Copers adopt an altered dynamic postural control compared to individuals with chronic ankle instability and controls in unanticipated single-leg landing

BackgroundSeveral prior studies involving “expected” single-leg landings have not succeeded in establishing a difference between copers and a control group.Research questionDoes expected and unanticipated single-leg landing affect dynamic postural stability in lateral ankle sprain individuals with chronic ankle instability (CAI), copers, and controls?MethodsIn this prospective cross-sectional study, physically active adults with CAI (n = 12), copers (n = 12), and controls (n = 12) were included. Participants performed expected single-leg landing by stepping off a 30-cm box. They also performed unanticipated landings including side-step cutting, side-step cutting at 60°, single-leg landing, and forward stepping. The expected and unanticipated conditions of each groups were compared in terms of time to stabilization (TTS) and center of pressure (COP) for the anterior-posterior (AP) and medial-lateral (ML) conditions. To analyze the data, a mixed-model one-way analysis of variance and a Tukey-Kramer post hoc test were performed.ResultsA significant condition × group interaction was observed in only TTS ML, with the CAI group demonstrating a significantly longer TTS ML than the coper (p < 0.001) and control (p < 0.001) groups during unanticipated trials. In addition, group interaction effects were observed for COP AP and TTS AP. The coper group demonstrated significantly longer COP AP and TTS AP than the control group (p < 0.001).SignificanceThe CAI group demonstrated a significantly longer TTS ML than the coper and control groups during the unanticipated condition, and the coper group demonstrated significantly longer TTS AP and COP AP than the control group. Thus, longer COP AP and TTS AP sway time in the coper group may be a protection mechanism, allowing greater freedom in the AP plane while quickly controlling ML sway and preventing lateral ankle sprains. These findings can help in the prevention of lateral ankle sprains and assessment of dynamic postural control.     

Individuals with chronic ankle instability exhibit altered ankle kinematics and neuromuscular control compared to copers during inversion single-leg landing

ObjectivesThis study compares the ankle kinematics and muscle activities of the individuals with chronic ankle instability (CAI), coper, and control groups in normal and inversion single-leg landings.Designcross-sectional study;SettingBiomechanics laboratory.ParticipantsPhysically active adults with CAI (N = 12); and coper (N = 12) and control (N = 12) groups.Main outcome measuresThe participants performed normal and inversion single-leg landing. The muscle activity 200 ms before and after landing of the tibialis anterior, the medial gastrocnemius, and the fibularis longus (FL) were recorded. The FL latency, sagittal and frontal co-contraction indexes (CCI), ankle inversion angle at the initial contact, and the maximum inversion angle were recorded.ResultsSignificantly longer FL latency, decreased FL muscle activity, frontal CCI, and an increased maximum inversion angle at post-landing were discovered during inversion single-leg landing in the CAI group compared to the coper and control groups. However, no significant difference was observed among the CAI and coper groups during normal single-leg landing.ConclusionThese results suggest prolonged FL latency and altered ankle kinematics suggest an increased risk of recurrent lateral ankle sprains in CAI with inversion single-leg landing.     

Hip and knee muscle torque is not impaired in the first three months of a first-time lateral ankle sprain

ObjectivesThe primary objective was to compare hip and knee isometric muscle strength between individuals with a first-time acute lateral ankle sprain and controls. A secondary objective was to investigate hip and knee isometric muscle strength three months post-injury.DesignCross-sectional and prospective follow-up components.SettingLaboratory environment.ParticipantsForty-two participants (21 acute lateral ankle sprain and 21 controls) matched for age, sex, physical activity and leg dominance participated.Main outcome measuresHip and knee isometric muscle torque was assessed using a rigidly fixated hand-held dynamometer. Testing in acute lateral ankle sprain participants was performed within four weeks of injury and three months post-injury. Controls were tested at one timepoint.ResultsThere were no differences in hip or knee isometric muscle torque between acute lateral ankle sprain and control participants (mean differences <0.08). Hip and knee isometric muscle torque in acute ankle sprain participants did not differ between baseline and three months post-injury testing (mean difference <0.06).ConclusionsProximal lower limb isometric strength is not impaired within the first three months of sustaining a first-time lateral ankle sprain injury. This implies that hip and knee isometric strength deficits in individuals with CAI may occur at some later stage.     

