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.

scholarly journals Altered Walking Neuromechanics in Patients With Chronic Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 684-697 ◽  
Author(s):  
S. Jun Son ◽  
Hyunsoo Kim ◽  
Matthew K. Seeley ◽  
J. Ty Hopkins
Keyword(s):  
Lower Extremity ◽  
Muscle Activation ◽  
Comprehensive Evaluation ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Reaction Force ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Internal Joint ◽  
Knee Abduction

Context The literature on gait kinematics and muscle activation in chronic ankle instability (CAI) is limited. A comprehensive evaluation of all relevant gait measures is needed to examine alterations in gait neuromechanics that may contribute to recurrent sprain. Objective To compare walking neuromechanics, including kinematics, muscle activity, and kinetics (ie, ground reaction force [GRF], moment, and power), between participants with and those without CAI by applying a novel statistical analysis to data from a large sample. Design Controlled laboratory study. Setting Biomechanics laboratory. Patients or Other Participants A total of 100 participants with CAI (49 men, 51 women; age = 22.2 ± 2.3 years, height = 174.0 ± 9.7 cm, mass = 70.8 ± 14.4 kg) and 100 individuals without CAI serving as controls (55 men, 45 women; age = 22.5 ± 3.3 years, height = 173.1 ± 13.3 cm, mass = 72.6 ± 18.7 kg). Intervention(s) Participants performed 5 trials of walking (shod) at a self-selected speed over 2 in-ground force plates. Main Outcome Measure(s) Three-dimensional GRFs, lower extremity joint angles, internal joint moments, joint powers, and activation amplitudes of 6 muscles were recorded during stance. Results Compared with the control group, the CAI group demonstrated (1) increased plantar flexion or decreased dorsiflexion, increased inversion or decreased eversion, decreased knee flexion, decreased knee abduction, and increased hip-flexion angles; (2) increased or decreased inversion, increased plantar flexion, decreased knee extension, decreased knee abduction, and increased hip-extension moments; (3) increased vertical, braking, and propulsive GRFs; (4) increased hip eccentric and concentric power; and (5) altered muscle activation in all 6 lower extremity muscles. Conclusions The CAI group demonstrated a hip-dominant strategy by limiting propulsive forces at the ankle while increasing force generation at the hip. The different walking neuromechanics exhibited by the CAI group could represent maladaptive strategies that developed after the initial sprain or an injurious gait pattern that may have predisposed the participants to their initial injuries. Increased joint loading and altered kinematics at the foot and ankle complex during initial stance could affect the long-term health of the ankle articular cartilage.

Motoneuron Function Does not Change Following Whole-Body Vibration in Individuals With Chronic Ankle Instability

2019 ◽  
Vol 28 (6) ◽  
pp. 614-622 ◽  
Author(s):  
Dana M. Otzel ◽  
Chris J. Hass ◽  
Erik A. Wikstrom ◽  
Mark D. Bishop ◽  
Paul A. Borsa ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Whole Body Vibration ◽  
Position Sense ◽  
Chronic Ankle Instability ◽  
Joint Position Sense ◽  
Whole Body ◽  
Control Group ◽  
Joint Position ◽  
Acute Bout ◽  
Body Vibration

Context: Following a lateral ankle sprain, ∼40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and, therefore, possibly prevent reinjury. Objective: To determine if an acute bout of WBV can improve AMI and proprioception in individuals with CAI. Design and Participants: The authors examined if an acute bout of WBV can improve AMI and proprioception in individuals with CAI with a repeated-measures design. A total of 10 young adults with CAI and 10 age-matched healthy controls underwent a control, sham, and WBV condition in randomized order. Setting: Biomechanics laboratory. Intervention: WBV. Main Outcome Measures: Motoneuron pool recruitment was assessed via Hoffmann reflex (H-reflex) in the soleus. Proprioception was evaluated using ankle joint position sense at 15° and 20° of inversion. Both were assessed prior to, immediately following, and 30 minutes after the intervention (pretest, posttest, and 30mPost, respectively). Results: Soleus maximum H-reflex:M-response (H:M) ratios were 25% lower in the CAI group compared with the control group (P = .03). Joint position sense mean constant error did not differ between groups (P = .45). Error at 15° in the CAI (pretest 0.8 [1.6], posttest 2.0 [2.8], 30mPost 2.0 [1.9]) and control group (pretest 0.8 [2.0], posttest 0.6 [2.9], 30mPost 0.5 [2.1]) did not improve post-WBV. Error at 20° did not change post-WBV in the CAI (pretest 1.3 [1.7], posttest 1.0 [2.4], 30mPost 1.5 [2.2]) or control group (pretest −0.3 [3.0], posttest 0.8 [2.1], 30mPost 0.6 [1.8]). Conclusion: AMI is present in the involved limb of individuals with CAI. The acute response following a single bout of WBV did not ameliorate the presence of AMI nor improve proprioception in those with CAI.

