Effect of dynamic tape on postural sway in individuals with chronic ankle instability

ObjectiveTo examine the effects of dynamic tape on balance control in subjects with chronic ankle instability (CAI).MethodsThis two group experimental pre- and post-treatment design included 18 individuals with CAI and 18 controls. The single-limb stance test with eyes open and closed, standing on a force plate (Accusway Plus; AMTI) for 30 s, was conducted before, 10 min (T1) and 24 h (T24) after a dynamic tape application over the gastrocnemius muscle. Outcome measurements were: mean sway velocity, sway area (circular area), and standard deviation of the body center of pressure path length in both mediolateral and anteroposterior directions. Individuals with poor (unable to perform a single leg test for at least 30 s, eyes closed) vs. good postural stability, were also compared.ResultsIn both groups, a repeated analysis of variance demonstrated a significant time main effect on sway velocity (F = 14.95; p < 0.001) and path length (F = 14.95; p < 0.001) during eyes closed. Post-hoc analysis revealed a significant decrease in T1 values compared to baseline. When comparing individuals with poor vs good stability amongst the CAI group, a statistically significant interaction was observed between group, time on sway velocity and path length (F = 3.92; p < 0.05) during eyes closed. In the poor postural group, most T1 values were significantly lower than baseline.ConclusionsDynamic tape when applied to posterior calf muscles, enhanced balance control with no difference between CAI individuals and controls. The contribution of the tape was greater in those with poor postural stability.     

The influence of fascial manipulation on function,ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability

BackgroundProprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear.ObjectiveThis study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI.DesignSingle group, pretest-posttest design.MethodsIndividuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance).ResultsThere was a significant improvement in the FADI scores (Z = −3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp ² = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM.ConclusionSince fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.     

Principal component based analysis of biomechanical inter-trial variability in individuals with chronic ankle instability

Background

Biomechanical variability during movement may influence joint stability in individuals with chronic ankle instability (CAI). The purpose of this study was to compare the kinematic and the kinetic inter-trial variability between healthy and CAI individuals.

Methods

Eleven individuals with CAI and 11 matched controls performed five repetitions of a single-leg landing task. Biomechanical data were collected from 100 ms before to 200 ms after touchdown, and were used to calculate touchdown angles, peak angles and moments at the ankle joint in the frontal and sagittal planes. In addition, principal component analyses were used to quantify kinematic and kinetic patterns in the same planes across the 300 ms time window. Five trial averages and inter-trial variability were calculated for all variables for each subject. Independent t-tests were used to compare variables between groups.

Findings

The CAI group displayed greater inter-trial variability for principal component scores in the sagittal and frontal planes. The sagittal plane principal component captured a phase shift in plantar–flexion motion before touchdown, while the frontal plane principal component captured the general magnitude of motion during the entire movement. The CAI group therefore exhibited greater inter-trial variability in the sagittal plane before touchdown and in the frontal plane during the entire movement.

Interpretation

While average motions did not differ between groups, the CAI group displayed greater kinematic inter-trial variability when analyzed with the principal component analysis. More variable joint motions may indicate less dynamic stability in the CAI group, which may originate from greater ligamentous laxity or diminished neuromotor control.     

Bilateral compensatory postural adjustments to a unilateral perturbation in subjects with chronic ankle instability

BackgroundTo evaluate the magnitude of bilateral compensatory postural adjustments in response to a unilateral sudden inversion perturbation in subjects with chronic ankle instability.Methods24 athletes with chronic ankle instability (14 with functional ankle instability, 10 with mechanical ankle instability) and twenty controls participated in this study. The bilateral electromyography of ankle muscles was collected during a unilateral sudden ankle inversion to assess the magnitude of subcortical and voluntary compensatory postural adjustments in both the perturbed and the contralateral limb (support limb).FindingsIn the support position, compared to the control group, the group with functional ankle instability presented decreased compensatory postural adjustments of the tibialis anterior in both the injured and the uninjured limbs in the support position and of the soleus in the uninjured limb. In the side of the perturbation, participants with functional ankle instability presented decreased soleus compensatory postural adjustments in the uninjured limb when compared to the control group. Increased values of soleus and peroneal brevis compensatory postural adjustments were observed in the group with mechanical instability when compared to the control group and to the group with functional ankle instability.InterpretationSubjects with functional ankle instability present bilateral impairment of compensatory postural adjustments of the tibialis anterior in a support position and of the soleus of the uninjured limb regardless of the position. Subjects with mechanical instability present bilateral increase of these adjustments in the peroneal brevis regardless of the position and in the soleus muscle in the side of the perturbation.     

