Unilateral Chronic Ankle Instability Research Articles

Structural and Organizational Strategies of Locomotor Modules during Landing in Patients with Chronic Ankle Instability.

Human locomotion involves the coordinated activation of a finite set of modules, known as muscle synergy, which represent the motor control strategy of the central nervous system. However, most prior studies have focused on isolated muscle activation, overlooking the modular organization of motor behavior. Therefore, to enhance comprehension of muscle coordination dynamics during multi-joint movements in chronic ankle instability (CAI), exploring muscle synergies during landing in CAI patients is imperative. A total of 22 patients with unilateral CAI and 22 healthy participants were recruited for this research. We employed a recursive model for second-order differential equations to process electromyographic (EMG) data after filtering preprocessing, generating the muscle activation matrix, which was subsequently inputted into the non-negative matrix factorization model for extraction of the muscle synergy. Muscle synergies were classified utilizing the K-means clustering algorithm and Pearson correlation coefficients. Statistical parameter mapping (SPM) was employed for temporal modular parameter analyses. Four muscle synergies were identified in both the CAI and healthy groups. In Synergy 1, only the gluteus maximus showed significantly higher relative weight in CAI compared to healthy controls (p = 0.0035). Synergy 2 showed significantly higher relative weights for the vastus lateralis in the healthy group compared to CAI (p = 0.018), while in Synergy 4, CAI demonstrated significantly higher relative weights of the vastus lateralis compared to healthy controls (p = 0.030). Furthermore, in Synergy 2, the CAI group exhibited higher weights of the tibialis anterior compared to the healthy group (p = 0.042). The study suggested that patients with CAI exhibit a comparable modular organizational framework to the healthy group. Investigation of amplitude adjustments within the synergy spatial module shed light on the adaptive strategies employed by the tibialis anterior and gluteus maximus muscles to optimize control strategies during landing in patients with CAI. Variances in the muscle-specific weights of the vastus lateralis across movement modules reveal novel biomechanical adaptations in CAI, offering valuable insights for refining rehabilitation protocols.

Changes in dynamic quadriceps angle in patients with chronic ankle instability

Background: Changes in dynamic Quadriceps Angle (Q angle) had been studied in healthy subjects and individuals with other musculoskeletal disorders; however, in chronic ankle instability (CAI), it has not yet been determined. The purpose of this study was to investigate the difference in dynamic Q angle of patients with unilateral chronic ankle instability and those without chronic ankle instability. Methods: One-hundred and four participants with and without chronic ankle instability from both genders aged between 18-30 years, with a BMI range of 17.9-27.3, were enrolled into 2 equal groups; a study group and a control group, with mean values of age of the study and control groups (20.8±2.4) and (20.9±3) years respectively and of BMI (24.1±4.3) and (23.8±2.9) kg/m2 respectively. Dynamic Q angle measurement is carried out using dynamic knee valgus (DKV) through the frontal plane projection angle (FPPA) during single limb squat. Results: A statistically significant difference in FPPA angle was observed between the affected limb of the CAI group and controls (P=0.001). Conclusion: The present study suggested that unilateral CAI display an increased knee valgus, suggesting an additional proximal kinematic alteration and chronic maladaptation in the CAI population.

Effects of Kinesio taping on lower limb biomechanical characteristics during unexpected jumping in patients with chronic ankle instability.

The current biomechanical research on the application of Kinesio taping (KT) to patients with chronic ankle instability (CAI) has focused on testing the expected movements. However, unexpected movements are more common in actual sports. Therefore, the present study aimed to investigate the effects of KT on the biomechanical characteristics of the knee and ankle joints during unexpected jumping movements. Twenty-one patients with unilateral CAI were recruited to capture the biomechanical parameters during unexpected jumping movements under different interventions: no taping (NT), placebo taping (PT), and KT. A one-way repeated measures analysis of variance was used to compare the differences in knee and ankle biomechanical characteristics among patients with CAI between the three intervention conditions. At initial contact, the KT group demonstrated a significant decrease in ankle plantarflexion and knee flexion angles compared to the NT group (p < 0.05). At the early landing phase, the KT group had a significant increase in peak ankle dorsiflexion angle, peak ankle eversion angle, peak ankle dorsiflexion moment, and peak ankle eversion moment compared to the NT and PT groups (p < 0.05). Furthermore, the KT group had a significantly reduced peak knee flexion angle, peak knee eversion angle, and peak vertical ground reaction force (p < 0.05) compared to the NT and PT groups. KT significantly improves the sprain-prone touchdown posture of patients with CAI. And reducing the risk of ankle sprains during the early landing phase by promoting ankle dorsiflexion and eversion angles and moments.

