The Effectiveness of Foot Orthotics in Improving Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2015 ◽  
Vol 24 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Michael L. Gabriner ◽  
Brittany A. Braun ◽  
Megan N. Houston ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Based Medicine ◽  
Level 2

Clinical Scenario:Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient’s postural control.Clinical Question:For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control?Summary of Key Findings:The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI.Clinical Bottom Line:There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control.Strength of Recommendation:There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

scholarly journals The Effect of Fibular Reposition Taping on Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 28 (2) ◽  
pp. 205-210
Author(s):  
Bradley C. Jackson ◽  
Robert T. Medina ◽  
Stephanie H. Clines ◽  
Julie M. Cavallario ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Range Of Motion ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Significant Difference ◽  
History Of

Clinical Scenario: History of acute ankle sprains can result in chronic ankle instability (CAI). Arthrokinematic changes resulting from CAI may restrict range of motion and contribute to postural control deficits. Mulligan or fibular reposition taping (FRT) has been suggested as a means to realign fibular positional faults and may be an effective way to improve postural control and balance in patients with CAI. Clinical Question: Is there evidence to suggest that FRT will improve postural control for patients with CAI in the affected limb compared with no taping? Summary of Key Findings: Three of the 4 included studies found no significant difference in postural control in patients receiving FRT compared with sham or no tape. Clinical Bottom Line: There is moderate evidence refuting the use of FRT to improve postural control in patients with CAI. Strength of Recommendation: There is grade B evidence to support that FRT does not improve postural control in people with CAI.

The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 24 (5) ◽  
pp. 186-192
Author(s):  
Jennifer F. Mullins ◽  
Arthur J. Nitz ◽  
Matthew C. Hoch
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
The Other ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Dry Needling ◽  
Bottom Line ◽  
Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

scholarly journals The Effect of Plantar Massage on Static Postural Control in Patients With Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
pp. 1-5
Author(s):  
Katherine L. Helly ◽  
Katherine A. Bain ◽  
Phillip A. Gribble ◽  
Matthew C. Hoch
Keyword(s):  
Randomized Controlled Trial ◽  
Postural Control ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Somatosensory System ◽  
Chronic Ankle Instability ◽  
Future Research ◽  
Bottom Line ◽  
Randomized Controlled ◽  
Crossover Studies

Clinical Scenario: Patients with chronic ankle instability (CAI) demonstrate deficits in both sensory and motor function, which can be objectively evaluated through static postural control testing. One intervention that has been suggested to improve somatosensation and, in turn, static postural control is plantar massage. Clinical Question: Does plantar massage improve static postural control during single-limb stance in patients with CAI relative to baseline? Summary of Key Findings: A search was performed for articles exploring the effect of plantar massage on static postural control in individuals with CAI. Three articles were included in this critically appraised topic including 1 randomized controlled trial and 2 crossover studies. All studies supported the use of plantar massage to improve static postural control in patients with CAI. Clinical Bottom Line: There is currently good-quality and consistent evidence that supports the use of plantar massage as an intervention that targets the somatosensory system to improve static postural control in patients with CAI. Future research should focus on incorporating plantar massage as a treatment intervention during long-term rehabilitation protocols for individuals with CAI. Strength of Recommendation: In agreement with the Center of Evidence-Based Medicine, the consistent results from 2 crossover studies and 1 randomized controlled trial designate that there is level B evidence due to consistent, moderate- to high-quality evidence.

Self-Mobilization Using a Foam Roller Versus a Roller Massager: Which Is More Effective for Increasing Hamstrings Flexibility?