踝关节平衡装置训练对功能性踝关节不稳患者踝关节功能及姿势控制能力的影响

目的:拟探究新型踝关节平衡装置训练对功能性踝关节不稳(FAI)患者踝关节功能及姿势控制能力的影响。方法:将符合纳入条件的FAI患者45名随机分为常规组(n=21)和平衡组(n=24),2组患者分别接受常规功能训练和新型踝关节平衡训练装置训练,8周干预前后,使用Noraxon表面肌电测试系统和Trap-door踝关节内翻诱发装置进行踝周肌肉潜伏期的测试,使用Biodex Systems IV型等速肌力测试系统进行踝关节位置觉和踝内外翻等速肌力的测试,使用Y型平衡测试(YBT)系统进行姿势控制能力的测试,使用坎伯兰踝关节不稳定工具(CAIT)对FAI患者进行评分。结果:干预8周后,平衡组FAI患者的CAIT评分、踝周肌肉潜伏期(腓肠肌内侧头、腓肠肌外侧头、腓骨长肌、胫骨前肌)、峰值踝外翻力矩和姿势控制能力(内收、外展的最大距离)相比于干预前显著改善(P<0.05),且明显优于对照组(P<0.05)。结论:相比于常规功能训练,踝关节平衡装置训练可以更显著地提高FAI患者的姿势控制能力和踝关节的功能。     

Kinematic predictors of star excursion balance test performance in individuals with chronic ankle instability

BackgroundThe Star Excursion Balance Test has identified dynamic postural control deficits in individuals with chronic ankle instability. While kinematic predictors of Star Excursion Balance Test performance have been evaluated in healthy individuals, this has not been thoroughly examined in individuals with chronic ankle instability.MethodsFifteen individuals with chronic ankle instability completed the anterior reach direction of the Star Excursion Balance Test and weight-bearing dorsiflexion assessments. Maximum reach distances on the Star Excursion Balance Test were measured in cm and normalized to leg length. Three-dimensional trunk, hip, knee, and ankle motion of the stance limb were recorded during each anterior reach trial using a motion capture system. Sagittal, frontal, and transverse plane displacement observed from trial initiation to the point of maximum reach was calculated for each joint or segment and averaged for analysis. Pearson product–moment correlations were performed to examine the relationships between kinematic variables, maximal reach, and weight-bearing dorsiflexion. A backward multiple linear regression model was developed with maximal reach as the criterion variable and kinematic variables as predictors.FindingsFrontal plane displacement of the trunk, hip, and ankle and sagittal plane knee displacement were entered into the analysis. The final model (p = 0.004) included all three frontal plane variables and explained 81% of the variance in maximal reach. Maximal reach distance and several kinematic variables were significantly related to weight-bearing dorsiflexion.InterpretationIndividuals with chronic ankle instability who demonstrated greater lateral trunk displacement toward the stance limb, hip adduction, and ankle eversion achieved greater maximal reach.     

Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability

BACKGROUND: Functional ankle instability is defined as the subjective sensation of giving way or feeling joint instability after repeated episodes of ankle sprain. The purpose of this study was to examine the effects of 12-week biomechanical ankle platform system training on static postural stability and ankle reposition sense in subjects with unilateral functional ankle instability. METHODS: Twelve university students (4 females and 8 males) with unilateral functional ankle instability volunteered as subjects. The active and passive reposition senses were assessed using an isokinetic dynamometer. The mean radius of the center of pressure excursion was recorded during single-leg standing with a force platform. A 12-week training program and a progression test for controlling the platform in certain directions and advancing to next training level was given to each subject. Repeated-measures 2-way analyses of variance were conducted to determine differences in postural stability and ankle proprioception between each limb before and after the training period. FINDINGS: The mean radius of center of pressure on unilateral standing and the absolute error from pre-selected ankle angle in the functional ankle instability limb were significantly reduced after 12 weeks of training. INTERPRETATION: These improvements in postural stability appear to reflect improved neuromuscular ability along with enhanced functional joint stability, as ankle proprioception also demonstrated the same positive improvements after training.     

