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Saleh MSM, Elbanna RHM, Abdelhakiem NM, Abdalla GAE. Sensorimotor Training Improves Gait, Ankle Joint Proprioception, and Quality of Life in Patients With Diabetic Peripheral Neuropathy: A Single-Blinded Randomized Controlled Trial. Am J Phys Med Rehabil 2024; 103:638-644. [PMID: 38466203 DOI: 10.1097/phm.0000000000002453] [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: 03/12/2024]
Abstract
OBJECTIVE To investigate the effect of sensorimotor training on gait, ankle joint proprioception, and quality of life in diabetic peripheral neuropathy patients. DESIGN A prospective, single-blind, randomized controlled experiment was performed. Forty patients with diabetic peripheral neuropathy aged 50-65 yrs were distributed randomly into two groups, the sensorimotor training group ( n = 20), and the control group ( n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 mins, every 2 wks. Moreover, the sensorimotor training group received 6 wks (3 d/wk) of sensorimotor training. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 wks of intervention. RESULTS Regarding baseline data, no significant differences were identified among groups ( P > 0.05). After 6-wk intervention, the sensorimotor training group exhibited significant improvements in all outcome variables ( P < 0.001), while the control group showed significant changes in quality of life only ( P = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the sensorimotor training group ( P < 0.001). CONCLUSIONS Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with diabetic peripheral neuropathy.
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Affiliation(s)
- Marwa Shafiek Mustafa Saleh
- From the Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt (MSMS, GAEA): Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan (MSMS); Department of Physical Therapy for cardiovascular/respiratory disorders and geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt (RHME); Department of Physical Therapy for Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Deraya University, El Minia, Egypt (NMA)
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Kazemi K, Javanshir K, Saadi F, Goharpey S, Shaterzadeh Yazdi MJ, Calvo-Lobo C, López-López D, Nassadj G. The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial. Sports Health 2024:19417381241258467. [PMID: 38898814 DOI: 10.1177/19417381241258467] [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: 06/21/2024] Open
Abstract
BACKGROUND Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI). HYPOTHESIS The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI. STUDY DESIGN A single-blind parallel-arm randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase. RESULTS Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73). CONCLUSION Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI. CLINICAL RELEVANCE The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.
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Affiliation(s)
- Khadijeh Kazemi
- Department of Rehabilitation, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Khodabakhsh Javanshir
- Department of Physiotherapy, Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Feryal Saadi
- Department of Radiology, Medicine School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Jafar Shaterzadeh Yazdi
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
| | - Gholamhossein Nassadj
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Laessoe U, Svendsen AW, Christensen MN, Rasmussen JR, Gaml AS. Evaluation of functional ankle instability assessed by an instrumented wobble board. Phys Ther Sport 2018; 35:133-138. [PMID: 30554122 DOI: 10.1016/j.ptsp.2018.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Ankle sprains often lead to a history of recurrent injuries and functional joint instability. This study evaluated a new method for assessing functional impairment in patients with chronic ankle instability. DESIGN Case-control study for construct validation purpose. SETTING The participants were tested during one-leg standing for 20 s on an instrumented wobble board and on a balance platform. PARTICIPANTS Twenty-five young people with previous ankle sprain and an instability score >11 in the "Identification of Functional Ankle Instability questionnaire" and an age-matched control group of 25 healthy individuals. MAIN OUTCOME MEASURES Wobble board variation of tilt angle measured by two accelerometers placed horizontally in the board. RESULTS The variation in angular tilt of the wobble board in the medio-lateral direction (standard deviation of tilt angle) was higher in the group with perceived ankle instability than in the control group: 1.5 (0.7) versus 1.1 (0.3). ICC for intra-tester reliability: 0.87 and correlation with COP area measures from the stable balance platform: 0.64. CONCLUSIONS People with functional ankle instability display poorer postural stability in the medio-lateral direction when challenged on an unstable surface. The instrumented wobble board may serve as a relevant tool in the clinical evaluation of functional ankle stability.
