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

Author(s):  
Luis López-González ◽  
Deborah Falla ◽  
Irene Lázaro-Navas ◽  
Cristina Lorenzo-Sánchez-Aguilera ◽  
Isabel Rodríguez-Costa ◽  
...  

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.

2020 ◽  
pp. 1-5
Author(s):  
Katherine L. Helly ◽  
Katherine A. Bain ◽  
Phillip A. Gribble ◽  
Matthew C. Hoch

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.


2016 ◽  
Vol 51 (3) ◽  
pp. 233-251 ◽  
Author(s):  
Luke Donovan ◽  
Joseph M. Hart ◽  
Susan A. Saliba ◽  
Joseph Park ◽  
Mark Anthony Feger ◽  
...  

Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective: Randomized controlled clinical trial.Design: Laboratory.Setting: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).Patients or Other Participants: Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s): We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:


Author(s):  
Kyung-Min Kim ◽  
María D. Estudillo-Martínez ◽  
Yolanda Castellote-Caballero ◽  
Alejandro Estepa-Gallego ◽  
David Cruz-Díaz

Chronic Ankle Instability (CAI) is one of the most common musculoskeletal dysfunctions. Stroboscopic vision (SV) training has been deemed to enhance somatosensorial pathways in this population group; nevertheless, until recently no studies have addressed the additional effects of this treatment option to the traditional therapeutic approach. Methods: To evaluate the effectiveness of a partial visual deprivation training protocol in patients with CAI, a randomized controlled trial was carried out. Patients with CAI (n = 73) were randomized into either a balance training, SV training, or a control (no training) group. For participants assigned into training groups, they received 18 training sessions over 6 weeks. The primary outcome was dynamic balance as measured by the Star Excursion Balance Test assessed at baseline and after 6 weeks of intervention. Secondary outcome measures included ankle dorsiflexion range of motion, self-reported instability feeling, and ankle functional status. Results: Better scores in stroboscopic training and balance training groups in all outcome measures were observed in comparison with the control group with moderate to large effect sizes. Stroboscopic training was more effective than neuromuscular training in self-reported instability feeling (cohen’s d = 0.71; p = 0.042) and anterior reach distance of the star excursion balance test (cohen’s d = 1.23; p = 0.001). Conclusions: Preliminary findings from the effects of SV Stroboscopic training in patients with CAI, suggest that SV may be beneficial in CAI rehabilitation.


2020 ◽  
pp. 1-8
Author(s):  
Cameron Bolton ◽  
Sheri Hale ◽  
Todd Telemeco

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.


2017 ◽  
Vol 26 (4) ◽  
pp. 238-249 ◽  
Author(s):  
Cynthia J. Wright ◽  
Shelley W. Linens ◽  
Mary S. Cain

Context:There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability (CAI). In addition, clinicians aiming to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy.Objective:To assess the comparative efficacy of 2 common ankle rehabilitation techniques (wobble-board [WB] balance training and ankle strengthening using resistance tubing [RT]) using patient-oriented outcomes.Design:Randomized controlled trial.Setting:Laboratory.Patients:40 patients with CAI randomized into 2 treatment groups: RT and WB. CAI inclusion criteria included a history of an ankle sprain, recurrent “giving way,” and a Cumberland Ankle Instability Tool (CAIT) score ≤25.Interventions:Participants completed 5 clinician-oriented tests (foot-lift test, time-in-balance, Star Excursion Balance Test, figure-of-8 hop, and side-hop) and 5 patient-oriented questionnaires (CAIT, Foot and Ankle Ability Measure [FAAM], Activities of Daily Living [ADL] and FAAM Sport scale, Short-Form 36 [SF-36], and Global Rating of Function [GRF]). After baseline testing, participants completed 12 sessions over 4 wk of graduated WB or RT exercise, then repeated baseline tests.Main Outcome Measures:For each patient- and clinician-oriented test, separate 2 × 2 RMANOVAs analyzed differences between groups over time (alpha set at P = .05).Results:There was a significant interaction between group and time for the FAAM-ADL (P = .04). Specifically, the WB group improved postintervention (P < .001) whereas the RT group remained the same (P = .29). There were no other significant interactions or significant differences between groups (all P > .05). There were significant improvements postintervention for the CAIT, FAAM-Sport, GRF, SF-36, and all 5 clinician-oriented tests (all P < .001).Conclusions:A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI. Limited evidence indicates that WB training was more effective than RT.Level of Evidence:Therapy, level 1b.


2009 ◽  
Vol 23 (7) ◽  
pp. 609-621 ◽  
Author(s):  
Patrick O McKeon ◽  
Gabriele Paolini ◽  
Christopher D Ingersoll ◽  
D Casey Kerrigan ◽  
Ethan N Saliba ◽  
...  

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