Proprioceptive Exercises Research Articles

Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair.

Substantial progress has been made in characterizing the benefit of early functional rehabilitation following Achilles tendon repair (ATR). However, standardized ATR rehabilitation guidelines have yet to be produced. Furthermore, as patients increasingly use the Internet to independently retrieve health care content, access to standardized, clinically effective rehabilitation protocols is necessary. Online ATR physical therapy protocols from US academic orthopaedic programs were reviewed. A comprehensive scoring rubric was designed after reviewing all identified protocols and was used to assess each protocol for both the presence of various rehabilitation components as well as when those components were introduced. Twenty-two of 155 US academic orthopaedic programs published postoperative Achilles rehabilitation protocols online, with a total of 27 individual protocols available for review. Twenty-one protocols (78%) recommended immediate postoperative splinting. Only one protocol recommended short-leg casting. Twenty-six protocols (96%) advised immediate nonweightbearing with progression to weightbearing as tolerated at an average of 3.0 weeks (range, 1-8 weeks) and to full weightbearing at an average of 7.3 weeks (range, 2-12 weeks). Active plantarflexion and dorsiflexion to neutral were included by most protocols (93%) at an average of 3.9 (range, 0-9) weeks and 3.4 (range, 0-8) weeks, respectively. There was considerable variability in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Fourteen protocols (52%) recommended return to training after meeting certain athletic activity criteria. The purpose of this investigation was to evaluate the quality, variability, and patient accessibility of publicly available rehabilitation protocols for ATR provided by US orthoapedic teaching programs. To this end, we found that a minority of US academic orthopaedic programs publish ATR rehabilitation protocols online. While a trend away from traditional ankle casting is apparent, many programs have not adopted the accelerated weightbearing and controlled mobilization techniques that have been shown to produce better functional outcomes and greater patient satisfaction. There is also a substantial degree of variability in both the composition and timing of rehabilitation components across physical therapy protocols. Level III: Retrospective comparative study.

The effects of proprioceptive neuromuscular facilitation, myofascial releasing maneuvers and home exercises on pain and jaw function in patients with bruxism

To evaluate the effects of proprioceptive neuromuscular facilitation exercises, myofascial releasing techniques and home exercises on temporamandibular joint pain and jaw function in patients with bruxism. This randomized, controlled experimental trial included 52 patients (42 females, 10 males) aged 16 to 50 years (a mean age of 28.9 ± 11.05 years) with bruxism. The patients were separated into 3 groups, as Group 1 (n: 20) treated with proprioceptive neuromuscular facilitation exercises + myofascial release techniques + home exercise, Group 2 (n: 15) treated with myofascial release + home exercise and Group 3 (n: 17), as the control group, treated with the classical methods of occlusal splint, antidepressant drugs and botox. The Visual Analog Scale, Jaw Restriction Scale and Oral Habits Checklist were used to evaluate pain, restriction of jaw movements and bad habits, respectively. All groups were evaluated at the end of 2 weeks and 6 weeks. When the pre-treatment and post-treatment parameters were compared between the groups, a decrease was determined in the parameters of pain, limitation of jaw function, and restriction of oral behavioursin Group1 and Group2 (p = 0.001, p = 0.05, respectively). This decrease was statistically greater in Group 1. No statistically significant difference was determined in Group 3 in respect of resting, active and night pain, limitation of jaw function and restriction of oral behaviour (p>0.05). Proprioceptive Neuromuscular Facilitation Exercises + myofascial releasing techniques + home exercise were found to be effective in reducing pain, improving restriction of jaw movement and oral behaviors in patients with bruxism. As the first such study, the results of this study can be considered to provide important contributions to the understanding and treatment of patients with bruxism.

