Hip Kinematics During a Stop-Jump Task in Patients With Chronic Ankle Instability

Context: Chronic ankle instability (CAI) commonly develops after lateral ankle sprain. Movement pattern differences at proximal joints may play a role in instability. Objective: To determine whether people with mechanical ankle instability (MAI) or functional ankle instability (FAI) exhibited different hip kinematics and kinetics during a stop-jump task compared with “copers.” Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Sixty-three recreational athletes, 21 (11 men, 10 women) per group, matched for sex, age, height, mass, and limb dominance. All participants reported a history of a moderate to severe ankle sprain. The participants with MAI and FAI reported 2 or more episodes of giving way at the ankle in the last year and decreased functional ability; copers did not. The MAI group demonstrated clinically positive anterior drawer and talar tilt tests, whereas the FAI group and copers did not. Intervention(s): Participants performed a maximum-speed approach run and a 2-legged stop jump followed by a maximum vertical jump. Main Outcome Measure(s): An electromagnetic tracking device synchronized with a force plate collected data during the stance phase of a 2-legged stop jump. Hip motion was measured from initial contact to takeoff into the vertical jump. Group differences in hip kinematics and kinetics were assessed. Results: The MAI group demonstrated greater hip flexion at initial contact and at maximum (P = .029 and P = .017, respectively) and greater hip external rotation at maximum (P = .035) than the coper group. The MAI group also demonstrated greater hip flexion displacement than both the FAI (P = .050) and coper groups (P = .006). No differences were noted between the FAI and coper groups in hip kinematic variables or among any of the groups in ground reaction force variables. Conclusions: The MAI group demonstrated different hip kinematics than the FAI and coper groups. Proximal joint motion may be affected by ankle joint function and laxity, and clinicians may need to assess proximal joints after repeated ankle sprains.

Download Full-text

Landing Kinematics and Isometric Hip Strength of Individuals With Chronic Ankle Instability

Foot & Ankle International ◽

10.1177/1071100719846085 ◽

2019 ◽

Vol 40 (8) ◽

pp. 969-977 ◽

Cited By ~ 5

Author(s):

Ryan S. McCann ◽

Masafumi Terada ◽

Kyle B. Kosik ◽

Phillip A. Gribble

Keyword(s):

Lower Extremity ◽

Ankle Instability ◽

External Rotation ◽

Peak Torque ◽

Chronic Ankle Instability ◽

Initial Contact ◽

Level Of Evidence ◽

Hip Strength ◽

Hip Kinematics ◽

Rotation Strength

Background: Chronic ankle instability (CAI) is associated with hip strength deficits and altered movement in the lower extremity. However, it remains unclear how hip strength deficits contribute to lateral ankle sprain (LAS) mechanisms. We aimed to compare lower extremity landing kinematics and isometric hip strength between individuals with and without CAI and examine associations between hip kinematics and strength. Methods: Seventy-six individuals completed 5 single-leg landings, during which we collected three-dimensional ankle, knee, and hip kinematics from 200 milliseconds pre–initial contact to 50 milliseconds post–initial contact. We calculated average peak torque (Nm/kg) from 3 trials of isometric hip extension, abduction, and external rotation strength testing. One-way analyses of variance assessed group differences (CAI, LAS coper, and control) in hip strength and kinematics. Pearson product moment correlations assessed associations between hip kinematics and strength. We adjusted the kinematic group comparisons and correlation analyses for multiple comparisons using the Benjamini-Hochberg method. Results: The CAI group exhibited less hip abduction during landing than LAS copers and controls. The CAI group had lower hip external rotation strength than LAS copers ( P = .04, d = 0.62 [0.05, 1.17]) and controls ( P < .01, d = 0.87 [0.28, 1.43]). Effect sizes suggest that the CAI group had deficits in EXT compared with controls ( d = 0.63 [0.06, 1.19]). Hip strength was not associated with hip landing kinematics for any group. Conclusion: Altered landing mechanics displayed by the CAI group may promote mechanisms of LAS, but they are not associated with isometric hip strength. However, hip strength deficits may negatively impact other functional tasks, and they should still be considered during rehabilitation. Level of Evidence: Level III, case-control study.