Investigating the Mediating Role of Pain in the Relationship between Ankle Joint Position Sense and Balance Assessed Using Computerized Posturography in Individuals with Unilateral Chronic Ankle Instability: A Cross-Sectional Study

Chronic ankle instability (CAI) is characterized by impaired ankle joint position sense (JPS) and compromised balance. Despite previous studies investigating the correlation between ankle JPS and balance in individuals with CAI, the potential mediating effect of pain in this relationship remains unclear. Understanding the role of pain as a mediator between ankle JPS and balance could provide valuable insights into the complex interplay among these variables in individuals with CAI. Therefore, further research is needed to elucidate the mediating effect of pain and its implications in assessing and managing ankle JPS and balance deficits in individuals with CAI. This cross-sectional study aimed to investigate the mediating role of pain in the association between ankle JPS and balance in individuals with unilateral CAI. Methods: Fifty-five individuals diagnosed with CAI participated in this study. Ankle JPS was assessed using a digital inclinometer, whereas the balance was measured using a computerized dynamic posturography device. Results: Participants with CAI showed impaired ankle JPS in the affected leg compared to that in the asymptomatic leg (p &lt; 0.001). Ankle JPS errors were greater in both dorsiflexion and plantarflexion directions in the CAI. Balance was compromised in the CAI leg (p &lt; 0.001). Moderate correlations (p &lt; 0.001, r = 0.31 to 0.48) were found between the balance variables. Pain significantly mediated the ankle JPS-balance relationship in the CAI (p &lt; 0.05, Sobel test). The findings suggest that individuals with CAI exhibit impaired ankle JPS and compromised balance. Pain plays a mediating role in the association between ankle JPS and balance in individuals with CAI. These results highlight the importance of considering pain as a potential mediator when assessing and treating balance issues in individuals with CAI. Healthcare professionals should incorporate assessments of ankle JPS and pain into the management of interventions that address these factors and improve balance and functional ability.

Test-retest reliability of ankle range of motion, proprioception, and balance for symptom and gender effects in individuals with chronic ankle instability

ObjectivesTo determine the reliability of the commonly used musculoskeletal assessments in individuals with chronic ankle instability (CAI). DesignWithin and between-days test-retest reliability. SettingUniversity laboratory. ParticipantsTwenty-four individuals with unilateral CAI. MethodFor both sides, ankle dorsiflexion range of motion (DFROM) was assessed by a goniometer and weight-bearing lunge test (WBLT), proprioception by the active movement extent discrimination apparatus (AMEDA), and balance by the Star Excursion Balance Test with anterior (SEBTA), posteromedial (SEBTPM) and posterolateral (SEBTPL) components. All measures were taken at enrollment, after 30 min and one week later. ResultsFor the asymptomatic side, all assessments demonstrated good to excellent reliability, with ICCs (3,1) between 0.8 and 0.96. On the symptomatic side, WBLT, SEBTA and SEBTPM showed excellent reliability, with ICCs (3,1) above 0.90, while SEBTPL, goniometer and AMEDA showed moderate reliability, with the 95% CI of the ICCs (3,1) crossing 0.5. Three-way repeated measures ANOVA showed a side main effect, with asymptomatic worse, for WBLT (F = 16.9, p < 0.001) and SEBTA (F = 5.4, p = 0.03); an overall improving time main effect for SEBTPL (F = 6.9, p = 0.02). Neither a gender main effect nor any interaction effect was found. ConclusionsWBLT, SEBTA and SEBTPM can be strongly recommended for measuring ankle dorsiflexion mobility and dynamic balance for both sides of individuals with unilateral CAI, while only WBLT can be used for side-to-side comparison. The application of a goniometer to measure DFROM, SEBTPL or AMEDA should be done cautiously for this specific cohort, considering their poor to good reliability for the symptomatic side.

