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Ramona Ritzmann
- Rennbahnklinik, Kriegackerstr 100, CH-4132 Muttenz, Basel, Switzerland
| | - Jochen Paul
- Rennbahnklinik, Kriegackerstr 100, CH-4132 Muttenz, Basel, Switzerland
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Fong DTP, Leung WC, Mok KM, Yung PSH. Delayed ankle muscle reaction time in female amateur footballers after the first 15 min of a simulated prolonged football protocol. J Exp Orthop 2020; 7:54. [PMID: 32712825 PMCID: PMC7382667 DOI: 10.1186/s40634-020-00275-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Ankle sprain injury rate is reported to be higher towards the end of a football match. Muscle fatigue may contribute to the delayed muscle reaction and subsequent injury. This study investigated the ankle muscle reaction time during a simulated, prolonged football protocol. METHODS Seven amateur female football players participated in a 105-min simulated, prolonged football protocol. An ankle muscle reaction test was conducted with a pair of ankle sprain simulators at a scheduled interval every 15-min. The reaction times of peroneus longus, tibialis anterior, and lateral gastrocnemius were collected using an electromyography system sampling at 1000 Hz. Repeated measures one-way multivariate analysis of variance with post-hoc paired t-tests were conducted to evaluate if the reaction time at each time point significantly differed from baseline. Statistical significance was set at p < 0.05 level. RESULTS Reaction times started from 40.5-47.7 ms at baseline and increased to 48.6-55.7 ms at the end. Reaction times significantly increased in all muscles after the first 15 min except for the dominant lateral gastrocnemius. Increased reaction times were seen in the non-dominant limb after 60 min for tibialis anterior, after 75 min for peroneus longus, and after 90 min for the lateral gastrocnemius. CONCLUSIONS Delayed reaction time of the ankle muscles were found after the first 15 min and in the final 45 min of a simulated prolonged football protocol. Strategies for injury prevention should also focus on tackling the delayed ankle muscle reaction time in the acute phase (the first 15 min), in addition to the latter minutes in the second half. LEVEL OF EVIDENCE Controlled laboratory study, Level V.
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Affiliation(s)
- Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wing-Ching Leung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Sports Medicine Centre, Elite Training Science & Technology Division, Hong Kong Sports Institute, Hong Kong, China
| | - Kam-Ming Mok
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Student Services Centre, Lingnan University, Hong Kong, China
| | - Patrick S H Yung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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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.
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Yoshida T, Suzuki T. Relationship between chronic ankle sprain instability and ultrasonographic evaluation of the peroneus during a single-leg standing task. J Phys Ther Sci 2020; 32:33-37. [PMID: 32082025 PMCID: PMC7008020 DOI: 10.1589/jpts.32.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to examine the relationship between chronic ankle sprain
instability and ultrasonography of the peroneus muscles during a single-leg standing task.
[Participants and Methods] We examined nine college-aged students with a history of
lateral ankle joint sprain with chronic ankle sprain instability scores less than 24.
Participants underwent ultrasonographic measurement of the pennation angle and muscle
thickness of the peroneal and gastrocnemius muscle groups of both legs. In addition,
participants were evaluated for fluctuation by the root mean square calculated from
accelerations in the anteroposterior, lateral-horizontal, and vertical directions during
the single-leg standing position by affixing the accelerometer to their waist. Measurement
results were compared between sprain and non-sprain sides. [Results] Ultrasonography
revealed a significant reduction in the feathered pennation angle of the long peroneal
muscle on the side of the sprain, but no other significant differences. Also, significant
extension was observed on the side of the sprain in the anteroposterior and vertical
directions during single-leg standing; however, no significant differences were found in
the lateral-horizontal direction. [Conclusion] Participants with chronic ankle sprain
instability exhibited greater fluctuation in the anteroposterior and vertical directions.
Such fluctuations are believed to be compensatory in nature because the feathered horn of
the long peroneal muscle is decreased, and pronation of the forefoot is difficult during
one-leg standing.
