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Oh M, Lee H, Han S, Bruening DA, Seeley MD, Hopkins JT. Effects of Chronic Pain on Static and Dynamic Postural Control in Chronic Ankle Instability. Clin J Sport Med 2024:00042752-990000000-00203. [PMID: 38967593 DOI: 10.1097/jsm.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To identify the effects of chronic pain levels on static and dynamic postural (DP) control in individuals with chronic ankle instability (CAI). DESIGN Cross-sectional study. SETTING Controlled laboratory. PARTICIPANTS Sixty participants were divided into the following 3 groups: 20 high pain individuals with CAI (high pain), 20 low pain individuals with CAI (low pain), and 20 healthy controls (control). INDEPENDENT VARIABLES Groups (CAI with high pain, CAI with low pain, and control) and visual conditions (eyes open and closed) for single-leg stance. MAIN OUTCOME MEASURES Participants performed single-leg stance with eyes open and closed, the star excursion balance test, and single-leg hop to stabilization. RESULTS The high pain group experienced worse self-reported outcomes, including Foot and Ankle Ability Measure activities of daily living and sports, than the low pain and control groups. Regardless of visual condition, both the high and low pain groups exhibited decreased static postural control in mediolateral (ML) compared with the control group. Specifically, the high pain group showed decreased static postural control in ML under closed eyes compared with the low pain and the control groups. The high pain group showed less reach distance than the control group and increased DP control in vertical and overall DP stability index compared with the low and control groups. CONCLUSIONS Chronic pain can significantly affect both static and DP control in individuals with CAI. Therefore, clinicians should consider chronic pain as one of the factors affecting postural control in individuals with CAI.
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Affiliation(s)
- Minsub Oh
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - Hyunwook Lee
- Department of Exercise Science, Brigham Young University, Provo, Utah
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Seunguk Han
- Department of Exercise Science, Brigham Young University, Provo, Utah
- Division of Sport Science, Pusan National University, Busan, South Korea
| | - Dustin A Bruening
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - Matthew D Seeley
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - J Ty Hopkins
- Department of Exercise Science, Brigham Young University, Provo, Utah
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Koshino Y, Watanabe K, Akimoto M, Ishida T, Samukawa M, Kasahara S, Tohyama H. Factors associated with persistent pain in college athletes with a history of lateral ankle sprain. Phys Ther Sport 2023; 64:27-31. [PMID: 37666120 DOI: 10.1016/j.ptsp.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI. DESIGN Cross-Sectional Study. SETTING Online survey at one university. PARTICIPANTS Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47). MAIN OUTCOME MEASURES Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score. RESULTS The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups. CONCLUSIONS Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | | | - Moeko Akimoto
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Wang L, Ye J, Zhang X. Ankle biomechanics of the three-step layup in a basketball player with chronic ankle instability. Sci Rep 2023; 13:18667. [PMID: 37907629 PMCID: PMC10618240 DOI: 10.1038/s41598-023-45794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
At present, the effects of chronic ankle instability (CAI) on the biomechanics of the ankle joint in the three-step layup of basketball players are not clear. This work aims to thoroughly investigate the impact of CAI on the biomechanical characteristics of the ankle during the execution of a three-step layup in basketball players. Thirty male basketball players were stratified into distinct groups-namely, a CAI group and a non-CAI group-comprising 15 individuals each, based on the presence or absence of CAI. Demographic attributes, including age, weight, height, and the Cumberland Ankle Instability Tool (CAIT) score, were subjected to rigorous statistical examination within both athlete cohorts. The research employed four Whistler 9281CA 3D force measuring platforms (Switzerland), recording at 1000 Hz, in conjunction with eight camera motion analysis systems (USA), functioning at a frequency of 200 Hz. The study recorded maximal plantarflexion angle, inversion angle, dorsiflexion angle, and peak ankle dorsiflexion moment across the subjects during the distinct phases of push-off, landing, and the ensuing landing period. The findings notably exhibited that within the context of the one-foot push-off phase, the maximum ankle inversion angle was notably diminished in the CAI group as contrasted with the non-CAI group, demonstrating statistical significance (t = - 3.006, P < 0.01). The CAI group exhibited a lesser alteration in ankle inversion angle compared to the non-CAI group. Notably, during the one-foot landing period, the CAI group demonstrated a significantly greater maximum ankle inversion angle in contrast to the non-CAI group (t = 8.802, P < 0.001). Furthermore, the CAI group displayed a substantially larger maximum dorsiflexion angle at the ankle joint compared to the non-CAI group (t = 2.265, P < 0.05). Additionally, the CAI group exhibited a prolonged peak time for ankle dorsiflexion moment as compared to the non-CAI group (t = - 2.428, P < 0.05). Collectively, the findings elucidated a reduction in the maximum ankle joint inversion angle during the one-foot push-off phase in individuals with CAI. Furthermore, increased maximum inversion angle and maximum dorsiflexion angle of the ankle joint were observed during the one-foot landing period, alongside a lengthening of the peak time of ankle dorsiflexion moment. These results contribute valuable insights into the selection of training methodologies for basketball players afflicted by CAI.
