Effects of Hip Strengthening on Neuromuscular Control, Hip Strength, and Self-Reported Functional Deficits in Individuals With Chronic Ankle Instability

2018 ◽  
Vol 27 (4) ◽  
pp. 364-370 ◽  
Author(s):  
Brent I. Smith ◽  
Denice Curtis ◽  
Carrie L. Docherty
Keyword(s):  
Strength Training ◽  
Ankle Instability ◽  
External Rotation ◽  
Neuromuscular Control ◽  
Training Group ◽  
Balance Test ◽  
Patient Reported ◽  
Hip Abduction ◽  
Hip Strengthening ◽  
Rotation Strength

Context: Deficits in ankle and hip strength and lower-extremity postural control are associated with chronic ankle instability (CAI). Following strength training, muscle groups demonstrate increased strength. This change is partially credited to improved neuromuscular control, and many studies have investigated ankle protocols for subjects with CAI. The effects of isolating hip musculature in strength training protocols in this population are not well understood. Objective: To examine the effects of hip strengthening on clinical and self-reported outcomes in patients with CAI. Design: Prospective randomized controlled clinical trial. Setting: Athletic training facility. Participants: Twenty-six participants with CAI (12 males and 14 females; age = 20.9 [1.5] y, height = 170.0 [12.7] cm, and mass = 77.5 [17.5] kg) were randomly assigned to training or control groups. Intervention: Participants completed either 4 weeks of supervised hip strengthening (resistance bands 3 times a week) or no intervention. Main Outcome Measures: Participants were assessed on 4 clinical measures (Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; Balance Error Scoring System; hip external rotation strength; and hip abduction strength) and a patient-reported measure (the Foot and Ankle Ability Measure activities of daily living and sports subscales) before and after the 4-week training period. Results: The training group displayed significantly improved posttest measures compared with the control group for hip abduction strength (training: 446.3 [77.4] N, control: 314.7 [49.6] N, P < .01); hip external rotation strength (training: 222.1 [48.7] N, control: 169.4 [34.6] N, P < .01); Star Excursion Balance Test reach in the anterior (training: 93.1% [7.4%], control: 90.2% [7.9%], P < .01), posteromedial (training: 96.3% [8.9%], control: 88.0% [8.8%], P < .01), and posterolateral (training: 95.4% [11.1%], control: 86.6% [9.6%], P < .01) directions; Balance Error Scoring System total errors (training: 9.9 [6.3] errors, control: 21.2 [6.3] errors, P < .01); and the Foot and Ankle Ability Measure-sports score (training: 88.0 [12.6], control: 84.8 [10.9], P < .01). Conclusion: Improved clinical and patient-reported outcomes in the training group suggest hip strengthening is beneficial in the management and prevention of recurrent symptoms associated with CAI.

Does Strength Training for Chronic Ankle Instability Improve Balance and Patient-Reported Outcomes and by Clinically Detectable Amounts? A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lijiang Luan ◽  
Roger Adams ◽  
Jeremy Witchalls ◽  
Charlotte Ganderton ◽  
Jia Han
Keyword(s):  
Strength Training ◽  
Evaluation System ◽  
Ankle Instability ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Neuromuscular Control ◽  
Chronic Ankle Instability ◽  
Cochrane Library ◽  
Minimal Detectable Change ◽  
Patient Reported

Abstract Objective Strength training as a form of exercise therapy has long been used to maintain or promote strength, but its effectiveness as a treatment intervention in chronic ankle instability is not fully understood. The purpose of this study was to evaluate the effects of strength training compared to no exercise and neuromuscular control training on balance and self-reported function in people with chronic ankle instability (CAI). Methods Eight databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, and WanFang) were searched in June 2020. Randomized controlled trials involving strength training conducted on individuals with CAI were included. Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed by using the PEDro scale. In addition, the evaluation system (Grading of Recommendations Assessment, Development and Evaluation [GRADE]) was used to determine the strength of evidence. A total of 554 studies were initially screened, resulting in a final selection of 11 RCTs involving 428 participants, and 8 RCTs were included in the final meta-analysis. Compared with no exercise, strength training demonstrated some benefits in the Star Excursion Balance Test (SEBT) (anterior: weighted mean difference [WMD] = 2.39, 95% CI = 0.60–4.18; posteromedial: WMD = 3.30, 95% CI = 0.24–6.35; posterolateral: WMD = 2.97, 95% CI = 0.37–5.57), but these intervention results did not reach the minimal detectable change values. Conclusions Available evidence showed that, compared with controls, strength training did not produce any minimal detectable changes on SEBT or Foot and Ankle Ability Measure scores in individuals with CAI. Clinicians should use strength training cautiously for improving balance and symptoms in CAI.