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Affiliation(s)
- Uffe Laessoe
- Physiotherapy Department, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark; Department of Research and Development, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark.
| | - Anne Weinreich Svendsen
- Physiotherapy Department, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark
| | - Mads Norre Christensen
- Physiotherapy Department, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark
| | - Jacob Rosenkrans Rasmussen
- Physiotherapy Department, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark
| | - Alexander Scharf Gaml
- Physiotherapy Department, University College of Northern Denmark, UCN, Selma Lagerloffsvej 2, DK-9220, Aalborg, Denmark
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Lazarou L, Kofotolis N, Malliou P, Kellis E. Effects of two proprioceptive training programs on joint position sense, strength, activation and recurrent injuries after ankle sprains. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-171146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Lazaros Lazarou
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Kofotolis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Paraskevi Malliou
- Laboratory of Therapeutic Exercise and Rehabilitation, Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Janssen KW, van der Wees PJ, Rowe BH, de Bie R, van Mechelen W, Verhagen E. Interventions for preventing ankle ligament injuries. Hippokratia 2017. [DOI: 10.1002/14651858.cd009512.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kasper W Janssen
- Sports Medical Centre Jeroen Bosch Hospital; Sports and Exercise Medicine; Marathonloop 9 's Hertogenbosch Noord Brabant Netherlands 5235 AA
| | - Philip J van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare); Radboud University Medical Center, Radboud Institute for Health Sciences; PO Box 9101 Nijmegen Netherlands 6500HB
| | - Brian H Rowe
- University of Alberta; Department of Emergency Medicine; Room 1G1.43 Walter C. Mackenzie Health Sciences Centre 8440 112th Street Edmonton AB Canada T6G 2B7
| | - Rob de Bie
- Maastricht University; Department of Epidemiology; P.O. Box 616 Maastricht Netherlands 6200 MD
| | - Willem van Mechelen
- VU University Medical Center; Department of Public and Occupational Health, EMGO Institute for Health and Care Research; PO Box 7057 Amsterdam Netherlands 1007 MB
| | - Evert Verhagen
- VU University Medical Center; Department of Public and Occupational Health, EMGO Institute for Health and Care Research; PO Box 7057 Amsterdam Netherlands 1007 MB
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Mittermaier C, Schindler M, Loader B, Waldhoer T, Ambrozy C, Crevenna R, Pieber K. Unique approach to sensorimotor training with a new device combining air cushion with stochastic translations-A prospective randomized controlled clinical trial. Gait Posture 2017; 52:153-158. [PMID: 27914309 DOI: 10.1016/j.gaitpost.2016.11.038] [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: 11/24/2015] [Revised: 11/16/2016] [Accepted: 11/24/2016] [Indexed: 02/02/2023]
Abstract
Sensorimotor training with a wide variety of available devices represents an important component in rehabilitation and prevention of different sports injuries and chronic diseases. The purpose of this study was to evaluate the effects of a sensorimotor training with a newly developed device, which consists of an instable platform moving on an air cushion, providing dynamic balance training by tilting and unanticipated stochastic translations on postural control. Seventy-two healthy young subjects were included in this prospective, randomized, controlled, and observer-blinded study. Balance was objectively assessed by posturography and Functional Reach Test (FRT). Additionally we evaluated the subjective rating of balance. After randomization the sensorimotor training group performed a training program on the new device over a 5-6 week study period. After this time improvement in objective and subjective measurements as a result of training became evident. A significant difference in challenging posturographic parameters (Sensory Organization Test 5: training group 5.32±5.25 vs. control group 1.78±5.05, p=0.006 and Head Shake Sensory Organization Test 5: training group 11.94±8.97 vs. control group 5.41±10.17, p=0.01) as well as a significant difference in the FRT (training group 3.34±3.35cm vs. control group 0.01±2.97cm, p=0.0001) was found. Subjective assessment revealed a significant improvement in the participants' rating of balance and alteration of balance. Subjects showed a high satisfaction with the new training device. Our findings suggest that the newly developed device could be a promising option for sensorimotor training to improve postural control.
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Affiliation(s)
- Christian Mittermaier
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria; Institute of Physical Medicine and Rehabilitation, Kepler University Hospital, Linz, Austria
| | - Maximilian Schindler
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria
| | - Benjamin Loader
- Department of Otorhinolaryngology, Medical University of Vienna, Austria
| | - Thomas Waldhoer
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, Austria
| | - Clemens Ambrozy
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria
| | - Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria.
