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 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.

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 Gait Biomechanics Following Taping and Bracing in Patients With Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
Vol 29 (3) ◽  
pp. 373-376
Author(s):  
Kimmery Migel ◽  
Erik Wikstrom
Keyword(s):  
Range Of Motion ◽  
Ankle Instability ◽  
External Rotation ◽  
Plantar Flexion ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Case Control Studies ◽  
Bottom Line ◽  
Gait Biomechanics ◽  
Evidence Grade

Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.

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 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 Evaluating and Differentiating Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 617-627 ◽  
Author(s):  
Phillip A. Gribble
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
High Rate ◽  
Diagnostic Tools ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
The Status ◽  
History Of ◽  
Ankle Complex

Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.

scholarly journals Systematic Review of Postural Control and Lateral Ankle Instability, Part I: Can Deficits Be Detected With Instrumented Testing?

2008 ◽  
Vol 43 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Patrick O. McKeon ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Increased Risk ◽  
Clinical Questions

Abstract Objective: To answer the following clinical questions: (1) Is poor postural control associated with increased risk of a lateral ankle sprain? (2) Is postural control adversely affected after acute lateral ankle sprain? (3) Is postural control adversely affected in those with chronic ankle instability? Data Sources: PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway. Study Selection: Only studies assessing postural control measures in participants on a stable force plate performing the modified Romberg test were included. To be included, a study had to address at least 1 of the 3 clinical questions stated above and provide adequate results for calculation of effect sizes or odds ratios where applicable. Data Extraction: We calculated odds ratios with 95% confidence intervals for studies assessing postural control as a risk factor for lateral ankle sprains. Effect sizes were estimated with the Cohen d and associated 95% confidence intervals for comparisons of postural control performance between healthy and injured groups, or healthy and injured limbs, respectively. Data Synthesis: Poor postural control is most likely associated with an increased risk of sustaining an acute ankle sprain. Postural control is impaired after acute lateral ankle sprain, with deficits identified in both the injured and uninjured sides compared with controls. Although chronic ankle instability has been purported to be associated with altered postural control, these impairments have not been detected consistently with the use of traditional instrumented measures. Conclusions: Instrumented postural control testing on stable force plates is better at identifying deficits that are associated with an increased risk of ankle sprain and that occur after acute ankle sprains than at detecting deficits related to chronic ankle instability.

scholarly journals The Effect of Cognitive Task on Postural Control Dynamic Regularity of Athletes With Chronic Ankle Instability When Standing on an Unstable Surface

2021 ◽  
Vol 15 (3) ◽  
pp. 161-168
Author(s):  
Shahab Asgari ◽  
◽  
Esmaeel Ebrahimi Takamjani ◽  
Reza Salehi ◽  
Soheil Mansour Sohani ◽  
...  
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Cognitive Task ◽  
Force Plate ◽  
Sample Entropy ◽  
Chronic Ankle Instability ◽  
Dual Task Condition ◽  
Control Behavior ◽  
Unstable Surface ◽  
Significant Difference

Background and Objectives: Postural control disorder is a common complication in patients with Chronic Ankle Instability (CAI). The present study aimed to investigate the effect of dual cognitive task on postural control behavior with regard to the Center of Pressure (CoP) signal regularity while standing on an unstable surface in athletes with CAI. Methods: In the present study, 58 men participated in two groups of healthy and patients with CAI. The CoP signal was examined in 4 different unstable states on the wobble board located at the center of the force plate. The regularity of the signals recorded from the force plate was investigated using sample entropy in two directions: anterior-posterior and medial-lateral. Results: In both groups, there was a significant difference in CoP’s sample entropy signal when performing a cognitive task with a postural task (P<0.001). There was a significant difference between the two groups in the cognitive task and the single task in the anteroposterior direction while standing on two legs. Conclusion: During dual tasks, the patients with CAI have a more dynamic regularity in the CoP signal than their normal counterparts. In the dual-task condition, more irregularities are observed in the CoP signal of healthy individuals. In unstable conditions, patients with CAI decrease the adaptability of postural control behavior with increasing CoP signal regularity.

Neuromuscular Control Training Does Not Improve Gait Biomechanics in Those With Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
Vol 25 (4) ◽  
pp. 165-169
Author(s):  
Kimmery Migel ◽  
Erik Wikstrom
Keyword(s):  
Ankle Instability ◽  
Balance Training ◽  
Neuromuscular Control ◽  
Chronic Ankle Instability ◽  
Program Completion ◽  
Ankle Sprains ◽  
Bottom Line ◽  
Gait Biomechanics ◽  
Rehabilitation Programs ◽  
Evidence Grade

Introduction/Clinical Scenario: Ankle sprains are highly common within the population and can lead to chronic ankle instability (CAI). Individuals with CAI have both functional and mechanical impairments, which are thought to contribute to maladaptive gait biomechanics. Neuromuscular control and balance training are frequently incorporated into rehabilitation programs, however the effect of balance training on gait biomechanics remains unknown. Focused Clinical Question: Does balance or neuromuscular training improve gait biomechanics in individuals with CAI? Summary of Key Findings: Three studies assessed 4–6 weeks of progressive neuromuscular control training and found no improvements in gait biomechanics. One study found a worsening of eversion position at midstance upon program completion. However, when training was augmented with destabilizing shoes, improvements in dorsiflexion were noted. Clinical Bottom Line: Cumulative findings suggest that neuromuscular control training does not improve gait biomechanics in those with CAI. However, augmentation of programs may be beneficial. Strength of Recommendation: There is high-quality evidence(Grade B) that balance training does not alter gait biomechanics in patients with CAI.

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