Effects of Ankle Muscle Fatigue and Visual Behavior on Postural Sway in Young Adults

Effects of Ankle Compression Garments on Fatigue and Single-Leg Balance in Collegiate Basketball Players

Basketball players are prone to ankle injuries. It is unclear if wearing ankle compression garments (CGs) can enhance balance control and time to fatigue in those athletes. The purpose of this study was to examine the impact of ankle CGs on both time to fatigue and single-leg balance. Sixteen Division II (D2) collegiate basketball players participated in the study. The Cumberland Ankle Instability Tool (CAIT) was used to assess ankle stability. Fatigue was induced through deficit heel raises, and single-leg balance was assessed with the Athletic Single Leg Stability Test (ASLST) of the Biodex Balance System. Ten out of 16 (62.5%) basketball players were classified as having chronic ankle instability (CAI). Wearing CGs did not significantly prolong the time to fatigue (P = .774), and participants with CAI and without CAI had a similar time to fatigue (P = .958). In addition, wearing CGs significantly worsened single-leg balance before fatigue (P = .021), but enhanced balance control after fatigue (P = .027). Results indicate a strong prevalence of CAI in collegiate basketball players, and wearing CGs may not be able to enhance single-leg balance before fatigue. Although participants who wore CGs did not significantly increase their time to fatigue, their single-leg balance significantly improved after fatigue. This finding suggests wearing ankle CGs may have the potential to remediate the impact of fatigue on balance control. Future studies with a larger sample size are needed to further examine the impact of wearing ankle CGs on fatigue and single-leg balance.

Sex differences concerning the effects of ankle muscle fatigue on static postural control and spinal proprioceptive input at the ankle

Aims

The main aim of this study was to determine sex differences in postural control changes with ankle muscle fatigue during a standing forward leaning (FL) task under different vision conditions. The secondary aim was to examine sex differences in the effect of fatigue on soleus (SOL) H-reflex amplitude, a measure of motoneuron excitability with activation of Ia afferents.

Methods

Fifteen healthy young adult males (mean age: 28.0 years) and 16 healthy young adult females (mean age: 26.1 years) were asked to perform four consecutive FL tasks [30 s; two with eyes open (EO) and two with eyes closed (EC)] before, and immediately following a fatiguing exercise consisting of alternating ankle plantarflexion (6 s) and dorsiflexion (2 s) maximal isometric contractions, and at 5 and 10 min of recovery. Center of pressure (COP) sway variables (mean position, standard deviation, ellipse area, average velocity, and frequency), an ankle co-contraction index, and a ratio of SOL H-reflex to the maximum amplitude of the compound muscle action potential (M-max) were obtained during the FL tasks. A rating of perceived fatigue (RPF) was also documented at the different time points.

Results

Time to task failure (reduction of 50% in maximal voluntary isometric contraction torque of ankle plantar flexors) and the increase in RPF value were not significantly different between males and females. Both sex groups showed similar and significant increases (p < 0.05) in mean COP sway velocity with no significant changes in co-contraction indices. No significant effects of fatigue and related interactions were found for SOL H/M-max ratio.

Discussion

The absence of a significant sex difference in postural control change (sway and co-contraction) with fatigue could be explained by similar perceived (RPF) and performance fatigability (exercise duration) between males and females in the present study. Fatigue did not lead to significant changes in SOL spinal motoneuron excitability with activation of Ia afferents.

The effects of experimentally-induced fatigue on gait parameters during obstacle crossing: A systematic review

Striking an obstacle while walking can be dangerous, reflecting the higher risks of losing one's balance, tripping and falling. Particular situations during which internal resources are limited, such as in a fatigued state, may impair performance when crossing obstacles, enhancing the risks of falls or accidents. Our goal was thus to review the effects of experimentally-induced fatigue (EIF) on gait parameters during obstacle crossing by healthy individuals. We systematically searched PubMed and Web of Science databases using 'fatigue', 'obstacle crossing' and their equivalent terms to extract data from studies investigating this domain. Nine studies were found. First, EIF-related effects on kinetics, EMG and obstacle contacts have been poorly studied. Second, consistent and inconsistent results were found in the kinematic outcomes after EIF. Consistent results included reductions in stride duration and increased step width. Inconsistent results included gait velocity (no-effect vs increased), leading and trailing-foot vertical clearance (reduced vs increased) and horizontal distance from foot to the obstacle before obstacle avoidance (no-effect vs increased). These findings should be interpreted cautiously, however, due to the heterogeneity of the obstacle crossing and EIF protocols.

