Swaying to the complex motion of a visual target affects postural sway variability

BackgroundVoluntary shifting body weight in the anteroposterior direction is an important element of daily life activities, such as rising from a chair or initiating a step. In order to accommodate the daily-life challenges of such tasks, voluntary postural sway needs to be flexible and variable.Research questionIn this study we asked how whole-body tracking of a complex visual target motion with the concurrent provision of feedback modulates the variability of voluntary sway.MethodsTwenty young adults (age: 27.10 ± 9.15years, height: 170.73 ± 9.40 cm, mass: 62.84 ± 11.48 kg) performed 132 cycles of voluntary antero-posterior sway, on a force platform, under two conditions: a) self-paced sway and b) swaying while tracking the complex motion of a visual target. Magnitude and temporal structure of variability of postural sway were investigated with the Coefficient of Variance (CoV) and the fractal exponent α, respectively. This analysis was performed for sway cycle duration, amplitude and velocity. The cross-correlation function between the target and sway cycle parameters was computed as a measure of visuo-postural coupling.ResultsThe CoV of sway cycle amplitude, duration and velocity increased during active tracking of the complex target. Fractal exponent α increased for sway cycle amplitude but decreased for cycle duration and remained unchanged for sway velocity. The cross-correlation function revealed a consistent peak at lag+1 indicating an asynchrony between the target and sway cycle duration, while the peak cross-correlation for cycle amplitude was noted at lag 0.SignificanceSwaying to the complex motion of a visual target improves the variability of sway cycle amplitude, at the cost of cycle duration. This is associated with a more synchronous spatial than temporal coupling to the visual target motion. This knowledge could inform the design of postural tracking paradigms as appropriate exercise interventions, for improving voluntary sway in populations with reduced limits of stability (i.e. older adults).     

Foot posture is associated with morphometry of the peroneus longus muscle,tibialis anterior tendon,and Achilles tendon

The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty‐one healthy participants (31 male, 30 female; aged 27.1 ± 8.8 years) underwent gray‐scale musculoskeletal ultrasound examination to determine the anterior‐posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat‐arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait.     

The effect of ankle Kinesio™ taping on ankle joint biomechanics during unilateral balance status among collegiate athletes with chronic ankle sprain

ObjectivesTo determine the effects of ankle Kinesio-taping (KT) on postural sway, lower limb ROM, and muscle activity during a unilateral balance tasks.DesignCase control study design.SettingData were collected at the human movement analysis laboratory.Participants30 collegiate athletes with chronic ankle sprain (11 females and 19 males, 23.91 ± 2.58 years).Main outcome measureHip, knee and ankle joints ranges of motion (ROMs); postural sway area and velocities in both anteroposterior and mediolateral directions; and muscular activity amplitudes (% peak) of lateral and medial gastrocnemius, tibialis anterior and peroneus longus in a 20s single leg balance test in two non-taped (control) and KT (intervention) conditions.ResultsSignificant decrease observed in ankle lateral ROM (p = 0.048, d = 0.52), mediolateral postural sway velocity (p = 0.029, d = 1.25), and peroneus longus activity amplitudes (p = 0.042, d = 0.55) after KT application.ConclusionAcute application of KT among athletes with chronic ankle instability could provide lateral mechanical support to the ankle, potentially decreasing the velocity of frontal plane sway, and decreasing the magnitude of muscle activation. These data suggest that KT may be beneficial for improving static joint stability among individuals with chronic ankle sprain, and thus could be considered an option to allow safe return-to-activity.     