Efficacy of combined proprioceptive exercises and conventional physiotherapy in patients with knee osteoarthritis: A double-blinded two-group pretest–posttest design

Background: Osteoarthritis (OA) is a chronic degenerative condition of the joint. Current physiotherapy interventions for OA focus on pain reduction, improve knee range of motion, and muscle strength. OA of knee impairs quadriceps function which affects balance and gait reducing patient's mobility and function. Therefore, there is a need to find out the effect of combined proprioceptive exercises with conventional physiotherapy in Patient with knee osteoarthritis (PKOA). Aim: The aim of this study is to analyze the effect of combined proprioceptive exercises and conventional physiotherapy in PKOA. Methods: A total of 40 female POAK were recruited for the study and were divided into two groups as follows: Group A (conventional group) and Group B (experimental group). Group B in addition to the conventional treatment received proprioceptive exercises. Both the groups were instructed to perform exercises for 5 days in a week for 3 months. Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were noted pre- and post-intervention. Results: On comparing the mean values of Group A and Group B on VAS and WOMAC scores, both the groups showed a significant decrease (P

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In the last decades several studies have been focused on the early diagnosis of the ACL lesion and indication of themost appropriate treatment. The knee is formed by the femur, tibia and patella that constitute a complex joint constantly subject tothe action of the corporal weight whose stability depends on the relation between the bony anatomy, the muscular activity andligamentar. The bones are connected by ligaments, four of which are the main function of which is to keep the bones together andthe knee stable. The lesion of the anterior cruciate ligament is very serious because the ligament has the function of keeping thetibia back in relation to the femur and, when it breaks, it moves forward. The objective of this research was the anterior cruciateligament injury, its forms of occurrence, treatments and, the importance of the physical trainer's participation in the rehabilitationprocess of this patient. The theoretical basis was elaborated using articles, periodicals, complete texts, dissertations and thesessearched in the Scientific Electronic Library Online (Scielo), Lilacse Google Scholar and CESUFOZ library platforms. Thekeywords or descriptors were: Anterior cruciate ligament injury (ACL), prevention, proprioceptive exercises, treatment,rehabilitation, physical trainer. The results showed that the most used treatments were conservative with strengthening of thequadriceps and posterior of the thigh, with the aid of bracing, proprioception works and hydrotherapy. It was concluded that thephysical trainer should act in a preventive way and in the process of rehabilitation of the lesions of the anterior cruciate ligament ofthe knee, being the work of strengthening, proprioception and hydrotherapy with emphasis on the lower limbs the most used.

Effect of proprioceptive and flexibility exercise program along with resisted training on anxiety and depression with diabetic neuropathy

Effect of proprioceptive and flexibility exercise program along with resisted training on anxiety and depression with diabetic neuropathy

Hand Rehabilitation Treatment for Charcot-Marie-Tooth Disease: An Open Label Pilot Study.

ObjectiveCharcot-Marie-Tooth neuropathy affects mainly and early the lower limbs, but hands deformities are a relevant problem, which involves the quality of life of the patients. Unfortunately, there are few studies about the evaluation of the upper limbs and very rare works about the rehabilitation. A treatment study at the moment is missing and it is important to search rehabilitation exercises to improve the dexterity and the quality of life of the patients.MethodsWe recruited 9 patients with clinical and genetic diagnosis of CMT and we proposed a rehabilitation protocol which includes muscle recruitment, stretching and proprioceptive exercises for the hand with the duration of 4 weeks (two sessions for week). We evaluated the patients before and one week after the treatment with Thumb Opposition Test, Sollerman Hand Function Scale, dynamometry (tripod pinch and hand grip).ResultsThe rehabilitation protocol has been well tolerated and there were not dropouts. We did not observe any worsening in every scale we used. Every parameter tested showed an improvement especially in the right/dominant hand.ConclusionThis study demonstrates that this three phases treatment is well tolerated by patients, it is not detrimental for the hands status and perfectly reproducible by professionals. Moreover, this could be the basis for future randomized single blind projects.

The effects of proprioception exercise with and without visual feedback on the pain and balance in patients after total knee arthroplasty.

[Purpose] The aim of this study was to determine the effects of proprioception exercise to decrease pain and increase the ability to balance by implementing visual feedback during early rehabilitation after total knee arthroplasty. [Subjects and Methods] In this study, 24 patients who receive a total knee arthroplasty were randomly and equally assigned to a visual feedback training group (VFT group) and a visual disuse group (Control group). They performed visual feedback training using the My Fitness Trainer (MFT, Austria) for 20 minutes, three times per week for eight weeks. The patients’ balance ability and pain was measured before and after the exercises. Pain was measured by the visual analogue scale (VAS). To assess balance ability, the anteroposterior and mediolateral directions on unstable ground was measured by using the MFT measurement system. [Results] The VFT group showed a significant decrease in VAS and an increase in balance ability within the group, as well as a significant increase in balance ability between groups when compared with the control group. [Conclusion] Visual feedback training during the rehabilitation of patients who received a total knee arthroplasty will be useful in reducing pain and improving balance.