2017 ◽  
Vol 26 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Danielle M. DeBruyne ◽  
Marina M. Dewhurst ◽  
Katelyn M. Fischer ◽  
Michael S. Wojtanowski ◽  
Chris Durall
Keyword(s):  
Therapeutic Benefit ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Duration Of Treatment ◽  
Bottom Line ◽  
Physically Active ◽  
Foam Rolling ◽  
Treatment Data ◽  
Active Adults ◽  
Level 2

Clinical Scenario:Increasing the length of the muscle–tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle–tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence.Clinical Question:Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults?Summary of Key Findings:The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size.Clinical Bottom Line:The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown.Strength of Recommendation:Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

The Effectiveness of Open Repair Versus Percutaneous Repair for an Acute Achilles Tendon Rupture

2016 ◽  
Vol 25 (4) ◽  
pp. 404-410 ◽  
Author(s):  
Heidi Krueger ◽  
Shannon David
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Supporting Evidence ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Men And Women ◽  
Percutaneous Repair ◽  
Tendon Ruptures

Clinical Scenario:There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior.Focused Clinical Question:Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included.Clinical Bottom Line:There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

scholarly journals Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability

2017 ◽  
Vol 52 (7) ◽  
pp. 629-635 ◽  
Author(s):  
Erik A. Wikstrom ◽  
Kyeongtak Song ◽  
Ashley Lea ◽  
Nastassia Brown
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Balance Test ◽  
Physically Active ◽  
Lateral Ankle ◽  
Massage Treatment ◽  
Eyes Open ◽  
University Setting ◽  
Stimulation Of

Context:  One of the major concerns after an acute lateral ankle sprain is the potential for development of chronic ankle instability (CAI). The existing research has determined that clinician-delivered plantar massage improves postural control in those with CAI. However, the effectiveness of self-administered treatments and the underlying cause of any improvements remain unclear. Objectives:  To determine (1) the effectiveness of a self-administered plantar-massage treatment in those with CAI and (2) whether the postural-control improvements were due to the stimulation of the plantar cutaneous receptors. Design:  Crossover study. Setting:  University setting. Patients or Other Participants:  A total of 20 physically active individuals (6 men and 14 women) with self-reported CAI. Intervention(s):  All participants completed 3 test sessions involving 3 treatments: a clinician-delivered manual plantar massage, a patient-delivered self-massage with a ball, and a clinician-delivered sensory brush massage. Main Outcome Measure(s):  Postural control was assessed using single-legged balance with eyes open and the Star Excursion Balance Test. Results:  Static postural control improved (P ≤ .014) after each of the interventions. However, no changes in dynamic postural control after any of the interventions were observed (P > .05). No differences were observed between a clinician-delivered manual plantar massage and either a patient-delivered self-massage with a ball or a clinician-delivered sensory brush massage in any postural-control outcome. Conclusions:  In those with CAI, single 5-minute sessions of traditional plantar massage, self-administered massage, and sensory brush massage each resulted in comparable static postural-control improvements. The results also provide empirical evidence suggesting that the mechanism for the postural-control improvements is the stimulation of the plantar cutaneous receptors.

Altered Plantar-Receptor Stimulation Impairs Postural Control in Those With Chronic Ankle Instability

2012 ◽  
Vol 21 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Patrick O. McKeon ◽  
Alex J. Stein ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Physically Active ◽  
Plantar Surface ◽  
Eyes Closed ◽  
Eyes Open ◽  
Sensorimotor Mechanisms ◽  
Control Sham

Context:Postural control as assessed via time-to-boundary (TTB) measures has been shown to be impaired in those with chronic ankle instability (CAI). Foot orthotics have been shown to improve postural control, although it is not clear if this is via mechanical or sensorimotor mechanisms.Objective:To assess the effect of textured shoe inserts that provide no mechanical support on postural control as assessed by TTB measures in subjects with CAI.Design:A crossover design to examine the effects of a textured insole on postural control in individuals with unilateral CAI. The independent variables were vision (eyes open, eyes closed) and texture (textured insole, sham insole, control).Setting:Laboratory.Participants:20 physically active individuals, 12 men, 8 women, age 18–45 y (21.5 ± 5.51) with self-reported CAI.Intervention:Each subject balanced in shod single-limb stance with eyes open and eyes closed under 3 conditions (control, sham, and textured insole). The order of testing under the 3 shoe conditions and 2 vision conditions was counterbalanced.Main Outcome Measures:The mean of TTB minima and the standard deviation of TTB minima in the mediolateral (ML) and anteroposterior directions.Results:There were significant reductions in TTB ML magnitude and variability found in the textured condition compared with the control and sham conditions. In the textured condition, subjects failed significantly more trials than any other condition.Conclusions:Stimulating the plantar surface of the foot, via a textured insole, has an effect in the broad spectrum of postural-control maintenance in individuals with CAI.