Neuromuscular control of the ankle during pre-landing in athletes with chronic ankle instability: Insights from statistical parametric mapping and muscle co-contraction analysis

ObjectiveThe present study aimed to compare the neuromuscular control of the muscles around the ankle between athletes with CAI and without history of any ankle sprain (Non-CAI) by using statistic parametric mapping (SPM) and co-contraction analyses.DesignCross-sectional study; Setting: Laboratory; Participants: 40 athletes (20 CAI, 20 Non-CAI) were pair-matched for age and gender.Main outcome measuresNeuromuscular control was examined using surface electromyography (EMG) amplitude and muscle co-contraction 200 ms before foot-contact with the ground during a jump-landing task.ResultsThe EMG amplitude of tibialis anterior, peroneus longus, and gastrocnemius medialis were analyzed using statistic parametric mapping. The CAI group exhibited decreased EMG amplitude of peroneus longus during preparation for foot-contact. There were no significant co-contraction differences between groups.ConclusionsOur findings demonstrate that SPM combined with the co-contraction provides a comprehensive EMG analysis to detect the differences of neuromuscular control between athletes with and without chronic ankle instability. Additionally, this finding indicates that CAI contributed to altered neuromuscular control during the pre-landing phase, which may contribute to re-injury mechanisms.     

Effects of initial foot position on postural responses to lateral standing surface perturbations in younger and older adults

BackgroundAn age-related decline in standing balance control in the medio-lateral direction is associated with increased risk of falls. A potential approach to improve postural stability is to change initial foot position (IFP).Research questionsIn response to a lateral surface perturbation, how are lower extremity muscle activation levels different and what are the effects of different IFPs on muscle activation patterns and postural stability in younger versus older adults?MethodsTen younger and ten older healthy adults participated in this study. Three IFPs were tested [Reference (REF): feet were placed parallel, shoulder-width apart; Toes-out with heels together (TOHT): heels together with toes pointing outward; Modified Semi-Tandem (M-ST): the heel of the anterior foot was placed by the big toe of the posterior foot]. Unexpected lateral translations of the standing surface were applied. Electromyographic (EMG) activity of the lower extremity muscles, standard deviation (SD) of the body’s CoM acceleration (SD of CoMAccel), and center of pressure (CoP) sway area were compared across IFPs and age.ResultsActivation levels of the muscles serving the ankle and gluteus medius were greater than for the knee joint muscles and gluteus maximus in the loaded leg across all IFPs in both groups. TOHT showed greater EMG peak amplitude of the soleus and fibularis longus compared to REF, and had smaller SD of CoMAccel and CoP sway area than M-ST. Compared to younger adults, older adults demonstrated lower EMG peak amplitude and delayed peak timing of the fibularis longus and greater SD of CoMAccel and CoP sway area in all IFPs during balance recovery.SignificanceDuring standing balance recovery, ankle muscles and gluteus medius are important active responders to unexpected lateral surface perturbations and a toes-out IFP could be a viable option to enhance ankle muscle activation that diminishes with age to improve postural stability.     

Unilateral jump landing neuromechanics of individuals with chronic ankle instability

ObjectivesTo assess the neuromechanical (kinematic, kinetic and electromyographic (EMG)) differences between individuals with and without chronic ankle instability (CAI) during unilateral jump landing.DesignCase-control study.MethodsKinematic, kinetic and EMG data of 32 participants with CAI and 31 control participants were collected during unilateral side jump landing (SIDE) and unilateral drop landing on three surfaces (even (DROP), unstable (FOAM) and laterally inclined (WEDGE)). Each participant had to complete five trials of each task in a randomised sequence. To compare the neuromechanical differences between groups, a one-dimensional statistical non-parametric mapping analysis was performed.ResultsCompared to the control group, the CAI group exhibited increased biceps femoris muscle activity during the preactivation and landing phases, decreased gluteus medius and peroneus longus muscles activity during the preactivation phase and increased knee extension moment during the landing phase of the WEDGE task. The CAI group also exhibited increased ankle dorsiflexion during the landing phase of the FOAM task and decreased vastus lateralis muscle activity during the preactivation phase of the DROP task. Finally, the CAI group exhibited decreased biceps femoris muscle activity during the preactivation and landing phases and decreased gluteus medius muscle activity during the preactivation phase of the SIDE task compared to the control group.ConclusionsIndividuals with CAI present neuromechanical differences during unilateral jump landing compared to healthy individuals. The results of this study will improve our understanding of underlying deficits associated with CAI and will help researchers and clinicians to better target them during rehabilitation.     