Download Full-text

Lower Extremity Biomechanics During a Drop-Vertical Jump in Participants With or Without Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-481-15 ◽

2018 ◽

Vol 53 (4) ◽

pp. 364-371 ◽

Cited By ~ 12

Author(s):

C. Collin Herb ◽

Kaitlyn Grossman ◽

Mark A. Feger ◽

Luke Donovan ◽

Jay Hertel

Keyword(s):

Lower Extremity ◽

Motion Capture ◽

Sagittal Plane ◽

Ankle Instability ◽

Vertical Jump ◽

Plantar Flexion ◽

Reaction Force ◽

Chronic Ankle Instability ◽

Vertical Ground Reaction Force ◽

Drop Vertical Jump

Context: Chronic ankle instability (CAI) is a condition characterized by range-of-motion, neuromuscular, and postural-control deficits and subjective disability, reinjury, and posttraumatic osteoarthritis. Differences have been reported in kinematics, kinetics, surface electromyography (EMG), and ground reaction forces during functional tasks performed by those with CAI. These measures are often collected independently, and the research on collecting measures simultaneously during a movement task is limited. Objective: To assess the kinematics and kinetics of the lower extremity, vertical ground reaction force (vGRF), and EMG of 4 shank muscles during a drop–vertical-jump (DVJ) task. Design: Controlled laboratory study. Setting: Motion-capture laboratory. Patients or Other Participants: Forty-seven young, active adults in either the CAI (n = 24) or control (n = 23) group. Intervention(s): Three-dimensional motion capture was performed using an electromagnetic motion-capture system. Lower extremity kinematics, frontal- and sagittal-plane kinetics, vGRF, and EMG of the shank musculature were collected while participants performed 10 DVJs. Main Outcome Measure(s): Means and 90% confidence intervals were calculated for all measures from 100 milliseconds before to 200 milliseconds after force-plate contact. Results: Patients with CAI had greater inversion from 107 to 200 milliseconds postcontact (difference = 4.01° ± 2.55°), smaller plantar-flexion kinematics from 11 to 71 milliseconds postcontact (difference = 5.33° ± 2.02°), greater ankle sagittal-plane kinetics from 11 to 77 milliseconds postcontact (difference = 0.17 ± 0.09 Nm/kg) and from 107 to 200 milliseconds postcontact (difference = 0.23 ± 0.03 Nm/kg), and smaller knee sagittal-plane kinematics from 95 to 200 milliseconds postcontact (difference = 8.23° ± 0.97°) than control participants after landing. The patients with CAI had greater vGRF from 94 to 98 milliseconds postcontact (difference = 0.83 ± 0.03 N/kg) and peroneal activity from 17 to 128 milliseconds postcontact (difference = 10.56 ± 4.52 N/kg) than the control participants. Conclusions: Patients with CAI presented with differences in their landing strategies that may be related to continued instability. Kinematic and kinetic changes after ground contact and greater vGRF may be related to a faulty landing strategy. The DVJ task should be considered for rehabilitation protocols in these individuals.

Download Full-text

Alterations in Knee Kinematics and Dynamic Stability Associated With Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-44.4.350 ◽

2009 ◽

Vol 44 (4) ◽

pp. 350-355 ◽

Cited By ~ 78

Author(s):

Phillip A. Gribble ◽

Richard H. Robinson

Keyword(s):

