Altered Ankle Kinematics and Shank-Rear-Foot Coupling in Those with Chronic Ankle Instability

2009 ◽  
Vol 18 (3) ◽  
pp. 375-388 ◽  
Author(s):  
Lindsay K. Drewes ◽  
Patrick O. McKeon ◽  
Gabriele Paolini ◽  
Patrick Riley ◽  
D. Casey Kerrigan ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Ankle Instability ◽  
External Rotation ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
3 Dimensional ◽  
Joint Coupling ◽  
Ankle Inversion ◽  
Ankle Kinematics ◽  
Phase Angles

Context:Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).Objective:To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.Design:Case control.Setting:Motion-analysis laboratory.Participants:7 participants (3 men, 4 women) suffering from CAI (age 24.6 ± 4.2 y, height 172.6 ± 9.4 cm, mass 70.9 ± 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 ± 4.5 y, height 168.2 ± 5.9 cm, mass 66.5 ± 9.8 kg).Interventions:Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.Main Outcome Measures:The positions of rear-foot inversion–eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.Results:The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.Conclusions:Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.

Landing Kinematics and Isometric Hip Strength of Individuals With Chronic Ankle Instability

2019 ◽  
Vol 40 (8) ◽  
pp. 969-977 ◽  
Author(s):  
Ryan S. McCann ◽  
Masafumi Terada ◽  
Kyle B. Kosik ◽  
Phillip A. Gribble
Keyword(s):  
Lower Extremity ◽  
Ankle Instability ◽  
External Rotation ◽  
Peak Torque ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Hip Kinematics ◽  
Rotation Strength

Background: Chronic ankle instability (CAI) is associated with hip strength deficits and altered movement in the lower extremity. However, it remains unclear how hip strength deficits contribute to lateral ankle sprain (LAS) mechanisms. We aimed to compare lower extremity landing kinematics and isometric hip strength between individuals with and without CAI and examine associations between hip kinematics and strength. Methods: Seventy-six individuals completed 5 single-leg landings, during which we collected three-dimensional ankle, knee, and hip kinematics from 200 milliseconds pre–initial contact to 50 milliseconds post–initial contact. We calculated average peak torque (Nm/kg) from 3 trials of isometric hip extension, abduction, and external rotation strength testing. One-way analyses of variance assessed group differences (CAI, LAS coper, and control) in hip strength and kinematics. Pearson product moment correlations assessed associations between hip kinematics and strength. We adjusted the kinematic group comparisons and correlation analyses for multiple comparisons using the Benjamini-Hochberg method. Results: The CAI group exhibited less hip abduction during landing than LAS copers and controls. The CAI group had lower hip external rotation strength than LAS copers ( P = .04, d = 0.62 [0.05, 1.17]) and controls ( P < .01, d = 0.87 [0.28, 1.43]). Effect sizes suggest that the CAI group had deficits in EXT compared with controls ( d = 0.63 [0.06, 1.19]). Hip strength was not associated with hip landing kinematics for any group. Conclusion: Altered landing mechanics displayed by the CAI group may promote mechanisms of LAS, but they are not associated with isometric hip strength. However, hip strength deficits may negatively impact other functional tasks, and they should still be considered during rehabilitation. Level of Evidence: Level III, case-control study.

Shank-Rearfoot Joint Coupling with Chronic Ankle Instability

2014 ◽  
Vol 30 (3) ◽  
pp. 366-372 ◽  
Author(s):  
C. Collin Herb ◽  
Lisa Chinn ◽  
Jay Dicharry ◽  
Patrick O. McKeon ◽  
Joseph M. Hart ◽  
...  
Keyword(s):  
Gait Cycle ◽  
Ankle Instability ◽  
External Rotation ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Vector Coding ◽  
Joint Coupling ◽  
Combined Motion ◽  
Coding Method ◽  
Lower Magnitude

