Eccentric Plantar-Flexor Torque Deficits in Participants With Functional Ankle Instability

Abstract Context: Inversion ankle sprains can lead to a chronic condition called functional ankle instability (FAI). Limited research has been reported regarding isokinetic measures for the plantar flexors and dorsiflexors of the ankle. Objective: To examine the isokinetic eccentric torque measures of the ankle musculature in participants with stable ankles and participants with functionally unstable ankles during inversion, eversion, plantar flexion, and dorsiflexion. Design: Case-control study. Setting: Athletic training research laboratory. Patients or Other Participants: Twenty participants with a history of “giving way” were included in the FAI group. Inclusion criteria for the FAI group included a history of at least 1 ankle sprain and repeated episodes of giving way. Twenty participants with no prior history of ankle injury were included in the control group. Intervention(s): Isokinetic eccentric torque was assessed in each participant. Main Outcome Measure(s): Isokinetic eccentric testing was conducted for inversion-eversion and plantar-flexion–dorsiflexion movements. Peak torque values were standardized to each participant's body weight. The average of the 3 trials for each direction was used for statistical analysis. Results: A significant side-by-group interaction was noted for eccentric plantar flexion torque (P < .01). Follow-up t tests revealed a significant difference between the FAI limb in the FAI group and the matched limb in the control group. Additionally, a significant difference was seen between the sides of the control group (P = .03). No significant interactions were identified for eccentric inversion, eversion, or dorsiflexion torques (P > .05). Conclusions: A deficit in plantar flexion torque was identified in the functionally unstable ankles. No deficits were identified for inversion, eversion, or dorsiflexion torque. Therefore, eccentric plantar flexion strength may be an important contributing factor to functional ankle instability.

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Ankle Strength Deficits in a Cohort of College Athletes With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0092 ◽

2019 ◽

Vol 28 (7) ◽

pp. 752-757 ◽

Cited By ~ 1

Author(s):

Bethany Wisthoff ◽

Shannon Matheny ◽

Aaron Struminger ◽

Geoffrey Gustavsen ◽

Joseph Glutting ◽

...

Keyword(s):

Athletic Training ◽

College Athletes ◽

Ankle Instability ◽

Plantar Flexion ◽

Chronic Ankle Instability ◽

Ankle Sprains ◽

Functional Ankle Instability ◽

History Of ◽

Ankle Strength ◽

And Inversion

Context: Lateral ankle sprains commonly occur in an athletic population and can lead to chronic ankle instability. Objective: To compare ankle strength measurements in athletes who have mechanical laxity and report functional instability after a history of unilateral ankle sprains. Design: Retrospective cohort. Setting: Athletic Training Research Lab. Participants: A total of 165 National Collegiate Athletic Association Division I athletes, 97 males and 68 females, with history of unilateral ankle sprains participated. Main Outcome Measures: Functional ankle instability was determined by Cumberland Ankle Instability Tool scores and mechanical ankle instability by the participant having both anterior and inversion/eversion laxity. Peak torque strength measures, concentric and eccentric, in 2 velocities were measured. Results: Of the 165 participants, 24 subjects had both anterior and inversion/eversion laxity and 74 self-reported functional ankle instability on their injured ankle. The mechanical ankle instability group presented with significantly lower plantar flexion concentric strength at 30°/s (139.7 [43.7] N·m) (P = .01) and eversion concentric strength at 120°/s (14.8 [5.3] N·m) (P = .03) than the contralateral, uninjured ankle (166.3 [56.8] N·m, 17.4 [6.2] N·m, respectively). Conclusion: College athletes who present with mechanical laxity on a previously injured ankle exhibit plantar flexion and eversion strength deficits between ankles.