Coper has altered foot joint coordination pattern compared to individuals with chronic ankle instability during running

BackgroundThere is limited information regarding the cause for the different etiologies in individuals with initial lateral ankle sprains (LAS) who have chronic ankle instability (CAI) and no recurrence or instability for > 12 months (copers) following initial LAS. Assessing the movement patterns of copers and individuals with CAI and LAS recurrence is essential for identifying the mechanical factors that affect patient outcomes.Research questionDoes coordination and coordination variability of rearfoot, midfoot, and forefoot present a potentially causative pattern for CAI or coper?MethodsThis cross-sectional study included 35 males who were divided into the CAI (n = 13), coper (n = 12), and control group (n = 10). Participants performed rearfoot strike running on the treadmill at a fixed speed of 3.5 m/s. The coupling angle between the rearfoot, midfoot, and forefoot, representing intersegmental coordination, was calculated using the modified vector coding technique and categorized into four coordination patterns. The coupling angle standard deviation served represented coordination variability during the stance phase.ResultsOne control participant and one CAI participant were excluded, and final analyses were performed on the CAI (n = 12), coper (n = 12), and control (n = 9) groups. During late stance, the coper group showed a significantly greater proportion of in-phase with distal dominancy (p = 0.02, effect size=0.17) and a significantly lower proportion of in-phase with proximal dominancy (p = 0.05, effect size=0.17), than the CAI group. During the early stance, the coper group showed a significantly lower proportion of anti-phase with distal dominancy than the CAI group (p = 0.03, effect size=0.18). There were no differences in intra-foot variability among the groups.SignificanceThe intra-foot coordination observed in the coper group suggests that this movement pattern may reduce the risk of ankle sprains.     

Dynamic joint stiffness of the ankle in chronic ankle instability patients

BackgroundWhile Individuals with chronic ankle instability (CAI) exhibit altered ankle joint movement and moments during stance phase of gait, the interaction or dynamic joint stiffness (DJS) between these is not fully understood. Little attention has been placed on DJS during gait, limiting our understanding of how the most common dynamic task during daily life could affect cartilage loading.Research questionDo Individuals with CAI exhibit altered ankle DJS and mechanical energy exerted at the ankle joint during stance phase of gait?MethodsEighty-four physically active individuals, consisting of 42 individuals with CAI (12 M and 30 F) and 42 control (12 M and 30 F) participants were recruited in this study. Three-dimensional gait analysis was conducted. The sagittal ankle joint angle and moment during stance phase of walking gait were obtained. Stance phase was divided into three sub-phases: controlled plantarflexion, controlled dorsiflexion, and powered plantarflexion. Ankle DJS was represented by the slope of the joint moment plotted as a function of the joint angle. The coefficient of determination was calculated to determine how accurately data fit a linear model. Net work was calculated by the difference between work produced and absorbed. Further, sex specific exploratory analyses of DJS and work between individuals with and without CAI were conducted.ResultsLower DJS during the controlled plantarflexion (CPF) sub-phase, work produced, and net work was found in the CAI group. Males with CAI exhibited lower ankle moment changes during controlled dorsiflexion (CDF) sub-phase and work absorbed. Females with CAI exhibited lower ankle moment changes during CPF and CDF sub-phases, lower DJS during the CPF sub-phase, and lower net work.SignificanceIndividuals with CAI have alterations in DJS and work relative to uninjured controls. Females with CAI showed greater DJS related alterations, relative to controls, than their male CAI counterparts.     

Effect of chronic ankle instability on lower extremity kinematics,dynamic postural stability,and muscle activity during unilateral jump-landing tasks: A systematic review and meta-analysis

ObjectiveTo determine if individuals with chronic ankle instability (CAI) demonstrate altered landing kinematics, muscle activity, and impaired dynamic postural stability during a unilateral jump-landing task.Methods21 studies were included from PubMed, MEDLINE, Embase and CINAHL searched on September 26, 2021. Mean differences in joint angles and muscle activity between CAI and controls were analysed as continuous variables and pooled using a random-effects model to obtain standardised mean differences and 95% confidence intervals. Dynamic postural stability measured using time to stabilisation (TTS) was assessed qualitatively.ResultsWe found greater plantarflexion (pooled SMD = 0.33, 95%CI [0.02,0.65]), reduced knee flexion (pooled SMD = −0.67, 95%CI [−0.97, −0.37]), and reduced hip flexion (pooled SMD = −0.52, 95%CI [−0.96, −0.07]) in CAI after landing. Regarding muscle activity, we observed reduced peroneus longus muscle activation (pooled SMD = −0.77, 95% CI [−1.17, −0.36]) in CAI prior to landing.ConclusionOur study provides preliminary evidence of altered landing kinematics in the sagittal plane and reduced peroneus muscle activity in CAI during a dynamic jump-landing task. These results may have clinical implications in the development of more effective and targeted rehabilitation programmes for patients with CAI.     