Rehabilitation after Pectoralis Major Muscle Rupture Repair: A case report

Purpose of this study is to describe the treatment, surgery, rehabilitation and return to daily life subject pectoralis major muscle rupture. The in patient with was a 26 years old, injured in training due to hyperextension and external rotation. Physical examination, manual test, and MRI were used to diagnose pectoral muscle rupture and operation took for the pectoralis major muscle rupture with allograft. The subject was referred for rehabilitation from 3 weeks. Range of motion (ROM) exercise was mainly performed until 3 months, strength was performed with tubing band, body weight, machine training and proprioceptive exercise. Shoulder range of motion (external rotation, flexion) were measured with goniometer and muscle strength (flexion, adduction, internal rotation) were measured with dynamometer. At 6momths, external rotation ROM was 50° (unaffected side 60°), and flexion almost recovered at 3 months. Muscle strength was gradually increased to 6.2kg, 15.7kg, and 27.0kg in flexion, while internal rotation The pain remained slightly after 9 months. The present results suggest that ROM exercise and strengthening exercise increase the muscle power and ROM, and decrease the pain.

The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial

ObjectiveProprioception, the perception of limb movements and spatial orientation derived from body stimuli, plays a critical role in maintaining joint stability. This study aimed to investigate the effect of combined exercise therapy (closed kinetic chain exercises and proprioception exercises) on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome. DesignSingle-blind randomized clinical trial. SettingShiraz School of Rehabilitation Sciences. ParticipantsTwenty four patients with hypermobility syndrome. InterventionsThe patients were assigned to the control (no intervention) or intervention group (exercise therapy) by random allocation. MeasurementsKnee proprioception, pain intensity and quality of life were evaluated before and immediately after the intervention. Exercise sessions were held 3 days a week for 4 weeks. ResultsThe results showed that knee proprioception improved significantly in the intervention group compared to the control group. Quality of life increased, and knee pain intensity decreased significantly in the intervention group compared to the control group. ConclusionCombined exercise therapy can reduce pain intensity and increase knee proprioception and quality of life in patients with hypermobility syndrome.

Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review.

Is neuromuscular and proprioceptive training effective in preventing knee and anterior cruciate ligament (ACL) injuries? The authors searched CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE/EMBASE, PubMed, and Web of Science databases from 1996 through December 2014 and limited the results to peer-reviewed manuscripts published in English. Search terms for all databases were knee injury OR knee injuries; OR anterior cruciate ligament injury OR anterior cruciate ligament injuries; OR ACL injury OR ACL injuries; OR lower limb injury OR lower limb injuries AND prevention. Inclusion criteria were (1) English language, (2) published from 1996 through 2014, (3) the intervention used neuromuscular or proprioceptive training to prevent knee or ACL injuries, (4) human participants, (5) the incidence of knee or ACL injury was provided. For the articles that met the inclusion criteria, 2 authors worked independently using the Jadad scale to extract the first author, year of publication, title, sport type, participant sex, participant age, country in which the study was conducted, number of participants in the control and intervention groups, intervention characteristics or components, and knee or ACL injury outcome. A total of 24 studies with 1093 participants were included in this review. Intervention efficacy was determined from weighted incidence rate ratios. After the intervention of neuromuscular and proprioceptive training exercises, the incidence ratio (frequency of a disease or injury occurrence in a population over a specific time frame) was calculated at 0.731 (95% confidence interval = 0.614, 0.871) for knee injury and at 0.493 (95% confidence interval = 0.285, 0.854) for ACL injury. This indicated a link between neuromuscular and proprioceptive training programs and injury reduction. No significant correlation was present between more components added to training and a greater decrease in injury to either the knee or ACL. Neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the ACL. However, no evidence suggested that a specific group of exercises was better than others.