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Affiliation(s)
- Luyu Wang
- China Basketball College, Beijing Sport University, Beijing City, 100084, China
| | - Jiahui Ye
- China Basketball College, Beijing Sport University, Beijing City, 100084, China
| | - Xuyang Zhang
- China Basketball College, Beijing Sport University, Beijing City, 100084, China.
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Xiang D, Jin W, Li H, Zhao G, Li B, Du S, Liu X. Biomechanical improvement of anterior talofibular ligament by augmentation repair of ligament advance reinforcement system: a cadaver study. BMC Surg 2023; 23:307. [PMID: 37817132 PMCID: PMC10566038 DOI: 10.1186/s12893-023-02136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Ankle sprain are one of the most frequent sports injuries. Some individuals will develop chronic lateral ankle instability (CLAI) after ankle sprain and suffer from recurrent ankle sprain. Current surgical treatment of CAI with anterior talofibular ligament (ATFL) rupture fails to restore the stability of the native ATFL. Ligament Advance Reinforcement System (LARS) augmentation repair of ATFL was developed to improve its primary stability after repaired. METHODS This study was performed to evaluate whether LARS augmentation repair of ATFL had similar stability as the modified Broström repair and the intact ATFL to maintain ankle construct stability. Standardized surgical techniques were performed on eighteen fresh frozen cadaver ankle specimens. The intact ATFL group has just undergone an ATFL exploratory surgery. The modified Broström procedure is based on anatomical repair of the ATFL with a 2.9 mm suture anchor, and the LARS procedure is an augmentation procedure of the ATFL using LARS ligaments based on the modified Broström procedure. A dynamic tensile test machine was used to assess load-to-failure testing in the three groups. The ultimate failure load and stiffness were calculated and reported from the load-displacement curve. A one-way analysis of variance was used to detect significant differences (p < 0.05) between the LARS augmentation repair, the modified Broström repair and the intact ATFL, followed by least significant difference (LSD) post-hoc tests. RESULTS The LARS augmentation repair group showed an increased in ultimate failure to load and stiffness compared to the other two groups. There were no significant differences in ultimate failure to load and stiffness between the modified Broström and the intact ATFL, the LARS ligament for ATFL augmentation allows for improved primary stability after repair and reduced stress on the repaired ATFL, which facilitates healing of the remnant ligament. CONCLUSIONS The LARS augmentation repair of ATFL represents a stable technique that may allow for the ankle stability to be restored in patients with CAI after surgery.
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Affiliation(s)
- Dulei Xiang
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Wenming Jin
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Han Li
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Gen Zhao
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Bao Li
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Shuyuan Du
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Xinwei Liu
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China.
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Abbasi L, Panahi F, Zarei-Kurdshooli Z, Yazdi Yahya-Abadi F. The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain. J Bodyw Mov Ther 2023; 35:233-237. [PMID: 37330775 DOI: 10.1016/j.jbmt.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN Randomized clinical trial; assessor-blind; before and after comparison. SETTING Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S) Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.
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Affiliation(s)
- Leila Abbasi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Panahi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Zarei-Kurdshooli
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Yazdi Yahya-Abadi
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang Y, Li Q, Xue X, Xu X, Tao W, Liu S, Li Y, Wang H, Hua Y. Neuroplasticity of pain processing and motor control in CAI patients: A UK Biobank study with clinical validation. Front Mol Neurosci 2023; 16:1096930. [PMID: 36866356 PMCID: PMC9971622 DOI: 10.3389/fnmol.2023.1096930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Background Pain plays an important role in chronic ankle instability (CAI), and prolonged pain may be associated with ankle dysfunction and abnormal neuroplasticity. Purpose To investigate the differences in resting-state functional connectivity among the pain-related brain regions and the ankle motor-related brain regions between healthy controls and patients with CAI, and explore the relationship between patients' motor function and pain. Study design A cross-database, cross-sectional study. Methods This study included a UK Biobank dataset of 28 patients with ankle pain and 109 healthy controls and a validation dataset of 15 patients with CAI and 15 healthy controls. All participants underwent resting-state functional magnetic resonance imaging scanning, and the functional connectivity (FC) among the pain-related brain regions and the ankle motor-related brain regions were calculated and compared between groups. The correlations between the potentially different functional connectivity and the clinical questionnaires were also explored in patients with CAI. Results The functional connection between the cingulate motor area and insula significantly differed between groups in both the UK Biobank (p = 0.005) and clinical validation dataset (p = 0.049), which was also significantly correlated with Tegner scores (r = 0.532, p = 0.041) in patients with CAI. Conclusion A reduced functional connection between the cingulate motor area and the insula was present in patients with CAI, which was also directly correlated with reduction in the level of patient physical activity.