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Comparison of the Effect of 6 Weeks of Balancing and Hopping Strengthening Training on the Kinematics of the Lower Extremities of Athletes with Functional Ankle Instability while Running: A Randomized Controlled Trial

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v28i7.4269 ◽

2020 ◽

Author(s):

Mohammad Hasan Kordi Ashkezari ◽

Mansur Sahebozamani ◽

Abdolhamid Daneshjoo ◽

Hamid Abbasi Bafghi

Keyword(s):

Knee Flexion ◽

Ankle Instability ◽

Controlled Trial ◽

Balance Training ◽

Lower Extremities ◽

Control Group ◽

Initial Contact ◽

Ankle Sprains ◽

Functional Ankle Instability ◽

Significant Difference

Introduction: Ankle sprains are one of the most common sports injuries. This injury can affect the kinematics of the athlete's lower extremities. Therefore, the aim of this study was to compare the effect of 6 weeks of balancing and hopping strengthening training on the kinematics of the lower extremities of athletes with functional ankle instability while running. Methods: The present study was a randomized clinical trial on 36 athletes with functional ankle instability who were randomly divided into three groups: hopping training, balance strengthening and control. The training lasted for six weeks and 3 sessions per week. Kinematic data were recorded by 3D OptiTrack camera while running at 10 km/h before and after training. SPSS software version 20 and ANCOVA test were used to compare the effect of exercises. Results: The results showed that there was a significant difference among the 3 groups in dorsiflexion (P = 0.009), inversion (P = 0.001) and knee flexion (P = 0.001). The results of Benferoni test also showed that hopping training in dorsiflexion, ankle inversion and knee flexion were significantly different from the control group (P = 0.009, P = 0.001, P = 0.001). The results also showed that balance strengthening training in the above movements were significantly different from the control group (P = 0.005, P = 0.002, P = 0.006) and in knee flexion, hoping training showed a significant difference compared to balance strengthening training (P =0.012). The results showed that both hopping and balance strengthening training improved the dorsiflexion, inversion and knee flexion angles in the initial contact in running. However, hopping exercises is better than balance strengthening in improving knee flexion angles. Conclusion: Therefore, according to the presented results, it can be concluded that the rehabilitation course of ankle sprains in athletes, coaches and sports rescue specialists should use a combination of balance strengthening training and hopping as a comprehensive program. In addition, hopping training can be used as a good alternative to balance training in places where there is not enough equipment.

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Effects of TRX Suspension Training on Proprioception and Muscle Strength in Female Athletes with Functional Ankle Instability

Asian Journal of Sports Medicine ◽

10.5812/asjsm.107042 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Ali Khorjahani ◽

Masoud Mirmoezzi ◽

Mina Bagheri ◽

Mohammad Kalantariyan

Keyword(s):

Muscle Strength ◽

Female Athletes ◽

Ankle Instability ◽

Training Group ◽

Test Phase ◽

Control Group ◽

Functional Ankle Instability ◽

Muscle Testing ◽

Significant Difference ◽

Post Test

Background: Functional ankle instability (FAI) is a common consequence of ankle sprain injury, especially in high-impact sports. Objectives: To investigate the effect of six weeks of suspension training with total resistance exercises (TRX) on proprioception and muscle strength in female athletes with FAI. Methods: Thirty female athletes with FAI (age: 21.9 ± 2.2 years, height: 169.3 ± 4.2 cm, and weight: 59.8 ± 6.1 kg) were randomly assigned to two equally numbered groups: TRX training and controls based on inclusion and exclusion criteria. In the pre-test, the anthropometric variables and also proprioception accuracy and muscle strength of subjects were evaluated by joint angle reset test (JART) and manual muscle testing (MMT) in both dorsiflexion and plantarflexion motions. The training group completed three sessions per week with progressive load for six weeks, and each training session lasted 15 - 20 minutes, whilst control subjects continued with their normal activity without special sport activities. After six weeks of training, all tests performed in the pre-test phase were also performed in the post-test phase. The t-test was used for statistic analysis (α ≤ 0.05). Results: The findings showed that TRX training significantly improved the proprioception accuracy (P ≤ 0.001) and muscle strength (P ≤ 0.001) in the training group rather than the control group. No statistically significant difference was found in any of the tests between pre-test and post-test for the control group (P > 0.05). Conclusions: Six weeks of TRX suspension training had a positive effect on strength and proprioception accuracy in female athletes with FAI.

