Role of external prophylactic support in restricting accessory ankle motion after exercise

External Ankle Support and Ankle Biomechanics in Chronic Ankle Instability: Systematic Review and Meta-Analysis

OBJECTIVE

To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks.

DATA SOURCES

A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021.

STUDY SELECTION

Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support.

DATA EXTRACTION

Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings.

DATA SYNTHESIS

A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient.

CONCLUSIONS

Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.

Six-Week Remodeled Bike Pedal Training Improves Dynamic Control of Lateral Shuffling in Athletes With Functional Ankle Instability

BACKGROUND

Remodeled bicycle pedal training with multidirectional challenges through muscle strengthening and neuromuscular facilitation may increase dynamic postural control and performance during lateral shuffling for athletes with functional ankle instability (FAI).

HYPOTHESIS

The 6-week remodeled bicycle pedal training is effective on the ankle joint control and muscle activation, and especially that of the ankle evertor muscle co-contraction to improve dynamic postural control during lateral shuffling for athletes with FAI.

STUDY DESIGN

Laboratory randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

Fourteen healthy athletes (healthy group) and 26 athletes with FAI aged 18 to 30 years were included in the study. The athletes with FAI were randomly assigned to either the training group (FAI-T group) or the nontraining group (FAI-NT group). The athletes in the FAI-T group underwent 6 weeks of remodeled bicycle pedal training, whereas those in the FAI-NT group did not undergo any intervention. Muscle co-contraction index and muscle activation in the initial contact (IC) and propulsion phases, and ankle joint angle in the IC and propulsion phases were measured during lateral shuffling before and after 6 weeks of training.

RESULTS

After remodeled bicycle pedal training, the FAI-T group demonstrated greater muscle activation in the hamstring (P = 0.01), greater muscle coactivation of the tibialis anterior (TA) and the peroneus longus (P = 0.01), and greater ankle eversion angle in the IC phase. Significantly greater muscle activation of the TA (P = 0.01), greater coactivation of quadriceps and hamstring (P = 0.03), and a smaller ankle inversion angle (P = 0.04) in the propulsion phase were observed in the FAI-T group after training compared with those in the FAI-NT group.

CONCLUSION

Remodeled bicycle pedal training facilitates the TA and peroneus longus activation and the coactivation of the quadriceps and hamstring muscles during lateral shuffling and resulted in enhanced ankle and knee joint stability. In addition, a better ankle movement strategy during a dynamic task can be achieved via a 6-week remodeled pedal training program.

CLINICAL RELEVANCE

This remodeled bicycle pedal training can be effective for rehabilitating athletes with FAI to recover lateral dynamic movement capability.

Effects of elastic ankle support on running ankle kinematics in individuals with chronic ankle instability and healthy controls

BACKGROUND

Individuals with chronic ankle instability (CAI) have an increased risk for recurrent injuries. The preventive effects of external ankle supports are not fully understood. This study aimed to examine the effect of elastic ankle support on running ankle kinematics.

METHODS

3D running gait analysis of individuals with and without CAI was conducted at three-minute-running trials at 2.78 m/s with and without elastic ankle support in a randomised order. Ankle kinematics and intra-individual standard deviations (variability) were calculated at each percent of the running gait cycle. Group and ankle support effects were calculated using statistical parameter mapping.

RESULTS

Twenty-seven individuals were analysed (CAI: n = 14, controls: n = 13). When wearing ankle support, CAI individuals showed significantly decreased plantarflexion angles at 43-47 % (p = 0.033) and 49-51 % (p = 0.043) of the running gait cycle compared to normal running. In healthy controls, no differences in ankle angles between both conditions were found. Comparisons between CAI individuals and healthy controls showed statistically significant differences in the plantar-/dorsiflexion angles at 38-41 % (p = 0.044) with ankle support and at 34-46 % (p = 0.004) without ankle support. Significant ankle angle variability differences were found for ankle in-/eversion between CAI individuals and healthy controls (p = 0.041) at 32-33 % of the running gait cycle.

CONCLUSIONS

Elastic ankle support reduces the range of sagittal plane running ankle kinematics of CAI individuals but not of healthy controls. Further research is needed to evaluate the association between ankle support effects and the risk for recurrent ankle sprains.