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Affiliation(s)
- Takaki Yoshida
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences: 2-11-1 Wakaba, Kumatori, Sennan, Osaka 590-0482, Japan
| | - Toshiaki Suzuki
- Faculty of Health Sciences, Kansai University of Health Sciences, Japan
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Kinematic, kinetic and electromyographic differences between young adults with and without chronic ankle instability during walking. J Electromyogr Kinesiol 2020; 51:102399. [PMID: 32028104 DOI: 10.1016/j.jelekin.2020.102399] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to quantify the kinematic, kinetic and electromyography differences between individuals with and without chronic ankle instability (CAI) during comfortable (CW) and fast (FW) walking. Twenty-one individuals with CAI and 21 healthy controls were recruited to walk at CW and FW speeds. The dependent variables were gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles mean activity, ankle and knee angles and moments. Kinematic, kinetic and electromyography variables were compared between groups with a one-dimensional statistical non-parametric mapping analysis. The CAI group exhibited no significant difference for ankle angles and moments compared to the control group. However, the CAI group showed less external knee rotation from 56 to 100% (CW) and 51 to 98% (FW) and more knee abduction moment from 1 to 6% and 7 to 9% (CW) and 1 to 2% (FW) of the stance phase. Less gluteus medius muscle activity was also observed from 6 to 9% and 99 to 100% (CW) of the stance phase for the CAI group. These results suggest proximal biomechanical compensations and will help better understand the underlying deficits associated with CAI. They also indicate that regardless of walking speeds, individuals with CAI exhibit similar differences compared to healthy participants.
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Individuals with recurrent ankle sprain demonstrate postural instability and neuromuscular control deficits in unaffected side. Knee Surg Sports Traumatol Arthrosc 2020; 28:184-192. [PMID: 30291398 DOI: 10.1007/s00167-018-5190-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/01/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare proprioception, postural stability, and neuromuscular control between patients with mechanical laxity and recurrent ankle sprain. METHODS Among 86 patients with ankle instability, 45 patients had mechanical laxity (mean age 27.2 ± 7.0 years) and 41 had recurrent ankle sprain (mean age 25.1 ± 9.2 years). Both the affected and unaffected ankles of each patient were evaluated. Proprioception and neuromuscular control tests were conducted using an isokinetic machine, and postural stability was tested using a postural stabilometry system. RESULTS Proprioception was not significantly different between the unaffected or affected ankles of the mechanical laxity group compared with those of the recurrent ankle sprain group (n.s). Static and dynamic postural stability and neuromuscular control were similar in the affected ankles between the two groups (n.s). However, postural stability (static, overall: p = 0.009, anterior-posterior: p = 0.028, medial-lateral: p = 0.022; dynamic, overall: p = 0.012, anterior-posterior: p = 0.004, medial-lateral: p = 0.001) and neuromuscular control (inversion: p = 0.031, eversion: p = 0.039, dorsiflexion: p = 0.029, plantarflexion: p = 0.035) were significantly decreased in the unaffected ankles of the recurrent ankle sprain group compared with those of the mechanical laxity group. CONCLUSION The unaffected ankles of the recurrent ankle sprain group showed significant decreases in both postural stability and neuromuscular control compared with the mechanical laxity group. Clinicians and therapists should consider unaffected ankle rehabilitation in patients with recurrent ankle sprain to prevent future sprain events. LEVEL OF EVIDENCE Case-control study, III.
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Moisan G, Mainville C, Descarreaux M, Cantin V. Unilateral jump landing neuromechanics of individuals with chronic ankle instability. J Sci Med Sport 2019; 23:430-436. [PMID: 31784236 DOI: 10.1016/j.jsams.2019.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the neuromechanical (kinematic, kinetic and electromyographic (EMG)) differences between individuals with and without chronic ankle instability (CAI) during unilateral jump landing. DESIGN Case-control study. METHODS Kinematic, kinetic and EMG data of 32 participants with CAI and 31 control participants were collected during unilateral side jump landing (SIDE) and unilateral drop landing on three surfaces (even (DROP), unstable (FOAM) and laterally inclined (WEDGE)). Each participant had to complete five trials of each task in a randomised sequence. To compare the neuromechanical differences between groups, a one-dimensional statistical non-parametric mapping analysis was performed. RESULTS Compared to the control group, the CAI group exhibited increased biceps femoris muscle activity during the preactivation and landing phases, decreased gluteus medius and peroneus longus muscles activity during the preactivation phase and increased knee extension moment during the landing phase of the WEDGE task. The CAI group also exhibited increased ankle dorsiflexion during the landing phase of the FOAM task and decreased vastus lateralis muscle activity during the preactivation phase of the DROP task. Finally, the CAI group exhibited decreased biceps femoris muscle activity during the preactivation and landing phases and decreased gluteus medius muscle activity during the preactivation phase of the SIDE task compared to the control group. CONCLUSIONS Individuals with CAI present neuromechanical differences during unilateral jump landing compared to healthy individuals. The results of this study will improve our understanding of underlying deficits associated with CAI and will help researchers and clinicians to better target them during rehabilitation.