Eversion Strength and Surface Electromyography Measures With and Without Chronic Ankle Instability Measured in 2 Positions

2017 ◽  
Vol 38 (7) ◽  
pp. 769-778 ◽  
Author(s):  
Lindsy Donnelly ◽  
Luke Donovan ◽  
Joseph M. Hart ◽  
Jay Hertel
Keyword(s):  
Surface Electromyography ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Neutral Position ◽  
Healthy Controls ◽  
Healthy Group ◽  
Peroneus Longus ◽  
And Control

Background: Individuals with chronic ankle instability (CAI) have demonstrated strength deficits compared to healthy controls; however, the influence of ankle position on force measures and surface electromyography (sEMG) activation of the peroneus longus and brevis has not been investigated. The purpose of this study was to compare sEMG amplitudes of the peroneus longus and brevis and eversion force measures in 2 testing positions, neutral and plantarflexion, in groups with and without CAI. Methods: Twenty-eight adults (19 females, 9 males) with CAI and 28 healthy controls (19 females, 9 males) participated. Hand-held dynamometer force measures were assessed during isometric eversion contractions in 2 testing positions (neutral, plantarflexion) while surface sEMG amplitudes of the peroneal muscles were recorded. Force measures were normalized to body mass, and sEMG amplitudes were normalized to a resting period. Results: The group with CAI demonstrated less force when compared to the control group ( P < .001) in both the neutral and plantarflexion positions: neutral position, CAI: 1.64 Nm/kg and control: 2.10 Nm/kg) and plantarflexion position, CAI: 1.40 Nm/kg and control: 1.73 Nm/kg). There were no differences in sEMG amplitudes between the groups or muscles ( P > .05). Force measures correlated with both muscles’ sEMG amplitudes in the healthy group (neutral peroneus longus: r = 0.42, P = .03; plantarflexion peroneus longus: r = 0.56, P = .002; neutral peroneus brevis: r = 0.38, P = .05; plantarflexion peroneus longus: r = 0.40, P = .04), but not in the group with CAI ( P > .05). Conclusions: The group with CAI generated less force when compared to the control group during both testing positions. There was no selective activation of the peroneal muscles with testing in both positions, and force output and sEMG activity was only related in the healthy group. Clinical relevance: Clinicians should assess eversion strength and implement strength training exercises in different sagittal plane positions and evaluate for other pathologies that may contribute to reduced eversion strength in patients with CAI. Level of Evidence: Level III, cross-sectional

scholarly journals Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures

2018 ◽  
Vol 53 (6) ◽  
pp. 568-577 ◽  
Author(s):  
Emily A. Hall ◽  
Andrea K. Chomistek ◽  
Jackie J. Kingma ◽  
Carrie L. Docherty
Keyword(s):  
Strength Training ◽  
Repeated Measures ◽  
Performance Test ◽  
Functional Performance ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Training Protocol ◽  
Training Protocols

Context:  Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI). Objective:  To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI. Design:  Randomized controlled clinical trial. Setting:  Athletic training research laboratory. Patients or Other Participants:  Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). Intervention(s):  Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. Main Outcome Measure(s):  Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05. Results:  We observed time-by-group interactions in concentric (P = .02) and eccentric (P = .01) inversion, eccentric eversion (P = .01), concentric (P = .001) and eccentric (P = .03) plantar flexion, BESS (P = .01), SEBT (P = .02), and side hop (P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable. Conclusions:  Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.

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 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.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

2021 ◽  
pp. 107110072199707
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Junichi Sumii ◽  
Akinori Nekomoto ◽  
Nobuo Adachi
Keyword(s):  
Ankle Instability ◽  
Ct Images ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

scholarly journals Bilateral Proprioceptive Evaluation in Individuals With Unilateral Chronic Ankle Instability

2017 ◽  
Vol 52 (4) ◽  
pp. 360-367 ◽  
Author(s):  
Andreia S. P. Sousa ◽  
João Leite ◽  
Bianca Costa ◽  
Rubim Santos
Keyword(s):  
Outcome Measure ◽  
Ankle Instability ◽  
Position Sense ◽  
Chronic Ankle Instability ◽  
Joint Position Sense ◽  
Control Group ◽  
Injured Limb ◽  
History Of ◽  
Ankle Proprioception ◽  
Force Sense

Context:  Despite extensive research on chronic ankle instability, the findings regarding proprioception have been conflicting and focused only on the injured limb. Also, the different components of proprioception have been evaluated in isolation. Objective:  To evaluate bilateral ankle proprioception in individuals with unilateral ankle instability. Design:  Cohort study. Setting:  Research laboratory center in a university. Patients or Other Participants:  Twenty-four individuals with a history of unilateral ankle sprain and chronic ankle instability (mechanical ankle instability group, n = 10; functional ankle instability [FAI] group, n = 14) and 20 controls. Main Outcome Measure(s):  Ankle active and passive joint position sense, kinesthesia, and force sense. Results:  We observed a significant interaction between the effects of limb and group for kinesthesia (F = 3.27, P = .049). Increased error values were observed in the injured limb of the FAI group compared with the control group (P = .031, Cohen d = 0.47). Differences were also evident for force sense (F = 9.31, P &lt; .001): the FAI group demonstrated increased error versus the control group (injured limb: P &lt; .001, Cohen d = 1.28; uninjured limb: P = .009, Cohen d = 0.89) and the mechanical ankle instability group (uninjured limb: P = .023, Cohen d = 0.76). Conclusions:  Individuals with unilateral FAI had increased error ipsilaterally (injured limb) for inversion movement detection (kinesthesia) and evertor force sense and increased error contralaterally (uninjured limb) for evertor force sense.

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