Peroneal Activation Deficits in Persons with Functional Ankle Instability

2009 ◽  
Vol 37 (5) ◽  
pp. 982-988 ◽  
Author(s):  
Riann M. Palmieri-Smith ◽  
J. Ty Hopkins ◽  
Tyler N. Brown
Keyword(s):  
Ankle Sprain ◽  
Muscle Activation ◽  
Ankle Instability ◽  
Cross Sectional Study ◽  
Functional Ankle Instability ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Emg Amplitude ◽  
Muscle Inhibition ◽  
Arthrogenic Muscle Inhibition

Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability. Hypothesis Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes. Results The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 ± 0.185) than in their pathological ankle (0.323 ± 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 ± 0.176 and 0.425 ± 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 ± 1.3) than in their uninjured ankle (EMG, 3.3 ± 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05). Conclusion Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads.

scholarly journals Impact of kinesiophobia on physical function and quality of life in functional ankle instability individuals: an observational study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Prachita P. Walankar ◽  
Vrushali P. Panhale ◽  
Kanchi M. Vyas
Keyword(s):  
Quality Of Life ◽  
Physical Function ◽  
Negative Correlation ◽  
Ankle Instability ◽  
Cross Sectional Study ◽  
Functional Ankle Instability ◽  
Cross Sectional ◽  
Sf 36 ◽  
Related Quality

Abstract Background Functional ankle instability is a common musculoskeletal condition affecting the community. It is characterized by repetitive bouts of giving away, recurrent sprains, and sensation of instability leading to functional deficits in an individual. The present study aimed to assess the influence of kinesiophobia on physical function and quality of life in participants with functional ankle instability. A cross-sectional study was conducted in 30 participants with functional ankle instability. Kinesiophobia was assessed using the 17-item Tampa Scale of Kinesiophobia, physical function using the Foot and Ankle Ability Measure (FAAM) and the FAAM-Sport version (FAAM-S), and quality of life using SF-36. Results The TSK score showed a moderate negative correlation with FAAM-S (r = −0.5, p = 0.005) and a weak negative correlation with SF-36 physical component summary (r = −0.42, p = 0.02). However, TSK showed no significant correlation with FAAM-ADL and SF-36 mental component summary. Conclusion Increased fear of movement, reduced physical function, and health-related quality of life were observed in functional ankle instability individuals. Hence, evaluation of these parameters is imperative in these individuals.

Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

2005 ◽  
Vol 26 (12) ◽  
pp. 1055-1061 ◽  
Author(s):  
Eric D. McVey ◽  
Riann M. Palmieri ◽  
Carrie L. Docherty ◽  
Steven M. Zinder ◽  
Christopher D. Ingersoll
Keyword(s):  
Tibialis Anterior ◽  
Ankle Instability ◽  
H Reflex ◽  
Functional Ankle Instability ◽  
Injured Limb ◽  
Lateral Ankle ◽  
M Wave ◽  
Muscle Inhibition ◽  
Lateral Ankle Ligaments ◽  
Arthrogenic Muscle Inhibition

Background: Functional ankle instability or a subjective report of “giving way” at the ankle may be present in up to 40% of patients after a lateral ankle sprain. Damage to mechanoreceptors within the lateral ankle ligaments after injury is hypothesized to interrupt neurologic feedback mechanisms resulting in functional ankle instability. The altered input can lead to weakness of muscles surrounding a joint, or arthrogenic muscle inhibition. Arthrogenic muscle inhibition may be the underlying cause of functional ankle instability. Establishing the involvement of arthrogenic muscle inhibition in functional ankle instability is critical to understanding the underlying mechanisms or chronic ankle instability. The purpose of this investigation was to determine if arthrogenic muscle inhibition is present in the ankle joint musculature of patients exhibiting unilateral functional ankle instability. Methods: Twenty-nine subjects, 15 with unilateral functional ankle instability and 14 healthy control subjects, consented to participate. Bilateral soleus, peroneal, and tibialis anterior H-reflex and M-wave recruitment curves were obtained. Maximal H-reflex and maximal M-wave values were identified and the H:M ratios were calculated for data analysis. Separate 1 × 2 ANOVA were done for both the functional ankle instability and control groups to evaluate differences between limbs on the H:M ratios. Bonferroni multiple comparison procedures were used for post hoc comparisons ( p ≤ 0.05). Results: The soleus and peroneal H:M ratios for subjects with functional ankle instability were smaller in the injured limb when compared with the uninjured limb (p < 0.05). No limb difference was detected for the tibialis anterior H:M ratio in the functional ankle instability group ( p = 0.904). No side-to-side differences were detected for the H:M ratios in patients reporting no history of ankle injury ( p > 0.05). Conclusions: Depressed H:M ratios in the injured limb suggest that arthrogenic muscle inhibition is present in the ankle musculature of patients exhibiting functional ankle instability. Establishing and using therapeutic techniques to reverse arthrogenic muscle inhibition may reduce the incidence of functional ankle instability.