Snapshot survey of physiotherapy practice for patients with hip osteoarthritis in the public sector

Purpose: Hip osteoarthritis (OA) is a chronic musculoskeletal condition affecting 2.5 million people in England. There is limited evidence on practice in the United Kingdom (UK) by physiotherapists in the public sector. A snapshot survey was conducted in a limited time period to inform standard care in a trial funding application.Methods: An online survey was circulated using Twitter. Thirteen Tweets linking to the survey were posted over 6 days to gain a snapshot view of physiotherapy practice within the public sector in the UK.Results: Sixty-two physiotherapists from 25 counties in the UK and Wales responded. The median waiting time from referral to physiotherapy treatment was 5 weeks and patients were seen a median of 3 times. The median total number of hours treated was 2 hours, and the median duration time for treatment was 8 weeks. All respondents used strengthening exercises, 73% stretches, 50% cardiovascular exercise, 73% balance exercises and 26% proprioceptive exercises. Thirty-nine percent of respondents use both strengthening and cardiovascular exercises, and provide an education leaflet, as contained within National Institute for Health and Clinical Excellence (NICE) guidance.Conclusions: This snapshot suggests that physiotherapeutic management varies widely across the UK.

Poster 358: Effective Proprioceptive Exercises for Sensory Ataxia due to Thalamic Stroke: A Case Report

Poster 358: Effective Proprioceptive Exercises for Sensory Ataxia due to Thalamic Stroke: A Case Report

Physical Exercise and Physical Activity for Children and Adolescents With Juvenile Idiopathic Arthritis: A Literature Review

This is a review of studies that investigate the efficacy of exercise therapy and physical activity for children with juvenile idiopathic arthritis since the 2008 Cochrane Review. Studies were identified that investigated the use of physical activity and exercise therapy in the treatment of children and adolescents with juvenile idiopathic arthritis, excluding the Cochrane Review. Two reviewers individually analyzed the results of the search to determine the eligibility of studies. The randomized controlled trial study designs were evaluated using PEDro scales. Recent literature supports the importance of the combination of strengthening, stretching, proprioceptive, and balance exercises and activities in water. Many of the reviewed studies proposed an intensive program of physical activity and exercise therapy, conducted 3 times a week for 12 weeks.

Quality and Variability of Online Physical Therapy Protocols for Isolated Meniscal Repairs

Objectives:Patients are attempting to access healthcare content online at a precipitously increasing rate given the efficiency and ease of modern search engines. The purpose of this study was to assess the quality and variability found across isolated meniscal repair rehabilitation protocols published online.Methods:Web-based meniscal repair physical therapy protocols from U.S. academic orthopaedic programs available online were included for review. The first 10 protocols identified by the Google search engine for the term “meniscal repair physical therapy protocol” were also included as these will be the most commonly encountered by patient searches. Exclusion criteria comprised treatment of concomitant injuries and protocols aimed at pediatric patients. A comprehensive custom scoring rubric was created to assess each protocol for presence or absence of various rehabilitation components, as well as their timing.Results:Twenty protocols were included from 155 U.S. academic orthopaedic programs for a total of 30 protocols. Only one protocol (5%) recommended a pre-operative rehabilitation program and no protocol recommended continuous passive motion post-operatively. Twenty-six protocols (86.6%) recommended immediate post-operative bracing with an average 5.0 (range 3 to 8) weeks of brace use. Twenty-three of these protocols (88.5%) specifically mentioned locking of the brace during ambulation. Twelve (40.0%) protocols permitted immediate weight bearing as tolerated (WBAT) post-operatively, while the remaining protocols permitted WBAT at an average 4.0 (range 1 to 7) weeks post-operatively. There was considerable variation in range of motion (ROM) goals with most protocols (73.3%) initiating immediate PROM to 90°. Full ROM was mentioned in 22 (73.3%) protocols and permitted at an average of 5.2 (range 1 to 7) weeks. The types of strength and proprioception exercises specifically recommended in each protocol were extremely diverse. In regard to modalities recommended for return to basic activity, stationary biking was the most commonly employed (90.0%) at an average 4.6 (range 1 to 7) weeks post-operatively. Agility and pivot training were permitted at an average of 12.5 (range 7 to 28) and 19.3 (range 11 to 28) weeks, respectively. Only five protocols (16.7%) employed functional testing during the rehabilitation process as a marker for return to athletic activities, with 14 (46.7%) protocols failing to mention return to practice or competition as a goal for meniscal repair rehabilitation.Conclusion:There is a paucity of evidence-based treatment modalities employed during physical therapy following isolated meniscal repair. The results of this study indicate that only a minority of academic orthopaedic programs publish meniscal repair physical therapy protocols online and that within these protocols there are significant disparities. These variations reflect the lack of consensus regarding the best-practice components of meniscal repair rehabilitation which can lead to confusion among patients, therapists and surgeons resulting in longer recovery times and inferior results. This inconsistency represents an opportunity for improvement through standardization.

