Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping

How do neuromuscular characteristics of the peroneal muscles differ in adults with and without chronic ankle instability? A systematic review with meta-analysis

BACKGROUND

Chronic ankle instability (CAI) has been associated with neuromuscular control dysfunction, particularly of the peroneal musculature.

RESEARCH QUESTION

How do neuromuscular characteristics of the peroneal muscles, including corticospinal excitability, strength, proprioception (force sense) and electromyographic measures differ in individuals with CAI compared to healthy control counterparts aged 18-45?

METHODS

A systematic review with meta-analysis was conducted by retrieving relevant articles from electronic databases including EBSCOhost (CINAHL Complete, AMED, SPORTDiscus), Ovid (MEDLINE, Embase), Web of Science, Scopus and Cochrane Library as well as Grey literature sources. The eligibility and methodological quality of the included case-control and cross-sectional studies were assessed by two reviewers. The random effects model and the standard mean difference with a 95 % confidence interval were utilised to calculate pooled estimates of the overall effect size.

RESULTS

Of the total 13,670 studies retrieved, 42 were included in the systematic review. Of these, 25 were eligible for the meta-analyses. Two of the meta-analyses, each consisting of two studies, showed less evertor force sense accuracy at 10 % (d=0.50, p = 0.03) and 20 % of maximum voluntary isometric contraction (d=1.14, p < 0.00001) in individuals with CAI than the control group. In addition, another meta-analysis of two studies showed that the CAI population had longer peroneus longus latency (d=1.69, p < 0.0001) than the control group during single-leg landing inversion perturbation test under unexpected conditions.

SIGNIFICANCE

Individuals with CAI showed specific sensorimotor impairments in evertor force sense accuracy and peroneus longus latency, which may indicate that neuromuscular dysfunction of the peroneal muscles is associated with the underlying mechanisms of the CAI pathogenesis. However, the meta-analyses are limited by the inclusion of only two studies with small sample sizes. Therefore, these findings should be cautiously interpreted, and further research is required to validate them.

Muscle mechanics and energetics in chronic ankle instability and copers during landing: Strategies for adaptive adjustments in locomotion pattern

Individuals with chronic ankle instability (CAI) and copers typically exhibited aberrant landing kinematics. Altered kinematics might lead to changes in muscle loading, potentially affecting the energy demand of locomotion. Understanding alterations in muscle mechanics and energetics during landing could enhance the rehabilitation program design. Therefore, the objective of this study was to explore the muscle mechanics and energetics of individuals with CAI, copers, and healthy controls during single leg jump landing. Three groups, CAI, copers, and healthy individuals (total n = 66), performed the landing task, and data on 3D motion capture, ground reaction force (GRF), and muscle activation were simultaneously collected. A musculoskeletal model was applied to estimate muscle force and mechanical power. Compared to healthy groups, individuals with CAI showed increased peak muscle forces in the gluteus maximus (p < 0.001), gluteus medius (p < 0.001), vastus lateralis (p < 0.001), and peroneus longus (p < 0.001) during landing. Whereas copers exhibited higher peak muscle forces in the vastus lateralis (p < 0.05), medial gastrocnemius (p < 0.05), soleus (p < 0.05), and peroneus longus (p < 0.001). Additionally, negative mechanical power redistribution in CAI shifted from the ankle to the hip (p < 0.001), while copers exhibited a similar redistribution from the ankle to the knee (p < 0.05). This study suggested that both CAI and copers exhibit biomechanical modifications in proximal joints. Copers showed a novel landing strategy aimed for enhancing landing stability, but with the risk of ACL injury. The identified energy redistribution observed in both CAI and copers could potentially contribute to the recurrent ankle sprains. This research facilitates a better understanding of how muscle mechanics and energy demands influence the landing pattern in individuals with CAI and copers.

Kinematics of balance controls in people with chronic ankle instability during unilateral stance on a moving platform

Balance control deficits resulting from ankle sprains are central to chronic ankle instability (CAI) and its persistent symptoms. This study aimed to identify differences in balance control between individuals with CAI and healthy controls (HC) using challenging single-leg balance tasks. Twenty-three CAI and 23 HC participants performed balance tasks on a force plate that either remained static or moved mediolaterally. Force and kinematic data were recorded to measure balance and joint movements. The CAI group showed significantly shorter time-to-boundary during static conditions but no significant differences during moving conditions compared to HC. During moving conditions, CAIs exhibited greater proximal compensations, with greater range of motion and higher angular velocity in the knee, hip, and torso. while no significant differences were observed in these parameters during static conditions. Principal component analysis indicated specific kinetic chain in CAI during one-leg balance under both static and moving conditions compared to HC. These findings suggest an altered movement strategy in CAI, that ankle injuries impair the ability to stabilize both distal and proximal joints, and an altered kinetic chain from ankle to torso. Rehabilitation programs for CAI might benefit from considering the integration of the entire kinetic chain, addressing both distal and proximal joint dynamics to support effective recovery and prevent secondary injuries.