Sex differences in the effect of muscle fatigue on static postural control under different vision and task conditions

The main aim of this study was to compare the effects of ankle plantar flexors fatigue on postural control between healthy young adult males and females. The secondary aim was to determine the effects of vision on the fatigue-induced postural changes. Ten healthy young males and nine females were asked to perform quiet standing (QS) and standing forward lean (FL) tasks with eyes open (EO) and closed (EC) before and immediately following exercise, and throughout a 15-min recovery period. A sustained isometric exercise of ankle plantar flexors was performed until participants were no longer able to maintain a target torque of 50% of maximal voluntary isometric contraction (MVIC). Mean anteroposterior (AP) and mediolateral (ML) positions of the center of pressure (COP), mean COP sway velocity, and 95% ellipse area of COP sway were measured. Ankle plantar flexors fatigue had significant effects on all dependent variables, except for sway area. A fatigue X sex interaction was found for sway velocity with the most challenging task condition (FL-EC), where males showed a significant increase in sway velocity up to 15 min following exercise, whereas females did not. Fatigue X vision interactions for AP position were also found, with the withdrawal of vision leading to a greater backward shift during recovery for both the QS (5 to 15 min) and FL (5 to 10 min) tasks. Our findings suggest the use of different postural control strategies with ankle fatigue between males and females, and also a contribution of vision to compensate for fatigue-induced instability that is not dependent on task difficulty.

Physiological Mechanisms of Exercise and Its Effects on Postural Sway: Does Sport Make a Difference?

While the effect of a variety of exercises on postural balance control has been extensively studied, less attention has been paid to those requiring sport-specific skills. Therefore there is a need to analyze the literature and elucidate changes in postural balance control after exercises performed in conditions close to a particular sport. This scoping review aims (i) To map the literature that addresses postural sway aspects of acute responses to general and sport-specific exercises and their underlying physiological mechanisms, and (ii) To identify gaps in the existing literature and propose future research on this topic. The main literature search conducted on MEDLINE, Web of Science, Scopus, PubMed, and Cochrane Library databases was completed by SpringerLink, Elsevier, and Google Scholar. A total of 60 articles met the inclusion criteria. Findings identified that among a variety of studies evaluating the effects of exercise on postural balance control, only few of them were conducted under sport-specific conditions (i.e., while shooting in biathlon or pentathlon, and after simulated or match-induced protocols in combat and team sports). Therefore, more research is still needed to address this gap in the literature and aim research at investigation of postural sway response to sport-specific exercises. Further analysis of the literature showed that the type, intensity and duration of exercise play a key role in increased postural sway. Whole body and localized muscular fatigue of the trunk, neck and lower limbs is considered to be a main factor responsible for the magnitude of balance impairment in an initial phase of recovery and speed of its readjustment to a pre-exercise level. Other likely factors affecting postural stability are hyperventilation and deterioration of sensorimotor functions, though some contribution of muscle damage, dehydration, hyperthermia or dizziness cannot be excluded. A better understanding of the physiological mechanisms of balance impairment after exercises performed under simulated fatigue induced protocol, close to conditions specific to a particular sport, has implications for designing smart exercise programs tailored to individual needs to improve athlete performance with high demands on postural stability and/or decrease their risk of injuries.

Correlation between ankle plantar flexion strength and degree of body sway

[Purpose] The purpose of this study is to consider the correlation between ankle plantar flexion strength and degree of body sway. [Participants and Methods] Twenty-one healthy adult males were targeted. A handheld dynamometer was used to measure ankle plantar flexion strength. The Body Pressure Measurement System was used to measure the degree of body sway. Lastly, correlation between ankle plantar flexion strength and degree of body sway was considered. [Results] A negative correlation was observed between ankle plantar flexion strength and degree of body sway. [Conclusion] Regarding ankle plantar flexion strength and degree of body sway, results of a consideration using a handheld dynamometer and Body Pressure Measurement System were the same as that of previous studies using large equipment.