Análise eletromiográfica durante exercícios de propriocepção de tornozelo em apoio unipodal

Introduo: A propriocepo um componente do sistema somatossensorial que tem a capacidade de fornecer informaes aferentes ao Sistema Nervoso Central sobre a posio e o movimento dos segmentos de vrios receptores. Objetivo: Analisar a atividade eletromiogrfica dos msculos, tibial anterior e fibulares, importantes na estabilizao do tornozelo, dos msculos multfidos e transverso do abdmen, importantes na estabilizao da coluna lombar, durante exerccios de propriocepo. Mtodos: Os participantes responderam a um questionrio sobre os seus dados pessoais e antropomtricos e realizaram exerccios de propriocepo em apoio unipodal em diferentes aparelhos de propriocepo. Resultados: A prancha de equilbrio foi o equipamento em que apresentaram maiores valores de pico de contrao. Os msculos, tibial anterior, multfidos e os fibulares foram os que mais apresentaram diferenas significativas para os grupos masculino e feminino. Concluses: Dos msculos avaliados pela eletromiografia os que mais apresentaram diferenas significativas foram o tibial anterior, multfidos e os fibulares.

Functional outcomes and return-to-sports rate after modified Brostrom repair for lateral ankle instability with absorbable sutures and immediate postoperative weightbearing

Category: Sports Introduction/Purpose: The ankle is commonly injured in sporting activities occurring in up to 1 in 10,000 people a day. About 80% of ankle sprains recover with nonoperative management, with the remaining 20% of patients developing symptomatic instability requiring surgery. There are various surgical options being used, including anatomic repair (Brostrom technique and modifications), anatomic recon- struction with autograft or allograft, and nonanatomic reconstructions such as the Watson-Jones, Evans, and Chrisman-Snook procedures. The outcome of the direct anatomic repair is likely dependent on tissue quality, ability to tension the ligaments, and the security of the fixation. Secure fixation is critical to enable an early rehabilitation without compromising clinical outcome. We hypothesized that using absorbable suture for anatomic reconstruction is not only cost effective but also allows early rehabilitation with immediate postoperative weightbearing with good functional outcomes. Methods: The study included 71 patients presenting with chronic lateral ankle instability (who failed non-operative management) who underwent modified Brostrom repair by a single surgeon between Jan 2012 and Feb 2014.The anterior talofibular ligament and calcaneo- fibular ligament were anatomically repaired , and the repair was augmented with inferior extensor retinaculum proximal advancement, both with 1 vicryl suture. Full weight bearing in normal shoe was allowed from the day of surgery. Physiotherapy commenced prior to discharge from day surgery with gentle active range of motion, calf strength, and static peroneii exercises. From 3 to 4 weeks proprioceptive, theraband, and dynamic peroneal exercises were started. No boots, braces, or casts were used at any stage in the post-operative period. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score (FAOS). Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Results: There were 41 were males and 30 females with mean age at surgery of 27 years (range 16 - 47 years), mean duration of symptoms of 2 years (range, 6 months to 8 years)and a mean follow-up duration of 34 months (range 24- 49 months). Significant improvement was seen in the FAOS from preoperatively to postoperatively (from 37 to 79): the pain subscale , the symptom subscale, the function subscale, the function in sports and recreation subscale, and the foot and ankle–related quality of life subscale improved from 38 to 79, 42 to 81, 43 to 82 , 31 to 79 and 32 to 77 respectively. All these findings were statistically significant. The failure rate was 4%, with 3 patients reporting instability after subsequent traumatic re-rupture. Two case of temporary neuropraxia of the superficial peroneal nerve was observed. Fifty four out of 71 patients were involved in sports prior to injury and forty seven (87%) returned to sport after reconstruction. Conclusion: This study demonstrates that lateral ligament reconstruction using absorbable sutures is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weight bearing. This allows a cost-effective approach to management with minimal impact on a patient’s activities of daily living in the post-operative period. The procedure also has high return-to-sport rate.