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Surgical Reconstruction with the Remnant Ligament Improves Joint Position Sense as well as Functional Ankle Instability: A 1-Year Follow-Up Study

The Scientific World JOURNAL ◽

10.1155/2014/523902 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Kamizato Iwao ◽

Deie Masataka ◽

Fukuhara Kohei

Keyword(s):

Ankle Instability ◽

Intervention Group ◽

Position Sense ◽

Joint Position Sense ◽

Surgical Reconstruction ◽

Functional Improvement ◽

Control Group ◽

Joint Position ◽

Functional Ankle Instability ◽

Significant Difference

Introduction. Chronic functional instability—characterized by repeated ankle inversion sprains and a subjective sensation of instability—is one of the most common residual disabilities after an inversion sprain. However, whether surgical reconstruction improves sensorimotor control has not been reported to date. The purpose of this study was to assess functional improvement of chronic ankle instability after surgical reconstruction using the remnant ligament.Materials and Methods. We performed 10 cases in the intervention group and 20 healthy individuals as the control group. Before and after surgical reconstruction, we evaluated joint position sense and functional ankle instability by means of a questionnaire.Results and Discussion. There was a statistically significant difference between the control and intervention groups before surgical reconstruction. Three months after surgery in the intervention group, the joint position sense was significantly different from those found preoperatively. Before surgery, the mean score of functional ankle instability in the intervention group was almost twice as low. Three months after surgery, however, the score significantly increased. The results showed that surgical reconstruction using the remnant ligament was effective not only for improving mechanical retensioning but also for ameliorating joint position sense and functional ankle instability.

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Comparison of Electromyographic Activity of Anterior Tibial Muscles and Long Fibular in Athletes With and Without Chronic Ankle Instability

Journal of Health Sciences ◽

10.17921/2447-8938.2020v22n4p260-264 ◽

2020 ◽

Vol 22 (4) ◽

pp. 260-264

Author(s):

Giovanna Piai Cezar ◽

Barbara Pasqualino Fachin ◽

Christiane de Souza Guerino Macedo

Keyword(s):

Surface Electromyography ◽

Ankle Instability ◽

Functional Limitation ◽

Chronic Ankle Instability ◽

Control Group ◽

Electromyographic Activity ◽

Ankle Sprains ◽

Muscle Recruitment ◽

Significant Difference ◽

Anterior Tibial

AbstractChronic ankle instability (ICT) is common in jumping sports, may alter muscle recruitment, result in functional limitations and recurrence of sprains in this joint. The purpose of the study was to compare the muscle recruitment of the anterior tibial and long fibular muscles of athletes with and without chronic ankle instability by means of surface electromyography. Thirty-four athletes were recruited, divided into instability group (GI: n=14) and control group (GC: n=20), of both sexes and from different sport modalities, aged between 18 and 27 years old, history of ankle sprain in the last 12 months and functional limitation established by the Cumberland Ankle Instability (CAIT) questionnaire, the recruitment of the anterior tibial and long fibular muscles was analyzed by surface electromyography during the lunge exercise. The results for GI and GC were, respectively: age 21.3±2.88 and 22.4±3.25, height 1.77±0.10 and 1.74±0.08, CAIT 17[12.2-19] and 29.5 [27-30] (p<0.001). The anterior tibial and long fibular muscle recruitment in GI was 111.1[62.5-165.4] and 68.2±29, respectively and in GC 106.8[79.8-230.5] and 54.4±26.4, without significant difference. ICT did not interfere in the recruitment of the anterior tibial and long fibular muscles during the lunge exercise in athletes. Keywords: Ankle. Sprains and Strains. Health Evaluation. ResumoA instabilidade crônica do tornozelo (ICT) é comum em esportes de saltos, pode alterar o recrutamento muscular, resultar em limitações funcionais e recidivas de entorses nesta articulação. O objeto do estudo foi comparar o recrutamento muscular dos músculos tibial anterior e fibular longo de atletas com e sem instabilidade crônica de tornozelo por meio da eletromiografia de superfície. Foram recrutados 34 atletas, divididos em grupo instabilidade (GI: n=14) e grupo controle (GC: n=20), de ambos os sexos e de diferentes modalidades esportivas, com idade entre 18 e 27 anos, história de entorse de tornozelo nos últimos 12 meses e limitação funcional estabelecida pelo questionário Cumberland Ankle Instability (CAIT), o recrutamento dos músculos tibial anterior e fibular longo foi analisado pela eletromiografia de superfície durante o exercício de agachamento afundo. Os resultados para GI e GC foram, respectivamente: idade 21,3±2,88 e 22,4±3,25, altura 1,77±0,10 e 1,74±0,08, CAIT 17[12,2–19] e 29,5 [27-30] (p<0,001). O recrutamento muscular do tibial anterior e fibular longo no GI foi 111,1[62,5-165,4] e 68,2±29, respectivamente e no GC 106,8[79,8-230,5] e 54,4±26,4, sem diferença significativa. A ICT não interferiu no recrutamento dos músculos tibial anterior e fibular longo durante a realização do exercício de agachamento afundo em atletas. Palavras-chave: Tornozelo. Entorses e Distensões. Avaliação em Saúde

