Assessing Outcomes in People With Chronic Ankle Instability: The Ability of Functional Performance Tests to Measure Deficits in Physical Function and Perceived Instability

Comparing the effectiveness of tissue flossing applied to ankle joint versus calf muscle on exercise performance in female adults: An observational, randomized crossover trial

BACKGROUND

The prevalence of ankle sprains in females has higher than in males. A deficit in ankle dorsiflexion range of motion (DFROM) is a substantial contributor to ankle injuries, resulting in hampering exercise performance. Tissue flossing improves joint ROM and enhances performance. However, evidence of how floss band (FB) intervention influences the ankle joint and calf muscle is still lacking, particularly in women. We investigated comparing the effectiveness of FB applied to ankle joint versus calf muscle on exercise performance.

METHODS

This study was a randomized, counterbalanced crossover trial. Eighteen recreationally women received functional movements without wrapping FB (WF), movements with wrapping the FB around the ankle joint (FAG), and movements with wrapping the FB around the calf muscle (FCM). Main outcome measures included ankle dorsiflexion range of motion (DFROM), pressure pain threshold (PPT), agility test before and 5 (POST5), 30 (POST30), and 60 (POST60) minutes after each of the three interventions in random order. Two-way repeated measures analysis of variance and effect size (Cohen's d) were statistically analyzed.

RESULTS

FAG significantly increased ankle DFROM at POST5 (p = 0.01, d = 0.5), POST30 (p = 0.03, d = 0.48), and POST60 (p = 0.001, d = 0.75). FCM significantly increased at POST30 (p = 0.01, d = 0.35) and POST60 (p = 0.004, d = 0.37). Furthermore, FAG significantly improved agility at POST5 (p < 0.001, d = 0.39), POST30 (p = 0.004, d = 0.44), and POST60 (p = 0.007, d = 0.45); however, FCM only did at POST5 (p = 0.04, d = 0.29). The pressure pain threshold on the calf muscle did not significantly change.

CONCLUSIONS

FAG and WF enhance ankle ROM and agility immediately. Moreover, FAG demonstrates a prolonged effect of agility for 1 h. Practitioners may take this information into account for choosing efficient applications.

Influence of neoprene ankle orthoses on dynamic balance during a vertical jump in healthy individuals and with sprain history: A cross-sectional study

INTRODUCTION

A sprain describes an excessive amount of force or strain on a ligament, which may or may not lead to its rupture. Orthoses are among the most common modalities prescribed as a conservative treatment for ankle instability and sprain.

OBJECTIVE

We aimed to analyse the effect of neoprene orthosis on the balance and functionality of healthy individuals and volunteers with lateral ankle sprains METHODS: We evaluated 12 healthy volunteers (control group) and 12 volunteers diagnosed with a sprain and/or instability (patient group). A total of 14 men and 10 women participated in the study, with an average age of 26.15 (± 4.40) years. The volunteers' tasks consisted of performing vertical bipodal and unipodal jumps on a force platform, which were recorded in a video from the lateral view of the lower limb for posterior evaluation of the knee and ankle angles. Mann-Whitney and Wilcoxon tests were used for comparisons, considering p < 0.05 level of significance.

RESULTS

The control group presented a decrease in ground reaction force when using Orthosis during the bipodal jump (p < 0.05). A decrease in anteroposterior force displacement was also observed in the left unipodal jump (p < 0.01). The patient group presented an increase in force and moment of medial-lateral displacement for both bipodal (p < 0.02) and left unipodal jumps with Orthosis (p < 0.02). A kinematic analysis showed that the control group presented the smallest knee flexion angle (p < 0.01), while the patient group presented the smallest dorsiflexion ankle angle in the bipodal jump when using orthosis (p < 0.01).

CONCLUSION

We concluded that orthosis had influence on individuals' balance and joint angles. In healthy individuals presented better balance with and without orthosis and greater flexion with orthosis in the bipodal jump, regarding to the patient group presented smaller oscillations in the unipodal jump with orthosis and showed smaller knee flexion and ankle dorsiflexion.

Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? A Narrative Review and Expert Opinion

Lateral ankle sprain is the most common injury in sports, with up to 40% of patients developing chronic ankle instability (CAI). One possible cause underlying this high rate of recurrence or feeling of giving way may be a premature return to sport (RTS). Indeed, except for time-based parameters, there are no specific criteria to guide clinicians in their RTS decisions in patients with CAI. A recent international consensus highlighted the relevance and importance of including patient-reported ankle function questionnaires combined with functional tests targeting ankle impairments in this population. Thus, the aim of this narrative review and expert opinion was to identify the most relevant functional performance tests and self-reported questionnaires to help clinicians in their RTS decision-making process following recurrent ankle sprains or surgical ankle stabilization. The PubMed (MEDLINE), PEDro, Cochrane Library and ScienceDirect databases were searched to identify published articles. Results showed that the single leg stance test on firm surfaces, the modified version of the star excursion balance test, the side hop test and the figure-of-8 test appeared to be the most relevant functional performance tests to target ankle impairments in patients with CAI. A combination of the Foot and Ankle Ability Measure (FAAM) and the Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) questionnaires were the most relevant self-reported questionnaires to assess patient function in the context of CAI. Although these functional tests and questionnaires provide a solid foundation for clinicians to validate their RTS decisions in patient with CAI, objective scientific criteria with cut-off scores are still lacking. In addition to the proposed test cluster, an analysis of the context, in particular characteristics related to sports (e.g., fatigue, cognitive constraints), to obtain more information about the patient's risk of recurrent injury could be of added value when making a RTS decision in patients with CAI. In order to evaluate the strength of evertors under ecological conditions, it would also be interesting to assess the ability to control weight-bearing ankle inversion in a unipodal stance. Further studies are needed to assess the relevance of this proposed test cluster in RTS decision-making following lateral ankle sprain injury and CAI.

Can the Eight Hop Test Be Measured with Sensors? A Systematic Review

Rehabilitation aims to increase the independence and physical function after injury, surgery, or other trauma, so that patients can recover to their previous ability as much as possible. To be able to measure the degree of recovery and impact of the treatment, various functional performance tests are used. The Eight Hop Test is a hop exercise that is directly linked to the rehabilitation of people suffering from tendon and ligament injuries on the lower limb. This paper presents a systematic review on the use of sensors for measuring functional movements during the execution of the Eight Hop Test, focusing primarily on the use of sensors, related diseases, and different methods implemented. Firstly, an automated search was performed on the publication databases: PubMed, Springer, ACM, IEEE Xplore, MDPI, and Elsevier. Secondly, the publications related to the Eight-Hop Test and sensors were filtered according to several search criteria and 15 papers were finally selected to be analyzed in detail. Our analysis found that the Eight Hop Test measurements can be performed with motion, force, and imaging sensors.

Effect of supervised rehabilitation combined with blood flow restriction training in athletes with chronic ankle instability: a randomized placebo-controlled trial

Blood flow restriction (BFR) resistance exercise has been advocated as an alternative approach for improving muscle strength in patients undergoing musculoskeletal rehabilitation. The present study aimed to evaluate the effectiveness of a 4-week supervised rehabilitation (R) with and without BFR on muscle strength, cross-sectional area (CSA), dynamic balance, and functional performance in athletes with chronic ankle instability (CAI). A total of 16 collegiate athletes with CAI participated in this study. They were randomly assigned to the BFR+R group (n=8) or the R group (n=8). Both groups underwent supervised rehabilitation 3 times weekly for 4 consecutive weeks. Additionally, the BFR+R group was applied with a cuff around the proximal thigh at 80% arterial occlusion pressure in addition to the traditional rehabilitation program, whereas the R group received the sham BFR only. Before and after 4 weeks of intervention, isokinetic muscle strength, CSA, Y-balance test, and side hop test (SHT) were measured. Following a 4-week intervention, the BFR+R group exhibited significant improvements in muscle strength of ankle plantarflexor and evertor, CSA of fibularis longus, and SHT timed performance compared with prior training and the R group (all, P<0.05). However, no significant difference was observed on dynamic balance among the groups. The present finding indicated that a 4-week supervised rehabilitation combined with BFR is more effective in improving muscle strength and size and functional performance compared with the traditional rehabilitation alone. This information could have implications for physical therapists and clinician in developing and designing a rehabilitation program for athletes with CAI.

Systematic review of motor control and somatosensation assessment tests for the ankle

Background/Aim

Ankle sprains are frequent musculoskeletal injuries that can lead to sensorimotor deficits provoking long-term instability at the ankle joint. A broad variety of clinical tests currently exist to assess sensorimotor processing, and are commonly clinically referred to as proprioceptive tests. However, there is a discrepancy in the use of the term proprioception when looking at the main outcome of these tests. As identifying specific deficits is important for motor recovery, it is critical for clinicians to select the most appropriate tests.