Center of Pressure Deviation during Posture Transition in Athletes with Chronic Ankle Instability.

Center of pressure (COP) tracking during posture transition is an ideal scale for determining the recurrence of an ankle injury, thereby preventing chronic ankle instability (CAI). However, the same is difficult to determine because the reduced ability of certain patients (who experienced sprain) to control posture at the ankle joint is masked by the chain of hip and ankle joint motion. Thus, we observed the effects of knee joint immobilization/non-immobilization on postural control strategies during the posture transition task and attempted to evaluate the detailed pathophysiology of CAI. Ten athletes with unilateral CAI were selected. To examine differences in COP trajectories in the CAI side and non-CAI legs, patients stood on both legs for 10 s and one leg for 20 s with/without knee braces. COP acceleration during the transition was significantly higher in the CAI group with a knee brace. The COP transition from the double- to single-leg stance phase was significantly longer in the CAI foot. In the CAI group, the fixation of the knee joint increased COP acceleration during postural deviation. This suggests that there is likely an ankle joint dysfunction in the CAI group that is masked by the hip strategy.

The effect of neuromuscular and vestibular-ocular reflex training program on balance, isokinetic muscle strength and proprioception in people with chronic ankle instability

ObjectiveThis study aimed to compare and investigate the effectiveness of neuromuscular exercise combined with vestibular-ocular reflex training and only neuromuscular exercise training on balance, isokinetic muscle strength, and proprioception in chronic ankle instability (CAI). MethodThe study included 20 patients with unilateral CAI. The functional status was evaluated with the Foot and Ankle Ability Measure (FAAM). The star-excursion balance test was used for dynamic balance, and the joint position sense test assessed proprioception. Ankle concentric muscle strength was measured by an isokinetic dynamometer. The subjects were randomly divided into neuromuscular and vestibular-ocular reflex training (VOG, n = 10) and neuromuscular training group (NG, n = 10). Both rehabilitation protocols were applied for four weeks. ResultsAlthough VOG had higher means of all parameters, no superiority was found between the two groups in post-treatment results. However, the VOG significantly improved FAAM scores at the sixth-month follow-up than NG (P < .05). In the linear regression analysis, the post-treatment proprioception inversion-eversion for unstable side and FAAM- S were found to be independent factors of FAAM-S scores at the six months follow -up in VOG. Post-treatment isokinetic strength for inversion of unstable side (120 º /s) and FAAM- S were determined as predictor factors of FAAM- S scores at the six months follow -up (p < .05) in NG. ConclusionThe Neuromuscular combined with vestibular-ocular reflex training protocol effectively managed unilateral CAI. Furthermore, it may be considered an effective strategy for clinical outcomes for a long-term period in terms of functional status.

Effects of fatigue on balance and ankle proprioception during drop landing among individuals with and without chronic ankle instability

This study aimed to explore the effects of fatigue on the balance and ankle proprioception during drop landing of individuals with chronic ankle instability (CAI). A total of 35 participants with unilateral CAI and 35 healthy participants participated in this study. A static balance test, dynamic balance test, and ankle proprioception test were conducted before and after fatigue. Fatigue was induced with turn back runs and vertical jumps protocol. Sway distance of the center of pressure (COP), root mean square of the COP (RMS), total excursions (TOTEX), mean velocity (MVELO), 95% confidence ellipse area of the COP movements (95% AREA), Normalise Reach Distance in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions, and the area under the curve (AUC) were calculated and analyzed. There were significant group by fatigue interactions for static balance variables, normalise reach distance in the PM and PL directions, and AUC. Fatigue reduced balance and ankle proprioception in individuals with CAI. After fatigue, static and dynamic balance and ankle proprioception during drop landing were significantly worse in the CAI group than in the control group. Fatigue had a significant negative effect on balance and ankle proprioception in CAI patients. Therefore, fatigue may be an important factor causing repeated ankle sprain in CAI patients.