Treatment of post-traumatic ankle ligament adhesions – case report

Ankle sprains are the most common sports injuries, but they also happen to people that do not do any sports at all. Most of them are inversion-type traumas which could harm soft tissues like lateral collateral ligaments, capsule and peroneal tendons. The vast majority of these injuries are grade 1 sprains where there is no clinical instability. Very often treatment is based on conservative protocols, i.e. RICE (rest, ice, compression, elevation), immobilization and avoiding weight bearing. Besides the above procedures, in the following period of time some modalities are planned, and there is not enough attention paid to regaining function after the acute stage. Such a conservative approach over a longer period of time should be reserved for fractures and grade 􀍗 sprains because immobilization leads to loss of proprioception and the formation of inelastic scar tissue caused by ligamentous adhesions. It takes about 6 weeks to form adhesions, and clinically those patients complain about pain, sometimes also with swelling, after some exertion. One treatment option is deep friction and manipulation of adherent lateral ligaments to break the adhesions. The aim of this paper is to show an alternative treatment option which is safer than manipulation. The authors propose the use of a shockwave therapy in combination with a home exercise stretching programme in positions reproducing the trauma mechanism to remodel the scar tissue. Additionally, there should be proprioception exercises for prophylaxis and regaining normal function.

Improving Strength and Mobility of Adults with Multiple Sclerosis Through a 16-week Exercise Program

Canada has the highest prevalence rate of multiple sclerosis (MS) globally (291 per 100,000). People with MS often experience intense fatigue, muscle weakness, decreased aerobic endurance, loss of flexibility, and impaired balance and gait. To mitigate these symptoms, which negatively affect quality of life, physical activity is often recommended. PURPOSE: To examine the effectiveness of a 16-week exercise program on improving common symptoms of MS. METHODS: Nine adults diagnosed with MS (Mage: 51.3 years; range: 42-65 years, 1 male) completed a progressive exercise program including cardiovascular, strength, flexibility, balance, and proprioception exercises (60 minutes, twice a week for 16 weeks). General measurements of health, physical fitness, functional movement, cognitive function, and quality of life were collected pre-, mid-, and post-program. A one-way ANOVA with repeated measures (Session: pre-, mid-, post-program) was performed on all dependent measures (α = 0.05). Effect sizes were calculated using the partial omega-squared (ω2p) test. RESULTS: Collectively, participants showed significant (p < 0.05) improvements from pre- to post-program on the timed up-and-go (TUG) (ω2p = 0.21) and wall push-up tests (ω2p = 0.45). Strong trends (p < 0.1) toward improvement were shown for flexibility (ω2p = 0.19), comfortable walking speed (CWS) (ω2p = 0.28), gait cadence (ω2p = 0.20), vitality (ω2p = 0.26), fatigue (ω2p = 0.17), and mental health (ω2p = 0.18). Individually, five participants showed improvement in mental health, six showed improvement in cadence, and seven showed improvement in one or more of TUG, wall push-ups, flexibility, CWS, vitality, and fatigue (all pre- to post-program). CONCLUSIONS: The progressive exercise program was successful in providing significant improvement in mobility (TUG) and upper body strength (wall push-ups). Although not statistically significant, strong trends were recognized in the areas of gait (CWS and cadence, which support the significant improvement in TUG) and quality of life (vitality, fatigue, and mental health), which may be functionally meaningful. Future research could investigate the possibility of using exercise to slow the progression of the degenerative effects of the disease. Supported by the University of Windsor Strategic Priority Fund.