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Affiliation(s)
- Yiran Wang
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Xiao'ao Xue
- Department of Sports Medicine, Fudan University, Shanghai, China
| | - Xiaoyun Xu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Weichu Tao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Sixu Liu
- Department of Biomedical Engineering, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunyi Li
- Department of Biomedical Engineering, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China,Human Phenome Institute, Fudan University, Shanghai, China,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Fudan University, Shanghai, China,He Wang ✉
| | - Yinghui Hua
- Department of Sports Medicine, Fudan University, Shanghai, China,Yiwu Research Institute of Fudan University, Yiwu, China,*Correspondence: Yinghui Hua ✉
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Chen Y, Cao S, Qian L, Chen W, Wang C, Ma X, Wang X, Huang J. The influence of local pain on balance control in patients with chronic ankle instability. BMC Musculoskelet Disord 2022; 23:699. [PMID: 35869458 PMCID: PMC9306023 DOI: 10.1186/s12891-022-05656-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Local pain around the ankle joint is a common symptom in patients with chronic ankle instability (CAI). However, whether the local pain would impose any influence on the balance control performance of CAI patients is still unknown. Methods A total of twenty-six subjects were recruited and divided into the following two groups: pain-free CAI (group A) and pain-present CAI (group B). Subjects in both groups received two independent tests: the star excursion balance test and the single-leg stance test, in order to reflect their balance control ability more accurately. Results Compared with group A, the group B showed significantly more episodes of the history of sprains, decreased ankle maximum plantarflexion angle, and lower Cumberland scores (all p < 0.05). In the star excursion balance test, group B demonstrated a significantly reduced anterior reach distance than group A (p < 0.05). During the single leg stance test, group B showed a significant increase in the magnitude of electromyographic signals both in peroneus longus and soleus muscles than group A (each p < 0.05). Additionally, group B had a significantly more anterolaterally positioned plantar center of pressure than group A (p < 0.05). Conclusion CAI patients with local pain around the ankle joint had more episodes of sprains and lower functional scores when compared to those without pain. The balance control performance was also worse in the pain-present CAI patients than those without pain.
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Yin Y, Yu Z, Wang J, Sun J. Effectiveness of the Rehabilitation Training Combined with Maitland Mobilization for the Treatment of Chronic Ankle Instability: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15328. [PMID: 36430049 PMCID: PMC9690276 DOI: 10.3390/ijerph192215328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The study aims to determine whether routine rehabilitation training combined with the Maitland mobilization is more effective than routine rehabilitation training alone in patients with chronic ankle instability, intending to provide a novel rehabilitation strategy for chronic ankle instability. A total of 48 subjects were divided into three groups: EG (Maitland mobilization and routine rehabilitation), CG (routine rehabilitation), and SG (sham mobilization and routine rehabilitation). The intervention was performed three times each week for 4 weeks, for a total of 12 sessions. Before and after the intervention, the muscle strength, star excursion balance test (SEBT), weight-bearing dorsiflexion range of motion (WB-DFROM), ankle range of movement, Cumberland ankle instability tool (CAIT), self-comfort visual analog scale (SCS-VAS), and self-induced stability scale (SISS-VAS) were assessed. The results showed that the improvement of SEBT, WB-DFROM, and active ankle range of movement without the pain in EG was more obvious than CG and SG, but the improvement of the self-report of ankle severity and muscle strength was not. Compared with routine rehabilitation training alone, routine rehabilitation training combined with Maitland mobilization for patients with chronic ankle instability may provide more benefit in terms of balance and ankle range of movement than routine rehabilitation alone, but the improvement in muscle strength was not evident enough.
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Affiliation(s)
- Yikun Yin
- College of Physical and Health Education, Guangxi Normal University, Guilin 541006, China
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Zhengze Yu
- College of Physical and Health Education, Guangxi Normal University, Guilin 541006, China
| | - Jialin Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Junzhi Sun
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
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Suttmiller AMB, Cavallario JM, Baez SE, Martinez JC, McCann RS. Perceived Instability, Pain, and Psychological Factors for Prediction of Function and Disability in Individuals With Chronic Ankle Instability. J Athl Train 2022; 57:1048-1054. [PMID: 35271731 PMCID: PMC9875700 DOI: 10.4085/1062-6050-0605.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The fear-avoidance model is a theoretical framework hypothesizing a relationship among pain catastrophizing, injury-related fear, chronic pain, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI. OBJECTIVE To explore relationships among instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI. DESIGN Cross-sectional study. SETTING Anonymous online survey. PATIENTS OR OTHER PARTICIPANTS A total of 259 people, recruited via email and social media, with a history of ankle sprain completed the survey; of those, 126 participants (age = 32.69 ± 4.38 years, females = 84.92%, highly active = 73.81%) were identified as having CAI and were included in the analysis. MAIN OUTCOME MEASURE(S) Demographics of gender identity, age, and physical activity level were recorded. Assessments used were the Identification of Functional Ankle Instability questionnaire (instability), the Pain Catastrophizing Scale (pain catastrophizing), the Tampa Scale of Kinesiophobia-11 (injury-related fear), a numeric pain rating scale and activity-based question (pain presence), the Quick Foot and Ankle Ability Measure (ankle function), and the modified Disablement in the Physically Active Scale (disability). Relationships among variables were explored through correlation and regression analyses. RESULTS After we controlled for instability and pain, pain catastrophizing and injury-related fear were significantly related to function and disability ratings in individuals with CAI. Together, the variables predicted 48.7% (P < .001) of the variance in function and 44.2% (P < .001) of the variance in disability. CONCLUSIONS Greater instability, pain catastrophizing, injury-related fear, and pain predicted decreased function and greater disability in those with CAI. These findings are consistent with the hypothesized relationships in the fear-avoidance model, although further investigation is needed to determine causality of these factors in the development of CAI.