Comparing the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability: Randomized controlled trial

Objective To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). Design Two-arm, parallel-group, randomized, double-blind, controlled trial. Participants 60 patients with unilateral CAI. Intervention integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). Outcomes Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. Results The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95–25.37), meanConventional = 29.46 (24.09–34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). Conclusion Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients’ functional ability.

The Effects of Chronic Ankle Instability on the Biomechanics of the Uninjured, Contralateral Ankle During Gait.

ObjectiveTo determine whether unilateral chronic ankle instability (CAI) affects the kinematics of the uninjured contralateral ankle.MethodsIn this case‐control study, 15 adult patients with unilateral CAI and 15 healthy controls were studied. Both the unstable and uninjured ankles in patients with unilateral CAI (CAI group, n = 15) were compared with that of healthy individuals (control group, n = 15). Applying body photo‐reflective markers, the participant's motion during gait was measured. Biomechanical variables including overall ankle‐toe angle, linear velocity, linear acceleration, angular velocity, angular acceleration, range of motion (RoM) in dorsiplantar flexion, and inversion‐eversion at initial contact, loading response, mid‐stance, terminal stance, pre‐swing, and swing phase of the gait were measured.ResultsIn patients with CAI, the injured and uninjured ankles were significantly different regarding angle‐toe angle, inversion‐eversion RoM, dorsiplantar flexion in mid‐stance, inversion‐eversion at initial contact and terminal stance as well as the pre‐swing and swing phases (p < 0.01). The uninjured ankles of patients showed lower ankle‐toe velocity (p = 0.01) and acceleration (p = 0.01) compared to both the left and right ankles of the controls. In addition, the uninjured ankles of the patients showed decreased ankle dorsiflexion and increased inversion during initial contact, loading response, mid‐stance, terminal stance, pre‐swing, and swing compared to the control group (p < 0.017).ConclusionThe results suggest that unilateral CAI can affect gait biomechanics in the contralateral uninjured ankle. Left unaddressed, unilateral CAI may lead to increased morbidity to the contralateral uninjured side. When surgery is not preferred for the management of unilateral CAI, rehabilitation protocols should focus on both sides.

Morphologic evaluation of injured and contralateral uninjured ankles in patients with unilateral chronic ankle instability.

To compare the morphological anatomy and abnormalities of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in unilateral chronic ankle instability (CAI). 22 patients (men: women, 13:9; mean age, 28.95 ± 8.127 years) with unilateral CAI and 18 healthy volunteers (men: women, 9:9, mean age, 28.33 ± 3.678 years) were recruited. MRI scans were divided into Group 1 (22 injured ankles), Group 2 (22 contralateral uninjured ankles), and Group 3 (36 healthy volunteer ankles). The morphologic variables, MRI signal intensity (SI) values were evaluated. The ATFL proximal, intermediate, and distal sites and the CFL proximal and distal sites in Group 3 were narrower than those in Group 1 (P ＜0.05). Both ATFL and CFL in Group 1 were thicker than those in Group 3 (P ＜0.01). The proximal and intermediate sites of the ATFL and the proximal site of the CFL in Group 3 were narrower than those in Group 2 (P ＜0.01). The intermediate site of the ATFL and the proximal and distal sites of the CFL in Group 2 were thicker than those in Group 3 (P ＜0.01). The mean SI values of the ATFL in Group 1 were higher than those in Groups 2 and 3 (P ＜0.01). The ATFL and CFL SI values were higher in Group 2 than those in Group 3 (P ＜0.05). Both the injured and contralateral uninjured ankles had wider ATFL and CFL, more thickness, and higher SI values compared with those of healthy volunteer ankles. High-resolution three-dimensional MRI provides a potential tool assisting clinical decision on the treatment and rehabilitation therapy of patients with unilateral CAI.