Response profile of fibular repositioning tape on ankle osteokinematics, arthrokinematics, perceived stability and confidence in chronic ankle instability

BACKGROUND

Preliminary evidence suggests that fibular repositioning tape reduces risk of recurrent ankle injuries, but the underlying mechanism has not been investigated.

OBJECTIVE

To investigate the effects of fibular repositioning tape on ankle osteokinematics, arthrokinematics and perceived stability and confidence in individuals with chronic ankle instability immediately post-tape and following exercise.

DESIGN

Cross-sectional repeated measures study.

METHOD

Passive ankle plantarflexion-inversion range of motion, weight-bearing dorsiflexion range of motion, anteroposterior translation, inversion-eversion tilt, and perceived ankle stability and confidence during hopping were assessed before and immediately after the application of fibular repositioning tape and after 15 min of exercise in 14 individuals with chronic ankle instability.

RESULTS

Ankle plantarflexion-inversion range of motion, inversion-eversion tilt and anteroposterior translation were reduced immediately after the application of tape compared to pre-tape (p < 0.01). After exercise, total inversion-eversion tilt was significantly lower than pre-tape (p = 0.01), but there were no differences for any of the other mechanical outcomes. Dorsiflexion range of motion did not differ between conditions (p > 0.11). Perceived ankle stability, ankle and task confidence were greater immediately post-tape and post-exercise compared to pre-tape (p < 0.01).

CONCLUSIONS

Fibular repositioning tape was associated with a restriction of ankle total inversion-eversion tilt and improved perceived ankle stability and confidence both immediately after application of tape and after participating in exercise. This data provides grounds for exploring mechanical and psychological mechanisms underpinning any clinical efficacy of fibular repositioning tape.

Effect of Novel Remodeled Bicycle Pedal Training on Balance Performance in Athletes With Functional Ankle Instability

Context

Appropriate training without risk of injury is a critical concern for athletes. Remodeled bicycle pedal training with multi-directional challenges may be effective in improving the balance performance of athletes with functional ankle instability (FAI).

Objective

To evaluate the effects of 6-week modified bicycle pedal training on the balance ability and proprioception of athletes with FAI.

Design

Randomized controlled trial.

Setting

University motion analysis laboratory.

Participants

Fourteen healthy athletes (healthy group) and twenty-six athletes with FAI and an age of 18 to 30 years old. The participants with FAI were randomly distributed to two groups, designated as the training group (AI-T group) and non-training group (AI-NT group), respectively. The athletes in the AI-T group received 6-week remodeled bicycle pedal training, while those in the AI-NT group received no intervention at all.

Intervention

A 6-week training using modified bicycle pedal capable of moving freely during loading cycle vs no intervention.

Main Outcome Measures

The passive ankle joint position sense (JPS) in four angles and the center of pressure (COP) parameters were analyzed during single-leg standing with and without vision, respectively.

Results

A 6-week remodeled pedal training: (1) significantly improved the passive JPS of ankle in all directions (P < 0.05); (2) reduced the excursion of the COP in the medial-lateral (ML) direction (p < 0.05), the velocity of the COP in the ML direction (p < 0.05), and the RMS of the COP in the ML direction (P < 0.05) during single-leg standing both with and without vision.

Conclusion

The remodeled bicycle pedal training improved the passive JPS and reduced the postural sway in single-leg standing both with and without vision. Therefore, remodeled bicycle pedal training can be considered for inclusion in rehabilitation programs for athletes with FAI to restore the proprioception and balance ability.

Ankle-knee coupling responses to ankle Kinesio™ taping during single-leg drop landings in collegiate athletes with chronic ankle instability

BACKGROUND

Ankle Kinesio-taping (KT) is being globally used an intervention to provide the ankle joint complex with sufficient support against sudden excessive mechanical stress during various activities. However, its effects on proximal joints are unclear. This study investigated the impact of ankle KT on ankle-knee joint coupling in sagittal, frontal and transverse planes.

METHODS

Adopting a pretest post-test study design, 30 collegiate athletes with chronic ankle instability performed 3 single-leg drop landings in each non-taped and Kinesio-taped conditions and their movement kinematics were recorded using 6 optoelectronic cameras.

RESULTS

The ankle angular velocities in sagittal (P=0.038, d=0.64) and transverse planes (P=0.001, d=0.95) decreased after KT application, while the knee internal rotation velocities increased (P=0.020, d=0.51). The coupling angles revealed that the ankle movement ratios significantly decreased in 3 planes in comparison with knee movement ratios.