Double-leg stance and dynamic balance in individuals with functional ankle instability

To investigate whether double-leg stance could reveal balance deficits in subjects with functional ankle instability (FAI) and whether such an assessment of static balance would be correlated with measures of dynamic instability, 16 individuals with FAI and 16 healthy controls participated in this study. Static postural control was tested using double-leg stance (either with the eyes open (EO) or closed (EC)) on a dual-plate force platform. Dynamic balance was evaluated using the Multiple Hop Test (MHT) and a weight-shifting task. FAI subjects were significantly less stable in the anteroposterior direction during double-leg stance (as assessed by velocity of centre of pressure, VCP), both for the EO and EC condition. In the mediolateral direction the VCP values were also higher in FAI, but significance was only found for the EC condition (p = .02). FAI subjects made significantly more balance errors compared to healthy controls (p < .001) on both the affected and less affected leg during MHT. There were no significant differences between FAI and healthy subjects during the weight-shifting task. No relationship was found between double-leg stance and MHT measures (all correlations (r_s) less than .30). This study suggests that static postural control during double-leg stance is impaired in FAI subjects. Although dynamic balance during MHT is also affected, no significant relationship was found between static and dynamic measurements, which indicate that they are most probably related to different aspects of postural control.     

Ankle inversion proprioception measured during landing in individuals with and without chronic ankle instability

BackgroundResearch evidence has suggested that a more sensitive ankle proprioceptive testing method with higher ecological validity is needed for assessing proprioceptive deficits in individuals with chronic ankle instability (CAI).Objectives(1) To determine the test–retest reliability of a novel ankle proprioception assessment tool, the Ankle Inversion Discrimination Apparatus for Landing (AIDAL); (2) To assess whether AIDAL scores were sufficiently sensitive to detect proprioceptive deficits in chronic ankle instability (CAI); and (3) To examine whether AIDAL scores correlated with Cumberland Ankle Instability Tool (CAIT) scores.DesignCross-sectional study.MethodsThe AIDAL was purpose-built to assess ankle discrimination in four positions of ankle inversion (10°, 12°, 14° and 16°) upon landing from a 10 cm drop. Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. Seven-day test–retest reliability was evaluated with 23 university students (12 CAI and 11 non-CAI), and another 36 university students (18 CAI and 18 non-CAI) were in the comparison study.ResultsThe test–retest reliability ICC score for the whole group was 0.763 (95% CI = 0.519–0.892), which showed an excellent reliability level. ICC _(3,1) was 0.701 for the non-CAI group (95%CI = 0.210–0.910) and 0.804 for the CAI group (95%CI = 0.451–0.939). The CAI group performed at a significantly lower level on the AIDAL assessment than the non-CAI group (0.777 ± 0.05 vs. 0.815 ± 0.05, F = 5.107, p = 0.03). The discriminative AUC value for the AIDAL test was 0.756 with a cut point of 0.819 (sensitivity = 0.733, specificity = 0.800). The MDC₉₀ scores for CAI and non-CAI groups were both 0.04. Spearman's correlation showed that the CAIT scores were significantly correlated with the ankle proprioceptive discrimination scores (rho = 0.401, p = 0.015).ConclusionThe AIDAL showed good test–retest reliability for both non-CAI and CAI groups. Measuring ankle inversion proprioception during landing may be important for assessing the outcomes of CAI rehabilitation, as proprioceptive performance obtained from the AIDAL was significantly correlated with severity of functional ankle instability CAIT scores.     