Analysis of the Stability of the Body in a Standing Position When Shooting at a Stationary Target-A Randomized Controlled Trial

Postural stability of the body depends on many factors. One of them is physical activity. It is especially important in the case of sports or professional work, which combine mobility with the accuracy of a shot in a standing position. The smaller the body fatigue, the more accurate the shot. The aim of the study was the assessment of the impact of physical effort on the center of gravity deflection and length of the COP (center of pressure) path, as well as the reaction of ground forces in people who do not engage in systematic physical activity. The study group included 139 people (23.1 ± 5.2 yr; M: 46.8%; F: 53.2%). The test consisted of performing a static test twice, shooting at the target in a multimedia shooting range. Group X performed the Harvard test between the static tests. Group Y made no effort. The reaction parameters of the ground forces were assessed using the Zebris PDM-L Platform. In Group X performing the Harvard test, an increase in the average COP, VCOP, and 95% confidence ellipse area was noted. The path length and the average velocity of COP speed increased. There were no differences in Group Y (p > 0.05). Physical effort significantly affected the postural stability of the studied people, increasing the average parameters assessing balance when adopting static firing position.

Ankle muscle fatigability impairs body sway for more than 24 h

This study aimed to investigate if the impairing in postural control, induced by ankle fatiguing exercise, remains after 24/48 h in young adults. Center of Pressure (CoP) was assessed in 16 participants (23 ± 3 years old) before, immediately after an ankle fatigability induction protocol (FI) and after 24 or 48 h of recovery using two 60-s trials with eyes open (EO) and closed (EC). The FI consisted of performing the ankle plantar flexion and dorsiflexion movement repeatedly (0.5 Hz). Ankle muscle fatigability increased CoP anterior-posterior (AP - p < 0.02) and medial-lateral (ML - p < 0.009) root mean square (RMS), and AP (p < 0.01) mean velocity immediately after compared to before FI. These effects remained after 24/48 h of recovery: higher CoP AP (p < 0.03) and ML (p < 0.009) RMS. No significant effects for detrend fluctuation analysis and entropy analysis among periods of postural evaluations was found. Fatigue*visual condition interaction revealed an increased AP median frequency (p < 0.001) during EC compared to EO only immediately after FI. Young adults' body sway remains impaired until 48 h, but not the postural control adaptability and complexity. Visual information may not attenuate the late deleterious ankle muscle fatigability effects. Individuals should be cautious during balance tasks and exercise after fatiguing exercise in the next 24/48 h, therefore avoiding unbalances and falls.

Activation of the Prefrontal Cortex and Improvement of Cognitive Performance with Standing on One Leg

The prefrontal cortex (PFC) is involved in attention, motor planning, and executive functions. In addition, it is known that postural control and cognitive performance are affected during dual-task paradigms, suggesting that postural control and cognition use common areas of the brain. Although postural control and cognition have been used as interfering dual tasks, the neuronal mechanisms underlying interference are not fully understood. We simultaneously performed postural and cognitive tasks in healthy young adults and evaluated activity in the PFC using near-infrared spectrometry. The displacement of the center of pressure (COP) is reduced by cognitive tasks. Difficult postural tasks increased the relative proportion and amplitude of postural sway in the high-frequency bandwidth, related to the adjustment of postural sway. Although the cognitive tasks did not affect the relative proportion of each frequency bandwidth, the amplitudes were selectively reduced. The postural task-dependent change in PFC activity was correlated with the relative proportion and amplitude of postural sway in the high-frequency bandwidth of the COP movement. Cognitive task-dependent changes in PFC activity were not correlated with postural sway. Cognitive performance was better in unipedal standing than bipedal standing. These findings suggest that postural tasks affect cognitive performance via the activation of the PFC, but cognitive tasks affect postural control through a different mechanism.

