The Immediate Effects of an Anterior-To-Posterior Talar Mobilization on Neural Excitability, Dorsiflexion Range of Motion, and Dynamic Balance in Patients With Chronic Ankle Instability

2014 ◽  
Vol 23 (4) ◽  
pp. 351-359 ◽  
Author(s):  
Matthew Harkey ◽  
Michelle McLeod ◽  
Ashley Van Scoit ◽  
Masafumi Terada ◽  
Michael Tevald ◽  
...  
Keyword(s):  
Postural Control ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Corticospinal Excitability ◽  
Spinal Reflex ◽  
Control Group ◽  
Joint Mobilization ◽  
Grade Iii

Context:Altered neuromuscular function and decreased dorsiflexion range of motion (DFROM) have been observed in patients with chronic ankle instability (CAI). Joint mobilizations are indicated for restoring DFROM and dynamic postural control, yet it remains unknown if a mobilization can alter neuromuscular excitability in muscles surrounding the ankle.Objective:To determine the immediate effects of a Maitland grade III anterior-to-posterior joint mobilization on spinal-reflex and corticospinal excitability in the fibularis longus (FL) and soleus (SOL), DFROM, and dynamic postural control.Design:Single-blinded randomized control trial.Setting:Research laboratory.Patients:30 patients with CAI randomized into a mobilization (n = 15) or control (n = 15) group.Intervention:Maitland grade III anterior-to-posterior joint mobilization.Main Outcome Measures:Spinal-reflex excitability was measured with the Hoffmann reflex, while corticospinal excitability was evaluated with transcranial magnetic stimulation. DFROM was measured seated with the knee extended, and dynamic postural control was quantified with the Star Excursion Balance Test. Separate 2 × 2 repeated-measures ANOVAs were performed for each outcome measure. Dependent t tests were used to evaluate individual differences within groups in the presence of significance.Results:Spinal-reflex and corticospinal excitability of the SOL and FL were not altered in the mobilization or control group (P > .05). DFROM increased immediately after the mobilization (P = .05) but not in the control group, while dynamic postural control was unchanged in both groups (P > .05).Conclusion:A single joint-mobilization treatment was efficacious at restoring DFROM in participants with CAI; however, excitability of spinal reflex and corticospinal pathways at the ankle and dynamic postural control were unaffected.

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.

Effect of a 2-Week Joint-Mobilization Intervention on Single-Limb Balance and Ankle Arthrokinematics in Those With Chronic Ankle Instability

2014 ◽  
Vol 23 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Matthew C. Hoch ◽  
David R. Mullineaux ◽  
Richard D. Andreatta ◽  
Robert A. English ◽  
Jennifer M. Medina-McKeon ◽  
...  
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Center Of Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Talocrural Joint ◽  
Joint Mobilization ◽  
Multiple Treatment ◽  
Eyes Open

Context:A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.Objective:To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.Design:Repeated measures.Setting:Research laboratory.Participants:12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).Intervention:Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.Main Outcome Measures:Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.Results:No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).Conclusions:The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

scholarly journals Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092737 ◽  
Author(s):  
Christopher J. Holland ◽  
Jonathan D. Hughes ◽  
Mark B.A. De Ste Croix
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Mixed Model ◽  
Female Athletes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Treatment Groups ◽  
Joint Mobilization ◽  
All Treatment

Background: Chronic ankle instability (CAI) is linked to mechanical and functional insufficiencies. Joint mobilization is purported to be effective at treating these deficits. Purpose: To examine the effect of different treatment durations of a grade IV anterior-to-posterior ankle joint mobilization on weightbearing dorsiflexion range of motion (WB-DFROM), posterior talar glide (PG), and dynamic postural control in individuals with CAI. Study Design: Controlled laboratory study. Methods: A total of 48 female athletes (mean age, 22.8 ± 4.8 years) with unilateral CAI participated in this study. Participants were randomly assigned to 1 of 3 treatment conditions: 30 seconds, 60 seconds, and 120 seconds. Treatment was provided to the injured limb on 3 separate occasions 48 hours apart and consisted of a Maitland grade IV anterior-to-posterior talar joint mobilization based on the participant’s initial group assignment. WB-DFROM; PG; and the anterior (ANT), posteromedial (PM), and posterolateral (PL) reach directions of the Star Excursion Balance Test were measured bilaterally before and after each treatment. The uninjured limb acted as a control. Data were analyzed using 2-way mixed-model analyses of variance, and effect sizes were calculated through use of Hedges g. Results: Significant differences were detected after all treatment sessions for all outcome measures ( P ≤ .001) and between treatment groups after sessions 1, 2, and 3 for all outcome measures ( P ≤ .001). Effect sizes were very large or huge for all treatment groups for WB-DFROM, PG, and ANT reach direction. Substantial variation was found in effect sizes for PM and PL measures. Conclusion: Accessory mobilization is an effective treatment to induce acute changes in ankle motion and dynamic postural control in patients with CAI, with longer treatment durations conferring greater improvements. Clinical Relevance: This study adds clarity to the use of joint mobilization treatments and will add to the current clinical practice strategy for patients with CAI.