Strength and Proprioceptive Training Increases Muscle Size in Patients with Chronic Ankle Instability

Chronic ankle instability (CAI) is related to strength deficits in ankle and hip musculature. Rehabilitation training improves muscular strength, but it is unclear whether strength gain results from an increase in muscle size or neuromuscular efficiency. PURPOSE: To examine the effect of a 6-week ankle and hip strength and proprioceptive program on peroneus longus (PL) and gluteus medius (GM) muscle size in patient with CAI. METHODS: 15 CAI subjects in a rehab group (23±2 yrs, 178±8 cm, 76±9 kg, 83±7% FAAM ADL, 56±10% FAAM Sports, 4.7±2 ankle sprains) completed a series of 10 ankle and hip strength and proprioceptive exercises (theraband, wobble board, ankle disk, etc.) 3 times/week for 6 weeks under supervision. 14 CAI subjects participated in a control group (22±2 yrs, 177±9 cm, 75±12 kg, 81±9% FAAM ADL, 56±12% FAAM Sports, 5.9±3.3 sprains). A Siemens Trio MRI scanner with a large flex coil was used to acquire images using a 3D multi-slice spiral gradient echo sequence with TE: 7.48 ms, TR: 17 ms, slice thickness: 5 mm. Images were acquired at pre- and post-intervention. Axial cross-sectional area (CSA) from each muscle was segmented using Analyze 12.0 software. PL muscle belly was consistently defined at 15th/96 slices (7.5 cm) from the superior head of the fibula. GM muscle belly was defined at 15th/64 slices (7.5 cm) from the superior greater trochanter of the femur. ANCOVA analyses (covariate: pre-intervention value) were used to detect group x time differences. RESULTS: ANCOVA analyses confirmed between-group differences in PL (F 1,26=39.087; p < .05) and GM CSA (F 1,26=22.965; p < .05) over time. The rehabilitation intervention resulted in a 3.9% increase in PL (pre= 5.9±1.5 cm2, post= 6.1±1.5 cm2; p < .05) and a 5.1% increase in GM CSA (pre=42.0±7.1 cm2, post=44.2±7.3 cm2; p < .05). No significant changes were detected in PL (0.7% reduction; pre= 6.96±1.7 cm2, post= 6.91±1.6 cm2; p > .05) and GM CSA (0.6% increase; pre=47.5±7.9 cm2, post=47.7±7.8 cm2; p > .05) in the control group. CONCLUSIONS: Relative to the control group, a 6-week strength and proprioceptive program is effective in increasing muscle size of ankle and hip musculature. As muscle size is proportional to muscular strength, increased muscle size might have a positive impact on dynamic functions at the ankle and hip.

Changes in Lower Extremity Energetics during Cutting in Chronic Ankle Instability Patients Following Rehabilitation Intervention

Energetic redistribution from the distal to proximal joints may be linked to sensorimotor deficits at the ankle in patients with chronic ankle instability (CAI). Little is known whether a rehab intervention improves lower extremity energetic patterns during cutting. PURPOSE: To examine the effect of a 6-week ankle and hip intervention program on ankle, knee and hip joint power during cutting in CAI patients. METHODS: 15 CAI subjects in a rehab group (23±2 yrs, 178±8 cm, 76±9 kg, 83±7% FAAM ADL, 56±10% FAAM Sports, 3.6±1.1 MAII, 4.7±2.0 ankle sprains) completed a series of 10 ankle and hip strength and proprioceptive exercises (theraband, wobble board, ankle disk, etc.) 3 times/week for 6 weeks under supervision. 14 CAI subjects participated in a control group (22±2 yrs, 177±9 cm, 75±12 kg, 81±9% FAAM ADL, 56±12% FAAM Sports, 3.4±1.2 MAII, 5.9±3.3 sprains). Subjects performed 10 jumps consisting of a max vertical jump plus a side cut. Functional analyses (α=.05) were used to detect a group x treatment interaction over time. If 95% CI did not cross the zero, significant differences existed. RESULTS: Figure 1. The rehab intervention resulted in up to (i) 0.8 W/kg less ankle power generation at 89-98% of stance, (ii) 2.9 W/kg more knee power absorption at 19-26% and 41-49% of stance, and 0.9 W/kg more knee power generation at 64-76% and 94-100% of stance, and (iii) 2.7 W/kg more hip power absorption at 2-5% and 17-25% stance and 1.6 W/kg less hip power absorption at 9-14% of stance. CONCLUSIONS: Relative to the control group, CAI patients in the rehab group tend to absorb power using the knee and hip during landing and to generate power using the knee during push-off. Proximal joints play a key role in landing energetics in patients with CAI following the intervention.Figure