Chronic ankle instability (CAI) results in longstanding symptoms and subjective feelings of “giving way” following initial ankle sprain. Our purpose was to identify differences in joint coupling and variability between shank internal/external rotation and rearfoot inversion/eversion throughout the gait cycle of CAI subjects and healthy controls. Twenty-eight young adults participated (CAI, n = 15, control, n = 13). Kinematics were collected while walking and jogging on a treadmill. A vector coding method in which direction (θ) and magnitude of the angle-angle relationship and stride-to-stride variability (VCV) in shank-rearfoot coupling were calculated. In walking, the CAI group demonstrated lower θ, indicating a greater proportion of rearfoot-to-shank motion, compared with the control group in early and late swing. The CAI group had higher magnitude, indicating greater combined motion between the two segments, in early swing, but lower magnitude, indicating less combined motion, during late swing. The CAI group also had lower VCV measures, indicating less stride-to-stride variability during stance. In jogging, the CAI group had lower θ measures than the control group during stance and swing. Differences in shank-rearfoot coupling of the CAI group may be related to changes in sensorimotor control and lead to further instances of instability.

scholarly journals Sagittal Plane Gait Kinematics in Individuals With Chronic Ankle Instability

2016 ◽  
Vol 21 (5) ◽  
pp. 28-35 ◽  
Author(s):  
Matthew C. Hoch ◽  
David R. Mullineaux ◽  
Kyoungkyu Jeon ◽  
Patrick O. McKeon
Keyword(s):  
Lower Extremity ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Three Dimensional ◽  
Chronic Ankle Instability ◽  
Initial Contact ◽  
Healthy Individuals ◽  
Gait Kinematics ◽  
Ankle Kinematics ◽  
Absorption Phase

Single joint kinematic alterations have been identified during gait in those with chronic ankle instability (CAI). The purpose of this study was to compare sagittal plane hip, knee, and ankle kinematics during walking in participants with and without CAI. Twelve individuals with CAI and 12 healthy individuals walked on a treadmill at 1.5 m/s. Three-dimensional kinematics were analyzed using mean ensemble curves and independent t tests. Participants with CAI demonstrated less lower extremity flexion during the absorption phase of stance and the limb placement phase of swing, which may have implications for limb placement at initial contact.

Altering Shank–Rear-Foot Joint Coupling During Gait With Ankle Taping in Patients With Chronic Ankle Instability and Healthy Controls

2016 ◽  
Vol 25 (1) ◽  
pp. 13-22 ◽  
Author(s):  
C. Collin Herb ◽  
Lisa Chinn ◽  
Jay Hertel
Keyword(s):  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Protective Mechanism ◽  
Ankle Sprains ◽  
Healthy Controls ◽  
Coupled Motion ◽  
Vector Coding ◽  
Joint Coupling ◽  
Foot Joint

Context:Lateral ankle sprain (LAS) is one of the most common injuries in active individuals. Chronic ankle instability (CAI) is a condition that commonly occurs after LAS and is associated with long-term disability and a high risk of multiple ankle sprains. Ankle taping is a commonly used intervention for the prevention of ankle sprains.Objective:To analyze the ankle-joint coupling using vector coding during walking and jogging gait with the application of ankle tape and without ankle tape in young adults with and without CAI.Design:Observational laboratory study design. Patients walked and jogged on an instrumented treadmill while taped and not taped. Fifteen strides for each subject were collected and analyzed using a vector-coding technique to compare magnitude coupled motion, ratio of coupled motion, and the variability (VCV) within groups. Within-group means and 90% confidence intervals (CI) were compared between the taped and nontaped condition, and where the CIs did not overlap was considered significant.Setting:A 12-camera 3D motion-capture system with instrumented treadmill.Patients:12 patients with CAI and 11 healthy controls.Main Outcome Measures:Magnitude to coupled motion, ratio of coupled motion, and the VCV of shank–rear-foot joint coupling.Results:Magnitude of coupled motion and VCV were significantly lower in the taped condition than in the nontaped condition in both groups. Magnitude differences were identified near initial contact during walking and during swing phase of jogging. VCV differences were identified throughout the gait cycle at both walking and jogging. No differences were identified in theta between tape and nontaped conditions.Conclusions:A decrease in the magnitude of coupled motion and VCV may represent a protective mechanism of ankle taping in CAI and healthy patients during gait.