Ultrasound Imaging for the Evaluation of Anterior Talofibular Ligament Remnants in 547 Ankles With Chronic Lateral Ankle Instability

BACKGROUND

There are few reports on the intra- and interobserver agreement and parameters for the diagnostic accuracy of ultrasound (US) imaging for chronic lateral ankle instability (LAI). The purpose of this study was to investigate the reliability and validity of US imaging for identifying anterior talofibular ligament (ATFL) remnants in patients with LAI.

METHODS

A total of 547 ankles from 406 patients underwent surgery for LAI between 2019 and 2022. If ligament fibers remained in US images, they were evaluated as positive. If the ligament was not visualized, it was evaluated as negative. Two observers performed repeated measurements. Arthroscopic findings were considered the "gold standard" for validity and diagnostic test accuracy purposes. The intra- and interobserver agreements and parameters for diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative US imaging as intraoperative arthroscopic findings were used as reference standards.

RESULTS

The intraobserver agreement was substantial, with an agreement of 98.54% and a kappa coefficient of 0.76. The interobserver agreement was also substantial, with an agreement of 98.72% and a kappa coefficient of 0.75. The sensitivity, specificity, and accuracy of preoperative US imaging were 98.7%, 100%, and 98.7%, respectively. The PPV and NPV of US imaging were 100% and 61.1%, respectively. In the arthroscopic evaluation of the 7 cases in which US imaging showed false negative results, the ATFL ruptured at the fibular attachment and ran in contact with the talus.

CONCLUSION

A US examination finding of an intact ATFL is highly likely to be correct. An US examination finding of a ruptured ATFL can be false and may require arthroscopic confirmation.

Biomechanical Analysis of Injury Risk in Two High-Altitude Landing Positions Using Xsens Inertial Units and EMG Sensors

High-altitude landing maneuvers can pose a significant injury risk, particularly when performed with different landing techniques. This study aims to compare the biomechanical parameters and injury risks associated with two landing positions-staggered foot landing and simultaneous bilateral landing-using Xsens inertial units and electromyography (EMG) sensors. A total of 26 university students (13 males, 13 females) participated in this study. Kinematic data were collected using inertial measurement units (IMUs), muscle activity was recorded with EMG, and ground reaction forces were captured using 3D force plates. The data were processed and analyzed using the AnyBody modeling system to simulate joint forces, moments, and muscle activation. This study found that simultaneous bilateral landing exhibited greater hip flexion-extension, knee flexion-extension, and ankle inversion. Vertical joint forces were also significantly higher in the hip, knee, and ankle during simultaneous bilateral landing. Staggered foot landing showed higher muscle forces in the gluteus maximus, iliopsoas, and quadriceps femoris (p < 0.001). The EMG analysis revealed significant differences in the biceps femoris (p = 0.008) and quadriceps femoris (p < 0.001). These findings suggest that simultaneous bilateral landing increases joint load, while staggered foot landing increases muscle activation, which may lead to different injury risks between the two techniques.

Immediate Effects of Leg-Press Coordination Training on Ankle Sway in Individuals With Chronic Ankle Instability: A Randomized Controlled Trial

Objectives This study aimed to determine the effects of leg-press coordination training on immediate ankle sway in individuals with chronic ankle instability (CAI). Methods Participants with CAI (age 19.8 ± 1.0 years, seven men and 17 women) were randomly allocated to a control group (CON), which performed regular leg-press training, or a coordination training group (CT), which performed coordination training using a leg-press device. The main outcome measure was the average angular jerk cost of the ankle joint in the Y-balance test (YBT), and the secondary outcome measures were the maximum ankle and hip joint angles, maximum reach distance in the YBT, ankle proprioception, and weight-bearing dorsiflexion angle. Results A significant group × period (pre- and post-intervention) interaction in the ankle average angular jerk cost was observed in the YBT in anterior reaching and posteromedial reaching ankle plantar flexion/dorsiflexion (anterior reaching: p = 0.03, posteromedial reaching: p < 0.01) as well as in adduction/abduction (posteromedial reaching: p = 0.02). The average ankle angular jerk cost in the CT group was significantly lower at post-intervention than at pre-intervention. Conclusions Leg-press coordination training immediately reduces ankle sway in individuals with CAI.

Different strategies for landing from different heights among people with chronic ankle instability

BACKGROUND

Lateral ankle sprain (LAS) usually occurs during landing from heights among people with chronic ankle instability (CAI). Although the kinematics when landing on the flat surface has been reported, no studies have explored the effect of different heights on the landing strategies using a trapdoor device among people with CAI.

RESEARCH QUESTION

Do people with CAI adopt different landing strategies when drop-landing on the trapdoor device from three heights?