The prevalence of chronic ankle instability in basketball athletes: a cross-sectional study

BackgroundAnkle sprain is the most common injury in basketball. Chronic ankle instability develops from an acute ankle sprain may cause negative effects on quality of life, ankle functionality or on increasing risk for recurrent ankle sprains and post-traumatic osteoarthritis. To facilitate a preventative strategy of chronic ankle instability (CAI) in the basketball population, gathering epidemiological data is essential. However, the epidemiological data of CAI in basketball is limited. Therefore, this study aims to investigate the prevalence of CAI in basketball athletes and to determine whether gender, competitive level, and basketball playing position influence this prevalence.MethodsIn a cross-sectional study, in total 391 Taiwanese basketball athletes from universities and sports clubs participated. Besides non-standardized questions about demographics and their history of ankle sprains, participants further filled out the standard Cumberland Ankle Instability Tool applied to determine the presence of ankle instability. Questionnaires from 255 collegiate and 133 semi-professional basketball athletes (male = 243, female = 145, 22.3 ± 3.8 years, 23.3 ± 2.2 kg/m2) were analyzed. Differences in prevalence between gender, competitive level and playing position were determined using the Chi-square test.ResultsIn the surveyed cohort, 26% had unilateral CAI while 50% of them had bilateral CAI. Women had a higher prevalence than men in the whole surveyed cohort (X2(1) = 0.515, p = 0.003). This gender disparity also showed from sub-analyses, that the collegiate female athletes had a higher prevalence than collegiate men athletes (X2(1) = 0.203, p = 0.001). Prevalence showed no difference between competitive levels (p > 0.05) and among playing positions (p > 0.05).ConclusionsCAI is highly prevalent in the basketball population. Gender affects the prevalence of CAI. Regardless of the competitive level and playing position the prevalence of CAI is similar. The characteristic of basketball contributes to the high prevalence. Prevention of CAI should be a focus in basketball. When applying the CAI prevention measures, gender should be taken into consideration.

Bilateral symmetry of vertical time to stabilization in postural sway after double-leg landing in elite athletes with unilateral chronic ankle sprain

BackgroundLower limb asymmetry among athlete with unilateral chronic ankle instability (CAI) during bilateral landing can be a potential source of ankle sprain reinjury. The aim of study was to investigate the effect of bilateral symmetry of vertical time to stabilization (vTTS) in postural sway after double-leg landing (DLL) in elite athletes with unilateral CAI.MethodsTwenty professional players with unilateral CAI and ten healthy controls were assigned to three groups (soccer, basketball, and control groups, n = 10 each). The postural balance during DLL tasks was assessed based on center of pressure (CoP) and vTTS. Multiple analysis of variance was conducted to statistically analyse the CoP and vTTS which followed by Bonferroni’s post hoc test (P < 0.05).ResultsThe vTTS of the injured foot was significantly longer in the soccer and basketball players than in the control players (P = 0.006, p < 0.001 respectively). The intragroup comparison showed a significant difference in the vTTS of CAI and uninjured feet among the basketball players (mean difference = 1.3 s). The basketball group exhibited a worse balance in CoP oscillations results between groups.ConclusionsThe findings suggested that symmetry between double-leg vTTS values, may be important as much as the sooner vTTS in reduced CoP oscillations and enhanced balance after DLL. Balancing exercises should achieve sooner vTTS in soccer players and symmetry in the double-leg vTTS of basketball players with unilateral CAI while maintaining static balance during dynamic-to-static postural changes to reduce recurrent ankle sprain.

Effect of Kinesiology Tape on Muscle Activation of Lower Extremity and Ankle Kinesthesia in Individuals With Unilateral Chronic Ankle Instability.