Joint mobilization and static stretching for individuals with chronic ankle instability – A pilot study

Objective

To complete preliminary analysis regarding the effects joint mobilization timing during a 4-week calf stretching intervention on clinician-oriented and patient-oriented outcomes in individuals with chronic ankle instability (CAI). Additionally, a secondary objective was to examine the combined effect of joint mobilization and calf stretching.

Movement variability during single leg jump landings in individuals with and without chronic ankle instability

Background

Repeated episodes of giving way at the ankle may be related to alterations in movement variability.

Methods

Eighty-eight recreational athletes (39 males, 49 females) were placed in 4 groups: mechanically unstable, functionally unstable, copers, and controls based on ankle injury history, episodes of giving way, and joint laxity. Lower extremity kinematics and ground reaction forces were measured during single leg landings from a 50% maximum vertical jump in the anterior, lateral, and medial directions. Ensemble curves of 10 trials were averaged and coefficients of variation were identified for ankle, knee, hip, and trunk motion in 3 planes. A log_e (ln) transformation was performed on the data. Mixed model analyses of variance (ANOVAs) with Tukey post-hoc tests were utilized with Bonferroni corrections to α ≤ 0.008.

Findings

At the knee, controls were more variable than functionally unstable and copers for knee rotation before initial contact, and were more variable during stance than functionally unstable in knee rotation (P ≤ 0.008). Interactions during stance revealed controls were more variable than functionally unstable in lateral jumps for hip flexion, and than mechanically and functionally unstable in hip abduction in the anterior direction (P ≤ 0.008). Controls were more variable than all other groups in hip flexion and than mechanically unstable in hip abduction (P ≤ 0.008).

Interpretation

Individuals with ankle instability demonstrated less variability at the hip and knee compared to controls during single leg jump landings. Inability to effectively utilize proximal joints to perform landing strategies may influence episodes of instability.     

Effect of elastic bandage on postural control in subjects with chronic ankle instability: a randomised clinical trial

Purpose: To report the immediate and prolonged (one week) effects of elastic bandage (EB) on balance control in subjects with chronic ankle instability.

Material and methods: Twenty-eight individuals successfully completed the study protocol, of whom 14 were randomly assigned to the EB group (7 men, 7 women) and 14 were assigned to the non-standardised tape (NST) group (9 men, 5 women). To objectively measure postural sway we used computerised dynamic posturography (CDP) with sensory organisation test (SOT) and unilateral stance (US) test. We analysed the following SOT parameters: the composite SOT score, the composite SOT strategy and the SOT condition 2 and its strategy. In addition, we studied the centre of gravity (COG) sway velocity with open eyes and close eyes during the US test.

Results: Repeated measures ANOVA showed a significant effect for time in composite SOT score (F=?34.98; p=?<0.01), composite SOT strategy (F=?12.082; p=?0.02), and COG sway with open eyes (F=?3.382; p=?0.039) in EB group and NST group. Therefore, there were improvements in balance control after bandage applications (defined as better scores in SOT parameters and decreased COG sway in US test). However, no differences between groups were observed in the most relevant parameters.

Conclusions: This study did not observe differences between EB and NST during the follow-up in the majority of measurements. Several outcome measures for SOT and US tests improved in both groups immediately after bandage applications and after one week of use. EB of the ankle joint has no advantage as compared to the non-standardised tape.

• Implications for rehabilitation

• Elastic bandage (EB) of the ankle joint has no advantage as compared to the non-standardised tape.

• The effects of the bandages could be due to a greater subjective sense of security.

• It is important to be prudent with the use of bandage, since a greater sense of safety could also bring with it a greater risk of injury.