Activation of the hip adductor muscles varies during a simulated weight-bearing task

ObjectiveTo investigate the pattern of muscle activation of the individual hip adductor muscles using a standardised simulated unilateral weight-bearing task.DesignA repeated measures design.SettingLaboratory.Participants20 healthy individuals (11 females, 9 males) participated in the study. Age ranged from 20 to 25 years.Main outcome measurementsSurface electromyography recordings from adductor magnus and adductor longus muscles were taken at levels representing 10–50% of body weight during a simulated weight-bearing task. Electromyography (EMG) data were normalised to maximal voluntary isometric contraction.ResultsThe adductor magnus was recruited at significantly higher levels than the adductor longus muscle during a simulated weight-bearing task performed across 10–50% of body weight (p < 0.01).ConclusionsAdductor magnus and adductor longus muscles are recruited to different extents during a simulated weight-bearing task. This information should be considered when selecting exercises for management and prevention of groin strains. Closed chain exercises with weight-bearing through the lower limb are more likely to recruit the adductor magnus muscle over the adductor longus muscle.     

Lower limb joint-specific contributions to standing postural sway in persons with unilateral lower limb loss

BackgroundIndividuals with lower limb loss are at an increased risk for falls, likely due to impaired balance control. Standing balance is typically explained by double- or single-inverted pendulum models of the hip and/or ankle, neglecting the knee joint. However, recent work suggests knee joint motion contributes toward stabilizing center-of-mass kinematics during standing balance.Research QuestionTo what extent do hip, knee, and ankle joint motions contribute to postural sway in standing among individuals with lower limb loss?MethodsForty-two individuals (25 m/17f) with unilateral lower limb loss (30 transtibial, 12 transfemoral) stood quietly with eyes open and eyes closed, for 30 s each, while wearing accelerometers on the pelvis, thigh, shank, and foot. Triaxial inertial measurement units were transformed to inertial anterior-posterior components and sway parameters were computed: ellipse area, root-mean-square, and jerk. A state-space model with a Kalman filter calculated hip, knee, and ankle joint flexion-extension angles and ranges of motion. Multiple linear regression predicted postural sway parameters from intact limb joint ranges of motion, with BMI as a covariate (p < 0.05).ResultsWith eyes open, intact limb hip flexion predicted larger sway ellipse area, whereas hip flexion and knee extension predicted larger sway root-mean-square, and hip flexion, knee extension, and ankle plantarflexion predicted larger sway jerk. With eyes closed, intact limb hip flexion remained the predictor of sway ellipse area; no other joint motions influenced sway parameters in this condition.SignificanceHip, knee, and ankle motions influence postural sway during standing balance among individuals with lower limb loss. Specifically, increasing intact-side hip flexion, knee extension, and ankle plantarflexion motion increased postural sway. With vision removed, a re-weighting of lower limb joint sensory mechanisms may control postural sway, such that increasing sway may be regulated by proximal coordination strategies and vestibular responses, with implications for fall risk.     

Eccentric/concentric training of ankle evertor and dorsiflexors in recreational athletes: Muscle latency and strength