scholarly journals Clinical evaluation of manual stress testing, stress ultrasound and 3D stress MRI in chronic mechanical ankle instability

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Markus Wenning ◽  
Dominic Gehring ◽  
Thomas Lange ◽  
David Fuerst-Meroth ◽  
Paul Streicher ◽  
...  
Keyword(s):  
Stress Testing ◽  
Ankle Instability ◽  
Tilt Test ◽  
Diagnostic Study ◽  
Mechanical Instability ◽  
Subjective Character ◽  
Balance Test ◽  
Research And Practice ◽  
Cutoff Values ◽  
Patient Reported

Abstract Background Chronic ankle instability (CAI) arises from the two etiological factors of functional (FAI) and mechanical ankle instability (MAI). To distinguish the contributions of the two etiologies, it is necessary to quantitively assess functional and mechanical deficits. Validated and reproducible assessment of mechanical instability remains a challenge in current research and practice. Physical examination, stress sonography and a novel 3D stress MRI have been used, while stress radiography has been called into question and arthrometry is limited to research purposes. The interaction of these primarily mechanical measurements with the functional and subjective components of CAI are subject to debate. The aim of this study was the evaluation of the clinical and biomechanical preferences of the three different methods in the diagnosis of MAI. Methods In this cross-sectional diagnostic study, we compared three different diagnostic approaches to mechanical ankle instability: (1) manual stress testing (anterior drawer test [ADT] and talar tilt test [TTT]), (2) stress sonography and (3) 3D stress MRI (3SAM) The latter includes quantification of 3D cartilage contact area (CCA) in plantarflexion-supination compared to neutral-null position. We applied these measurements to a cohort of patients suffering from chronic mechanical ankle instability (n = 25) to a matched cohort of healthy controls (n = 25). Perceived instability was assessed using the Cumberland Ankle Instability Tool (CAIT) and Forgotten Joint Score (FJS). Functional deficits were measured using postural sway and the y-Balance test. Results Significant differences between the two groups (single-factor “group” ANOVA, p < 0.05) were found in all of the mechanical assessments with strong effect sizes. Spearman’s correlations were strong for CAIT and manual stress testing (TTT rho = − 0.83, ADT rho = − 0.81), 3D stress MRI (rho = − 0.53) and stress sonography (TTT rho = − 0.48, ADT rho = − 0.44). Furthermore, the correlation between manual stress testing and CCA in the fibulotalar articulation (CCAFT) was strong (rho = 0.54) and the correlations to stress sonography were moderate (ADT rho = 0.47 and TTT rho = 0.43). The calculation of cutoff values revealed a distance of > 5.4 mm increase in ligament length during stress sonography (sensitivity 0.92, specificity 0.6) and > 43% loss of articulating surface in the fibulotalar joint (CCAFT in supination-plantarflexion using 3SAM, sensitivity 0.71, specificity 0.8) as potential cutoff values for diagnosing MAI. Conclusions Manual stress testing showed to be a valuable method of identifying mechanical ankle instability. However, due to is subjective character it may overvalue patient-reported instability as a factor which explains the high correlation to the CAIT-score, but this may also reduce its value in diagnosing the isolated mechanical quality of the joint. Thus, there is a persisting need for objective and reproducible alternatives focusing on MAI. According to our results, 3D stress MRI and stress sonography represent valuable alternatives and may be used to quantitively assess mechanical ankle instability in research and practice. Trial registration German Registry of Clinical Trials # DRKS00016356, registered on 05/11/2019.