scholarly journals Effects of Dry Needling on Neuromuscular Control of Ankle Stabilizer Muscles and Center of Pressure Displacement in Basketball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

2021 ◽  
Vol 18 (4) ◽  
pp. 2092
Author(s):  
Luis López-González ◽  
Deborah Falla ◽  
Irene Lázaro-Navas ◽  
Cristina Lorenzo-Sánchez-Aguilera ◽  
Isabel Rodríguez-Costa ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postural Control ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Neuromuscular Control ◽  
Chronic Ankle Instability ◽  
Dry Needling ◽  
Basketball Players ◽  
Randomized Controlled

This study aimed to compare the effects of dry needling (DN) versus placebo DN applied to the peroneus longus (PL) and tibialis anterior (TA) on neuromuscular control and static postural control in basketball players with chronic ankle instability (CAI). A single-blinded randomized controlled trial was conducted. Thirty-two male and female basketball players with CAI were randomly assigned to receive either DN (n = 16) or placebo DN (n = 16). Pre-activation amplitudes of PL and TA were assessed with surface electromyography (EMG) during a dynamic landing test. Center of pressure (CoP) displacement and sway variability in anterior-posterior (AP) and medio-lateral (ML) directions were measured with a force platform during a single leg balance test (SLBT). Measures were obtained prior to a single DN intervention, immediately after, at 48 h, and 1 month after. The DN group displayed a significant increase in PL and TA pre-activation values, which were maintained 1 month later. Significant reductions in the ML and AP displacements and sway variability of CoP were found for the DN group. These results showed improvements in feedback/feed-forward strategies following DN, including enhanced neuromuscular control and static postural control, with the potential to become a convenient and accessible preventive treatment in CAI subjects.

Diminished Plantar Cutaneous Sensation in Patients With Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
Vol 25 (3) ◽  
pp. 117-120
Author(s):  
Christina Jones ◽  
Kyle B. Kosik ◽  
Phillip Gribble ◽  
Matthew C. Hoch
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Healthy Controls ◽  
Clinical Question ◽  
Bottom Line ◽  
Cutaneous Sensation ◽  
History Of

Clinical Question: Do individuals with chronic ankle instability have diminished plantar cutaneous sensation compared to ankle sprain copers or individuals with no history of ankle sprain? Clinical Bottom Line: Patients with chronic ankle instability have diminished plantar cutaneous sensation compared to healthy controls with no history of ankle sprain and ankle sprain copers.

The Effectiveness of Cervical Strengthening in Decreasing Neck-Injury Risk in Wrestling

2017 ◽  
Vol 26 (4) ◽  
pp. 306-310
Author(s):  
Katherine Lee ◽  
James Onate ◽  
Samar McCann ◽  
Tamerah Hunt ◽  
Wilbert Turner ◽  
...  
Keyword(s):  
Injury Risk ◽  
Vital Role ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Level Of Evidence ◽  
Risk Of Injury ◽  
Cervical Musculature ◽  
Based Medicine ◽  
Work Done

Clinical Scenario:In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions. Strengthening of these cervical muscles is clinically considered to play a vital role in being competitive on the wrestling mat. The cervical stability provided by strengthening these muscles may also play a part in injury prevention among wrestlers.Focused Clinical Question:Does increased cervical strength lead to a decreased risk of injury in wrestling?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 4 evidence or higher using the Oxford Centre for Evidence-Based Medicine level of evidence system that investigated the relationship between cervical strength and injury risk in wrestling. No studies were found comparing cervical strength to injury risk in wrestling, but 2 related studies were found and have been included in this critically appraised topic.Clinical Bottom Line:There is poor evidence to support a relationship between cervical strength and injury risk in wrestling.Strength of Recommendation:There is grade C evidence to indicate that increased cervical strength decreases the risk of injury in wrestling.

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