Background: The purpose of the study was to determine the effect of kinesiology tape (KT) on lower limb muscle activation during computerized dynamic posturography (CDP) tasks and ankle kinesthesia in individuals with chronic ankle instability (CAI).Methods: Thirty-five men with CAI participated in this study. The experimental procedure followed a repeated measures design. Muscle activation of lower extremity and ankle kinesthesia of participants were measured using four taping treatments, namely, KT, athletic tape (AT), sham tape (ST), and no tape (NT) in a randomized order. Muscle activation was assessed using surface electromyography (sEMG) synchronized with CDP tests from seven lower extremity muscles of the unstable limb. Ankle kinesthesia was measured by using a threshold to detect the passive motion direction of the unstable ankle. Parameters were analyzed by using a one-way repeated measures ANOVA and followed by pairwise comparisons with a Bonferroni correction.Results: No significant difference was observed among different taping treatments for the majority of parameters during CDP. Except for condition 4 with open eyes, sway-referenced surface, and fixed surround in the sensory organization test (SOT), gastrocnemius medialis root mean square (RMS) was 28.19% lower in AT compared with NT (p = 0.021, 95% CI = 0.002–0.039), while gastrocnemius lateralis RMS was 20.25% lower in AT compared with KT (p = 0.038, 95% CI = 0.000–0.021). In forward-small sudden translation from motor control test (MCT), for peroneal longus (PL), RMS was 24.04% lower in KT compared with ST (p = 0.036, 95% CI = 0.000–0.018). In toes-down sudden rotation from adaption test (ADT), for PL, RMS was 23.41% lower in AT compared with ST (p = 0.015, 95% CI = 0.002–0.027). In addition, no significant difference was observed for a threshold to the detection of passive motion direction among different taping treatments.Conclusion: This study indicated that KT had minimal effect on the muscle activation of the unstable lower limb during static stance, self-initiated, and externally triggered perturbation tasks from CDP and ankle kinesthesia among individuals with CAI, suggesting that the benefit of KT was too small to be clinically worthwhile during application for CAI.

Progressive Visual Occlusion and Postural Control Responses in Individuals With and Without Chronic Ankle Instability.

Prophylactic and rehabilitative balance training is needed to maximize postural control and develop appropriate sensory organization strategies. Partially occluding vision during functional exercise may promote appropriate sensory organization strategies, but little is known about the influence of partially occluded vision on postural control in those with and without a history of musculoskeletal injury. To determine the effect of increasing levels of visual occlusion on postural control in a heterogeneous sample of those with and without chronic ankle instability (CAI). The secondary objective was to explore postural control responses to increasing levels of visual occlusion among those with unilateral and bilateral CAI relative to uninjured controls. Cross-sectional. Sports medicine research laboratory. Twenty-five participants with unilateral CAI, 10 with bilateral CAI, and 16 participants with no history of lower extremity injury. All participants completed four 3-minute postural control assessments in double-limb stance under the following 4 visual conditions: (1) eyes open, (2) low occlusion, (3) high occlusion, and (4) eyes closed. Low- and high-occlusion conditions were produced using stroboscopic eyewear. Postural control outcomes included time-to-boundary minima means in the anteroposterior (TTB-AP) and mediolateral directions (TTB-ML). Repeated-measures analysis of variances tested the effects of visual condition on TTB-AP and TTB-ML. Postural control under the eyes-open condition was significantly better (ie,higher) than the limited visual occlusion and eyes-closed conditions (P < .001) for TTB-AP and TTB-ML. For TTB-AP only, partially occluded vision resulted in better postural control than the eyes-closed condition (P ≤ .003). Partial and complete visual occlusion impaired postural control during dual-limb stance in a heterogeneous sample of those with and without CAI. Stroboscopic eyewear appears to induce postural control impairments to the same extent as complete visual occlusion in the mediolateral direction.