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

Journal of Athletic Training ◽

10.4085/1062-6050-47.3.06 ◽

2012 ◽

Vol 47 (3) ◽

pp. 282-288 ◽

Cited By ~ 32

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 < 0.01, ηp2 = 0.23, power = 0.91) and eversion (F1,38 = 57.68, P < .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.

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Clinical Examination Results in Individuals With Functional Ankle Instability and Ankle-Sprain Copers

Journal of Athletic Training ◽

10.4085/1062-6050-48.3.15 ◽

2013 ◽

Vol 48 (5) ◽

pp. 581-589 ◽

Cited By ~ 22

Author(s):

Cynthia J. Wright ◽

Brent L. Arnold ◽

Scott E. Ross ◽

Jessica Ketchum ◽

Jeffrey Ericksen ◽

...

Keyword(s):

Activities Of Daily Living ◽

Clinical Examination ◽

Ankle Sprain ◽

Daily Living ◽

Ankle Instability ◽

Ankle Sprains ◽

Foot And Ankle ◽

Functional Ankle Instability ◽

History Of ◽

Ability Measure

Context: Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. Objective: To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Intervention(s): Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Main Outcome Measure(s): Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Results: Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). Conclusions: Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

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Effect of a Semirigid Ankle Brace on the In Vivo Kinematics of Patients with Functional Ankle Instability during the Stance Phase of Walking

BioMed Research International ◽

10.1155/2019/4398469 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Gonghao Zhang ◽

Shengxuan Cao ◽

Chen Wang ◽

Xin Ma ◽

Xu Wang ◽

...

Keyword(s):

Stance Phase ◽

Ankle Instability ◽

Control Group ◽

Ankle Sprains ◽

Functional Ankle Instability ◽

Joint Rotation ◽

Gait Kinematics ◽

Computed Tomography Images ◽

Ankle Brace ◽

Ankle Joints

An ankle brace is commonly used by patients after they suffer from initial ankle sprains, reducing the incidents of recurrent sprain or limiting laxity in joints with functional ankle instability (FAI). However, whether the application of a semirigid ankle brace can improve the abnormal ankle gait kinematics of patients with FAI remains unknown. This study aimed to determine the effect of a semirigid ankle brace on the gait kinematics of ankle joints through 3D-2D fluoroscopy image registration. A total of 8 subjects with FAI (3 males and 5 females, 10 feet) as FAI group and 10 subjects without FAI (6 males and 4 females, 10 feet) as control group were enrolled in this study. Three-dimensional bone models created from computed tomography images were matched to fluoroscopic images to compute the 6 degrees of freedom (DOF) talocrural, subtalar, and ankle joints complex kinematics for control and FAI group with or without brace during the stance phase of walking. FAI patients had significantly less ROMs in inversion/eversion rotation of the talocrural and subtalar joint after wearing semirigid ankle brace. Laxity was observed in most of the displacements of the talocrural and subtalar joints in FAI group. The brace partly altered the ankle joints movement in opposite directions, especially joint rotation, and restricted the talocrural and subtalar joints in the dorsiflexion position during the touch down phase of walking.