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Affiliation(s)
| | | | - Shelby E. Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Ryan S. McCann
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA
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Michels F, Wastyn H, Pottel H, Stockmans F, Vereecke E, Matricali G. The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:817-826. [PMID: 34961654 DOI: 10.1016/j.fas.2021.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND A lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population. It is uncertain what percentage of these patients develop persisting symptoms including pain, recurrent sprains and subjective instability. This systematic review was conducted to assess the presence and duration of persistent symptoms after a first LAS. METHODS A systematic review of the Medline, Web of Sciences, Embase, CINAHL and Pedro databases was performed to identify peer-reviewed articles concerning the occurrence and duration of remaining symptoms after a first LAS. Inclusion criteria focused on selection of patients without previous ankle injuries and study quality. One of the following outcomes had to be described: subjective instability, resprains, remaining symptoms. RESULTS In total, 15 studies were included. The occurrence of patients with subjective instability decreased from 37.9% (95%CI [6.0-69.7]) at 3 months to 16.1% (95%CI [7.8-24.3]) at 6 months and 8.1% (95%CI [3.3-13.3]) at 12 months. The occurrence of patients with a recurrent LAS was 15.8% (95%CI [6.3-25.3]) at 12 months. The occurrence of patients with residual pain decreased from 48.6% (95%CI [23.6-73.5]) at 3 months, to 21.5% (95%CI [2.8-40.2]) at 6 months and 6.7% (95%CI [3.2-10.1]) at 12 months. CONCLUSION This study offers new insights in the presence of remaining symptoms after a first LAS and the development of chronic ankle instability. Twelve months following an initial LAS, a significant number of patients may still have symptoms. The incidence of subjective instability, and pain, continues to decrease until 12 months post-injury. This new information may suggest that a longer period of non-operative treatment may be warranted before recommending surgical intervention in patients with a first LAS.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; ESSKA-AFAS Ankle Instability Group, Luxembourg.
| | - Heline Wastyn
- Department of Orthopaedics, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Catholic University Leuven, Kortrijk, Belgium.
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Evie Vereecke
- Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium.
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Chui VWT, Tong AHK, Hui JYN, Yu HHT, Yung PSH, Ling SKK. Prevalence of ankle instability in performers of Chinese classical dance: a cross-sectional study of 105 Chinese dancers. BMJ Open Sport Exerc Med 2022; 8:e001413. [PMID: 36120109 PMCID: PMC9478852 DOI: 10.1136/bmjsem-2022-001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Foot and ankle injuries are commonly seen in dancers, yet limited studies exist on the injury prevalence of performers of Chinese classical dance. This study aims to determine and assess the prevalence of chronic ankle instability (CAI) in Chinese dancers and correlate the impact of CAI with foot function. Methods This is a cross-sectional study of 105 Chinese dancers. CAI was assessed using the Cumberland Ankle Instability Tool and foot function via the Foot and Ankle Outcome Score (FAOS). Both self-reported assessment tools were distributed online between January and February 2021. Subjects were divided into CAI and healthy groups to observe any correlations in demographics, training hours and foot function. Results CAI was seen in 28% of Chinese dancers, with most being unilateral instability. The number of training hours, level of expertise, occupation, gender and age showed no statistical significance with CAI. The FAOS showed that subjects with CAI had significantly greater pain and poorer quality of life. Discussion and conclusion CAI is a problem affecting 28% of performers of Chinese dance. Future research should investigate the ankle biomechanics in Chinese dance and specific risk factors for CAI to formulate strategies to prevent ankle injuries in Chinese dancers.
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Affiliation(s)
- Vivian Wai-Ting Chui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anson Hei-Ka Tong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jasmine Yat-Ning Hui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Heidi Hiu-Tung Yu
- School of Dance, Hong Kong Academy of Performing Arts, Hong Kong, Hong Kong
- Hong Kong Association of Dance Medicine and Science, Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Ka-Kin Ling
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Association of Dance Medicine and Science, Hong Kong, Hong Kong
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12
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Gribble PA, Kleis RE, Simon JE, Vela LI, Thomas AC. Differences in health-related quality of life among patients after ankle injury. Front Sports Act Living 2022; 4:909921. [PMID: 35992155 PMCID: PMC9382240 DOI: 10.3389/fspor.2022.909921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Ankle sprains are the most common injuries sustained in the physically active, often associated with pain and functional limitations long after initial recovery. In recent years, the impact of ankle sprains on general health and health-related quality of life (HRQoL) has been noted in athletes, but is not well-documented in the general population. We examined differences in HRQoL and general health between individuals with ankle sprain history and healthy controls. Those with ankle sprain reported significantly higher body mass index and general body pain, and lower SF-8 physical component scores than healthy controls. Additionally, there is some indication that physical activity is lower in those with ankle sprain history. This is an important step in illustrating the adverse sequelae of ankle sprains on population health and HRQoL.
