Anterior-to-Posterior Ankle Joint Mobilizations Improve Dynamic Postural Control in Chronic Ankle Instability Patients: A Critically Appraised Topic

Context Ankle-joint mobilization and neuromuscular and strength training have been deemed beneficial in the management of patients with chronic ankle instability (CAI). CrossFit training is a sport modality that involves these techniques. Objective To determine and compare the influence of adding self-mobilization of the ankle joint to CrossFit training versus CrossFit alone or no intervention in patients with CAI. Design Randomized controlled clinical trial. Setting Research laboratory. Patients or Other Participants Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group. Intervention(s) Participants in the self-mobilization plus CrossFit group and the CrossFit training-alone group pursued a CrossFit training program twice a week for 12 weeks. The self-mobilization plus CrossFit group performed an ankle self-mobilization protocol before their CrossFit training, and the control group received no intervention. Main Outcome Measure(s) Ankle-dorsiflexion range of motion (DFROM), subjective feeling of instability, and dynamic postural control were assessed via the weight-bearing lunge test, Cumberland Ankle Instability Tool, and Star Excursion Balance Test (SEBT), respectively. Results After 12 weeks of the intervention, both the self-mobilization plus CrossFit and CrossFit training-alone groups improved compared with the control group (P < .001). The self-mobilization plus CrossFit intervention was superior to the CrossFit training-alone intervention regarding ankle DFROM as well as the posterolateral- and posteromedial-reach distances of the SEBT but not for the anterior-reach distance of the SEBT or the Cumberland Ankle Instability Tool. Conclusions Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control and self-reported instability in patients with CAI.

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People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00452-0 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Patrick Fuerst ◽

Albert Gollhofer ◽

Markus Wenning ◽

Dominic Gehring

Keyword(s):

Ankle Joint ◽

Repeated Measures ◽

Ankle Instability ◽

Dynamic Change ◽

Chronic Ankle Instability ◽

Mechanical Resistance ◽

Healthy Controls ◽

Neuromuscular Activation ◽

Ankle Inversion ◽

Ankle Brace

Abstract Background The application of ankle braces is an effective method for the prevention of recurrent ankle sprains. It has been proposed that the reduction of injury rates is based on the mechanical stiffness of the brace and on beneficial effects on proprioception and neuromuscular activation. Yet, how the neuromuscular system responds to the application of various types of ankle braces during highly dynamic injury-relevant movements is not well understood. Enhanced stability of the ankle joint seems especially important for people with chronic ankle instability. We therefore aimed to analyse the effects of a soft and a semi-rigid ankle brace on the execution of highly dynamic 180° turning movements in participants with and without chronic ankle instability. Methods Fifteen participants with functional ankle instability, 15 participants with functional and mechanical ankle instability and 15 healthy controls performed 180° turning movements in reaction to light signals in a cross-sectional descriptive laboratory study. Ankle joint kinematics and kinetics as well as neuromuscular activation of muscles surrounding the ankle joint were determined. Two-way repeated measures analyses of variance and post-hoc t-tests were calculated. Results Maximum ankle inversion angles and velocities were significantly reduced with the semi-rigid brace in comparison to the conditions without a brace and with the soft brace (p ≤ 0.006, d ≥ 0.303). Effect sizes of these reductions were larger in participants with chronic ankle instability than in healthy controls. Furthermore, peroneal activation levels decreased significantly with the semi-rigid brace in the 100 ms before and after ground contact. No statistically significant brace by group effects were found. Conclusions Based on these findings, we argue that people with ankle instability in particular seem to benefit from a semi-rigid ankle brace, which allows them to keep ankle inversion angles in a range that is comparable to values of healthy people. Lower ankle inversion angles and velocities with a semi-rigid brace may explain reduced injury incidences with brace application. The lack of effect of the soft brace indicates that the primary mechanism behind the reduction of inversion angles and velocities is the mechanical resistance of the brace in the frontal plane.

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Effects of Three Tape Methods on Static Postural Control of Individuals with Chronic Ankle Instability

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000538253.54181.aa ◽

2018 ◽

Vol 50 (5S) ◽

pp. 683

Author(s):

Youngmin Chun ◽

Jinah Kim ◽

Songah Chae ◽

Emi Takahashi ◽

Adrian Pettaway ◽

...

Keyword(s):

Postural Control ◽

Ankle Instability ◽

Chronic Ankle Instability

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The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2015-0152 ◽

2017 ◽

Vol 26 (3) ◽

pp. 239-244 ◽

Cited By ~ 1

Author(s):

Cameron J. Powden ◽

Kathleen K. Hogan ◽

Erik A. Wikstrom ◽

Matthew C. Hoch

Keyword(s):

Postural Control ◽

Range Of Motion ◽

Outcome Measures ◽

Ankle Instability ◽

Weight Bearing ◽

Chronic Ankle Instability ◽

Physical Contact ◽

Future Research ◽

Talocrural Joint ◽

Sham Condition

Context:Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).Objective:Examine the immediate effects of talocrural joint traction in those with CAI.Design:Blinded, crossover.Setting:Laboratory.Participants:Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering “yes” to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.Intervention:Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.Main Outcome Measures:The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.Results:No significant treatment effects were identified for any variables.Conclusion:A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

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