The aim of this study was to investigate the effects of a combined eccentric–concentric exercise program of the ankle evertors and dorsiflexors on the latency time of the peroneus longus and tibialis anterior muscles. Twenty‐four healthy male recreational athletes were admitted to this study and were randomly assigned to either the exercise group (n = 12) or the control group (n = 12). Subjects in the exercise group performed an isokinetic exercise program of the ankle evertors and dorsiflexors in a combined eccentric–concentric mode for 3 days per week for 6 weeks. Before and after the exercise program, muscle reaction times of the peroneus longus and tibialis anterior muscles to sudden supinating maneuvers on a tilting platform, and isokinetic strength of the ankle joint musculature were evaluated. The peroneus longus and tibialis anterior reaction times showed significant (P < 0.01–0.05) reductions following six weeks of intervention in the exercise group. Additionally, eccentric peak torques for the ankle evertor and dorsiflexors represented significant (P < 0.05) increases in the exercise group compared with the control group. The results of this study suggest that it is possible to reduce peroneal and anterior tibial reaction times following a six week eccentric/concentric isokinetic training program in healthy ankles.     

Ankle function during hopping in subjects with functional instability of the ankle joint

A common mechanism of inversion injury involves a lateral movement producing a hypersupination of the ankle joint. To date, no study has investigated patterns of muscle activity, three-dimensional (3D) joint kinematics and kinetics simultaneously in a group of subjects with functional instability (FI) compared with a non-injured control group during a lateral hopping test. Twenty-six subjects with the subjective complaint of FI of the ankle joint and 24 non-injured healthy control subjects volunteered to participate in the study. We measured 3D lower limb kinematics, kinetics and surface electromyography (EMG) of the rectus femoris, tibialis anterior, peroneus longus and soleus muscle in all subjects during a lateral hop task for the period 200 ms pre- and post-initial contact (IC). FI subjects were observed to have a less-everted position of the ankle joint during the time period from 45 ms pre-IC to 95 ms post-IC (P<0.05). FI subjects were also found to have an increase in pre- and post-IC rectus femoris, tibialis anterior and solues EMG activity. The results suggest that subjects with FI exhibit changes in ankle joint movement and neuromuscular control that could predispose to further injury.     

Altered leg muscle activity in volleyball players with functional ankle instability during a sideward lateral cutting movement

Objectives

To study the activation patterns of tibialis anterior, peroneus longus and gastrocnemius lateralis muscles during a lateral shuffle maneuver in volleyball players with functional instability of the ankle joint.

Design

Observational case-control study.

Setting

Research laboratory.

Participants

Sixteen players with functional instability and 18 matched controls.

Main outcome measures

RMS values of tibialis anterior, peroneus longus and gastrocnemius lateralis muscles for the 50 ms before initial ground contact, timing of onset of muscle activity and linear envelopes for the period of ground contact were calculated.

Results

Onset values showed similar patterns of activation for both groups. In healthy subjects, gastrocnemius lateralis activated earlier, followed by peroneus longus and tibialis anterior. In the unstable subjects, gastrocnemius lateralis and peroneus longus activated at the same time, followed by tibialis anterior. Unstable subjects also presented lower peroneus longus activity during the 50 ms before initial ground impact, a lower peroneus longus peak magnitude and a higher gastrocnemius lateralis peak magnitude.

Conclusions

Volleyball players with ankle functional instability showed decreased peroneus longus activity before ground impact that may predispose them to repetitive sprains and explain their “giving way” sensation, since peroneus longus is the main ankle evertor and an important stabilizer against sudden and excessive inversion.     

Effects of regular Tai Chi practice and jogging on neuromuscular reaction during lateral postural control in older people

This study examined the effects of regular Tai Chi practice and jogging on the neuromuscular activity of the trunk, hip, and ankle joint muscles of older people during lateral postural perturbation. A total of 42 older people participated in the study and formed the Tai Chi, jogging, and sedentary control groups. Electromyography signals were collected from the peroneus longus, anterior tibialis, gluteus medius, and erector spinae during unpredictable mediolateral perturbation. The Tai Chi group exhibited significantly faster latencies of the tibialis anterior and erector spinae than the control group. The jogging group showed a significantly shorter neuromuscular reaction time of the erector spinae than the control group. No significant difference was observed between the Tai Chi and jogging groups. Long-term regular Tai Chi practice enhanced the neuromuscular reaction of the erector spinae and tibialis anterior to lateral perturbation and will help timely posture correction when lateral postural distributions occur.     