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Altered Kinematics and Time to Stabilization During Drop-Jump Landings in Individuals With or Without Functional Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-51.2.10 ◽

2016 ◽

Vol 51 (1) ◽

pp. 5-15 ◽

Cited By ~ 15

Author(s):

Cynthia J. Wright ◽

Brent L. Arnold ◽

Scott E. Ross

Keyword(s):

Ankle Sprain ◽

Sagittal Plane ◽

Ankle Instability ◽

Control Group ◽

Initial Contact ◽

Functional Ankle Instability ◽

Jump Landing ◽

Time To Stabilization ◽

History Of ◽

Jump Landings

Context It has been proposed that altered dynamic-control strategies during functional activity such as jump landings may partially explain recurrent instability in individuals with functional ankle instability (FAI). Objective To capture jump-landing time to stabilization (TTS) and ankle motion using a multisegment foot model among FAI, coper, and healthy control individuals. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Participants were 23 individuals with a history of at least 1 ankle sprain and at least 2 episodes of giving way in the past year (FAI), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers), and 23 individuals with no history of ankle sprain or instability in their lifetime (controls). Participants were matched for age, height, and weight (age = 23.3 ± 3.8 years, height = 1.71 ± 0.09 m, weight = 69.0 ± 13.7 kg). Intervention(s) Ten single-legged drop jumps were recorded using a 12-camera Vicon MX motion-capture system and a strain-gauge force plate. Main Outcome Measures Mediolateral (ML) and anteroposterior (AP) TTS in seconds, as well as forefoot and hindfoot sagittal- and frontal-plane angles at jump-landing initial contact and at the point of maximum vertical ground reaction force were calculated. Results For the forefoot and hindfoot in the sagittal plane, group differences were present at initial contact (forefoot: P = .043, hindfoot: P = .004). At the hindfoot, individuals with FAI displayed more dorsiflexion than the control and coper groups. Time to stabilization differed among groups (AP TTS: P < .001; ML TTS: P = .040). Anteroposterior TTS was longer in the coper group than in the FAI or control groups, and ML TTS was longer in the FAI group than in the control group. Conclusions During jump landings, copers showed differences in sagittal-plane control, including less plantar flexion at initial contact and increased AP sway during stabilization, which may contribute to increased dynamic stability.

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The Role of Ankle Strength in Functional Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.6.1.21 ◽

1997 ◽

Vol 6 (1) ◽

pp. 21-29 ◽

Cited By ~ 34

Author(s):

Cynthia M. McKnight ◽

Charles W. Armstrong

Keyword(s):

Range Of Motion ◽

Ankle Instability ◽

Plantar Flexion ◽

Normative Values ◽

Functional Ankle Instability ◽

Full Activity ◽

History Of ◽

Ankle Strength

The purpose of this study was to determine if there were any differences in ankle range of motion, strength, or work between persons with normal ankles (Normal,n= 14), those with functional ankle instability (FAI,n= 15), and those with a history of FAI who have been through formal proprioceptive rehabilitation (Rehab,n= 14). A second puipose was to determine normative values for ankle strength and work measurements using the Biodex® isokinetic system. There were no significant differences between groups for ankle range of motion or for any strength or work measurements. The overall strength/work averages were 11.75/3.42 for plantar flexion, 339/1.48 for dorsiflexion, 3.30/2.40 for inversion, and 2.62/1.79 for eversion. Dorsiflexion torque overall was 31.43% of plantar flexion, and the evertors produced 75.42% of the torque produced by the invertors. It is recommended that clinicians continue to rehabilitate ankles with strength and proprioceptive exercises but do not rely on ankle strength/work testing as the only criteria for determining an athlete's readiness to return to full activity.

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