Ice Application Effects on Peroneus Longus and Tibialis Anterior Motoneuron Excitability in Subjects with Functional Ankle Instability

Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis

CONTEXT

Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI.

DATA SOURCES

Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022.

STUDY SELECTION

A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 3a.

DATA EXTRACTION

A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale.

RESULTS

The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI.

CONCLUSION

The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy.

PROSPERO REGISTRATION

CRD42022372998.

What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis

PURPOSE

To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI).

MATERIALS AND METHODS

Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus.

RESULTS

Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior).

CONCLUSIONS

FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.

Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.

Efeitos do resfriamento e aquecimento articular no desempenho funcional do ombro

INTRODUÇÃO: Um dos recursos mais utilizados na reabilitação de lesões musculoesqueléticas é a termoterapia por subtração de calor (crioterapia), enquanto a termoterapia por adição de calor é considerada o procedimento mais antigo de reabilitação física. Entretanto, há poucas evidências que tenham investigado os efeitos desses recursos sobre o desempenho de membros superiores. OBJETIVO: Comparar o efeito do resfriamento e do aquecimento articular sobre o desempenho funcional do membro superior. MÉTODOS: Trinta e quatro voluntários (22,23 ± 2,17 anos; 22,39 ± 2,53 kg/m2), de ambos os sexos, foram divididos aleatoriamente em um dos três grupos: 1) grupo crioterapia GCR (n=10): submetidos ao resfriamento articular por compressas frias; 2) grupo termoterapia - GTE (n=10): submetidos ao aquecimento articular por ondas curtas e 3) grupo controle - GCO (n=14), não submetidos a qualquer intervenção. Os voluntários foram avaliados, pré e pós-intervenção, quanto ao desempenho funcional de membros superiores por meio dos testes de estabilidade da extremidade superior em cadeia cinética fechada (TEESCCF) e das condições de equilíbrio em apoio bimanual sobre o baropodômetro. Ainda, os voluntários foram avaliados quanto ao desempenho funcional virtual por meio do jogo Mario Kart (Nintendo Wii (r) ). RESULTADOS: Houve melhora significativa nos valores pós-intervenção no TEESCCF para o GCR (p<0,001), GTE (p=0,002) e GCO (p=0,01). Não houve alteração significativa na área de deslocamento do centro de pressão na condição de olhos abertos, nos três grupos (p>0,05). Entretanto, na condição de olhos fechados, houve piora de desempenho para GTE (p=0,04) e melhora de desempenho para o GCO (p=0,02). Não houve alteração significativa no desempenho funcional virtual para os três grupos (p>0,05). CONCLUSÃO: Embora não tenha favorecido o desempenho funcional em todos os testes reais e virtuais utilizados, o resfriamento articular foi mais efetivo que o aquecimento articular para manter o desempenho muscular do membro superior, especialmente nas condições de equilíbrio sobre membros superiores na condição de olhos fechados.

Effects of focal ankle joint cooling on unipedal static balance in individuals with and without chronic ankle instability

Application of cryotherapy over an injured joint has been shown to improve muscle function, yet it is unknown how ankle cryotherapy affects postural control. Our purpose was to determine the effects of a 20-min focal ankle joint cooling on unipedal static stance in individuals with and without chronic ankle instability (CAI). Fifteen young subjects with CAI (9 males, 6 females) and 15 healthy gender-matched controls participated. All subjects underwent two intervention sessions on different days in which they had a 1.5L plastic bag filled with either crushed ice (active treatment) or candy corn (sham) applied to the ankle. Unipedal stance with eyes closed for 10s were assessed with a forceplate before and after each intervention. Center of pressure (COP) data were used to compute 10 specific dependent measures including velocity, area, standard deviation (SD), and percent range of COP excursions, and mean and SD of time-to-boundary (TTB) minima in the anterior-posterior (AP) and mediolateral directions. For each measure a three-way (Group-Intervention-Time) repeated ANOVAs found no significant interactions and main effects involving intervention (all Ps > 0.05). There were group main effects found for mean velocity (F(1,28) = 6.46, P = .017), area (F(1,28) = 12.83, P = .001), and mean of TTB minima in the AP direction (F(1,28) = 5.19, P = .031) indicating that the CAI group demonstrated greater postural instability compared to the healthy group. Postural control of unipedal stance was not significantly altered following focal ankle joint cooling in groups both with and without CAI. Ankle joint cryotherapy was neither beneficial nor harmful to single leg balance.

Cold water immersion of the ankle decreases neuromuscular response of lower limb after inversion movement

Background

Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training.

Objectives

To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion.

Method

The peak values of the root mean square (RMS) were obtained from 35 healthy and active university subjects after the use of a tilt platform to force the ankle into 30º of inversion before, immediately after, and 10, 20, and 30 minutes after water immersion at 4±2ºC, for 20 minutes. The Shapiro-Wilk test, repeated measures analysis, Bonferroni's post-hoc, and linear regression analysis provided the results.

Results

Peak RMS was significantly lower at all times after cold water immersion, with residual effect of up to 30 minutes, when compared to pre-immersion for all muscles, except for immediate post-immersion for the gluteus medius.

Conclusions

After cold water immersion of the ankle, special care should be taken in activities that require greater neuromuscular control.

Cryotherapy Effects, Part 2: Time to Numbness Onset and Numbness Duration

Context:

Recommended treatment duration for cryotherapy varies, but the primary therapeutic benefit may be related to the amount of time required for changes in cutaneous sensation.

Objective:

To determine the amount of time required to induce numbness for three different modes of cryotherapy administration, and the amount of time that numbness persists after treatment.

Design:

Repeated measures.

Participants:

30 healthy adults (12 males, 18 females, age = 21.1 ± 1.9 years).

Interventions:

Crushed ice bag, ice massage, and cold water immersion.

Main Outcome Measures:

Time required to induce numbness and the amount of time numbness remained after removal of each mode of cryotherapy.

Results:

Ice massage and cold water immersion produced numbness significantly faster than the crushed ice. There were no significant differences in terms of numbness duration.

Conclusions:

Changes in cutaneous sensation can be achieved in a relatively short amount of time (6–12 minutes) with ice massage and cold water immersion. The duration of the treatment effect did not differ among the three modes of cryotherapy administration.