Transient characteristics of body sway during single-leg stance in athletes with a history of ankle sprain

BackgroundThe role of the measurements of postural stability in the context of screening for ankle sprain risk is still equivocal. Transient characteristics of body sway have been suggested as an alternative or an improvement to traditional whole-trial analyses.Research questionAre transient characteristics of body sway sensitive to the history of ankle sprain?.MethodsThe assessment of 30-s single-leg body sway was performed on a group of 93 athletes from basketball, soccer, tennis and running who reported at least 1 ankle sprain in the last 12 months, while a group of 244 athletes from the same disciplines served as a control group without an ankle sprain reported for the same time period. We considered the mean center-of-pressure (CoP) velocity, CoP amplitude and CoP frequency. In addition to traditional whole-trial variables, we calculated the relative differences between the 1 st and the 2nd (DIF_21) and 1 st and 3rd (DIF_31) 10-s time intervals within the whole trial.ResultsThe indexes of transient characteristics of body sway (i.e., the DIF_21 and DIF_31) were in trivial or weak correlations with whole-trial variables (all r ≤ 0.29). Athletes with ankle sprain history exhibited smaller CoP ML velocity (p = 0.002) and larger CoP ML frequency (p = 0.001). In the injured group, the injured leg exhibited lower total and medial-lateral (ML) CoP velocity (p = 0.005−0.040), as well as lower CoP ML amplitude (p = 0.002) and higher CoP ML frequency (p = 0.010). The transient characteristics of body sway (DIF_21 and DIF_31) were very similar between the groups and between the injured and uninjured legs.SignificanceTransient characteristics of body sway do not appear to differentiate the athletes with and without a history of ankle sprain. Further research is needed to confirm if the transient characteristics of body sway could be used for detection of risk of falls in older adults or assessment of athletic performance.     

Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome

Previous history of medial tibial stress syndrome (MTSS ) is a risk factor for MTSS relapse, which suggests that there might be some physical factors that are related to MTSS development in runners with a history of MTSS . The relationship between MTSS and muscle stiffness can be assessed in a cross‐sectional study that measures muscle stiffness in subjects with a history of MTSS , who do not have pain at the time of measurement, and in those without a history of MTSS . The purpose of this study was to compare the shear elastic modulus, which is an index of muscle stiffness, of all posterior lower leg muscles of subjects with a history of MTSS and those with no history and investigate which muscles could be related to MTSS . Twenty‐four male collegiate runners (age, 20.0±1.7 years; height, 172.7±4.8 cm; weight, 57.3±3.7 kg) participated in this study; 14 had a history of MTSS , and 10 did not. The shear elastic moduli of the lateral gastrocnemius, medial gastrocnemius, soleus, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and tibialis posterior were measured using shear wave elastography. The shear elastic moduli of the flexor digitorum longus and tibialis posterior were significantly higher in subjects with a history of MTSS than in those with no history. However, there was no significant difference in the shear elastic moduli of other muscles. The results of this study suggest that flexor digitorum longus and tibialis posterior stiffness could be related to MTSS .     