The Effect of Lower-Body Blood Flow Restriction on Static and Perturbated Stable Stand in Young, Healthy Adults

Muscular fatigue can affect postural control processes by impacting on the neuromuscular and somatosensory system. It is assumed that this leads to an increased risk of injury, especially in sports such as alpine skiing that expose the body to strong and rapidly changing external forces. In this context, posture constraints and contraction-related muscular pressure may lead to muscular deoxygenation. This study investigates whether these constraints and pressure affect static and dynamic postural control. To simulate impaired blood flow in sports within a laboratory task, oxygen saturation was manipulated locally by using an inflatable cuff to induce blood flow restriction (BFR). Twenty-three subjects were asked to stand on a perturbatable platform used to assess postural-related movements. Using a 2 × 2 within-subject design, each participant performed postural control tasks both with and without BFR. BFR resulted in lower oxygenation of the m. quadriceps femoris (p = 0.024) and was associated with a significantly lower time to exhaustion (TTE) compared to the non-restricted condition [F_(1,19) = 16.22, p < 0.001, η_p² = 0.46]. Perturbation resulted in a significantly increased TTE [F_(1,19) = 7.28, p = 0.014, η_p² = 0.277]. There were no significant effects on static and dynamic postural control within the saturation conditions. The present data indicate that BFR conditions leads to deoxygenation and a reduced TTE. Postural control and the ability to regain stability after perturbation were not affected within this investigation.

Static Balancing Ability and Lower Body Kinematics Examination of Hungarian Folk Dancers: A Pilot Study Investigating the “Kalocsai Mars” Dance Sequence

Folk dance is a collection of traditional dances that requires years of practicing to perform correctly. The aim of the present study was to develop a complex biomechanical measurement procedure that investigated Hungarian folk dancers’ balancing ability and lower body kinematics through a dance movement called “Kalocsai mars”. Therefore, 11 dancers’ motion (5 female and 6 male; age: 20.5 ± 2.5 years; height: 173.82 ± 7.82 cm; weight: 64.77 ± 8.67 kg) was recorded with an optical-based motion capture system and force platforms simultaneously. Before and after the dancing session, static balancing tests were performed, examining bipedal stance with eyes opened and closed conditions. The ANOVA results showed that the values of the range of motions of the knee joint flexion-extension angles and hip flexion averaged for sessions increased significantly (p=0.044, p=0.003, p=0.005) during the dancing sessions. The deviation in the joint angle was greater in the nondominant legs, suggesting that the nondominant side requires more attention to execute the dance steps correctly. The results of the balance tests showed that the oscillation in the posterior direction increased significantly after dancing (p=0.023). In comparison, the visual feedback had no significant effect on the dancers’ balancing ability.

The Effect of Fatigue on Single-Leg Postural Sway and Its Transient Characteristics in Healthy Young Adults

Neuromuscular fatigue is known to impair balance ability, which is reflected in increased postural sway during quiet standing tasks. Recently, quantifying transient characteristics of postural sway has been suggested as an approach to obtain additional information regarding postural control. However, this approach is currently vastly unexplored. The purpose of this study was to investigate the effects of fatigue (induced by a repeated change of direction task) on postural sway and its transient characteristics during single-leg standing, including whole-trial estimates and indexes of transient behavior in young healthy active adults. The study involved 28 physically active students (14 females). Single-leg postural sway was recorded for 30s before and after a fatiguing protocol, which consisted of a repeated change of direction tasks. We calculated the traditional whole-trial estimates of postural sway [center-of-pressure (CoP) velocity and amplitude in anterior-posterior (AP) and medial-lateral (ML) directions] and corresponding transient behavior indexes, based on three 10-s intervals. Statistically significant sex×fatigue interaction with medium effect sizes was found for whole-trial CoP velocity in AP (p=0.028; η²=0.17) and ML directions (p=0.019; η²=0.19). Post-hoc test showed that both variables substantially decreased in female participants (p=0.041–0.045; d=0.54–0.56), but remained similar in males (p=0.194–0.294). There were small to medium statistically significant main effects of fatigue on transient index for CoP amplitude in both directions (p=0.042–0.049; η²=0.02–0.14). Notably, CoP AP amplitude increased in the first 10-s interval for males (before fatigue: 5.6±1.3mm; after fatigue: 6.3±1.6mm), while the CoP AP amplitude in the third interval remained similar after fatigue (before fatigue: 5.5±1.4mm; after fatigue: 5.1±1.2mm). In conclusion, the responses to fatigue in terms of postural sway were time interval specific, and there were certain sex-differences in responses to fatigue, which could be related to better ability to adapt balance strategies in females. Moreover, our results demonstrate that the indexes of transient behavior could perhaps detect smaller fatigue-induced changes in postural sway that are seen in whole-trial estimates.