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Lubetzky AV, McCoy SW, Price R, Kartin D. Response to Tendon Vibration Questions the Underlying Rationale of Proprioceptive Training. J Athl Train 2017; 52:97-107. [PMID: 28125270 DOI: 10.4085/1062-6050-52.1.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Proprioceptive training on compliant surfaces is used to rehabilitate and prevent ankle sprains. The ability to improve proprioceptive function via such training has been questioned. Achilles tendon vibration is used in motor-control research as a form of proprioceptive stimulus. Using measures of postural steadiness with nonlinear measures to elucidate control mechanisms, tendon vibration can be applied to investigate the underlying rationale of proprioceptive training. OBJECTIVE To test whether the effect of vibration on young adults' postural control depended on the support surface. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty healthy adults and 10 adults with chronic ankle instability (CAI; age range = 18-40 years). INTERVENTION(S) With eyes open, participants stood in bilateral stance on a rigid plate (floor), memory foam, and a Both Sides Up (BOSU) ball covering a force platform. We applied bilateral Achilles tendon vibration for the middle 20 seconds in a series of 60-second trials and analyzed participants' responses from previbration to vibration (pre-vib) and from vibration to postvibration (vib-post). MAIN OUTCOME MEASURE(S) We calculated anterior-posterior excursion of the center of pressure and complexity index derived from the area under multiscale entropy curves. RESULTS The excursion response to vibration differed by surface, as indicated by a significant interaction of P < .001 for the healthy group at both time points and for the CAI group vib-post. Although both groups demonstrated increased excursion from pre-vib and from vib-post, a decrease was observed on the BOSU. The complexity response to vibration differed by surface for the healthy group (pre-vib, P < .001). The pattern for the CAI group was similar but not significant. Complexity changes vib-post were the same on all surfaces for both groups. CONCLUSIONS Participants reacted less to ankle vibration when standing on the BOSU as compared with the floor, suggesting that proprioceptive training may not be occurring. Different balance-training paradigms to target proprioception, including tendon vibration, should be explored.
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Affiliation(s)
- Anat Vilnai Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Performance, New York University
| | | | - Robert Price
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Fransz DP, Huurnink A, de Boode VA, Kingma I, van Dieën JH. Time series of ground reaction forces following a single leg drop jump landing in elite youth soccer players consist of four distinct phases. Gait Posture 2016; 50:137-144. [PMID: 27611061 DOI: 10.1016/j.gaitpost.2016.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
The single leg drop jump landing test may assess dynamic and static balance abilities in different phases of the landing. However objective definitions of different phases following landing and associated reliability are lacking. Therefore, we determined the existence of possible distinct phases of single leg drop jump landing on a force plate in 82 elite youth soccer players. Three outcome measures were calculated over moving windows of five sizes: center of pressure (COP) speed, COP sway and horizontal ground reaction force (GRF). Per outcome measure, a Factor Analysis was employed with all windows as input variables. It showed that four factors (patterns of variance) largely (>75%) explained the variance across subjects/trials along the 12s time series. Each factor was highly associated with a distinct phase of the time series signal: dynamic (0.4-2.7s), late dynamic (2.5-5.0s), static 1 (5.0-8.3s) and static 2 (8.1-11.7s). Intra-class correlations (ICC) between trials were lower for the dynamic phases (0.45-0.68) than for the static phases (0.60-0.86). The COP speed showed higher ICC's (0.63-0.86) than COP sway (0.45-0.61) and GRF (0.57-0.71) for all four phases. In conclusion, following a drop jump landing unique information is available in four distinct phases. The COP speed is most reliable, with higher reliability in the static phases compared to the dynamic phases. Future studies should assess the sensitivity of information from dynamic, late dynamic and static phases.
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Affiliation(s)
- Duncan P Fransz
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
| | - Arnold Huurnink
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Vosse A de Boode
- adidas miCoach Performance Centre, AFC Ajax, Amsterdam, The Netherlands
| | - Idsart Kingma
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Jain TK, Wauneka CN, Liu W. Four Weeks of Balance Training does not Affect Ankle Joint Stiffness in Subjects with Unilateral Chronic Ankle Instability. ACTA ACUST UNITED AC 2016; 2. [PMID: 27642647 PMCID: PMC5025258 DOI: 10.23937/2469-5718/1510036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Balance training has been shown to be effective in preventing ankle sprain recurrences in subjects with chronic ankle instability (CAI) but the biomechanical pathways underlying the clinical outcomes are still unknown. This study was conducted to determine if a 4-week balance training intervention can alter the mechanical characteristics in ankles with CAI. Methods Twenty-two recreationally active subjects with unilateral CAI were randomized to either a control (n = 11, 35.1 ± 9.3 years) or intervention (n = 11, 33.5 ± 6.6 years) group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The ankle joint stiffness and neutral zone in inversion and eversion directions on the involved and uninvolved limbs was measured at baseline and post-intervention using a dynamometer. Results At baseline, the mean values of the inversion stiffness (0.69 ± 0.37 Nm/degree) in the involved ankle was significantly lower (p < 0.011, 95% CI [0.563, 0.544]) than that of uninvolved contralateral ankle (0.99 ± 0.41 Nm/degree). With the available sample size, the eversion stiffness, inversion neutral zone, and eversion neutral zone were not found to be significantly different between the involved and uninvolved contralateral ankles. The 4-week balance training intervention failed to show any significant effect on the passive ankle stiffness and neutral zones in inversion and eversion. Conclusion Decreased inversion stiffness in the involved chronic unstable ankle was found that of uninvolved contralateral ankle. The 4-week balance training program intervention was ineffective in altering the mechanical characteristics of ankles with CAI. Level of evidence Randomized controlled clinical trial; Level of evidence, 1.