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Affiliation(s)
- Phillip A. Gribble
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- *Correspondence: Phillip A. Gribble
| | - Rachel E. Kleis
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Janet E. Simon
- Division of Athletic Training, Ohio University, Athens, OH, United States
| | - Luzita I. Vela
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Abbey C. Thomas
- Department of Kinesiology and Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, NC, United States
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13
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Misencoding of ankle joint angle control system via cutaneous afferents reflex pathway in chronic ankle instability. Exp Brain Res 2022; 240:2327-2337. [PMID: 35764722 DOI: 10.1007/s00221-022-06406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
This study aimed to investigate how the cutaneous reflexes in the peroneus longus (PL) muscle are affected by changing the ankle joint position in patients with chronic ankle instability (CAI). We also investigated the correlation between the degree of reflex modulation and angle position sense of the ankle joint. The participants were 19 patients with CAI and 20 age-matched controls. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve at the ankle joint in the neutral standing and eversion/inversion standing positions. The suppressive middle latency cutaneous reflex (MLR; ~ 70-120 ms) and angle position sense of the ankle joint were assessed. During neutral standing, the gain of the suppressive MLR was more prominent in the CAI patients than in controls, although no significant difference was seen during 30° inversion standing. In addition, the ratios of the suppressive MLR and background electromyography in a neutral position were significantly larger than those at the 15°, 25°, and 30° inversion positions in CAI patients. No such difference was seen in control individuals. Furthermore, the correlations between reflex modulation degree and position sense error were quite different in CAI patients compared to controls. These findings suggest that the sensory-motor system was deteriorated in CAI patients due to changes in the PL cutaneous reflex pathway excitability and position sense of the ankle joint.
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14
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Is Kinesio Taping Effective for Sport Performance and Ankle Function of Athletes with Chronic Ankle Instability (CAI)? A Systematic Review and Meta-Analysis. Medicina (B Aires) 2022; 58:medicina58050620. [PMID: 35630037 PMCID: PMC9146435 DOI: 10.3390/medicina58050620] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The aim of the present review is to evaluate the effects of Kinesio Taping (or KT) on sports performances and ankle functions in athletes with CAI. Materials and Methods: This systematic review with meta-analysis was carried out following the criteria of the Prisma Statement system (registered on Open Science Framework, number: 10.17605/OSF.IO/D8QN5). For the selection of the studies, PubMed, Scopus and Web of Science were used as databases in which the following string was used: (“kinesiology tape” OR “tape” OR “taping” OR “elastic taping” OR “kinesio taping” OR “neuro taping”) AND (unstable OR instability) AND (ankle OR (ankle OR “ankle sprain” OR “injured ankle” OR “ankle injury”)). The Downs and Black Scale was used for the quality analysis. The outcomes considered were gait functions, ROM, muscle activation, postural sway, dynamic balance, lateral landing from a monopodalic drop and agility. Effect sizes (ESs) were synthesised as standardized mean differences between the control and intervention groups. Calculation of the 95% confidence interval (CI) for each ES was conducted according to Hedges and Olkin. Results: In total, 1448 articles were identified and 8 studies were included, with a total of 270 athletes. The application of the tape had a significant effect size on gait functions, ROM, muscle activation and postural sway. Conclusions: The meta-analysis showed a significant improvement in gait functions (step velocity, step and stride length and reduction in the base of support in dynamics), reduction in the joint ROM in inversion and eversion, decrease in the muscle activation of the long peroneus and decrease in the postural sway in movement in the mid-lateral direction. It is possible to conclude that KT provides a moderate stabilising effect on the ankles of the athletes of most popular contact sports with CAI.
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15
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Sánchez CA, Briceño I, Robledo J. Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo. Rev Bras Ortop 2022; 57:577-583. [PMID: 35966426 PMCID: PMC9365499 DOI: 10.1055/s-0041-1741446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Objective
The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management.
Methods
The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019.
Results
The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up.
Conclusion
The technique in the present study is easy and achieves satisfactory results for function and pain control.
Level of Evidence
IV.