Motor strategy during postural control is not muscle fatigue joint-dependent, but muscle fatigue increases postural asymmetry

The aim of this study was to investigate the effects of ankle and hip muscle fatigue on motor adjustments (experiment 1) and symmetry (experiment 2) of postural control during a quiet standing task. Twenty-three young adults performed a bipedal postural task on separate force platforms, before and after a bilateral ankle and hip muscle fatigue protocol (randomized). Ankle and hip muscles were fatigued separately using a standing calf raise protocol (ankle fatigue) on a step and flexion and extension of the hip (hip fatigue) sitting on a chair, at a controlled movement frequency (0.5Hz), respectively. In both experiments, force, center of pressure, and electromyography parameters were measured. The symmetry index was used in experiment 2 to analyze the postural asymmetry in the parameters. Our main findings showed that muscle fatigue impaired postural stability, regardless of the fatigued muscle region (i.e., ankle or hip). In addition, young adults used an ankle motor strategy (experiment 1) before and after both the ankle and hip muscle fatigue protocols. Moreover, we found increased asymmetry between the lower limbs (experiment 2) during the quiet standing task after muscle fatigue. Thus, we can conclude that the postural motor strategy is not muscle fatigue joint-dependent and a fatigue task increases postural asymmetry, regardless of the fatigued region (hip or ankle). These findings could be applied in sports training and rehabilitation programs with the objective of reducing the fatigue effects on asymmetry and improving balance.

Saccadic Eye Movements Attenuate Postural Sway but Less in Sleep-Deprived Young Adults

Sleep deprivation affects the performance of postural control and several other aspects related to attentional mechanisms that may alter sensory cue acquisition strategies. This study aimed to examine the possible effects of horizontal saccades and ocular fixation on a target in the performance of postural control in young adults with sleep deprivation. Twenty-six adults formed two groups, tested in two evaluations. In the first evaluation, participants slept normally on the night before. In the second evaluation, 13 participants were sleep deprived (SD) and 13 slept normally (control group [CG]) on the night before. In both evaluations, each participant stood upright as still as possible, in two experimental conditions: fixating the eye on a target and performing saccadic movement toward a target presented in two different locations (0.5 Hz). Each participant performed 3 trials in each condition, lasting 62 s each. Body oscillation was obtained in both anterior-posterior and medial-lateral directions. Results showed that SD participants swayed with a larger magnitude and higher velocity after sleep deprivation in the fixation condition. In the saccadic condition, body sway magnitude and velocity were reduced but were still larger/higher in the SD participants. Sleep deprivation deteriorates the performance of postural control. Saccadic eye movements improve postural control performance even in sleep-deprived participants but are still not sufficient to avoid postural control deterioration due to sleep deprivation.

Prolonged Standing Task Affects Adaptability of Postural Control in People With Parkinson's Disease

BACKGROUND

Studies on short-term upright quiet standing tasks have presented contradictory findings about postural control in people with Parkinson's disease (pwPD). Prolonged trial durations might better depict body sway and discriminate pwPD and controls.

OBJECTIVE

The aim of this study was to investigate postural control in pwPD during a prolonged standing task.

METHODS

A total of 26 pwPD and 25 neurologically healthy individuals performed 3 quiet standing trials (60 s) before completing a constrained prolonged standing task for 15 minutes. Motion capture was used to record body sway (Vicon, 100 Hz). To investigate the body sway behavior during the 15 minutes of standing, the analysis was divided into three 5-minute-long phases: early, middle, and late. The following body sway parameters were calculated for the anterior-posterior (AP) and medial-lateral (ML) directions: velocity, root-mean-square, and detrended fluctuations analysis (DFA). The body sway area was also calculated. Two-way ANOVAs (group and phases) and 1-way ANOVA (group) were used to compare these parameters for the prolonged standing and quiet standing, respectively.

RESULTS

pwPD presented smaller sway area (P < .001), less complexity (DFA; AP: P < .009; ML: P < .01), and faster velocity (AP: P < .002; ML: P < .001) of body sway compared with the control group during the prolonged standing task. Although the groups swayed similarly (no difference for sway area) during quiet standing, they presented differences in sway area during the prolonged standing task (P < .001).

CONCLUSIONS

Prolonged standing task reduced adaptability of the postural control system in pwPD. In addition, the prolonged standing task may better analyze the adaptability of the postural control system in pwPD.