scholarly journals Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

2019 ◽  
Vol 8 (7) ◽  
pp. 1037 ◽  
Author(s):  
Kyung-Min Kim ◽  
Joo-Sung Kim ◽  
David Cruz-Díaz ◽  
Seungho Ryu ◽  
Minsoo Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Chronic Ankle Instability ◽  
H Reflex ◽  
Corticospinal Excitability ◽  
Spinal Reflex ◽  
Control Group ◽  
Neural Excitability ◽  
Ankle Muscles

The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.

Erratum: Harkey et al (2014)

2015 ◽  
Vol 24 (2) ◽  
pp. 197
Keyword(s):  
Range Of Motion ◽  
Ankle Instability ◽  
Dynamic Balance ◽  
Chronic Ankle Instability ◽  
Correct Version ◽  
Balance Test ◽  
Neural Excitability ◽  
Joint Mobilization ◽  
Star Excursion Balance Test

In Table 2 in the article by Harkey M, McLeod M, Van Scoit A, et al, “The Immediate Effects of an Anterior-to-Posterior Talar Mobilization on Neural Excitability, Dorsiflexion Range of Motion, and Dynamic Balance in Patients With Chronic Ankle Instability,” in J Sport Rehabil. 23(4):351–359, the composite and anterior scores for the Star Excursion Balance Test in the joint-mobilization group were transposed. Printed here is the correct version of the table.

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.

Effects of a 4-Week Dynamic-Balance-Training Program Supplemented With Graston Instrument-Assisted Soft-Tissue Mobilization for Chronic Ankle Instability

2012 ◽  
Vol 21 (4) ◽  
pp. 313-326 ◽  
Author(s):  
Jessica L. Schaefer ◽  
Michelle A. Sandrey
Keyword(s):  
Soft Tissue ◽  
Postural Control ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Ankle Instability ◽  
Dynamic Balance ◽  
Plantar Flexion ◽  
Balance Training ◽  
Chronic Ankle Instability ◽  
Soft Tissue Mobilization

Context:A dynamic-balance-training (DBT) program supplemented with the Graston instrument-assisted soft-tissue mobilization (GISTM) technique has not been evaluated collectively as a treatment in subjects with chronic ankle instability (CAI).Objective:To examine the effects of GISTM in conjunction with a DBT program on outcomes associated with CAI, including pain and disability, range of motion (ROM), and dynamic postural control.Design:Pretest/posttest, repeated measures.Setting:High school and a Division I mid-Atlantic university.Participants:Thirty-six healthy, physically active individuals (5 female, 31 male; age 17.7 ± 1.9 y; height 175.3 ± 14.6 cm) with a history of CAI as determined by an ankle-instability questionnaire volunteered to be in this study.Interventions:Subjects were randomly assigned to 1 of 3 intervention groups: both treatments (DBT/GISTM, n = 13), DBT and a sham GISTM treatment (DBT/GISTM-S, n = 12), or DBT and control—no GISTM (DBT/C, n = 11). All groups participated in a 4-wk DBT program consisting of low-impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 min before performing the DBT program. Pretest and posttest measurements included the Foot and Ankle Ability Measure (FAAM), FAAM Sport, the visual analog scale (VAS), ankle ROM in 4 directions, and the Star Excursion Balance Test (SEBT) in 3 directions.Main Outcome Measures:FAAM and FAAM-Sport scores, VAS, goniometric ROM (plantar flexion, dorsiflexion, inversion, eversion), and SEBT (anterior, posteromedial, posterolateral).Results:Subjects in all groups posttest demonstrated an increase in FAAM, FAAM Sport, ROM, and SEBT in all directions but not in VAS, which decreased. No other results were significant.Conclusion:For subjects with CAI, dynamic postural control, ROM, pain and disability improved pretest to posttest regardless of group membership, with the largest effects found in most measures in the DBT/GISTM group.

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