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Affiliation(s)
- Carlos A. Sánchez
- Departamento de Ortopedia e Traumatologia, Pontificia Universidad Javeriana, Bogotá, D.C., Colômbia
| | - Ignacio Briceño
- Departamento de Ortopedia e Traumatologia, Pontificia Universidad Javeriana, Bogotá, D.C., Colômbia
| | - Jaime Robledo
- Departamento de Ortopedia e Traumatologia, Hospital Universitario San Ignacio, Bogotá, D.C., Colômbia
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Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Hamidi Panah S, Tabatabaee SM, Azarakhsh A. Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury. Anesth Pain Med 2022; 12:e118317. [PMID: 35433383 PMCID: PMC8994863 DOI: 10.5812/aapm.118317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Due to the anti-inflammatory effects of dextrose prolotherapy, we evaluated the effectiveness of extra-articular, neurofascial dextrose prolotherapy in chronic ankle ligament injury. Methods Patients with chronic ankle ligament injury entered this uncontrolled before-after study based on eligibility criteria. Patients who consented to participate in the study filled out the prepared questionnaire containing demographic data, the Cumberland ankle instability tool (CAIT), and the Visual Analogue Scale (VAS). The initial CAIT score of less than 25 indicated functional instability following an ankle sprain. Patients underwent neurofascial prolotherapy with dextrose 12.5%. Two injections within one month were done. The CAIT was completed one, three, and six months after the intervention. Results Twenty-five patients with chronic ankle ligament injury were investigated. The mean CAIT score was 1.88 (± 2.35) before the intervention, which increased significantly over the study (P < 0.001). The CAIT score reached 21.84 (± 6.04) in the sixth month after the intervention. Moreover, the VAS score decreased significantly over the study from 6.12 (± 2.35) before the intervention to 1.24 (± 0.43) in the sixth month after the intervention (P < 0.001). Conclusions Our findings revealed the therapeutic effectiveness of dextrose neurofascial prolotherapy in decreasing pain and functional instability in patients suffering chronic ankle pain due to ligamentous injury accompanied by chronic ankle instability.
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Affiliation(s)
| | - Zahra Rezasoltani
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Corresponding Author: Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, 1411718541, Tehran, Iran.
| | - Afsaneh Dadarkhah
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Emam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
| | - Sanaz Hamidi Panah
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Tabatabaee
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Arezoo Azarakhsh
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Goulart Neto AM, Maffulli N, Migliorini F, de Menezes FS, Okubo R. Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study. J Orthop Surg Res 2022; 17:38. [PMID: 35062990 PMCID: PMC8781557 DOI: 10.1186/s13018-022-02925-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/06/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
Ankle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.
Methods
This is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).
Results
50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).
Conclusion
Both the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.
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18
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Health-Related Quality of Life Among Patients With Painful Chronic Ankle Instability. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2022. [DOI: 10.1123/ijatt.2022-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
More than half of individuals with chronic ankle instability (CAI) experience lingering pain from a previous injury. However, there is little empirical evidence investigating the role pain has on health-related quality of life (HRQL). The purpose of this cross-sectional study was to compare physical and psychological HRQL between CAI individuals with and without pain. Group comparisons demonstrated that CAI individuals with pain displayed a lower physical and mental HRQL than those without pain. In addition, CAI individuals with pain reported greater injury-related fear. These findings suggest that persistent pain compounds the negative effect that ankle joint instability has on physical and mental HRQL outcomes. Therefore, conservative therapies should consider multimodal approaches rather than focusing on joint stability alone.
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19
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McCreadie J, Whyte O, Greig M. A critical appraisal of ankle rehabilitative interventions. Res Sports Med 2021:1-9. [PMID: 34779324 DOI: 10.1080/15438627.2021.2001648] [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: 10/19/2022]
Abstract
Introduction Lateral ankle sprain is a common musculoskeletal pathology. Functional exercise progression is vital to restore full function. Aim The aim of this study was to compare the electromyographical response to a standard balance task on one stable and four unstable surfaces. Participants Twenty subjects (5 male, 15 females; age at 23 ± 7.1 years) were recruited to participate in the study. Methods A gym-based single session cross over design was used to compare peak and mean surface EMG (sEMG) activity of the Peroneus Longus, Tibilais Anterior and medial head of the gastrocnemius muscles whilst performing a standardized balance task on one stable surface and four unstable surfaces stable surface. Results A significant main effect for surface was found. Post-hoc testing revealed that the Floor and Trampoline (Trampet) elicited similar mean sEMG response. Discussion The results of the study propose a safe and stepwise progressive rehabilitation regime following ankle injury whilst considering the healing process of the injured structure.
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Affiliation(s)
- John McCreadie
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
| | - Olivia Whyte
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
| | - Matt Greig
- Sports Injuries Research Group, Faculty of Arts and Science, Edgehill University, Ormskirk, UK
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20
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Wang J, Zhang D, Zhao T, Ma J, Jin S. Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e053755. [PMID: 34548370 PMCID: PMC8458363 DOI: 10.1136/bmjopen-2021-053755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI. METHODS AND ANALYSIS We will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Ju Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Di Zhang
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianyu Zhao
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiang Ma
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Song Jin
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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21
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Yuan C, Zhu G, Wang Z, Wang C, Wang X, Ma X. The fibula and talus position difference in functional and mechanical ankle instability: MRI findings. J Orthop Surg (Hong Kong) 2021; 29:2309499020984575. [PMID: 33427040 DOI: 10.1177/2309499020984575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients. METHODS 61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula. RESULTS Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers. CONCLUSION The functional instability patients didn't have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.