Relationships between Knee Valgus, Hip-Muscle Strength, and Hip-Muscle Recruitment during a Single-Limb Step-Down

2009 ◽  
Vol 18 (1) ◽  
pp. 104-117 ◽  
Author(s):  
John H. Hollman ◽  
Barbara E. Ginos ◽  
Jakub Kozuchowski ◽  
Amanda S. Vaughn ◽  
David A. Krause ◽  
...  
Keyword(s):  
Muscle Strength ◽  
External Rotation ◽  
Frontal Plane ◽  
Gluteus Maximus ◽  
Knee Valgus ◽  
Outcome Measurements ◽  
Hip Muscle ◽  
Hip Abduction ◽  
Step Down ◽  
Rotation Strength

Context:Reduced strength and activation of hip muscles might correlate with increased weight-bearing knee valgus.Objective:To describe relationships among frontal-plane hip and knee angles, hip-muscle strength, and electromyographic (EMG) recruitment in women during a step-down.Design:Exploratory study.Setting:Laboratory.Participants:20 healthy women 20 to 30 years of age.Interventions:Frontal-plane hip and knee angles were measured. Gluteus maximus and medius recruitment were examined with surface EMG. Hip-abduction and -external-rotation strength were quantified with handheld dynamometry.Main Outcome Measurements:The authors analyzed correlation coefficients between knee and hip angles, gluteus maximus and medius EMG, and hip-abduction and -external-rotation strength.Results:Hip-adduction angles (r = .755, P = .001), gluteus maximus EMG (r = −.451, P = .026), and hip-abduction strength (r = .455, P = .022) correlated with frontal-plane projections of knee valgus.Conclusions:Gluteus maximus recruitment might have greater association with reduced knee valgus in women than does external-rotation strength during step-down tasks. Gluteus medius strength might be associated with increased knee valgus.

scholarly journals Hip Muscle Activity During 3 Side-Lying Hip-Strengthening Exercises in Distance Runners

2012 ◽  
Vol 47 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Joseph M. McBeth ◽  
Jennifer E. Earl-Boehm ◽  
Stephen C. Cobb ◽  
Wendy E. Huddleston
Keyword(s):  
Muscle Activity ◽  
Repeated Measures ◽  
External Rotation ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Electromyographic Activity ◽  
Maximal Voluntary Isometric Contraction ◽  
Strengthening Exercises ◽  
Hip Abduction ◽  
Hip Strengthening

Context: Lower extremity overuse injuries are associated with gluteus medius (GMed) weakness. Understanding the activation of muscles about the hip during strengthening exercises is important for rehabilitation. Objective: To compare the electromyographic activity produced by the gluteus medius (GMed), tensor fascia latae (TFL), anterior hip flexors (AHF), and gluteus maximus (GMax) during 3 hip-strengthening exercises: hip abduction (ABD), hip abduction with external rotation (ABD-ER), and clamshell (CLAM) exercises. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: Twenty healthy runners (9 men, 11 women; age = 25.45 ± 5.80 years, height = 1.71 ± 0.07 m, mass = 64.43 ± 7.75 kg) participated. Intervention(s): A weight equal to 5% body mass was affixed to the ankle for the ABD and ABD-ER exercises, and an equivalent load was affixed for the CLAM exercise. A pressure biofeedback unit was placed beneath the trunk to provide positional feedback. Main Outcome Measure(s): Surface electromyography (root mean square normalized to maximal voluntary isometric contraction) was recorded over the GMed, TFL, AHF, and GMax. Results: Three 1-way, repeated-measures analyses of variance indicated differences for muscle activity among the ABD (F3,57 = 25.903, P&lt;.001), ABD-ER (F3,57 = 10.458, P&lt;.001), and CLAM (F3,57 = 4.640, P=.006) exercises. For the ABD exercise, the GMed (70.1 ± 29.9%), TFL (54.3 ± 19.1%), and AHF (28.2 ± 21.5%) differed in muscle activity. The GMax (25.3 ± 24.6%) was less active than the GMed and TFL but was not different from the AHF. For the ABD-ER exercise, the TFL (70.9 ± 17.2%) was more active than the AHF (54.3 ± 24.8%), GMed (53.03 ± 28.4%), and GMax (31.7 ± 24.1 %). For the CLAM exercise, the AHF (54.2 ± 25.2%) was more active than the TFL (34.4 ± 20.1%) and GMed (32.6 ± 16.9%) but was not different from the GMax (34.2 ± 24.8%). Conclusions: The ABD exercise is preferred if targeted activation of the GMed is a goal. Activation of the other muscles in the ABD-ER and CLAM exercises exceeded that of GMed, which might indicate the exercises are less appropriate when the primary goal is the GMed activation and strengthening.