Dynamic Stability ◽

Repeated Measures ◽

Knee Flexion ◽

Ankle Instability ◽

Plantar Flexion ◽

Reaction Force ◽

Rest Period ◽

Chronic Ankle Instability ◽

Therapeutic Interventions ◽

Initial Contact

Abstract Chronic ankle instability (CAI) has been previously and separately associated with deficits in dynamic stability and proximal joint neuromuscular alterations, but how the 2 factors relate is unclear.Context: To examine the contributions of lower extremity kinematics during an assessment of dynamic stability in participants with CAI.Objective: Repeated-measures case-control design.Design: Research laboratory.Setting: Thirty-eight volunteers were categorized into groups of those with unilateral CAI (10 men, 9 women; age = 20.3 ± 2.9 years, height = 1.77 ± 0.1 m, mass = 76.19 ± 13.19 kg) and those without (10 men, 9 women; age = 23.1 ± 3.9 years, height = 1.72 ± 0.1 m, mass = 72.67 ± 16.0 kg).Patients or Other Participants: Participants performed 10 jump landings on each limb with a rest period between test limbs.Intervention(s): Ankle plantar flexion, knee flexion, and hip flexion were captured with an electromagnetic tracking device at the point of ground impact. Ground reaction force data were used to calculate time to stabilization in the anteroposterior and mediolateral planes.Main Outcome Measure(s): For the anteroposterior plane, we found a group-by-side interaction (P = .003), with the injured side of the CAI group demonstrating reduced dynamic stability. For knee flexion, a group main effect (P = .008) showed that the CAI group landed with less knee flexion than the control group.Results: Diminished dynamic stability and decreased knee flexion angle at initial contact were apparent in the CAI group and may play a role in contributing to CAI. This altered kinematic pattern may influence preventive and therapeutic interventions for those with CAI.Conclusions:

Download Full-text

Injury-Related Fear in Individuals With and Without Chronic Ankle Instability: A Systematic Review

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0015 ◽

2021 ◽

pp. 1-10

Author(s):

Ashley M.B. Suttmiller ◽

Ryan S. McCann

Keyword(s):

Systematic Review ◽

Ankle Sprain ◽

Methodological Quality ◽

Ankle Instability ◽

Evidence Synthesis ◽

Chronic Ankle Instability ◽

Fear Avoidance ◽

Physically Active ◽

Fear Avoidance Beliefs ◽

Fear Avoidance Beliefs Questionnaire

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.

Download Full-text

Comparison of the effect of foot orthoses on Star Excursion Balance Test performance in patients with chronic ankle instability

Prosthetics and Orthotics International ◽

10.1177/0309364618792718 ◽

2018 ◽

Vol 43 (1) ◽

pp. 6-11 ◽

Cited By ~ 3

Author(s):

Faezeh Abbasi ◽

Mahmood bahramizadeh ◽

Mohammad Hadadi

Keyword(s):

Ankle Sprain ◽

Ankle Instability ◽

Dynamic Balance ◽

Chronic Ankle Instability ◽

Textured Surface ◽

Foot Orthoses ◽

Textured Surfaces ◽

Balance Test ◽

Star Excursion Balance Test ◽

Foot Orthosis

Background: Chronic ankle instability as a prevalent consequence of ankle sprain causes various impairments such as balance and postural control deficits. Foot orthoses are one of the common interventions for rehabilitation of patients with chronic ankle instability. Objectives: To investigate the effect of custom-molded foot orthoses with textured surfaces on dynamic balance of chronic ankle instability patients and to compare their effects with other types of foot orthoses. Study design: This is a repeated measure design. Methods: A total of 30 participants were recruited based on the guideline introduced by the International Ankle Consortium. The effect of prefabricated, custom-molded, and custom-molded with textured surface foot orthoses was evaluated on dynamic balance by the Star Excursion Balance Test. Normalized reach distances in anteromedial, medial, and posteromedial directions of the test were computed to be used for statistical analysis. Results: The foot orthoses increased reach distances compared to the no-orthosis conditions in all three directions. The custom-molded with textured surface foot orthosis has significant differences compared with prefabricated foot orthosis ( p = 0.001) in all measured directions and with custom-molded foot orthosis ( p < 0.01) in medial and posteromedial directions. Conclusion: Foot orthoses improve reach distances in patients with chronic ankle instability. Custom-molded with textured surface foot orthosis has a more pronounced effect compared with other foot orthoses. Clinical relevance The custom-molded foot orthosis with textured surface could be an effective device to improve dynamic balance in chronic ankle instability (CAI) patients. It may be considered as an efficient intervention to reduce ankle sprain recurrence in these individuals, although further research should be conducted.