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Affiliation(s)
- Chengjie Yuan
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Genrui Zhu
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Zhifeng Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
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22
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Bain KA, Hoch MC, Kosik KB, Gribble PA, Hoch JM. Psychological impairments in individuals with history of ankle sprain: a systematic review. Physiother Theory Pract 2021; 38:1889-1907. [PMID: 33896345 DOI: 10.1080/09593985.2021.1920079] [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: 10/21/2022]
Abstract
Patient-reported outcomes (PROs) can be used to assess and monitor psychological health following musculoskeletal injury. Studies have reported decreased psychological health after lateral ankle sprain (LAS) using numerous PROs. The purpose of this systematic review was to critically evaluate individual studies, summarize PROs utilized to quantify psychological health, and examine the effect of ankle injury on psychological health between groups (1 LAS, >1 LAS, and healthy controls). Databases searched included: CINAHL, MEDLINE, SPORTDiscus, APA, Psychinfo and PubMed Central. All case-control studies were critically appraised using the modified Downs and Black. Effect sizes (ES) were calculated between the groups (1 LAS, >1 LAS, healthy control) for each of the identified studies, for each included PRO used to quantify psychological impairments. Nine high-quality manuscripts were included. Overall, individuals with history of > 1 LAS self-reported greater psychological impairments compared to healthy controls (ES range = -0.37-12.16), while those with 1 LAS had similar psychological health to healthy control groups (ES rang e = -0.65-0.65). Conclusion: The main findings from this systematic review were individuals with > 1 LAS have increased levels of injury-related fear and decreased psychological health compared to healthy controls. PROs can aid clinicians in identifying psychological health concerns during rehabilitation.
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Affiliation(s)
- Katherine A Bain
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Matthew C Hoch
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Kyle B Kosik
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Johanna M Hoch
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
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23
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Ahn BH, Cho BK. Persistent Pain After Operative Treatment for Chronic Lateral Ankle Instability. Orthop Res Rev 2021; 13:47-56. [PMID: 33907476 PMCID: PMC8064723 DOI: 10.2147/orr.s299409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022] Open
Abstract
A high frequency of associated injuries is seen in patients with chronic lateral ankle instability. Comorbidities include intraarticular pathologies (osteochondral lesion, soft tissue or bony impingement syndrome, loose body, synovitis, etc.), peroneal tendon pathologies, neural injuries, and other extraarticular pathologies. Surgeons should have a high index of suspicion for these associated pathologies before operative intervention, correlate with clinical findings, and plan the treatment. Despite the restoration of ankle stability following ligament repair or reconstruction surgery, postoperative residual pain, which can negatively affect clinical outcomes and patient satisfaction, is highly prevalent (13–35%). The aim of this review was to discuss the causes of persistent pain after operative treatment for chronic lateral ankle instability.
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Affiliation(s)
- Byung-Hyun Ahn
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, South Korea.,Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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Kosik KB, Johnson NF, Terada M, Thomas-Fenwick AC, Mattacola CG, Gribble PA. Health-Related Quality of Life Among Middle-Aged Adults With Chronic Ankle Instability, Copers, and Uninjured Controls. J Athl Train 2020; 55:733-738. [PMID: 32432901 DOI: 10.4085/1062-6050-190-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT People with chronic ankle instability (CAI) display a lower regional and global health-related quality of life (HRQoL). Examinations of HRQoL outcomes associated with CAI have addressed younger adults, restricting our understanding of the long-term consequences of CAI. OBJECTIVE To compare ankle regional and global HRQoL in middle-aged participants with and those without CAI. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 59 middle-aged volunteers, consisting of 18 with CAI (age = 50.2 ± 9.3 years), 17 who were ankle-sprain copers (age = 54.5 ± 8.7 years), and 24 uninjured controls (age = 56.7 ± 10.0 years). MAIN OUTCOME MEASURE(S) Participants completed the Foot and Ankle Disability Index (FADI) and the Patient-Reported Outcomes Measurement Information System Adult Profile. Regional HRQoL was assessed using the FADI Activities of Daily Living and Sport subscales. Global HRQoL was measured using the 43-item Patient-Reported Outcomes Measurement Information System Adult Profile, which contains 7 short forms-Physical Function, Pain Interference, Fatigue, Depression, Sleep Disturbance, Anxiety, and Ability to Participate in Social Roles and Activities. Separate Kruskal-Wallis tests were used to determine between-groups differences. RESULTS Middle-aged participants with CAI had lower scores on both subscales of the FADI than the coper and control groups (all P values <.001). Participants with CAI scored lower on the Physical Function (U = 116.0, z = -2.78, P = .005) and Ability to Participate in Social Roles and Activities (U = 96.0, z = -3.09, P = .002) subscales but higher on the Pain Interference (U = 144.0, z = -2.36, P = .02), Fatigue (U = 110.0, z = -2.72, P = .006), and Depression (U = 110.5, z = -2.91, P = .004) subscales than the control group. Participants with CAI also scored lower on the Physical Function (U = 74.5, z = -2.79, P = .005) and Ability to Participate in Social Roles and Activities (U = 55.0, z = -3.29, P = .001) subscales but higher on the Fatigue (U = 90.0, z = -2.09, P = .04) and Depression (U = 96.5, z = -1.97, P = .048) subscales than the coper group. CONCLUSIONS Middle-aged participants with CAI displayed worse ankle regional and global HRQoL than their age-matched healthy counterparts and copers. These results demonstrated that CAI can affect HRQoL outcomes in middle-aged adults.
