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.

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.

scholarly journals Changes in Dorsiflexion and Dynamic Postural Control After Mobilizations in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 54 (4) ◽  
pp. 403-417 ◽  
Author(s):  
Robert A. Vallandingham ◽  
Stacey L. Gaven ◽  
Cameron J. Powden
Keyword(s):  
Systematic Review ◽  
Postural Control ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Intervention Group ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Quality Level ◽  
Methodologic Quality ◽  
Evidence Database

Objective To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability. Data Sources Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017. Study Selection Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs). Data Extraction Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons. Data Synthesis We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%–80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P &lt; .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = −0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = −0.12, 0.87; P = .14) analyses. Conclusions We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.

scholarly journals Evaluation of Joint Position Recognition Measurement Variables Associated With Chronic Ankle Instability: A Meta-Analysis

2012 ◽  
Vol 47 (4) ◽  
pp. 444-456 ◽  
Author(s):  
Jennifer M. Medina McKeon ◽  
Patrick O. McKeon
Keyword(s):  
Ankle Instability ◽  
Meta Analysis ◽  
Plantar Flexion ◽  
Absolute Error ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Control Group ◽  
Neutral Position ◽  
Joint Position ◽  
Standard Deviations

Objective To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI). Data Sources We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals. Study Selection Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes. Data Extraction Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study. Data Synthesis Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5°/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.

Is chronic ankle instability associated with impaired muscle strength? Ankle, knee and hip muscle strength in individuals with chronic ankle instability: a systematic review with meta-analysis

2020 ◽  
Vol 54 (14) ◽  
pp. 839-847 ◽  
Author(s):  
Nafiseh Khalaj ◽  
Bill Vicenzino ◽  
Luke James Heales ◽  
Michelle D Smith
Keyword(s):  
Systematic Review ◽  
Muscle Strength ◽  
Lower Limb ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Sample Size Calculation ◽  
Chronic Ankle Instability ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Kinetic Chain

ObjectiveDetermine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls.DesignSystematic review with meta-analysis.Data sourceA comprehensive search of PubMed, Cochrane, CINAHL, Web of Science and EMBASE electronic databases from inception to 10 February 2019.Eligibility criteria for selecting studiesCross-sectional and case–control studies were included if they objectively measured lower limb muscle strength in individuals with CAI compared with controls. Risk of bias and quality of included studies were assessed. Data of included studies were extracted, and meta-analysis was conducted where appropriate.Results12 397 unique studies were identified, of which 20 were included and 16 were eligible for meta-analysis. Reviewed studies clearly described the aim/hypothesis and main outcome measure, but most lacked sample size calculation and assessor blinding. Meta-analyses showed individuals with CAI had lower eccentric and concentric evertor strength (30 and 120°/s; Nm; standardised mean difference (SMD) between −0.73 and −0.95), eccentric invertor strength (60 and 120°/s; both Nm and Nm/kg; SMD between −0.61 and −1.37), concentric invertor strength (60 and 120°/s; Nm; SMD=−0.7) and concentric knee extensor strength (SMD=−0.64) compared with control participants. Ankle eccentric dorsiflexor strength was not different between groups. Although pooling was not possible, data from three separate studies indicated that hip flexor, abductor and external rotator strength, but not hip adductor and extensor strength, was lower in individuals with CAI than in control participants.ConclusionIndividuals with CAI have ankle inversion and eversion strength deficits. Our data also point to differences between individuals with CAI and controls in hip and knee strength. These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI.PROSPERO registration numberCRD42016037759.

scholarly journals Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takumi Kobayashi ◽  
Yuta Koshino ◽  
Takahiro Miki
Keyword(s):  
Systematic Review ◽  
Internal Rotation ◽  
Methodological Quality ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Foot And Ankle ◽  
Anterior Displacement ◽  
Foot Posture

Abstract Background To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. Methods A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. Results Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. Conclusions This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

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