Download Full-text

Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0052 ◽

2019 ◽

Vol 28 (6) ◽

pp. 584-592 ◽

Cited By ~ 1

Author(s):

Nili Steinberg ◽

Roger Adams ◽

Oren Tirosh ◽

Janet Karin ◽

Gordon Waddington

Keyword(s):

Ankle Sprain ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Textured Surface ◽

Ballet Dancers ◽

Discrimination Ability ◽

Board Training ◽

Ankle Proprioception ◽

Balance Board ◽

Group 1

Context:Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation.Objective:To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS).Design:Intervention study.Setting:The Australian Ballet School.Participants:Forty-two ballet dancers, aged 14–18 years.Interventions:Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks.Main Outcome Measures:Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks.Results:Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002).Conclusions:Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.

Download Full-text

Acceleration and Jerk After a Jump Stabilization Task in Individuals With and Without Chronic Ankle Instability

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0104 ◽

2021 ◽

pp. 1-6

Author(s):

Kyle B. Kosik ◽

Kathryn Lucas ◽

Matthew C. Hoch ◽

Jacob T. Hartzell ◽

Katherine A. Bain ◽

...

Keyword(s):

Confidence Interval ◽

Ankle Instability ◽

Dynamic Balance ◽

Vertical Jump ◽

Chronic Ankle Instability ◽

Mean Difference ◽

Vertical Jump Height ◽

Study Participants ◽

Third Derivative ◽

Control Study

Studies have demonstrated that individuals with chronic ankle instability (CAI) have diminished dynamic stability. Jerk-based measures have been utilized to examine dynamic balance because of their ability to quantify changes in acceleration and may provide an understanding of the postural corrections that occur during stabilizing following a jumping task. The purpose of this study was to compare acceleration and jerk following a jump stabilization task between individuals with CAI and the uninjured controls. Thirty-nine participants volunteered to participate in this case control study. Participants completed a jump stabilization task requiring them to jump off 2 feet, touch a marker set at 50% of their maximal vertical jump height, land on a single limb, and maintain balance for 3 seconds. Acceleration was calculated as the second derivative, and jerk was calculated as the third derivative of the displacement of the resultant vector position. Participants with CAI had greater acceleration (mean difference = 55.6 cm/s2; 95% confidence interval, 10.3 to 100.90; P = .017) and jerk compared with the uninjured controls (mean difference = 1804.5 cm/s3; 95% confidence interval, 98.7 to 3510.3; P = .039). These results suggest that individuals with CAI made faster and more frequent active postural control corrections to regain balance following a jump compared with the uninjured controls.

Download Full-text

Altered Ankle Kinematics and Shank-Rear-Foot Coupling in Those with Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.18.3.375 ◽

2009 ◽

Vol 18 (3) ◽

pp. 375-388 ◽

Cited By ~ 86

Author(s):

Lindsay K. Drewes ◽

Patrick O. McKeon ◽

Gabriele Paolini ◽

Patrick Riley ◽

D. Casey Kerrigan ◽

...

Keyword(s):

Outcome Measures ◽

Ankle Instability ◽

External Rotation ◽

Chronic Ankle Instability ◽

Initial Contact ◽

3 Dimensional ◽

Joint Coupling ◽

Ankle Inversion ◽

Ankle Kinematics ◽

Phase Angles

Context:Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).Objective:To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.Design:Case control.Setting:Motion-analysis laboratory.Participants:7 participants (3 men, 4 women) suffering from CAI (age 24.6 ± 4.2 y, height 172.6 ± 9.4 cm, mass 70.9 ± 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 ± 4.5 y, height 168.2 ± 5.9 cm, mass 66.5 ± 9.8 kg).Interventions:Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.Main Outcome Measures:The positions of rear-foot inversion–eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.Results:The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.Conclusions:Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.

Download Full-text