scholarly journals Lack of Medical Treatment From a Medical Professional After an Ankle Sprain

2019 ◽  
Vol 54 (6) ◽  
pp. 671-675 ◽  
Author(s):  
Tricia Hubbard-Turner
Keyword(s):  
Medical Treatment ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Cross Sectional Study ◽  
Chronic Ankle Instability ◽  
Medical Professional ◽  
Medical Attention ◽  
Ankle Sprains ◽  
Cross Sectional ◽  
Initial Management

Context Despite the prevalence of ankle sprains and the potential for developing chronic ankle instability and ankle osteoarthritis, ankle sprains are often perceived as an innocuous injury. Objective To understand the initial management and treatment sought by patients after a lateral ankle sprain (LAS) and to identify any differences in subjective function and self-reported injury. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants A total of 175 participants with chronic ankle instability (73 men, 102 women; age = 20.9 ± 3.4 years, height = 173.5 ± 13.2 cm, mass = 81.4 ± 24.6 kg) were involved in the study. Main Outcome Measure(s) Participants were administered a questionnaire regarding their initial LAS. All participants also completed the Foot and Ankle Ability Measure (FAAM). The primary questions of interest were (1) Did the participants seek treatment from a medical professional for their initial LAS? (2) Did the participants perform rehabilitation? (3) Was the initial LAS immobilized? and (4) Did the participants use crutches? The other variables measured were scores on the FAAM and the FAAM Sports subscale, total number of ankle sprains, and incidents of giving way. Results Sixty-four percent of participants did not seek medical treatment after their LAS. Those who did not seek medical treatment scored worse on the FAAM (81.21% ± 3.1% versus 89.23% ± 2.8%, P = .03) and the FAAM Sports subscale (72.34% ± 5.3% versus 81.26% ± 3.1%, P = .001). Those not seeking treatment also reported more ankle sprains since the initial injury (4.7 ± 2.4 versus 1.9 ± 0.90, P = .02) and more incidents of giving way each month (3.8 ± 1.9 versus 1.1 ± 0.87, P = .04). Conclusions It is not surprising that those who did not seek medical treatment for their LASs had worse subjective function, more ankle sprains, and more incidents of the ankle giving way. The public needs to be educated on the significance of ankle sprains and the need for medical attention to provide appropriate management. However, we also need to continue to evaluate initial management and rehabilitation to ensure that those who seek treatment receive the best care in order to reduce reinjury rates.

scholarly journals Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097789
Author(s):  
Rodolfo Morales-Avalos ◽  
Adriana Tapia-Náñez ◽  
Mario Simental-Mendía ◽  
Guillermo Elizondo-Riojas ◽  
Michelle Morcos-Sandino ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Crossover Sign ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Morphological Variations ◽  
Pelvic Radiographs ◽  
Center Edge

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

Head Impact Biomechanics in Youth Flag Football: A Prospective Cohort Study

2021 ◽  
pp. 036354652110266
Author(s):  
Landon B. Lempke ◽  
Rachel S. Johnson ◽  
Rachel K. Le ◽  
Melissa N. Anderson ◽  
Julianne D. Schmidt ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Acceleration ◽  
Cross Sectional Study ◽  
Head Impact ◽  
Rotational Acceleration ◽  
Event Type ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Head Impact Biomechanics ◽  
Impact Biomechanics

