Abstract
After an initial ankle sprain, a relevant number of participants develop chronic ankle instability (CAI). Compensatory strategies in patients with CAI may change the inter-limb symmetry needed for absorbing movement-related forces. Accordingly, an increased risk of injury can occur. The present study aimed to compare the inter-limb asymmetry of kinetic and electromyography between individuals with CAI and without a history of an ankle sprain (Non-CAI) during walking. In this cross-sectional study, fifty-six athletes (28 CAI; 28 Non-CAI) participated. Participants walked at a comfortable pace over level ground while vertical ground reaction force (vGRF) and muscle activity of the tibialis anterior, peroneus longus, medial gastrocnemius, and gluteus medius were recorded. Inter-limb asymmetry during walking was calculated for each of the variables. Patients with CAI exhibited a greater inter-limb asymmetry of the first peak of vGRF, time to peak vGRF, and loading rate (P < 0.001), as well as presenting a greater inter-limb asymmetry of peroneus longus activity (contact phase) (P = 0.003) and gluteus medius activity (midstance/propulsion phase) (P = 0.010) compared to the Non-CAI group. No other differences in vGRF or muscles activity were observed between the groups. Our findings indicate that patients with CAI walk with greater inter-limb asymmetry in vGRF and muscle activity in different phases of the gait cycle compared to Non-CAI group. Our results could inform future studies on gait training aimed to reduce asymmetry during walking in patients with CAI.
Highlights
After an initial ankle sprain, a relevant number of participants develop chronic ankle instability (CAI)
The analysis revealed that given the effect size of 0.80, at least 21 participants per group was needed for a power of 0.80 and an alpha level of 0.05
During the contact phase of walking, patients with CAI demonstrated a greater inter-limb asymmetry of peroneus longus activity compared to the Non-CAI group (P = 0.003, effect sizes (ES) = 0.82; CAI: 15.34 ± 11.40 vs Non-CAI: 7.29 ± 7.70) (Table 3)
Summary
After an initial ankle sprain, a relevant number of participants develop chronic ankle instability (CAI). The present study aimed to compare the inter-limb asymmetry of kinetic and electromyography between individuals with CAI and without a history of an ankle sprain (Non-CAI) during walking. Our findings indicate that patients with CAI walk with greater inter-limb asymmetry in vGRF and muscle activity in different phases of the gait cycle compared to Non-CAI group. Residual and persistent symptoms associated with CAI can lead to decreased physical a ctivity[6,7], reduced quality of life[8], and an increased risk of ankle osteoarthritis after injury[9] Both lateral ankle sprains and CAI have been linked to decreased cartilage health and post-traumatic o steoarthritis[10], accounting for 78% of end-stage ankle osteoarthritis c ases[10]. Quantification of vGRF differences in individuals with CAI compared to Non-CAI is warranted as a precursor to assessing the relationship between load and cartilage health in this population. Understanding differences in how patients with CAI load their ankles may assist with developing the treatment to slow ankle joint degeneration
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