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Affiliation(s)
- Kyle B Kosik
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
| | - Nathan F Johnson
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
| | - Masafumi Terada
- Department of Sport and Health Science, Ritsumeikan University, Kyoto, Japan
| | | | - Carl G Mattacola
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
| | - Phillip A Gribble
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
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The effectiveness of lateral ankle ligament reconstruction when treating chronic ankle instability: A systematic review and meta-analysis. Injury 2020; 51:1726-1732. [PMID: 32534817 DOI: 10.1016/j.injury.2020.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023]
Abstract
UNLABELLED Chronic ankle instability predominantly occurs due to multiple exercise-related diseases. Conservative treatment methods regarding this condition have not effectively improved in recent years, which is why more focus has been put on exploring different novel reconstruction procedures of the lateral ankle ligament for the treatment of chronic ankle instability. OBJECTIVES This study aims to obtain the overall effectiveness of various lateral ankle ligament reconstruction methods for chronic ankle ligament instability. METHODS We gathered data from PubMed and EMBASE databases using the keywords: ankle, malleolar, and reconstruction. Newcastle - Ottawa quality assessment was carried out for the obtained studies; effect volume combination and image drawing were performed by Stata14, and Excel was used for data statistics. RESULTS A total of 12 articles were included in the quantitative analysis by performing full-text reading and data inclusion. Among them, 476 patients (485 ankle joints) were treated. The results showed that the overall valid efficiency of "excellent" was 59% and "good" lateral ligament reconstruction was 26%, I2=87.3%, P = 0.000; the subgroup analysis anatomic reconstruction group I2=0.0%, P = 0.993; the autograft group I2=0.0%, P = 1.000; allograft group I2=0.0%, P = 0.993. CONCLUSION Reconstruction of the lateral ankle ligament is a relatively stable treatment for chronic ankle instability.
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Kosik KB, Johnson NF, Terada M, Thomas AC, Mattacola CG, Gribble PA. Decreased ankle and hip isometric peak torque in young and middle-aged adults with chronic ankle instability. Phys Ther Sport 2020; 43:127-133. [DOI: 10.1016/j.ptsp.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/26/2022]
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Adal SA, Mackey M, Pourkazemi F, Hiller CE. The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:96-101. [PMID: 31921485 PMCID: PMC6943759 DOI: 10.1016/j.jshs.2019.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Up to 74% of people with a history of ankle sprain develop chronic ankle instability (CAI). One commonly reported residual impairment is ankle pain; however, it has not been included in models or inclusion criteria for CAI. We investigated the prevalence of pain in people with CAI and the association between presence of pain and other CAI characteristics. METHODS Retrospective data from 1147 participants with CAI (age 26.6 ± 10.7 years, 59% female) were collated from previous studies that used the Cumberland Ankle Instability Tool as an assessment tool. Pain was assessed from Item 1 of the Cumberland Ankle Instability Tool, which asks participants about ankle pain. Responses were divided into 3 categories: pain during daily activities, pain during moderate/vigorous physical activities, and no pain. The presence of pain was analyzed with descriptive statistics, the correlation between pain category and CAI characteristics was analyzed by χ2 tests and factors associated with each pain category were analyzed by logistic regression. RESULTS Among the participants, 60.1% (n = 689) reported ankle pain. Of all participants, 12.4% (n = 142) reported pain during daily activities, 47.7% (n = 547) reported pain during moderate/vigorous physical activities, and 39.9% (n = 458) reported no pain. There was a strong association between ankle instability and ankle pain (χ2 = 122.2, p < 0.001, OR = 5.38, 95% confidence interval (CI): 3.84-7.53). Perceived ankle instability, age and unilateral ankle sprains were independently associated with pain (ankle instability: χ2 = 43.29, p < 0.001; age: χ2 = 30.37, p < 0.001; unilateral ankle sprains: χ2 = 6.25, p < 0.05). There was no significant difference in the presence of pain between genders. CONCLUSION The prevalence of pain in people with CAI was high and was related to perceived ankle instability. Number of sprains, age, gender and unilateral or bilateral sprain did not modify this result except for the first pain category (pain during daily activities). There is large gap in current knowledge about the impact of pain in people with CAI, and this topic needs further investigation.
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Affiliation(s)
- Saeed Al Adal
- Faculty of Health Sciences, University of Sydney, Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
- Faculty of Applied Medical Sciences, Najran University, Najran, PO Box 1988, Saudi Arabia
| | - Martin Mackey
- Faculty of Health Sciences, University of Sydney, Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - Fereshteh Pourkazemi
- Faculty of Health Sciences, University of Sydney, Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - Claire E. Hiller
- Faculty of Health Sciences, University of Sydney, Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
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