Muscle coordination and function during cutting movements

PURPOSE: The objectives of this study were to: 1) establish a database of kinematic and EMG data during cutting movements, 2) describe normal muscle function and coordination of 12 lower extremity muscles during cutting movements susceptible to ankle sprains, and 3) identify potential muscle coordination deficiencies that may lead to ankle sprain injuries. METHODS: Kinematic, EMG, and GRF data were collected from 10 recreationally active male subjects during both a side-shuffle and v-cut movement. RESULTS: The data showed that muscles functioned similarly during both movements. The primary function of the hip and knee extensors was to decelerate the center-of-mass during landing and to provide propulsion during toe-off. The hip add/abductors functioned primarily to stabilize the hip rather than provide mechanical power. The ankle plantar flexors functioned to provide propulsion during toe-off, and the gastrocnemius had an additional burst of activity to plantarflex the foot before touchdown during the side-shuffle to help absorb the impact. The tibialis anterior functioned differently during each movement: to dorsiflex and supinate the foot after toe-off in preparation for the next step cycle during the side-shuffle and to dorsiflex the foot before impact to provide the heel-down landing and ankle stability in the stance phase during the v-cut. CONCLUSIONS: The muscles crossing the ankle joint, especially the tibialis anterior and peroneus longus, may play an important role to prevent ankle sprain injuries. Both muscles provided stability about the subtalar joint by preventing excessive joint rotations. Future theoretical studies with forward dynamic simulations incorporating individual muscle actuators are needed to quantify the segment accelerations induced by active muscles which may prevent or lead to ankle sprain injuries.     

Postural adaptation to unilateral hip muscle fatigue during human bipedal standing

Although previous studies have investigated the effects of bilateral muscle fatigue on bipedal postural control, whether and how the central nervous system could adapt to unilateral muscle fatigue for controlling bipedal stance remains to be investigated. The purpose of the present experiment was designed to address this issue by assessing the effect of unilateral muscle fatigue induced on the hip's abductors of the dominant leg on bipedal standing. Twenty-four young healthy adults stood barefoot, feet together, with their eyes closed and were asked to sway as little as possible. The experimental group (n = 12) executed this postural task in two conditions, pre- and post-fatigue. In the post-fatigue condition, the measurements were performed immediately after a designated fatiguing exercise for the hip abductors of their dominant leg. For the control group (n = 12), this fatiguing exercise was replaced by a laying rest period corresponding to the fatiguing exercise. The distribution of the body weight and plantar centre of foot pressure (CoP) displacements from the non-fatigued and fatigued leg were recorded along the mediolateral and anteroposterior axes using a plantar pressure data acquisition system. Results of the experimental group showed that unilateral muscle fatigue induced on the hip's abductors of the dominant leg had different effects on the plantar CoP displacements (1) under the non-fatigued and fatigued legs, yielding larger displacements under the non-fatigued leg only, and (2) in the anteroposterior and mediolateral axes, yielding larger displacements along the mediolateral axis only. These observations could not be accounted for by any asymmetrical distribution of the body weight on both legs which were similar for both pre- and post-fatigue conditions. The observed postural responses could be viewed as an adaptive process to cope with an unilateral alteration in the hip neuromuscular function induced by the fatiguing exercise for controlling bipedal stance. The increase in CoP displacements observed under the non-fatigued leg in the fatigue condition could reflect enhanced exploratory “testing of the ground” movements with sensors of the non-fatigued leg's feet, providing supplementary somatosensory inputs to the central nervous system to preserve/facilitate postural control in condition of altered neuromuscular function of the dominant leg's hip abductors induced by the fatiguing exercise.     

Reliability study of tibialis posterior and selected leg muscle EMG and multi-segment foot kinematics in rheumatoid arthritis associated pes planovalgus

ObjectiveTo determine within- and between-day reliability characteristics of electromyographic (EMG) activity patterns of selected lower leg muscles and kinematic variables in patients with rheumatoid arthritis (RA) and pes planovalgus.MethodsFive patients with RA underwent gait analysis barefoot and shod on two occasions 1 week apart. Fine-wire (tibialis posterior [TP]) and surface EMG for selected muscles and 3D kinematics using a multi-segmented foot model was undertaken barefoot and shod. Reliability of pre-determined variables including EMG activity patterns and inter-segment kinematics were analysed using coefficients of multiple correlation, intraclass correlation coefficients (ICC) and the standard error of the measurement (SEM).ResultsMuscle activation patterns within- and between-day ranged from fair-to-good to excellent in both conditions. Discrete temporal and amplitude variables were highly variable across all muscle groups in both conditions but particularly poor for TP and peroneus longus. SEMs ranged from 1% to 9% of stance and 4% to 27% of maximum voluntary contraction; in most cases the 95% confidence interval crossed zero. Excellent within-day reliability was found for the inter-segment kinematics in both conditions. Between-day reliability ranged from fair-to-good to excellent for kinematic variables and all ICCs were excellent; the SEM ranged from 0.60° to 1.99°.ConclusionMulti-segmented foot kinematics can be reliably measured in RA patients with pes planovalgus. Serial measurement of discrete variables for TP and other selected leg muscles via EMG is not supported from the findings in this cohort of RA patients. Caution should be exercised when EMG measurements are considered to study disease progression or intervention effects.     

