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Kim KM, Kim JS, Needle AR. Soleus arthrogenic muscle inhibition following acute lateral ankle sprain correlates with symptoms and ankle disability but not with postural control. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:559-568. [PMID: 38428732 PMCID: PMC11184308 DOI: 10.1016/j.jshs.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/20/2023] [Accepted: 11/27/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Acute lateral ankle sprains (ALAS) are associated with long-term impairments and instability tied to altered neural excitability. Arthrogenic muscle inhibition (AMI) has been observed in this population; however, relationships with injury-related impairments are unclear, potentially due to the resting, prone position in which AMI is typically measured. Assessing AMI during bipedal stance may provide a better understanding of this relationship. METHODS AMI was assessed in 38 young adults (19 ALAS within 72 h of injury: 10 males, 21.4 ± 2.7 years; 19 healthy controls: 10 males, 21.9 ± 2.2 years; mean ± SD) using the Hoffmann reflex (H-reflex) during bipedal stance. Electrical stimulation was administered to identify the maximal H-reflex (Hmax) and maximal motor response (Mmax) from the soleus, fibularis longus, and tibialis anterior muscles. The primary outcome measure was the Hmax/Mmax ratio. Secondary outcomes included acute symptoms (pain and swelling), postural control during bipedal stance, and self-reported function. RESULTS No significant group-by-limb interactions were observed for any muscle. However, a significant group main effect was observed in the soleus muscle (F(1,35) = 6.82, p = 0.013), indicating significantly lower Hmax/Mmax ratios following ALAS (0.38 ± 0.20) compared to healthy controls (0.53 ± 0.16). Furthermore, lower Hmax/Mmax ratios in the soleus significantly correlated with acute symptoms and self-reported function but not with postural control. CONCLUSION This study supports previous evidence of AMI in patients with ALAS, providing insight into neurophysiologic impacts of musculoskeletal injury. Our results suggest that assessing AMI in a standing position following acute injury may provide valuable insight into how AMI develops and guide potential therapeutic options to curb and offset the formation of joint instability.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si 16419, Republic of Korea
| | - Joo-Sung Kim
- Department of Health and Human Performance, Texas State University, San Marcos, TX 78666, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC 28608, USA; Department of Rehabilitation Science, Appalachian State University, Boone, NC 28608, USA.
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Needle AR, Tinsley JE, Cash JJ, Koeval BK, Barton JA, Howard JS. The effects of neuromuscular electrical stimulation to the ankle pronators on neural excitability & functional status in patients with chronic ankle instability. Phys Ther Sport 2023; 60:1-8. [PMID: 36634453 DOI: 10.1016/j.ptsp.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Chronic ankle instability (CAI) is associated with decreased neural excitability that negatively impacts function. This study assessed a 2-week neuromuscular electrical stimulation (NMES) or transcutaneous electrical nerve stimulation (TENS) intervention over the ankle pronators on neural excitability, performance, and patient-reported function in patients with CAI. STUDY DESIGN Randomized controlled trial. PARTICIPANTS Twenty participants with CAI completed the study. MAIN OUTCOME MEASURES Participants were assessed for reflexive and corticospinal excitability to the ankle muscles, dynamic balance, side-hop test performance and patient-reported outcomes at baseline, post-intervention (2-weeks), and retention (4-weeks). Between baseline and post-intervention, participants reported for 5 sessions where they received either sub-noxious NMES (n = 11) or sensory-level TENS (n = 9) over the ankle pronators. RESULTS Improved reflexive excitability to the ankle pronators was observed in TENS at post-intervention (p = 0.030) and retention (p = 0.029). Cortical excitability to the dorsiflexors increased in TENS at post-intervention (p = 0.017), but not at retention (p = 0.511). No significant changes were found for other neural measures, balance ability, hopping, or patient-reported function (p > 0.050). CONCLUSIONS Our results suggest TENS modified neural excitability; however, these changes were not enough to impact clinical function. While TENS may be capable of neuromodulation, it may require rehabilitative exercise to generate lasting changes. NCT04322409. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA; Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA.