CONCLUSIONS

Outcomes of this study illustrated that application of ankle KT leaves the individuals with a stiffer ankle joint, which increases the mechanical stresses to this joint and decreases its stiffness in absorbing the applied shocks. Further, ankle KT application resulted in more knee internal rotation moments and may increase the risk of knee injuries during landing after a long-term usage in patients with instability ankle sprain.

Prevention of Lateral Ankle Sprains

CONTEXT

Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals.

OBJECTIVE

To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs.

CONCLUSIONS

External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.

Effect of a Semirigid Ankle Brace on the In Vivo Kinematics of Patients with Functional Ankle Instability during the Stance Phase of Walking

An ankle brace is commonly used by patients after they suffer from initial ankle sprains, reducing the incidents of recurrent sprain or limiting laxity in joints with functional ankle instability (FAI). However, whether the application of a semirigid ankle brace can improve the abnormal ankle gait kinematics of patients with FAI remains unknown. This study aimed to determine the effect of a semirigid ankle brace on the gait kinematics of ankle joints through 3D-2D fluoroscopy image registration. A total of 8 subjects with FAI (3 males and 5 females, 10 feet) as FAI group and 10 subjects without FAI (6 males and 4 females, 10 feet) as control group were enrolled in this study. Three-dimensional bone models created from computed tomography images were matched to fluoroscopic images to compute the 6 degrees of freedom (DOF) talocrural, subtalar, and ankle joints complex kinematics for control and FAI group with or without brace during the stance phase of walking. FAI patients had significantly less ROMs in inversion/eversion rotation of the talocrural and subtalar joint after wearing semirigid ankle brace. Laxity was observed in most of the displacements of the talocrural and subtalar joints in FAI group. The brace partly altered the ankle joints movement in opposite directions, especially joint rotation, and restricted the talocrural and subtalar joints in the dorsiflexion position during the touch down phase of walking.

The effects of ankle braces and taping on lower extremity running kinematics and energy expenditure in healthy, non-injured adults

Ankle braces and taping are commonly used to prevent ankle sprains and allow return to play following injury, however, it is unclear how passive restriction of joint motion may effect running gait kinematics and energy expenditure during exercise. The purpose of this study was to determine the effect of different types of ankle supports on lower extremity kinematics and energy expenditure during continuous running. Thirteen healthy physically active adults ran at self-selected speed on the treadmill for 30min in four different ankle support conditions: semi-rigid hinged brace, lace-up brace, tape and control. Three-dimensional lower extremity kinematics and energy expenditure were recorded every five minutes. The semi-rigid hinged brace was most effective in restricting frontal plane ankle motion. The lace-up brace and tape restricted sagittal plane ankle motion, while semi-rigid hinged bracing allowed for normal sagittal plane ankle kinematics. Kinematic changes from all three ankle supports were generally persistent through 25-30min of exercise. Only tape influenced knee kinematics, limiting flexion velocity and flexion-extension excursion. Small but significant increased in energy expenditure was found in tape and semi-rigid hinged brace conditions; however, the increases were not to any practically significant level (<0.5kcal/min).

Effect of ankle kinesio taping on vertical jump with run-up and countermovement jump in athletes with ankle functional instability

[Purpose] Limited research has been performed in spite of biomechanical evaluation of jump landing with kinesio taping. Therefore, the main objective of this study was to evaluate the effect of kinesio taping applied to athletes. In this study, the authors wished to investigate the effect of kinesio taping during a vertical jump with run-up and countermovement jump on ankle functional instability. [Subjects and Methods] Ten male athletes with ankle functional instability (FI) were recruited in this study from a college volleyball team. Each participant was requested to perform two tasks, the countermovement jump and vertical jump with run-up. Infrared high-speed cameras and force plates were used to assess the effect of ankle taping. [Results] The results showed that the peak ground reaction force in the sagittal plane during a vertical jump with run-up slowed down after kinesio taping and that the peak ankle plantar flexion moment in both types of jump also decreased. [Conclusion] In conclusion, this study proved the effect of kinesio taping on ankle functional instability, which was evaluated by measuring the vertical ground reaction force and peak plantar flexion moment. Its finding may allow us to provide some recommendations for athletes and trainers.