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Affiliation(s)
- Gabriel Moisan
- Department of Anatomy, Université du Québec à Trois-Rivières, Canada; Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Canada.
| | - Camille Mainville
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Canada
| | - Vincent Cantin
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Canada
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Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability. Physiother Theory Pract 2019; 37:672-681. [PMID: 31311365 DOI: 10.1080/09593985.2019.1641870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with chronic ankle instability (CAI) experience a dynamic interplay between impaired mechanical structures and sensorimotor deficiencies that contribute to recurrent sprains and sensations of instability. Concomitantly, muscular trigger points (MTrPs) are known to occur following trauma, maximal or submaximal concentric contractions, and unaccustomed eccentric loads. Additionally, MTrPs are theorized to be exacerbated in low-load and repetitive strain activities. MTrPs located within a muscle are associated with altered motor control, reaction delay, and decreased strength, deficits also found among those with CAI. Dry needling (DN) is reported to improve muscle range of motion, motor control, and pain in a myriad of neuromusculoskeletal conditions by decreasing spontaneous electrical activity and stiffness of taut muscle bands while improving filament overlap. Building on evidence supporting neuromechanical decoupling in chronic ligamentous injury with what is known about the development of MTrPs, this paper proposes a centrally mediated mechanism for improved sensorimotor function following DN for individuals with CAI. Dry needling equilibration theory (DNET) states that proprioception is improved following DN in the lower extremity by changing the muscle's length-tension relationship and leveraging minor acute discomfort to improve muscle spindle afferent information via the gamma motor system. The application of DNET for individuals with CAI may provide a mechanistic explanation for improved descending cortical output, resulting in enhanced sensorimotor function.
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Sarcon AK, Heyrani N, Giza E, Kreulen C. Lateral Ankle Sprain and Chronic Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419846938. [PMID: 35097325 PMCID: PMC8696766 DOI: 10.1177/2473011419846938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle “giving way” with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle’s biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.
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Affiliation(s)
- Aida K. Sarcon
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Nasser Heyrani
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Christopher Kreulen
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
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Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train 2019; 54:589-602. [PMID: 31184957 DOI: 10.4085/1062-6050-472-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
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Affiliation(s)
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington
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Abstract
Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.
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Affiliation(s)
- Jay Hertel
- Department of * Kinesiology, University of Virginia, Charlottesville.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Revay O Corbett
- Department of * Kinesiology, University of Virginia, Charlottesville
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50
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Lopes M, Rodrigues JM, Monteiro P, Rodrigues M, Costa R, Oliveira J, Ribeiro F. Effects of the FIFA 11+ on ankle evertors latency time and knee muscle strength in amateur futsal players. Eur J Sport Sci 2019; 20:24-34. [PMID: 31092112 DOI: 10.1080/17461391.2019.1609588] [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: 10/26/2022]
Abstract
Background: The FIFA 11+ has shown to increase muscle strength and reduce injury risk. The purpose of this study was to assess the short and long-term effects of the FIFA 11+ on knee strength, and muscle latency after sudden inversion of amateur futsal players.Methods: Seventy-one male futsal players were recruited and randomized to a FIFA 11+ (n = 37, age: 27.0 ± 5.1 years) and a control group (n = 34, age: 26.0 ± 5.1 years). The FIFA 11+ programme was executed twice a week, for 10 weeks, followed-up after 10 weeks where both groups executed regular warm-ups. Concentric and eccentric isokinetic knee muscle strength was tested and latency time of the evertor muscles after sudden inversion of the ankle was executed with a trapdoor mechanism following an EMG protocol of selected leg muscles (peroneus brevis and peroneus longus).Results: No significant difference were observed between groups for short-term changes in isokinetic strength after adjustment for baseline differences. At long-term, significant gains were obtained after adjustment for baseline differences in eccentric strength for both lower limbs as for the H/Q ratios for the dominant limb. No changes between groups were observed in the peroneus brevis and peroneus longus latency time.Conclusions: Performing FIFA 11+ did not have short-term effects on knee strength and muscle latency after sudden inversion in amateur futsal players. However, significant long-term benefits were observed for eccentric strength and H/Q ratios.
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Affiliation(s)
- Mário Lopes
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - João Manuel Rodrigues
- IEETA - Institute of Electronics and Informatics Engineering of Aveiro and DETI - Department of Electronics, Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal
| | - Pedro Monteiro
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Rodrigues
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Rui Costa
- School of Health Sciences and CINTESIS@UA, University of Aveiro, Aveiro, Portugal
| | - José Oliveira
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
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