Background: Youth flag football participation has rapidly grown and is a potentially safer alternative to tackle football. However, limited research has quantitatively assessed youth flag football head impact biomechanics. Purpose: To describe head impact biomechanics outcomes in youth flag football and explore factors associated with head impact magnitudes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We monitored 52 player-seasons among 48 male flag football players (mean ± SD; age, 9.4 ± 1.1 years; height, 138.6 ± 9.5 cm; mass, 34.7 ± 9.2 kg) across 3 seasons using head impact sensors during practices and games. Sensors recorded head impact frequencies, peak linear ( g) and rotational (rad/s2) acceleration, and estimated impact location. Impact rates (IRs) were calculated as 1 impact per 10 player-exposures; IR ratios (IRRs) were used to compare season, event type, and age group IRs; and 95% CIs were calculated for IRs and IRRs. Weekly and seasonal cumulative head impact frequencies and magnitudes were calculated. Mixed-model regression models examined the association between player characteristics, event type, and seasons and peak linear and rotational accelerations. Results: A total of 429 head impacts from 604 exposures occurred across the study period (IR, 7.10; 95% CI, 4.81-10.50). Weekly and seasonal cumulative median head impact frequencies were 1.00 (range, 0-2.63) and 7.50 (range, 0-21.00), respectively. The most frequent estimated head impact locations were the skull base (n = 96; 22.4%), top of the head (n = 74; 17.2%), and back of the head (n = 66; 15.4%). The combined event type IRs differed among the 3 seasons (IRR range, 1.45-2.68). Games produced greater IRs (IRR, 1.24; 95% CI, 1.01-1.53) and peak linear acceleration (mean difference, 5.69 g; P = .008) than did practices. Older players demonstrated greater combined event–type IRs (IRR, 1.46; 95% CI, 1.12-1.90) and increased head impact magnitudes than did younger players, with every 1-year age increase associated with a 3.78 g and 602.81-rad/s2 increase in peak linear and rotational acceleration magnitude, respectively ( P≤ .005). Conclusion: Head IRs and magnitudes varied across seasons, thus highlighting multiple season and cohort data are valuable when providing estimates. Head IRs were relatively low across seasons, while linear and rotational acceleration magnitudes were relatively high.

scholarly journals Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

scholarly journals Factors Associated With Knee Pain and Heel Pain in Youth Soccer Players Aged 8 to 12 Years

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988337 ◽  
Author(s):  
Toshiyuki Iwame ◽  
Tetsuya Matsuura ◽  
Naoto Suzue ◽  
Joji Iwase ◽  
Hirokazu Uemura ◽  
...  
Keyword(s):  
Knee Pain ◽  
Cross Sectional Study ◽  
Heel Pain ◽  
Older Age ◽  
Soccer Players ◽  
Clinical Factors ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Youth Soccer ◽  
Study Participants

Background: Soccer is played by many children younger than 12 years. Despite its health benefits, soccer has also been linked to a high number of sport-related injuries. Purpose: To investigate the relationship between clinical factors and knee or heel pain in youth soccer players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants included 602 soccer players aged 8 to 12 years who were asked whether they had experienced episodes of knee or heel pain. Data were collected on age, body mass index, years of playing soccer, playing position, and training hours per week. Associations of clinical factors with the prevalence of knee or heel pain were examined by univariate and multivariate logistic regression analyses. Results: Episodes of knee and heel pain were reported by 29.4% and 31.1% of players, respectively. Multivariate analyses revealed that older age and more years of playing soccer were significantly and positively associated with the prevalence of knee pain ( P = .037 and P = .015 for trend, respectively) but did not identify any significant associations for heel pain. Conclusion: In this study of youth soccer players, knee pain was associated with older age and more years of play, but heel pain was not significantly associated with any factor.

In Vivo Kinematics of Functional Ankle Instability Patients and Lateral Ankle Sprain Copers During Stair Descent

2019 ◽  
Vol 37 (8) ◽  
pp. 1860-1867 ◽  
Author(s):  
Shengxuan Cao ◽  
Chen Wang ◽  
Xin Ma ◽  
Xu Wang ◽  
Jiazhang Huang ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Functional Ankle Instability ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
In Vivo Kinematics ◽  
Stair Descent

Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

2017 ◽  
Vol 45 (11) ◽  
pp. 2501-2506 ◽  
Author(s):  
Carlos Suarez-Ahedo ◽  
Chengcheng Gui ◽  
Stephanie M. Rabe ◽  
Sivashankar Chandrasekaran ◽  
Parth Lodhia ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Demographic Factors ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chondral Lesion ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Chondral Lesions ◽  
Chondral Damage ◽  
Male Sex

Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. Purpose: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients’ demographic factors such as age and body mass index (BMI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. Results: Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. Conclusion: Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.

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