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

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.

scholarly journals Short-Term Effects of Balance Training with Stroboscopic Vision for Patients with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

2021 ◽  
Vol 18 (10) ◽  
pp. 5364
Author(s):  
Kyung-Min Kim ◽  
María D. Estudillo-Martínez ◽  
Yolanda Castellote-Caballero ◽  
Alejandro Estepa-Gallego ◽  
David Cruz-Díaz
Keyword(s):  
Randomized Controlled Trial ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Balance Training ◽  
Chronic Ankle Instability ◽  
Balance Test ◽  
Training Groups ◽  
Randomized Controlled ◽  
Star Excursion Balance Test

Chronic Ankle Instability (CAI) is one of the most common musculoskeletal dysfunctions. Stroboscopic vision (SV) training has been deemed to enhance somatosensorial pathways in this population group; nevertheless, until recently no studies have addressed the additional effects of this treatment option to the traditional therapeutic approach. Methods: To evaluate the effectiveness of a partial visual deprivation training protocol in patients with CAI, a randomized controlled trial was carried out. Patients with CAI (n = 73) were randomized into either a balance training, SV training, or a control (no training) group. For participants assigned into training groups, they received 18 training sessions over 6 weeks. The primary outcome was dynamic balance as measured by the Star Excursion Balance Test assessed at baseline and after 6 weeks of intervention. Secondary outcome measures included ankle dorsiflexion range of motion, self-reported instability feeling, and ankle functional status. Results: Better scores in stroboscopic training and balance training groups in all outcome measures were observed in comparison with the control group with moderate to large effect sizes. Stroboscopic training was more effective than neuromuscular training in self-reported instability feeling (cohen’s d = 0.71; p = 0.042) and anterior reach distance of the star excursion balance test (cohen’s d = 1.23; p = 0.001). Conclusions: Preliminary findings from the effects of SV Stroboscopic training in patients with CAI, suggest that SV may be beneficial in CAI rehabilitation.

scholarly journals Preliminary Evidence That Taping Does Not Optimize Joint Coupling of the Foot and Ankle Joints in Patients with Chronic Ankle Instability

2021 ◽  
Vol 18 (4) ◽  
pp. 2029
Author(s):  
Charles Deltour ◽  
Bart Dingenen ◽  
Filip Staes ◽  
Kevin Deschamps ◽  
Giovanni A. Matricali
Keyword(s):  
Cross Correlation ◽  
Ankle Instability ◽  
Correlation Coefficients ◽  
Preliminary Evidence ◽  
Chronic Ankle Instability ◽  
Heel Strike ◽  
Segmental Motion ◽  
Barefoot Running ◽  
Ankle Motion ◽  
Joint Coupling

Background: Foot–ankle motion is affected by chronic ankle instability (CAI) in terms of altered kinematics. This study focuses on multisegmental foot–ankle motion and joint coupling in barefoot and taped CAI patients during the three subphases of stance at running. Methods: Foot segmental motion data of 12 controls and 15 CAI participants during running with a heel strike pattern were collected through gait analysis. CAI participants performed running trials in three conditions: barefoot running, and running with high-dye and low-dye taping. Dependent variables were the range of motion (RoM) occurring at the different inter-segment angles as well as the cross-correlation coefficients between predetermined segments. Results: There were no significant RoM differences for barefoot running between CAI patients and controls. In taped conditions, the first two subphases only showed RoM changes at the midfoot without apparent RoM reduction compared to the barefoot CAI condition. In the last subphase there was limited RoM reduction at the mid- and rearfoot. Cross-correlation coefficients highlighted a tendency towards weaker joint coupling in the barefoot CAI condition compared to the controls. Joint coupling within the taped CAI conditions did not show optimization compared to the barefoot CAI condition. Conclusions: RoM was not significantly changed for barefoot running between CAI patients and controls. In taped conditions, there was no distinct tendency towards lower mean RoM values due to the mechanical restraints of taping. Joint coupling in CAI patients was not optimized by taping.

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

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
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.

scholarly journals The Effects of Therapeutic Exercise With and Without Mobilization in Participants With Chronic Ankle Instability: A Randomized Controlled Trial

2020 ◽  
pp. 1-8
Author(s):  
Cameron Bolton ◽  
Sheri Hale ◽  
Todd Telemeco
Keyword(s):  
Randomized Controlled Trial ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Therapeutic Exercise ◽  
Convenience Sample ◽  
Randomized Controlled ◽  
Hop Test

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.

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