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.

The Relationship Between Hip Strength and the Y Balance Test

2018 ◽  
Vol 27 (5) ◽  
pp. 445-450 ◽  
Author(s):  
Benjamin R. Wilson ◽  
Kaley E. Robertson ◽  
Jeremy M. Burnham ◽  
Michael C. Yonz ◽  
Mary Lloyd Ireland ◽  
...  
Keyword(s):  
Linear Regression ◽  
Test Performance ◽  
External Rotation ◽  
Linear Regression Analysis ◽  
Balance Performance ◽  
Balance Test ◽  
Hip Strength ◽  
Hip Abduction ◽  
The Relationship ◽  
Abduction Strength

Context: The Y Balance Test was developed as a test of dynamic postural control and has been shown to be predictive of lower-extremity injury. However, the relationship between hip strength and performance on the Y Balance Test has not been fully elucidated. Objective: The goal of this study was to identify the relationship between components of isometric hip strength and the Y Balance Test, to provide clinicians better guidance as to specific areas of muscle performance to address in the event of poor performance on the Y Balance Test. Design: Laboratory study. Setting: Biomechanics laboratory. Participants: A total of 73 healthy participants (40 males and 33 females) volunteered for this study. Intervention: None. Main Outcome Measures: Participants completed the Y Balance Test on the right leg. The authors then measured peak isometric torque in hip external rotation, abduction, and extension. Correlations were calculated between torque measurements, normalized for mass and Y Balance Test performance. Significant relationships were used in linear regression models to determine which variables were predictive of the Y Balance Test performance. Results: The authors found significant positive correlations between Y Balance Test performance and hip abduction strength. They also found correlations between the Y Balance Test and hip extension and external rotation strengths. Linear regression analysis showed hip abduction to be the only significant predictor of Y Balance performance. Conclusions: The authors found the strongest association between the Y Balance Test and hip abduction strength. They also showed smaller but significant associations with hip extension and external rotation strength. When entered into a linear regression analysis, hip abduction strength was the only significant predictor of Y Balance performance. Using this information, practitioners should look to hip abduction strength when patients exhibit deficits in the Y Balance Test.

scholarly journals Ankle Strength and Force Sense After a Progressive, 6-Week Strength-Training Program in People With Functional Ankle Instability

2012 ◽  
Vol 47 (3) ◽  
pp. 282-288 ◽  
Author(s):  
Brent I. Smith ◽  
Carrie L. Docherty ◽  
Janet Simon ◽  
Joanne Klossner ◽  
John Schrader
Keyword(s):  
Strength Training ◽  
Athletic Training ◽  
Ankle Instability ◽  
Training Group ◽  
Ankle Injuries ◽  
Control Group ◽  
Strength Development ◽  
Functional Ankle Instability ◽  
Group 10 ◽  
Force Sense