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Affiliation(s)
- Tarang Kumar Jain
- Department of Physical Therapy and Athletic Training, Northern Arizona University, USA
| | - Clayton N Wauneka
- Bioengineering Graduate Program, University of Kansas, Lawrence, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, USA
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Lubetzky AV, Price R, McCoy SW. Effects of Achilles tendon vibration, surface and visual conditions on lower leg electromyography in young adults with and without recurrent ankle sprains. J Bodyw Mov Ther 2016; 20:639-49. [PMID: 27634090 DOI: 10.1016/j.jbmt.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/04/2016] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
Abstract
Functional ankle instability is associated with decreased ankle muscle function. Compliant surfaces and eyes-closed training are commonly used for rehabilitation and prevention of ankle sprains. Brief Achilles tendon vibration is commonly used in the study of postural control. To test the level of activation of tibialis anterior (TIB) and fibularis longus (FIB), bilateral Achilles tendon vibration was applied for the middle 20 s in a series of 60-s trials, when 10 healthy young adults and 10 adults with history of repeated ankle sprains were standing bipedal: on floor, on memory foam, or on a Both Sides Up (BOSU) ball, with eyes open, and on floor and foam with eyes closed. Differences in Integrated surface electromyography (IEMG) of TIB and FIB were significant for both groups pre, during, and post vibration (Friedman Tests, p < 0.001 for all). In both groups, the highest IEMG for TIB was obtained during vibration when standing on foam with eyes closed, whereas the highest IEMG for FIB was obtained during vibration when standing on the BOSU. Bipedal stance on BOSU and brief Achilles tendon vibration may be a useful intervention when a session's goal is to facilitate lower leg muscles activation. Future research should explore training effects as well as the effect of FIB tendon vibration.
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Affiliation(s)
| | - Robert Price
- University of Washington, Seattle, WA, United States
| | - Sarah W McCoy
- University of Washington, Seattle, WA, United States
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Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk. J Orthop Sports Phys Ther 2016; 46:650-7. [PMID: 27374015 DOI: 10.2519/jospt.2016.6278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016;46(8):650-657. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6278.
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Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:790209. [PMID: 26064172 PMCID: PMC4430654 DOI: 10.1155/2015/790209] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 01/31/2023]
Abstract
Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.
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Affiliation(s)
- Jaime Salom-Moreno
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Blanca Ayuso-Casado
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Beatriz Tamaral-Costa
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
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McCriskin BJ, Cameron KL, Orr JD, Waterman BR. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop 2015; 6:161-171. [PMID: 25793157 PMCID: PMC4363799 DOI: 10.5312/wjo.v6.i2.161] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 11/16/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.
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Fransz DP, Huurnink A, Kingma I, van Dieën JH. How does postural stability following a single leg drop jump landing task relate to postural stability during a single leg stance balance task? J Biomech 2014; 47:3248-53. [DOI: 10.1016/j.jbiomech.2014.06.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/22/2014] [Accepted: 06/11/2014] [Indexed: 11/26/2022]
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Calatayud J, Borreani S, Colado JC, Flandez J, Page P, Andersen LL. Exercise and ankle sprain injuries: a comprehensive review. PHYSICIAN SPORTSMED 2014; 42:88-93. [PMID: 24565825 DOI: 10.3810/psm.2014.02.2051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.