Anatomical repair of lateral ligaments in patients with chronic ankle instability

In a prospective study, 19 patients with chronic ankle instability underwent clinical and radiographic reexaminations 36 months after anatomical reconstruction. In addition, dynamic pedography was conducted and peroneal reaction time measured on a tilting platform for an evaluation of functional aspects. Prior to this examination, 32 patients had been asked to fill in a questionnaire and make a detailed subjective evaluation of current discomfort, stability, flexibility and sporting abilities. Eighty-eight percent of the patients reported satisfactory results; only 3% complained of persistent instability. In 71% the ability to take part in sports had improved after surgery, and 85% of the patients reported unrestricted walking abilities. Supination ability was impaired in 5% of the patients at the follow-up. The radiographic examination showed restored ankle stability with a significant reduction of talar tilt and talar translation; a postoperative increase in signs and symptoms of arthrosis was not observed. Dynamic pedography showed a large degree of symmetry of plantar pressure distribution after surgery. There were no significant differences in peroneal reaction time in the repaired and intact ankles. The results of the study show that it is possible to restore ankle stability with anatomical reconstruction without impairing the range of movement in the ankle joint complex. Progressive osteoarthrosis can be prevented.     

Subgroup characteristics of patients with chronic ankle instability in primary care

ObjectivesTo examine clinical and radiological characteristics of participants with an ankle sprain in general practice, classified into subgroups of a previously described chronic ankle instability (CAI) model.DesignCross-sectional study.Methods206 participants, who visited their general practitioner with a lateral ankle sprain 6–12 months before inclusion, completed a questionnaire, physical examination, radiography and magnetic resonance imaging. They were classified into three subgroups of the previously described CAI-model: mechanical instability (MI), perceived instability (PI) and recurrent sprains (RS). Regression analyses were applied to evaluate differences in subgroup characteristics.ResultsA total of 192 participants were eligible to be classified into the model. Of these participants, 153 participants were classified into the subgroups and 39 could not be classified. With overlap between the subgroups and patients falling into more than one subgroup, 59 were classified having MI, 145 having PI and 30 having RS. Participants with RS and PI were more often sports participants (OR 6.83;95%CI 1.35–34.56 and OR 4.44;95%CI1.06–18.63 respectively) than participants without RS and PI. Participants with MI more often had a tenderness on palpation of the anterior talofibular ligament (OR 4.09;95%CI 1.91–8.72) and a KL-score ≥ 1 in the talonavicular joint on X-ray (OR 2.24;95%CI 1.09–4.58), compared to participants without MI.ConclusionsSports participation, tenderness on palpation of the anterior talofibular ligament and early signs of osteoarthritis were variables that discriminated between subgroups of CAI. However, further research is mandatory in order to examine the usefulness of the CAI model in relation to prognosis and suitable intervention.     

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.     

Predicting dynamic balance improvements following 4-weeks of balance training in chronic ankle instability patients

Objectives

Balance training typically features as a central component of exercise-based rehabilitation programs for patients with lateral ankle sprain and chronic ankle instability (CAI). The purpose of this study was to conduct a responder/non-responder analysis using existing data to identify factors associated with improvements in dynamic balance performance in CAI patients.

Short-term and long-term effects of ankle joint taping and bandaging on balance,proprioception and vertical jump among volleyball players with chronic ankle instability

ObjectiveThis study hypothesized that the prolonged use of taping during athletic activities produces more significant increases in proprioception, balance, and vertical jump among volleyball players with CAI.DesignA randomized controlled study.ParticipantsOne-hundred participants with chronic ankle instability (CAI) participated in this study. Participants were distributed into 3-groups: taping group, bandaging group, and control group.Primary outcome measuresProprioception (ankle range of motion absolute error), balance(Y-balance test), and vertical jump (vertical jump tester).InterventionsThree interventions were performed: ankle rigid taping, ankle bandaging, and placebo taping. The measurements were performed at baseline, immediately, 2-weeks and 2-months after support.ResultsImmediately after supports, there were non-significant differences between all groups for proprioception, balance (P < .05). There was a significant difference between banding and control groups, and taping and control groups for the vertical jump (P < .05). After 2-weeks and 2-months, there were significant differences between bandaging and control groups, and taping and control groups for proprioception, balance, and vertical jump (P < .05). There were non-significant differences between taping and bandaging groups (P < .05) during all assessments.ConclusionThis study indicated that ankle taping and bandaging immediately improve vertical jump only; while they improve proprioception, balance, and vertical jump after 2-weeks and 2-months.     