| | - Jennifer E Tinsley
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Jasmine J Cash
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Blake K Koeval
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jacob A Barton
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jennifer S Howard
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
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Cash JJ, van Werkhoven H, Cole KJ, Needle AR. The effects of 72 h of dynamic ankle immobilization on neural excitability and lower extremity kinematics. Gait Posture 2022; 93:198-204. [PMID: 35183836 DOI: 10.1016/j.gaitpost.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle injuries can foster maladaptive changes in nervous system function that predisposes patients to subsequent injury. Patients are often placed in a dynamic boot immobilizer (BI) following injury; however, little is known about the effects of this treatment on neuromechanical function. RESEARCH QUESTION We aimed to determine the effect of 72 h of BI-use on neural excitability and lower extremity joint motion in a healthy cohort. METHODS Twelve uninjured individuals (20.8 ± 1.4 yrs, 1.7 ± 0.1 m, 75.2 ± 9.9 kg) participated in this crossover study. Neural excitability and lower extremity kinematics were assessed before and after 72 h of BI or compression sock (CS) use. Neural excitability was assessed via the Hoffmann (H) reflex and transcranial magnetic stimulation of the motor cortex by measuring muscle activation at the tibialis anterior, peroneus longus, and soleus of the immobilized extremity. Three-dimensional lower extremity joint angles were assessed while participants walked on a treadmill. Repeated-measures analyses of variance detected changes in neural excitability and peak joint angles across time-points and testing conditions, while statistical parametric mapping (SPM) was implemented to determine continuous joint angle changes (α = 0.05). RESULTS Pre-BI to post-BI, HMax:MMax ratio (F = 6.496; p = 0.031) significantly decreased. The BI did not alter resting motor threshold (F = 0.601; p = 0.468), or motor evoked potential amplitudes (F > 2.82; p > 0.608). Significant changes in peak knee and hip angles in the frontal and transverse planes were observed (p < 0.05), with no changes at the ankle. SPM analyses revealed significant hip and knee changes in range of motion (p < 0.05). SIGNIFICANCE Decreased measures of reflex but not corticospinal excitability suggest that BI-use for 72 h unloaded the joint enough to generate peripheral changes, but not the CNS, as has been described in casting models. Further, kinematic changes were observed in proximal lower extremity joints, likely due to swing-phase adaptations while wearing the BI.
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Affiliation(s)
- Jasmine J Cash
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
| | - Herman van Werkhoven
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA.
| | - Kelly J Cole
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA.
| | - Alan R Needle
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA.
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Dewar C, Grindstaff TL, Farmer B, Sainsbury M, Gay S, Kroes W, Martin KD. EMG Activity With Use of a Hands-Free Single Crutch vs a Knee Scooter. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211060054. [PMID: 35097481 PMCID: PMC8664314 DOI: 10.1177/24730114211060054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Foot and ankle injuries frequently require a period of nonweightbearing, resulting in muscle atrophy. Our previous study compared a hands-free single crutch (HFSC) to standard axillary crutches and found increased muscle recruitment and intensity while using the HFSC. Knee scooters are another commonly prescribed nonweightbearing device. The purpose of this study is to examine the electromyographic (EMG) differences between an HFSC and knee scooter, in conjunction with device preference and perceived exertion. Methods: A randomized crossover study was performed using 30 noninjured young adults. Wireless surface EMG electrodes were placed on the belly of the rectus femoris (RF), vastus lateralis (VL), lateral gastrocnemius (LG), and gluteus maximus (GM). Participants then ambulated along a 20-m walking area while 15 seconds of the gait cycle was recorded across 3 conditions: walking with a knee scooter, an HFSC, and with no assistive device. Mean muscle activity and peak EMG activity were recorded for each ambulatory modality. Immediately following testing, patient exertion and device preference was recorded. Results: The RF, LG, and GM showed increased peak EMG activity percentage, and the LG showed increased mean muscle activity while using the HFSC compared with the knee scooter. When comparing the knee scooter and HFSC to walking, both showed increased muscle activity in the RF, VL, and LG but no difference in the GM. There was no statistical difference in participant preference, whereas the HFSC had a statistically significant higher perceived exertion than the knee scooter (P < .001). Conclusion: In this group of young, healthy noninjured volunteers, the HFSC demonstrated increased peak EMG activity in most muscle groups tested compared with the knee scooter. Level of Evidence: Level II, prospective comparative study.