Methods

A systematic review of four databases was performed to provide an up-to-date review of the psychometric properties of available tests referred to as proprioceptive tests. Seventy-nine articles on eight ankle proprioceptive tests were included and critically appraised. Data on validity, reliability and responsiveness were extracted from the included articles and synthesised. The tests reviewed were then divided into two categories based on their main outcome: motor control or somatosensation.

Results

Strong evidence showed that the Star Excursion Balance Test, a motor control test, is capable of differentiating between stable and unstable ankles. Moderate evidence suggests that somatosensation tests, such as Joint Position Sense, are also valid and reliable, but their responsiveness has yet to be evaluated.

Conclusions

Together, these findings indicate that the Star Excursion Balance Test can be used in the clinic to assess motor control based on its excellent psychometric properties. However, as ankle stability control involves complex sensorimotor interactions, care has to be taken regarding the use of this test as a specific tool for proprioception assessment.

Patient-Reported Outcomes and Perceived Confidence Measures in Athletes With a History of Ankle Sprain

CONTEXT

Patient-reported outcome measures (PROs) and functional performance tests are recommended in the National Athletic Trainers' Association's position statement on the prevention and management of ankle sprains during the return-to-play process. Evaluating perceived confidence may be another valuable method to evaluate an athlete's readiness to return-to-play following an ankle sprain.

OBJECTIVE

To evaluate the relationship between PROs and perceived confidence when performing functional performance tasks in high school athletes with a history of ankle sprain.

DESIGN

Descriptive study.

SETTING

Public high school.

PATIENTS OR OTHER PARTICIPANTS

A total of 25 high school student-athletes (6 males and 19 females, age 16.2 [1.1] y, height 169.3 [7.7] cm, mass 63.2 [9.8] kg).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES

The Cumberland Ankle Instability Tool, visual analog scale (VAS) for pain, Identification of Functional Ankle Instability, and Tampa Scale of Kinesiophobia-11 were completed by all participants. Participants then completed the weight-bearing lunge test; star excursion balance test; lateral, up-down, and triple hop tests; the single-leg vertical jump; and Southeast Missouri agility test and were asked to report their confidence in completing each task using a VAS with anchors of "no confidence" and "complete confidence." Pearson r correlations were calculated between the PROs and the confidence VAS scores of the functional tests.

RESULTS

Moderate to strong negative correlations were identified between pain VAS measures and confidence VAS measures for all functional tests except the star excursion balance test and vertical jump. Moderate negative correlations were found between Tampa Scale of Kinesiophobia-11 scores and perceived confidence during the star excursion balance test and vertical jump. Finally, a moderate positive correlation was identified between Cumberland Ankle Instability Tool scores and perceived confidence measures during the Southeast Missouri agility test.

CONCLUSIONS

High school athletes with a history of ankle sprain demonstrated significant correlations between several PROs and perceived confidence during various functional performance tests. The value of perceived confidence measures when making return-to-play decisions after ankle sprains warrants further investigation.

Reliability, validity, and minimal detectable change of Side Hop Test in male children and adolescents

OBJECTIVE

To determine the reliability, measurement error, and construct validity of the Side Hop Test in male children and adolescents.

DESIGN

Intra-and inter-rater reliability and construct validity study.

SETTINGS

Soccer club.

PARTICIPANTS

Thirty-six asymptomatic boys, 10-16 years old.

MAIN OUTCOME

The intra and inter-rater reliability of the Side Hop Test were analyzed by Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimum Detectable Change (MDC). The construct validity of the Side Hop Test in reference to the Single Hop Test, the Standing Long Jump Test, the Shuttle Run, and isometric muscle strength was analyzed.

RESULTS

The intra-rater ICC of the Side Hop Test ranged from 0.63 to 0.67, SEM ranged from 1.2 to 2.5 s, and MDC ranged from 2.8 to 5.7 s. The inter-rater ICC ranged from 0.83 to 0.91, SEM ranged from 0.6 to 0.8 s, and MDC ranged from 1.4 to 1.9 s. The Side Hop Test was significantly correlated (p < 0.05) with the Single Hop Test (r = -0.49) and the Standing Long Jump (r = -0.47).

CONCLUSION

The results support the use of the Side Hop Test to evaluate children and adolescents. The measurements showed good intra-rater and very good inter-rater reliability.