A new approach of the Star Excursion Balance Test to assess dynamic postural control in people complaining from chronic ankle instability

The purpose of this study was to quantitatively and qualitatively assess dynamic balance with accuracy in individuals with chronic ankle instability (CAI). To this aim, a motion capture system was used while participants performed the Star Excursion Balance Test (SEBT). Reached distances for the 8 points of the star were automatically computed, thereby excluding any dependence to the experimenter. In addition, new relevant variables were also computed, such as absolute time needed to reach each distance, lower limb ranges of motion during unipodal stance, as well as absolute error of pointing. Velocity of the center of pressure and range of variation of ground reaction forces have also been assessed during the unipodal phase of the SEBT thanks to force plates. CAI group exhibited smaller reached distances and greater absolute error of pointing than the control group (p < 0.05). Moreover, the ranges of motion of lower limbs joints, the velocity of the center of pressure and the range of variation of the ground reaction forces were all significantly smaller in the CAI group (p < 0.05). These reduced quantitative and qualitative performances highlighted a lower dynamic postural control. The limited body movements and accelerations during the unipodal stance in the CAI group could highlight a protective strategy. The present findings could help clinicians to better understand the motor strategies used by CAI patients during dynamic balance and may guide the rehabilitation process.     

Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability

ObjectivesTo determine the effects of fibular taping on ankle dorsiflexion range of motion (ROM) and dynamic balance in individuals with chronic ankle instability (CAI).DesignSingle-blind, randomized crossover.MethodsTwenty-three individuals (age = 23.4 ± 2.5 years, height = 171.6 ± 12.4 cm, mass = 71.5 ± 13.1 kg) with CAI were allocated to either a fibular taping intervention or sham taping intervention (tape applied without tension) over the course of two visits. Weight-bearing ankle dorsiflexion ROM and components of the Star Excursion Balance Test (SEBT) were measured before and after intervention.ResultsThere was not a significant change in ankle dorsiflexion ROM when comparing the taping interventions (F_1,43 = 1.03, P = .32), but both interventions resulted in a small increase (F_1,43 = 8.07, P = .007) in dorsiflexion ROM (pre = 36.7° ± 6.9°, post = 37.7° ± 6.2°). This increase in ROM did not exceed the established minimal detectable change for dorsiflexion ROM. Fibular taping with tension produced an increase (F_1,41 = 5.84, P = .02) (pre = 69.0 ± 9.1%, post = 70.6 ± 8.6%) in posterolateral reach distance when compared to taping without tension (pre = 72.7 ± 11.0%, post = 71.4 ± 9.6%), but this increase did not exceed the established minimal detectable change. There was not a significant change in dynamic balance between groups for the anterior (F_1,41 = 2.33, P = .14) and posteromedial (F_1,41 = .41, P = .53) reach directions.ConclusionsAlthough small changes in ankle dorsiflexion ROM and posterolateral reach distances were observed, these changes did not exceed established minimal detectable change values for these measures. These results suggest that the benefits of fibular taping are not related to an increase in ankle dorsiflexion ROM or dynamic balance.     

The effect of sensory-targeted ankle rehabilitation strategies on single-leg center of pressure elements in those with chronic ankle instability: A randomized clinical trial

Objectives

To determine the effects of sensory-targeted ankle rehabilitation strategies on laboratory-oriented measures of single-leg balance in those with chronic ankle instability.

Applicability of cutoff scores of Chinese Cumberland Ankle Instability Tool and Foot and Ankle Ability Measure as inclusion criteria for study of chronic ankle instability in Chinese individuals

ObjectiveTo examine the applicability of Chinese Cumberland Ankle Instability Tool (CAIT-C) and Foot and Ankle Ability Measure (FAAM-C) as inclusion criteria recommended by the International Ankle Consortium (IAC) for study of chronic ankle instability in the Chinese individuals.DesignCross-sectional comparative design with known groups.SettingResearch laboratory.Participants145 participants with chronic ankle instability (CAI) and 66 participants without injury.Main outcome measuresCAIT-C and FAAM-C Activities of Daily Living (FAAM-C-ADL) and FAAM-C Sports (FAAM-C-Sports).ResultsThe CAIT-C scores (18.2 ± 5.6), FAAM-C-ADL scores (97.0 ± 4.3) and FAAM-C-Sports scores (92.2 ± 10.3) of the CAI group were all lower than the CAIT-C scores (27.4 ± 3.1), FAAM-ADL scores (99.0 ± 2.1) and FAAM-Sports scores (98.4 ± 3.1) (P < 0.01) of the uninjured group. The recommended cutoff score of CAIT-C<24 by the IAC for identifying CAI had a sensitivity of 80.7% and a specificity of 84.9%. If the recommended cutoff scores of FAAM-ADL<90,FAAM-Sports<80 by the IAC as inclusion criteria for the study of CAI were applied, 97% of participants with CAI in this sample would be excluded.ConclusionThe results support the recommended cutoff score of CAIT-C<24 by the IAC to identify Chinese individuals with CAI for study. However, the recommended cutoff scores of FAAM-ADL<90 and FAAM-Sports<80 will exclude most Chinese individuals with CAI having only mild functional impairments.     