• The application of the bandage on subjects with chronic ankle instability (CAI) should be prolonged and used alongside other physiotherapy treatments.

     

慢性踝关节不稳的诊断与修复

背景：慢性踝关节不稳会对正常的生活造成严重的影响。因此,慢性踝关节不稳得到越来越多的专家重视,而慢性踝关节不稳患者早期合理有效的诊断和针对性的治疗方法的选择在临床上已经成为一个重要的课题。目的：回顾近年来慢性踝关节不稳的诊断及治疗方法的文献研究,为临床实践中慢性踝关节不稳的诊断及合理有效的治疗提供参考和评价标准。方法：计算机检索 PubMed数据库、中国期刊全文数据库（CNKI）、万方和维普数据库有关慢性踝关节不稳的临床及基础实验研究,检索关键词分别为“慢性踝关节,不稳,诊断,康复锻炼,手术方法,研究进展”和“Chronic ankle,Instability,Diagnosis,Rehabilitation exercises,Surgical methods,Research”。共纳入40篇文献进行分析。结果与结论：由于踝关节特殊的解剖结构特征和生物力学优点,在针对慢性踝关节不稳的患者应首先考虑早期的诊断和有效的治疗方法。而治疗方法应综合踝关节的解剖结构特点、生物力学特征、慢性踝关节的发病原因和诊断方法等各方面的因素决定。保守治疗和手术治疗后的康复锻炼对慢性踝关节不稳的恢复起着重大作用。平衡板、倾斜板、登山机的使用是慢性踝关节不稳康复锻炼的有效手段。AOFOS．踝后足和腓骨肌反应时间的应用对踝关节功能恢复的评定有重要意义。关节镜的出现是踝关节的手术治疗中重大的临床研究方向。这对于慢性踝关节不稳的治疗起着显著的效果。     

Immediate effects of vibration biofeedback on ankle kinematics in people with chronic ankle instability

BackgroundPeople with chronic ankle instability are more inverted during initial contact and loading response which may increase the risk of subsequent ankle injuries. Vibration feedback gait retraining causes medial center of pressure shifts but its impact on ankle kinematics remains unknown. The purpose of this study was to understand kinematic ankle changes in people with chronic ankle instability following vibration feedback gait retraining.MethodsNineteen participants with chronic ankle instability walked with vibration feedback for 10 min on a treadmill and for one mile in the real-world. A vibration stimulus occurred at the lower leg when pressure under the 5th metatarsal exceeded a threshold. Three-dimensional kinematics of the ankle were recorded in the lab before and after training. Paired t-tests compared baseline and posttest ankle, hindfoot, and forefoot positions during initial contact and loading response for the lab and real-world conditions.FindingsAfter lab training the ankle (mean difference:-1.68 ± 1.62°, effect size:0.95) and forefoot (mean difference:-1.68 ± 1.67°, effect size:0.92) were more abducted. After real-world training, the ankle (mean difference:-1.19 ± 2.12°, effect size:0.54) and forefoot (mean difference:-1.87 ± 3.00°, effect size:0.63) were more everted. Similarly the ankle (mean difference:-2.37 ± 4.79°, effect size:0.46) and forefoot (mean difference:-2.78 ± 4.91°, effect size:0.51) were more abducted after real-world training.InterpretationVibration feedback decreases inversion and adduction during loading response. However, RW compared to lab training may have more beneficial frontal plane changes for people with chronic ankle instability.     