Reliability of musculoskeletal ultrasonography for peri-ankle muscles in subjects with unilateral chronic ankle instability

BackgroundAnkle sprain is a common problem among active people and athletes. It causes reduces their activity of daily living and quality of life. Because of the impaired muscle strength and neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles are changed. ObjectiveThis study aimed to develop a reliable method for measuring tibialis anterior (TA) and peroneus longus (PL) muscles in the injured and intact side of lower limbs in people with unilateral chronic ankle instability (CAI). Study designCross-sectional study. MethodThis study was intra-tester reliability by ultrasound imaging to measure ultrasonography characteristics contains thickness, width, fiber length, pennation angle, and cross-sectional area (CSA) of TA, and PL in both limbs of 25 subjects at three separate times. Intra-class correlation coefficients (ICC), limits of agreement (LOA), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to analyzed relative and absolute intra-tester reliability, respectively. ResultsThe present study showed good to excellent relative reliability for both injured and intact sides (ICC 0.88-0.98), less proportional measurement error (β coefficient of LOA≈ 0), and suitable absolute reliability. ConclusionMusculoskeletal ultrasonography is a reliable method for the measurement of peri-ankle muscle morphology such as thickness, width, CSA, fiber length, and pennation angle.

Kinesiology tape length and ankle inversion proprioception at step-down landing in individuals with chronic ankle instability

ObjectivesTo determine the effect of different lengths of kinesiology tape (KT) on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI). DesignA repeated measures study. MethodsFifteen participants with unilateral CAI and fifteen participants with no CAI volunteered. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL) was used to measure ankle proprioceptive acuity. All participants were tested under four KT conditions: no tape (baseline), short tape length (only foot and ankle complex involved), mid length (below the knee) and long length (above the knee) taping. After the baseline test, participants underwent the 3 different taping tests in a random order. ResultsRepeated measures ANOVA indicated that, compared to those without CAI, individuals with CAI performed significantly worse across the 4 different conditions (F = 8.196, p = 0.008). There was a significant KT main effect (F = 7.489, p < 0.001) and a significant linear effect (F = 17.083, p < 0.001), suggesting that KT significantly improved ankle proprioceptive performance in landing, and with longer tape length there was greater proprioceptive enhancement. Post-hoc analysis showed that for the CAI group, both mid length (p = 0.013, 95%CI = −0.063, −0.009) and long length (p = 0.010, 95%CI = −0.067, −0.011) taping can significantly improve ankle proprioceptive performance compared to no tape, whereas for the non-CAI group, ankle proprioceptive acuity was significantly improved only with long length taping (p = 0.007, 95%CI = −0.080, −0.015). ConclusionsKT can be used to improve ankle inversion proprioceptive performance during landing in both individuals with and without CAI and increasing tape length may achieve greater proprioceptive improvement.

Ankle stiffness assessment in individuals with chronic ankle instability in dual-task single leg stance on an unstable surface

Introduction The ankle sprain is one of the most prevalent traumatic injuries in sport, associated with a significant risk of developing Chronic Ankle Instability (CAI) [1,2]. This condition involves postural control deregulation expressed in feedback and feedforward mechanisms and stiffness as a consequence of incorrect or ineffective sensorial input that compromise the ankle joint stability [3]. This study aims to analyse the functional stiffness and postural stability in single leg stance on an unstable surface with dual tasking subjects with CAI. Material and methods A cross sectional study was performed with a sample of 28 athletes of modalities of increased risk for ankle sprain. Participants were divided into two groups according to the presence (n = 14 (11 with mechanical ankle instability; 8 with CAI in the non-dominant limb), age 22.0 ± 2.225 years) or absence of unilateral CAI (n = 14, age 22.5 ± 1.75 years) identified through the Ankle Instability Instrument and the Foot and Ankle Outcome Score. The ground reaction forces, and centre of pressure (CoP) were assessed during dominant and non-dominant single leg stance during 30 sec on an unstable surface while the participants performed the Stroop test. The measures of CoP displacement, root mean square (RMS), standard deviation, velocity and area and functional stiffness were assessed through the data obtained by a force plate. Functional stiffness was assessed through the relation between the moment of force and the angular position of the ankle according to the method proposed by Winter [4]. This study was approved by the School of Health’s Ethical Committee and was performed in a research centre. Results The CAI group showed an increase in the functional stiffness for mediolateral direction in the lesioned limb when this limb was the dominant one (U = 1.000; p = .001) but also when this limb was the non dominant one (U = 15.000; p = .033) and in the contralesional dominant limb (U = 7.000; p = .004). An increase in the RMS in the anteroposterior direction was observed in the lesioned limb (U = 13.000; p = .017), and a decrease in the CoP displacement in the non lesioned limb (U = 25.000; p = .034), in comparison to the control group but only when these limbs were dominant. Discussion and conclusion Subjects with CAI seem to present increased bilateral functional stiffness as a possible strategy to increase postural stability in single leg stance, however stiffness assessments based on kinematics should be performed to confirm these findings. Rehabilitation should consider strategies to promote more efficient bilateral postural control mechanisms in subjects with chronic ankle instability.