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Time course and dimensions of postural control changes following neuromuscular training in youth field hockey athletes. Eur J Appl Physiol 2013; 114:395-403. [PMID: 24318788 DOI: 10.1007/s00421-013-2786-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/28/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE Injury prevention effects of neuromuscular training have been partly attributed to postural control adaptations. Uncertainty exists regarding the magnitude of these adaptations and on how they can be adequately monitored. The objective was to determine the time course of neuromuscular training effects on functional, dynamic and static balance measures. METHODS Thirty youth (14.9 ± 3 years) field hockey athletes were randomised to an intervention or control group. The intervention included a 20-min neuromuscular warm-up program performed twice weekly for 10 weeks. Balance assessments were performed at baseline, week three, week six and post-intervention. They included the star excursion balance test (SEBT), balance error scoring system (BESS), jump-landing time to stabilization (TTS) and center of pressure (COP) sway velocity during single-leg standing. RESULTS No baseline differences were found between groups in demographic data and balance measures. Adherence was at 86%. All balance measures except the medial-lateral TTS improved significantly over time (p < 0.05) in both groups. Significant group by time interactions were found for the BESS score (p < 0.001). The intervention group showed greater improvements (69.3 ± 10.3%) after 10 weeks in comparison to controls (31.8 ± 22.1%). There were no significant group by time interactions in the SEBT, TTS and COP sway velocity. CONCLUSIONS Neuromuscular training was effective in improving postural control in youth team athletes. However, this effect was not reflected in all balance measures suggesting that the neuromuscular training did not influence all dimensions of postural control. Further studies are needed to confirm the potential of specific warm-up programs to improve postural control.
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Witchalls JB, Waddington G, Adams R, Blanch P. Chronic ankle instability affects learning rate during repeated proprioception testing. Phys Ther Sport 2013; 15:106-11. [PMID: 23954386 DOI: 10.1016/j.ptsp.2013.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 03/12/2013] [Accepted: 04/30/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES 1. To determine whether individuals with chronic ankle instability (CAI) have lower proprioception sensitivity scores from a test on the Active Movement Extent Discrimination Apparatus (AMEDA). 2. To determine whether individuals with CAI can improve proprioception sensitivity scores with repeated active movement testing using the AMEDA. 3. To assess the test-retest reliability of the AMEDA. DESIGN A cohort study comparing those with CAI or healthy ankles. SETTING University clinical laboratory. PARTICIPANTS 61 healthy university students, 36 with CAI, 25 with stable ankles. MAIN OUTCOME MEASURES A 2-way ANOVA was conducted to compare performance of CAI and stable ankle groups, over 3 test repetitions on the AMEDA. The reliability intra-class correlation coefficient (ICC) was obtained for test repetitions. RESULTS The scores improved in both groups when the AMEDA test was repeated (p = <0.001). The rates of improvement in proprioception test scores differed, with the CAI group showing a slower learning rate than the stable ankle group (p = 0.047). The ICC for the whole group across the three trials was 0.80 (95% CI = 0.69 to 0.87, p = <0.001). CONCLUSIONS CAI participants improve their proprioception scores more slowly upon repeated AMEDA testing, suggesting differences in learning strategies.
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Affiliation(s)
- Jeremy B Witchalls
- Faculty of Health, University of Canberra, University Drive, Bruce, ACT 2609, Australia; Dept of Physical Therapies, Australian Institute of Sport, Leverier Crescent, Bruce, ACT 2617, Australia.
| | - Gordon Waddington
- Faculty of Health, University of Canberra, University Drive, Bruce, ACT 2609, Australia
| | - Roger Adams
- Faculty of Health, Sydney University, Sydney, Australia
| | - Peter Blanch
- Dept of Physical Therapies, Australian Institute of Sport, Leverier Crescent, Bruce, ACT 2617, Australia
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Almeida Neto AFD, Tonin JP, Navega MT. Caracterização de lesões desportivas no basquetebol. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000200013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O basquete apresenta altos índices de lesão. Na literatura ainda não se definiu existem ou não diferenças entre os sexos. OBJETIVO: Caracterizar e analisar a incidência de lesões desportivas em atletas de basquetebol, com comparação entre os sexos. MATERIAIS E MÉTODOS: Quinze atletas de cada sexo, da categoria sub-23, foram entrevistados com o inquérito de morbidade referida. RESULTADOS: A média de idade das equipes feminina e masculina foi de 18 ± 0,65 e 18,20 ± 1,57 anos, respectivamente. A equipe masculina apresentou mais lesões que a feminina (2,6 ± 1,45 contra 1,2 ± 1,18 respectivamente, p < 0,05). A lesão articular foi o tipo de lesão mais comum na equipe masculina, representando 58,97%, e o segundo mais comum na feminina (33,33%). Os membros inferiores foram a região mais acometida por lesões (80,95% na feminina e 69,23% na masculina). O mecanismo de lesão mais comum na equipe masculina foi a aterrissagem (43,59%) e na feminina o salto vertical (28,57%). Em ambas as equipes, a maior parte das lesões ocorreu durante os treinos (61,9% na feminina e 71,8% na masculina). Foi necessário o afastamento em 47,62% (feminina) e 56,41% (masculina). A maioria dos atletas não realizou tratamento (61,9% e 51,28% feminino e masculino, respectivamente). O retorno às atividades, na maioria das vezes, foi sintomático, tanto na equipe feminina quanto na masculina (85,71% e 84,62% respectivamente). CONCLUSÃO: A incidência de lesões no basquetebol é maior nos membros inferiores. A equipe masculina mostra-se mais propensa a sofrer lesões, e os principais mecanismos de lesão foram diferentes entre as equipes masculina e feminina.