慢性功能性踝关节不稳患者踝部电流感觉阈值的研究

摘要 目的：探索慢性功能性踝关节不稳患者踝部电流感觉阈值(current perception threshold,CPT)与正常人的差异,及CPT与主观疼痛评分、足踝部功能评分、病程及身体质量指数（body mass index,BMI）的关系。 方法：测量慢性功能性踝关节不稳患者（n=30）外踝部位2000Hz、250Hz、5Hz CPT,与正常值数据库比较,同时测量患者疼痛数字模拟评分,分析CPT与疼痛数字模拟评分的相关性。 结果：慢性功能性踝关节不稳患者外踝部位2000Hz、250Hz、5Hz CPT分别为198.60±74.19、38.66±27.32、21.28±19.28,与正常人比较CPT均降低（P<0.05）。2000Hz、250Hz、5Hz CPT与疼痛数字模拟评分的相关系数为0.159、0.317、0.224,与AOFAS-AHS评分的相关系数为-0.362、-0.483、-0.349,与病程的相关系数为-0.183、0.052、0.057,与BMI的相关系数为0.221、-0.076、0.242,CPT与主观疼痛评分、AOFAS-AHS评分、病程及BMI之间无相关关系（P>0.05）。 结论：慢性功能性踝关节不稳患者踝部CPT降低,提示损伤后的踝部可能存在感觉过敏。CPT与主观疼痛评分、AOFAS-AHS评分、病程及BMI之间无相关关系。     

Investigating the anticipatory postural adjustment phase of gait initiation in different directions in chronic ankle instability patients

Objective

The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions.

Impaired control of weight bearing ankle inversion in subjects with chronic ankle instability

Background

Previous studies have proposed that evertor muscle weakness represents an important factor affecting chronic ankle instability. For research purposes, ankle evertor strength is assessed by means of isokinetic evaluations. However, this methodology is constraining for daily clinical use. The present study proposes to assess ankle evertor muscle weakness using a new procedure, one that is easily accessible for rehabilitation specialists. To do so, we compared weight bearing ankle inversion control between patients suffering from chronic ankle instability and healthy subjects.

Methods

12 healthy subjects and 11 patients suffering from chronic ankle instability conducted repetitions of one leg weight bearing ankle inversion on a specific ankle destabilization device equipped with a gyroscope. Ankle inversion control was performed by means of an eccentric recruitment of evertor muscles. Instructions were to perform, as slow as possible, the ankle inversion while resisting against full body weight applied on the tested ankle.

Results

Data clearly showed higher angular inversion velocity peaks in patients suffering from chronic ankle instability. This illustrates an impaired control of weight bearing ankle inversion and, by extension, an eccentric weakness of evertor muscles.

Interpretation

The present study supports the hypothesis of a link between the decrease of ankle joint stability and evertor muscle weakness. Moreover, it appears that the new parameter is of use in a clinical setting.     

全身性疲劳对功能性踝关节不稳者平衡能力和跳跃落地时踝关节本体感觉的影响

摘要目的：通过比较功能性踝关节不稳（functional ankle instability,FAI）者和健康人群在疲劳前后静态、动态平衡能力及跳跃落地时踝关节本体感觉的差异,探讨全身性疲劳对FAI者平衡能力和本体感觉的影响。方法：单侧FAI者和健康者各31例被纳入研究,并在疲劳前后分别进行了静态、动态平衡测试及跳跃落地时踝关节的本体感觉测试。足底压力中心动摇径、均方根距离、95%包络面积、标准化伸展距离和AUC值等相关指标用于计算与分析。结果：全身性疲劳前,FAI组的静态、动态平衡能力及踝关节的本体感觉均显著低于健康对照组（P<0.05）。全身性疲劳后,FAI组和健康对照组的静态、动态平衡能力以及踝关节的本体感觉均显著降低（P<0.05）,且FAI组的动摇径、均方根距离和95%包络面积增加的幅度均显著大于健康对照组（P<0.05）,在后内侧、后外侧的标准化动态伸展距离及AUC值的降低幅度显著大于健康对照组（P<0.05）。结论：FAI及健康者在全身性运动疲劳后静态、动态平衡能力以及跳跃落地时踝关节的本体感觉均下降,且FAI者静态、动态平衡能力及本体感觉功能下降程度更大。因此,全身性疲劳可能通过降低FAI者的姿势控制和本体感觉,增加了踝关节反复扭伤的风险。     

软式支具对慢性踝关节不稳患者的即时疗效

目的 探讨佩戴踝关节软式支具对慢性踝关节不稳(CAI)患者动、静态平衡功能及步行模式下患侧下肢生物力学的即时疗效。     

Validity of the lower extremity functional movement screen in patients with chronic ankle instability

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI.Key words: Ankle, Chronic ankle instability, Functional movement screen