scholarly journals Chronic Ankle Instability Impairs Submaximal Force Steadiness and Accuracy

10.4085/15-20 ◽  
2020 ◽  
Author(s):  
Hyunwook Lee ◽  
S. Jun Son ◽  
Hyunsoo Kim ◽  
Seunguk Han ◽  
Matthew Seeley ◽  
...  
Keyword(s):  
Visual Information ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Feedback Mechanism ◽  
Controlled Study ◽  
Control Group ◽  
Force Output ◽  
Force Steadiness ◽  
Lower Accuracy ◽  
Accuracy Measure

Abstract Context: Patients with chronic ankle instability (CAI) have demonstrated sensorimotor impairments. Submaximal force steadiness and accuracy measure sensory, motor, and visual function via a feedback mechanism, which helps researchers and clinicians to comprehend sensorimotor deficits associated with CAI. Objective: To determine if participants with chronic ankle instability experience deficits in hip and ankle submaximal force steadiness and accuracy compared to healthy controls. Design: A case-controlled study Setting: Research Laboratory Patients and Other Participants: Twenty-one CAI patients and 21 uninjured controls participated in this study. Intervention(s): n/a. Main Outcome Measure(s): Maximal voluntary isometric contraction (MVIC), force steadiness and accuracy (10% and 30% of their MVIC) of ankle evertors, invertors, and hip abductors. The central 10-sec (20–87% of the total time) of the 3 trials were analyzed. An independent t-test was used to assess MVIC. Two-way, 2 × 3, ANOVAs were used to assess force steadiness and accuracy. Results: Relative to controls, the CAI group demonstrated lower accuracy in invertors (p =.0006). Across all motions, the CAI group showed less steadiness (p = .0005) and lower accuracy (p = .0074) than the controls in 10% MVIC. In terms of MVIC, the CAI group showed less force output in hip abduction compared with the control group (p < .0001). Conclusions: CAI patients showed an inability to control ongoing fine force (10% and 30% of their MVIC) through a feedback mechanism during an active test. These findings suggest deficits in sensorimotor control that lead CAI patients to be more susceptible to injury positions since they have difficulty integrating the peripheral information and correcting their movement in relation to visual information.

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.

scholarly journals Strength-Training Protocols to Improve Deficits in Participants With Chronic Ankle Instability: A Randomized Controlled Trial

2015 ◽  
Vol 50 (1) ◽  
pp. 36-44 ◽  
Author(s):  
Emily A. Hall ◽  
Carrie L. Docherty ◽  
Janet Simon ◽  
Jackie J. Kingma ◽  
Joanne C. Klossner
Keyword(s):  
Strength Training ◽  
Visual Analog Scale ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Analog Scale ◽  
Protocol Group ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Hop Test

Context: Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. Objective: To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. Design: Randomized controlled trial. Setting: Athletic training research laboratory. Patients or Other Participants: A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band–protocol group (n = 13 [33%] age = 19.7 ± 2.2 years, height = 172.9 ± 12.8 cm, weight = 69.1 ± 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 [33%], age = 18.9 ± 1.3 years, height = 172.5 ± 5.9 cm, weight = 72.7 ± 14.6 kg), or a control group (n = 13 [33%], age = 20.5 ± 2.1 years, height = 175.2 ± 8.1 cm, weight = 70.2 ± 11.1 kg). Intervention(s): Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions. Main Outcome Measure(s): Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. Results: The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (P &lt; .05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (P &lt; .05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (P &gt; .05). Conclusions: Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.

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 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.

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 Stability of Measurement Outcomes for Voluntary Task Performance in Participants With Chronic Ankle Instability and Healthy Participants

2011 ◽  
Vol 46 (4) ◽  
pp. 366-375 ◽  
Author(s):  
Sara Van Deun ◽  
Karel Stappaerts ◽  
Oron Levin ◽  
Luc Janssens ◽  
Filip Staes
Keyword(s):  
Muscle Activity ◽  
Muscle Activation ◽  
Intervention Program ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Muscle Recruitment ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Recruitment Order

Context: Acceptable measurement stability during data collection is critically important to research. To interpret differences in measurement outcomes among participants or changes within participants after an intervention program, we need to know whether the measurement is stable and consistent. Objective: To determine the within-session stability of muscle activation patterns for a voluntary postural-control task in a group of noninjured participants and a group of participants with chronic ankle instability (CAI). Design: Descriptive laboratory study. Setting: Musculoskeletal laboratory. Patients or Other Participants: Twenty control participants (8 men, 12 women; age = 21.8 ± 2.4 years, height = 164.3 ± 13.4 cm, mass = 68.4 ± 17.9 kg) and 20 participants with CAI (12 men, 8 women; age = 21.2 ± 2.1 years, height = 176 ± 10.2 cm, mass = 71.7 ± 11.3 kg). Intervention(s): Participants performed 4 barefoot standing trials, each of which included a 30-second double-legged stance followed by a 30-second single-legged stance in 3 conditions: with vision, without vision, and with vision on a balance pad. Main Outcome Measure(s): The activity of 7 muscles of the lower limb was measured for the stance task in the 3 different conditions for each trial. The onset of muscle activity and muscle recruitment order were determined and compared between the first and the fourth trials for both groups and for each condition. Results: We found no differences in the onset of muscle activity among trials for both groups or for each condition. The measurement error was 0.9 seconds at maximum for the control group and 0.12 seconds for the CAI group. In the control group, 70% to 80% of the participants used the same muscle recruitment order in both trials. In the CAI group, 75% to 90% used the same recruitment order. Conclusions: Within 1 session, measurement stability for this task was acceptable for use in further research. Furthermore, no differences were found in measurement stability across conditions in the control or CAI groups.

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