Context: Although strength training is commonly used to rehabilitate ankle injuries, studies investigating the effects of strength training on proprioception have shown conflicting results. Objective: To determine the effects of a 6-week strength-training protocol on force sense and strength development in participants with functional ankle instability. Design: Randomized controlled clinical trial. Setting: University athletic training research laboratory. Patients or Other Participants: A total of 40 participants with functional ankle instability were recruited. They were randomly placed into a training group (10 men, 10 women: age  =  20.9 ± 2.2 years, height  =  76.4 ± 16.1 cm, mass  =  173.0 ± 7.9 kg) or control group (10 men, 10 women: age  =  20.2 ± 2.1 years, height  =  78.8 ± 24.5 cm, mass  =  173.7 ± 8.2 kg). Intervention(s): Participants in the training group performed strength exercises with the injured ankle 3 times per week for 6 weeks. The protocol consisted of a combination of rubber exercise bands and the Multiaxial Ankle Exerciser, both clinically accepted strengthening methods for ankle rehabilitation. The progression of this protocol provided increasingly resistive exercise as participants changed either the number of sets or resistance of the Thera-Band or Multiaxial Ankle Exerciser. Main Outcome Measure(s): A load cell was used to measure strength and force sense. Inversion and eversion strength was recorded to the nearest 0.01 N. Force-sense reproduction was measured at 2 loads: 20% and 30% of maximal voluntary isometric contraction. Results: Increases in inversion (F1,38  =  11.59, P &lt; 0.01, ηp2  =  0.23, power  =  0.91) and eversion (F1,38  =  57.68, P &lt; .01, ηp2  =  0.60, power  =  0.99) strength were found in the training group at the posttest when compared with the control group. No significant improvements were noted in force-sense reproduction for either group. Conclusions: Strength training at the ankle increased strength but did not improve force sense.

scholarly journals Comparative Study of Wobble Board and Bosu Ball along with Strength Training on Lower Limb Strength, Dynamic Balance, Agility and Functional Performance of Runners with Lateral Ankle Instability

2021 ◽  
Author(s):  
. Roshni ◽  
Sheetal Kalra ◽  
Sajjan Pal ◽  
Sonia Pawaria ◽  
Joginder Yadav
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Functional Performance ◽  
Ankle Instability ◽  
Dynamic Balance ◽  
T Test ◽  
Subjective Feeling ◽  
Sensorimotor Training ◽  
Balance Test ◽  
Hop Test

Introduction: Chronic ankle instability (CAI) is characterised by a subjective feeling of recurrent instability, continuedepisode of giving way and self-reported disability. A wealth of literature is available reporting causes and risk factors related to CAI,still thereis a lack of understanding regarding rehabilitation procedures. Aim: To compare effect of BOSU ball and wobble board along with strength training on muscle strength, dynamic balance, agility and functional performance in recreational runners with CAI. Materials and Methods: It was an experimental study design conducted at Physiotherapy OPD of SGT Hospital, Gurugram. Data collection was done from July 2019 till October 2019. Analysis and report writing took 2 months i.e from November 2019 till December 2019. 60 male runners in the age group of 18-35 years with CAI were randomly divided into two groups i.e. A (Wobble board) and B (BOSU Ball) with 30 players in each group. All subjects were evaluated for ankle muscle strength, agility, dynamic balance and functional performance as measured by Manual muscle tester, T-test, Y balance test and figure of eight hop test respectively on day one and last day of 3rd and 6th week of intervention. SPSS software version 20.0 was used to analyse result. Mean and Standard deviations were calculated. ANOVA and Student T test was used for analysing inter group differences. Results: The statistical findings in this study postulate that both groups had significantly improved fitness and skill related variables but BOSU ball group showed highly significant improvement compared to wobble board group (p<0.05). Conclusion: The current results support that sensorimotor training can be progressed in difficulty by systematically reducing the base of support with help of BOSU ball.

scholarly journals Four-Week Ankle-Rehabilitation Programs in Adolescent Athletes With Chronic Ankle Instability

2020 ◽  
Vol 55 (8) ◽  
pp. 801-810
Author(s):  
M. Spencer Cain ◽  
Rebecca J. Ban ◽  
Yu-Ping Chen ◽  
Mark D. Geil ◽  
Benjamin M. Goerger ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Balance Test ◽  
Rehabilitation Programs ◽  
Patient Reported ◽  
Hop Test ◽  
Star Excursion Balance Test ◽  
Platform System ◽  
Clinical Measures

Context Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown. Objective To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI. Design Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652). Setting High school athletic training facilities. Patients or Other Participants Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups. Intervention(s) Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises. Main Outcome Measure(s) Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different. Results Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P &lt; .05). However, no intervention group was superior. Conclusions All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

Sign in / Sign up

Export Citation Format

Share Document