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Postle K, Pak D, Smith TO. Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. ACTA ACUST UNITED AC 2012; 17:285-91. [PMID: 22459604 DOI: 10.1016/j.math.2012.02.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/04/2012] [Accepted: 02/22/2012] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to assess the effectiveness of such proprioceptive exercise following ankle ligament injury. A systematic review of the databases MEDLINE, EMBASE, CINHAL, AMED, the Cochrane library database and the PEDro database, in addition to unpublished literature databases was conducted to July 2011. When appropriate, meta-analysis was conducted to pool results from homogeneous studies. The methodological quality of the literature was reviewed using the Critical Appraisal Skills Programme tool. The results indicated that there is no statistically significant difference in recurrent injury between the addition of proprioceptive exercises during the rehabilitation of patients following ankle ligament injury (p = 0.68). The addition of proprioceptive training demonstrated a significant reduction in subjective instability and functional outcomes (p < 0.05). There was no consensus on the advantages of including proprioceptive training in the rehabilitation of this population for swelling, postural sway, joint position sense, ankle range of motion or return to sport outcomes. Further study is warranted to develop the rigour of the evidence-base and to determine the optimal proprioceptive training programme following ankle ligament injury with different populations.
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Affiliation(s)
- K Postle
- School of Allied Health Professions, Faculty of Medicine and Health Science, University of East Anglia, Queen's Building, Norwich NR4 7TJ, UK.
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Pau M, Loi A, Pezzotta MC. Does sensorimotor training improve the static balance of young volleyball players? Sports Biomech 2012; 11:97-107. [DOI: 10.1080/14763141.2011.637126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, Grote S. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia) 2012; 4:e5. [PMID: 22577506 PMCID: PMC3348693 DOI: 10.4081/or.2012.e5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/12/2011] [Indexed: 02/06/2023] Open
Abstract
Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician.
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Affiliation(s)
- Hans Polzer
- Munich University Hospital, Dept. Trauma Surgery - Innenstadt Campus, Ludwig-Maximilians-University, Munich, Germany
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Ankle proprioception is not targeted by exercises on an unstable surface. Eur J Appl Physiol 2011; 112:1577-85. [DOI: 10.1007/s00421-011-2124-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 08/10/2011] [Indexed: 12/26/2022]
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Abstract
Kinaesthesia and Methods for its Assessment: Literature Review
In this review measurement techniques used for kinaesthetic sense assessment are presented. Kinaesthesia is an important part of human movement control and provides us with better understanding of specific movement system adaptations to fatigue, training and injury. Additionally, decreased kinaesthesia can be an injury predisposing factor, which stresses the necessity for its assessment in sports injury prevention programs. First, terminology and functional concept of kinaesthesia is presented in relation to other related concepts like proprioception and sensory-motor function. For better understanding, basic underlying neurological backgrounds are discussed in chapter two, encompassing peripheral sensory fields as well as the basics of the central processing. Additionally, factors affecting kinaesthesia and its adaptations to training are presented. Functional aspects are discussed, supporting the role of assessment of kinaesthesia in sports and rehabilitation. In the third chapter, a proposal for measuring methods classification is given. In the final chapter, different measuring protocols and their modifications are presented. Due to their usefulness in sports and injury prevention, methods for measuring sense of joint position, movement onset and active tracking are discussed in more detail. Possibilities and examples of their application to sports and sports injury rehabilitation settings are presented. Some basic guidelines are given of how to use these methods in training or for screening kinaesthesia.
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