Effects of an ankle brace on the in vivo kinematics of patients with chronic ankle instability during walking on an inversion platform

BackgroundAs in vivo tibiotalar and subtalar joint kinematics are not currently known following the application of an ankle brace, an investigation of these kinematics may provide insight into the mechanisms of ankle braces.Research questionThis study aimed to determine the effect of an ankle brace on in vivo kinematics of patients with chronic ankle instability.MethodsEleven patients with chronic ankle instability were recruited in this study. A dual fluoroscopic imaging system and a solid modeling software were utilized to calculate the joint positions of the participants as they walked barefooted on a level platform, walked barefooted on a 15° inversion platform, and walked with an ankle brace on a 15° inversion platform. The joint positions during the three walking conditions were compared.ResultsTibiotalar joints were more inverted (pose 2, p = .004), and subtalar joints were more anteriorly translated (pose 2–6, p = .003), more plantarflexed (pose 2, p = .008; pose 3, p = .013; pose 5, p = .008; pose 6, p = .016) and more inverted (pose 1–5, p = .003; pose 6, p = .013) during barefooted walking on the inversion platform than during walking on the level platform. The inversion of subtalar joints was decreased after the brace application (pose 2–4, p = .003; pose 5, p = .004; pose 7, p = .016).SignificanceBrace application reduced the increased subtalar inversion induced by the inversion platform. Nevertheless, increased subtalar anterior translation and plantarflexion persisted after brace application. The ankle brace might be beneficial for clinical populations with increased subtalar inversion.     

The interrater reliability of dynamic leap and balance test in healthy and chronic ankle instability

The primary aim of this study was to assess the interrater reliability of the Dynamic Leap and Balance Test (DLBT) in chronic ankle instability (CAI) and healthy groups. The secondary aim was to assess the differences in errors and time taken to complete the DLBT between the two groups for both raters and to identify cutoff scores to distinguish between patients with CAI and healthy controls. This was a controlled laboratory reliability analysis study. Fourteen healthy college-aged subjects (9 women 5 men; weight = 62.10 ± 8.03; height = 168.35 ± 6.0) and sixteen with a history of CAI (9 women, 7 men; weight = 68.01 ± 10.74; height = 172.08 ± 11.37) participated. Interrater reliability was determined by independent raters for both total time taken to complete the task and errors made. The most optimal score to discriminate between two groups was determined by receiver operator curve analysis. Total time taken and errors made were also documented for group differences as secondary analysis. A strong agreement was found between the two raters for time and errors with intraclass correlation coefficient >0.80. Significantly (P < .05) higher number of errors were made and greater time taken by the CAI subjects when compared with healthy for both raters. The most optimal score to discriminate between CAI and healthy control was 43.28s and 4 errors. Excellent interrater reliability substantiates that it can be used confidently by different clinicians for testing dynamic balance. CAI group took more time and made more errors to complete the DLBT.     

Decreased dynamic balance and dorsiflexion range of motion in young and middle-aged adults with chronic ankle instability

ObjectivesThe purpose of this study was to compare dynamic balance and weight-bearing dorsiflexion range of motion between young and middle-aged adults with and without chronic ankle instability.DesignCross-sectional.MethodsOne hundred and two young adults were classified as either having chronic ankle instability (n = 38), coper (n = 27) or a healthy-control (n = 37). A total of 55 middle-aged adults were identified as having chronic ankle instability (n = 16), coper (n = 15) or a healthy-control (n = 24). Participants completed the weight-bearing lunge test and the anterior, posteromedial and posterolateral reach directions of the star excursion balance test.ResultsMiddle-aged adults had shorter reach distances for each direction of the star excursion balance test compared to the young adults (p < 0.001). Regardless of age, participants with chronic ankle instability performed worse on the star excursion balance test compared to the coper (p < 0.05) and healthy-control group (p < 0.05). Similarly, participants with chronic ankle instability had less dorsiflexion compared to healthy-controls (p < 0.05), but not the coper group (p > 0.05).ConclusionsDeficits in dynamic postural control do not continue to decline with advancing age in individuals with chronic ankle instability, however, these impairments appear to continue to persist compared to uninjured controls.