Ankle ligament laxity and stiffness in chronic ankle instability

BACKGROUND

The contribution of mechanical laxity and ligament stiffness to chronic ankle instability is unclear, particularly when using the inversion laxity test, and may have implications for diagnosis, prognosis, and treatment. Our purpose was to determine if individuals with chronic ankle instability demonstrate greater mechanical ligament laxity and altered stiffness compared to controls and copers (those with a healed sprain) during an instrumented arthrometer inversion stress test.

METHODS

Recreationally active individuals were classified as those with chronic ankle instability (n = 16), copers (n = 16), or controls (n = 16) based on injury history and self-reported score on the Cumberland Ankle Instability Tool (CAIT). Three trials of an inversion stress test were applied with an instrumented arthrometer utilizing a reliable tester. Talocrural inversion (degrees) and stiffness values were extracted. One-way ANOVAs were calculated, and Tukey post hoc testing was applied (α ≤ .05).

RESULTS

Groups were not different in age, height, or weight. The chronic ankle instability group (19 ± 6) had significantly lower CAIT scores than the control (30 ± 1) and coper (29 ± 1) groups (P < .001). The chronic ankle instability group (23 ± 12 degrees) demonstrated significantly greater inversion than the controls (13 ± 9 degrees) (P = .04) but was not significantly different than the copers (17 ± 10 degrees). No significant differences were detected in stiffness between the groups.

CONCLUSION

The chronic ankle instability group demonstrated decreased self-reported ankle function and increased mechanical laxity utilizing an instrumented arthrometer for inversion compared to the control group but not the coper group. Laxity, but not stiffness, may be a factor affecting chronic ankle instability and self-reported function.

LEVEL OF EVIDENCE

Level III, comparative study.

Minimum reporting standards for copers in chronic ankle instability research

Lateral ankle sprains (LASs) are among the most common sports-related injuries and a high percentage of individuals who sprain their ankle go on to develop chronic ankle instability (CAI). The condition of CAI is often classified as having pain, loss of function, and a restriction of, or failure to, return to levels of previous activity. Historically, uninjured healthy controls are used as a comparison group to study the biomechanical and neuromuscular consequences of CAI. However, this model is not ideal to determine why a portion of the population experiencing an ankle sprain does not recover. A more appropriate comparison may be individuals who had an ankle sprain, and thus the exposure, but did not go on to develop CAI (i.e., copers). Thus, the purpose of this review was to determine the existing discrepancies and common standards in definitions of, terminology used for, and the inclusionary/exclusionary criteria used to describe copers within the CAI literature. Multiple databases were searched by keywords and specific authors. Potential studies were screened independently by both authors. Inclusion criteria consisted of an explicit definition of copers and explicit inclusionary/exclusionary criteria. A total of 21 studies were included in the current study and had four outcomes extracted: (1) the definition of copers; (2) the terminology used; (3) specific inclusionary/exclusionary criteria; and (4) injury characteristics of the copers. Based on the included operational definitions, it is recommend that future operational definitions of copers include three key components: (1) an initial LAS; (2) subsequent lack of CAI symptoms (i.e., no complaints of disability or giving way); and (3) a time since injury component. The term coper was overwhelming used within the existing literature (n = 15) and is thus recommended to be used in future studies when describing individuals who have suffered an LAS but failed to develop CAI. Minimal inclusionary criteria should consist of three things: (1) an initial LAS severe enough to warrant either the use of a protective device (e.g., ankle brace) for at least 1 week or immobilization and/or non-weight bearing for at least 3 days, or both; (2) a return to at least moderate levels of weight-bearing physical activity for at least 12 months without recurrent injury, episodes of giving way, and/or feelings of instability; and (3) minimal, if any, level of self-reported disability. Acute head and/or lower extremity injuries that occurred ≤3 months prior to testing, a history of ankle fractures and/or surgeries, and the presence of pain (constant or intermittent) should be used as minimal exclusionary criteria in future investigations dealing with copers. Finally, at least seven items should be reported to better contextualize copers across investigations. These items should include the initial mechanism of injury, the presence of mechanical laxity, number of days immobilized and/or non-weight bearing after the initial ankle sprain, time since the latest ankle sprain, percentage of coper participants with a recurrent ankle sprain or giving way episode, current physical activity levels, and whether copers attended formal rehabilitation for their involved ankle.

The effects of ankle Kinesio taping on ankle stiffness and dynamic balance

The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.