English

BACKGROUND Ankle sprain is a common problem among active people and athletes. About 80 % of the people and 73 % of the athletes, who once had an ankle sprain, have experienced a recurrence of ankle sprain during their work or sport. Chronic ankle instability is described as a repeated ankle sprain, ankle giving way, pain and swelling and functional decline. Due to impaired muscle strength and impaired neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles have changed. The study aimed to identify the morphological and muscle performance components of peroneus longus (PL) muscle in subjects with injured and intact sides of the chronic ankle sprain. Furthermore, the difference in ultrasonographic characteristics of PL muscle between genders, and the effect of the dominant limb on PL muscle ultrasonographic characteristics were investigated. METHODS The thickness, width and cross-sectional area (CSA) as morphological components and muscle performance components like fiber length, and pennation angle of PL muscle of the injured were calculated and compared to the intact side of the control in 25 subjects with unilateral chronic ankle instability via ultrasonography. RESULTS The findings of this study indicated a significant difference in the morphological component of PL muscle between both sides with no statistically significant difference in the muscle performance component of PL muscle. CONCLUSIONS Awareness of these changes in the injured side muscle morphology may lead to better clinical decision-making to design the best treatment plan by the physiotherapist. KEY WORDS Ankle Sprain, Chronic Ankle Instability, Ankle Muscle Ultrasonography

Ankle and foot mechanics in individuals with chronic ankle instability during shod walking and barefoot walking: A cross-sectional study

PurposeThis study evaluated the angular kinematic and moment of the ankle and foot during shod walking and barefoot walking in individuals with unilateral chronic ankle instability (CAI). MethodsRecreational soccer players with unilateral CAI were recruited for this cross sectional study conducted between January and August 2019. A total of 40 participants were screened for eligibility but only 31 met the inclusion criteria based on the methods of Delahunt et al and Gribble et al. Except for 3 participants not attending the evaluation session, 28 participants were finally included. A three dimensional motion analysis system made up of ProReflex motion capture unit and an AMTIb Kistler force plate, embedded in the middle of nine meter walkway, were used to assess the ankle and foot angles and moment during shod walking and barefoot walking conditions. A Statistical Package for Social Sciences (version 20.0) was used to analyze data. ResultsDuring shod walking, the ankle joint plantar-flexion range of motion (ROM) at 10% of the gait cycle (GC) and dorsiflexion ROM at 30% of the GC were significantly higher than those during barefoot walking for both feet (p = 0.001, 0.001, 0.027, and 0.036 respectively). The inversion ROM during shod walking was significantly higher than that during barefoot walking for both feet at 10% and 30% of the GC (p = 0.001. 0.001, 0.001, and 0.042 respectively). At 10% of the GC, the eversion moment was significantly higher between barefoot and shod walking for both feet (both p = 0.001). At 30% of the GC, there was no significant difference between shod and barefoot walking plantar-flexion moment of both feet (p = 0.975 and 0.763 respectively), and the eversion moment of both feet (p = 0.116 and 0.101 respectively). ConclusionAt the early stance, shod walking increases the ankle plantar-flexion and foot inversion ROM, and decreases the eversion moment for both feet in subjects with unilateral CAI. Therefore, the foot wearing condition should be considered during evaluation of ankle and foot kinematics and kinetics.