Altered movement strategies during jump landing/cutting in patients with chronic ankle instability

Centrally mediated changes in sensorimotor function have been reported in patients with chronic ankle instability (CAI). However, little is known regarding supraspinal/spinal adaptations during lower‐extremity dynamic movement during a multiplanar, single‐leg landing/cutting task. The purpose of this study was to investigate the effect of CAI on landing/cutting neuromechanics, including lower‐extremity kinematic, electromyography (EMG) activation, and ground reaction force (GRF) characteristics. One hundred CAI patients and 100 matched healthy controls performed five trials of a jump landing/cutting task. Sagittal‐ and frontal‐plane ankle, knee and hip kinematics, EMG activation in eight lower‐extremity muscles, and 3D GRF were collected during jump landing/cutting. Functional analyses of variance (FANOVA) were used to evaluate between‐group differences for dependent variables throughout the entire ground contact of the task. Relative to the control group, the CAI group revealed (a) reduced dorsiflexion, increased knee and hip flexion angles, (b) increased inversion and hip adduction angles, (c) increased EMG activation of medial gastrocnemius, peroneus longus, adductor longus, vastus lateralis, gluteus medius, and gluteus maximus, and (d) increased posterior and vertical GRF during initial landing, and reduced medial, posterior, and vertical GRF during mid‐landing and mid‐cutting. CAI patients demonstrated alterations in landing/cutting movement strategies as demonstrated by a higher susceptibility of foot placement for lateral ankle sprains, and more flexed positions of the knee and hip with higher EMG activation of knee and hip extensors to modulate GRF to compensate for the unstable ankle. This apparent compensation may be due to mechanical (limited dorsiflexion angle) and/or sensorimotor deficits in the ankle.     

Effects of ankle destabilization devices and rehabilitation on gait biomechanics in chronic ankle instability patients: A randomized controlled trial

Patients with chronic ankle instability (CAI) have altered gait patterns, which are characterized by increased inversion positioning during gait. Ankle destabilization devices increase peroneus longus muscle activation during gait, which may increase eversion.ObjectiveTo determine whether incorporating destabilization devices into a 4-week impairment-based rehabilitation program has beneficial effects on gait biomechanics and surface electromyography (sEMG) compared to impairment-based rehabilitation without destabilization devices in CAI patients.DesignRandomized controlled trial.SettingLaboratory.ParticipantsTwenty-six CAI patients.Outcome measuresPatients completed baseline gait trials and were randomized into no device or device groups. Groups completed 4-weeks of rehabilitation with or without devices, and then completed post-intervention gait trials. Lower extremity sagittal and frontal plane kinematics and kinetics and sEMG activity were measured.ResultsThe device group increased dorsiflexion during mid-late stance and had lower normalized sEMG amplitude for the peroneus longus during early stance and mid-swing after rehabilitation. The no device group had less peroneus brevis sEMG activity during early stance after rehabilitation.ConclusionIncorporating destabilization devices in a 4-week rehabilitation program was an effective method of improving dorsiflexion during the stance phase of gait. However, impairment-based rehabilitation, regardless of instability tool, was not effective at improving frontal plane motion.