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Affiliation(s)
- Cuyler Dewar
- School of Medicine, Creighton University, Omaha, NE, USA
| | | | - Brooke Farmer
- Department of Physical Therapy, Creighton University, Omaha, NE, USA
| | | | - Sam Gay
- School of Medicine, Creighton University, Omaha, NE, USA
| | - Weston Kroes
- School of Medicine, Creighton University, Omaha, NE, USA
| | - Kevin D. Martin
- Wexner Medical Center, Ohio State University, Columbus, OH, USA
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Bruce AS, Howard JS, VAN Werkhoven H, McBride JM, Needle AR. The Effects of Transcranial Direct Current Stimulation on Chronic Ankle Instability. Med Sci Sports Exerc 2020; 52:335-344. [PMID: 31453883 DOI: 10.1249/mss.0000000000002129] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Given maladaptive neuroplasticity after musculoskeletal injury, interventions capable of restoring corticospinal excitability should be considered. We therefore aimed to determine if a 4-wk intervention of anodal transcranial direct current stimulation (aTDCS) with eccentric exercise would improve neural excitability, functional performance, and patient-reported function in individuals with chronic ankle instability (CAI). METHODS Twenty-six individuals with CAI were recruited to undergo 4 wk of eccentric evertor strengthening. Subjects were randomized into aTDCS (n = 13) and sham (n = 13) groups, where the aTDCS group received 18 min of aTDCS (1.5 mA) over the primary motor cortex. Participants were assessed for cortical excitability, dynamic balance, muscle activation, functional performance, strength, and patient-reported function at baseline, week 2, week 4, and week 6. RESULTS Twenty-two subjects completed the training and test sessions. Cortical excitability (resting motor threshold) to peroneus longus in aTDCS increased from baseline (36.92 ± 11.53) to week 6 (32.91 ± 12.33, P = 0.024), whereas sham increased excitability from baseline (36.67 ± 12.74) to week 2 (27.86 ± 14.69, P = 0.007), but decreased at week 4 (35.63 ± 13.10, P = 0.022) and week 6 (35.99 ± 13.52, P = 0.006). Dynamic balance and muscle activation also improved in the aTDCS group from baseline to week 6 (P = 0.034). Functional performance on a side-hop test increased in all participants from baseline to week 2 (P = 0.003). The aTDCS group had decreased perceived disablement from week 2 (18.09 ± 6.41) to week 4 (15.55 ± 4.82, P = 0.046), whereas the sham group reported increased disablement from baseline (17.91 ± 4.59) to week 2 (21.00 ± 8.52, P = 0.047). CONCLUSIONS Our results provide preliminary evidence that 4 wk of eccentric training with aTDCS improves cortical excitability, functional performance, and patient-reported function in individuals with CAI. These data are the first to show the efficacy of noninvasive brain stimulation therapies in patients with musculoskeletal injury, and demonstrate the link between improved neural excitability and functional outcomes.
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Affiliation(s)
- Amelia S Bruce
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
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Abstract
CONTEXT Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals. OBJECTIVE To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs. CONCLUSIONS External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.
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The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures. Gait Posture 2019; 68:569-574. [PMID: 30640157 DOI: 10.1016/j.gaitpost.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity fractures have a profound negative effect on a patient's gait and outcomes. Correction of deformity, and with it normalization of objective gait parameters, may result in better subjective and objective functional outcomes in patients treated with circular external fixation for malunited tibial fractures. AIM The purpose of this study was to investigate the relationships between gait parameters, patient reported outcome measures (PROMs), and health related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. METHODS This retrospective study included patients with posttraumatic tibial deformities, aged 14-65, with a minimum follow-up of 24 months following deformity correction. Patients with congenital deformities, head injuries, spinal cord injury, neurological disorders, or contralateral lower limb amputation were excluded. Functional outcomes were assessed by the Foot Function Index (FFI); Short Form 12 (SF-12); the EQ 5D; and the ASAMI score. Gait analysis was performed using Dartfish® and the Edinburgh Visual Gait Score (EVGS). The relationships between the EVGS and functional outcome scores were analyzed using Pearsons' moment correlations with Bonferroni corrections. RESULTS Eleven patients with a mean age of 42 (range 23-57) were analyzed. The mean EVGS was 2.6 ± 2.1, the mean FFI 29.6 ± 33.4, the mean EQ5 Index Value 0.7 ± 0.2, the mean EQ5 VAS 85.4 ± 19.5, the SF12 mean Physical Component Score (PCS) 46.7 ± 11.1, and the mean Mental Component Score (MCS) 55.2 ± 7.5. The following relationships were strong and significant: EVGS and FFI (r = 0.7; P = 0.02), EVGS and PCS (r = -0.82; P = 0.02), and FFI and EQ5 (r = -0.79, P = 0.05). SIGNIFICANCE The results of this study suggest that correction of deformity with realignment and restoration of normal anatomy was associated with improved functional outcomes and physical well-being. Patient reported quality of life is strongly associated with patient perceived functional outcome, but not with objective gait parameters.
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Needle AR, Baumeister J, Farquhar WB, Greaney JL, Higginson JS, Kaminski TW, Swanik CB. The relationship between the sensory responses to ankle-joint loading and corticomotor excitability. Int J Neurosci 2017; 128:435-441. [DOI: 10.1080/00207454.2017.1396219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alan R. Needle
- Department of Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jochen Baumeister
- Exercise & Neuroscience Unit, Institute of Health, Nutrition, and Sports Sciences, Europa-Universität Flensburg, Flensburg, Germany
| | - William B. Farquhar
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Jody L. Greaney
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Jill S. Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Thomas W. Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - C. Buz Swanik
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
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