METHODS

Thirty-one participants with CAI (24 males and 7 females, age=21.1±1.8 years, height=176.9±7.4 cm, body mass=71.9±9.2 kg, injured side=18 R&13 L) were recruited. They dropped from three different heights (low height (16 cm), medium height (23 cm), high height (30 cm)) with their affected foot landing on a movable surface of a trapdoor device, which was tilted 24° inward and 15° forward to simulate LAS. Kinematic data was collected using a twelve-camera motion capture system. One-way analysis of variance with repeated measures was used to compare the differences between the three heights.

RESULTS

Significant height effects were detected in the peak ankle inversion angle (p=0.009, η2p=0.280) and angular velocity (p<0.001, η2p=0.444), and the peak ankle plantarflexion (p=0.002, η2p=0.360), knee flexion (p<0.001, η2p=0.555), and hip flexion (p=0.030, η2p=0.215) angles at the time of peak ankle inversion. Post-hoc tests showed that all the angles and velocities were higher at a low height than at medium (p: 0.001-0.045, d: 0.14-0.44) and high heights (p: 0.001-0.023, d: 0.28-0.66), except for the ankle plantarflexion angle, which was lower at a low height than at medium (p<0.001, d=0.44) and high (p=0.021, d=0.38) heights.

SIGNIFICANCE

People with CAI adopt a protective strategy during drop-landing at medium and high heights compared to a low height. This strategy involves increased ankle dorsiflexion angle as well as knee and hip flexion angles.

Task-specific differences in lower limb biomechanics during dynamic movements in individuals with chronic ankle instability compared with controls

BACKGROUND

Chronic ankle instability (CAI) has been associated with lower limb deficits that can lead to altered biomechanics during dynamic tasks. There have been contradictory findings in terms of ankle and hip joint biomechanics to date, influenced by the variety of movement tasks and varying definitions of the CAI condition.

RESEARCH QUESTION

How do biomechanical variables of the lower extremity differ during walking, running, and jump-landing in individuals with CAI compared with those without CAI?

METHODS

Thirty-two individuals (17 CAI and 15 controls) participated in this retrospective case-control study. Sagittal and frontal plane ankle and hip joint angles and moments, and mediolateral foot balance (MLFB) were calculated during the tasks. Statistical parametric mapping (SPM) was used for the whole trajectory analysis to detect group differences. Discrete variables, including initial contact (IC) and peak angles and moments, were additionally compared.

RESULTS

No differences were found between groups during walking. During running, the CAI group exhibited a lower plantar flexor moment (p < 0.001) and more laterally deviated MLFB (p = 0.014) during mid-stance when compared to controls. Additionally, participants with CAI had a significantly greater peak plantar flexion angle in early stance (p = 0.022) and a reduced peak plantar flexor moment (p = 0.002). In the jump-landing, the CAI group demonstrated an increased hip extensor moment (p = 0.008), and a greater peak hip adduction angle (p = 0.039) shortly after ground contact compared to the control group.

SIGNIFICANCE

Differences in ankle and hip biomechanics were observed between groups during running and jump landing, but not during walking. These differences may be indicative of impairments in the sensorimotor system or of learnt strategies adopted to try to minimise instability and injury risk and can help to inform future intervention design.

Does chronic ankle instability patients lead to changes in biomechanical parameters associated with anterior cruciate ligament injury during landing? A systematic review and meta-analysis

OBJECTIVE

This study aimed to determine if patients with chronic ankle instability (CAI) exhibit biomechanical changes associated with the increased risk of anterior cruciate ligament (ACL) injury during landing tasks.

STUDY DESIGN

This study was conducted through systematic review and meta-analysis.

DATA SOURCES

Searches were conducted in May 2024 across five electronic databases, including Web of Science, Scopus, PubMed, SPORTDiscus, and Cochrane Library.

ELIGIBILITY CRITERIA

Studies were included if they (1) involved subjects with CAI and healthy controls and (2) assessed biomechanical variables such as ground reaction forces, joint angles, and joint torques.

RESULTS

Of the 675 identified studies, 171 were included in the review, and 13 were eligible for meta-analysis. The reviewed studies clearly defined research objectives, study populations, consistent participant recruitment, and exposures, and they used valid and reliable measures for outcomes. However, areas such as sample size calculation, study sample justification, blinding in assessments, and addressing confounders were not robust. This meta-analysis involved 542 participants (healthy group: n = 251; CAI group: n = 291). Compared with healthy individuals, patients with CAI exhibited a greater peak vertical ground reaction force (peak VGRF; SMD = 0.30, 95% CI: 0.07-0.53, p = 0.009), reduced hip flexion angles (SMD = -0.30, 95% CI: -0.51 to -0.17, p < 0.0001), increased trunk lateral flexion (SMD = 0.47, 95% CI: 0.05 to 0.9, p = 0.03), greater hip extension moments (SMD = 0.47, 95% CI: 0.09-0.84, p = 0.02), and increased knee extension moments (SMD = 0.39, 95% CI: 0.02-0.77, p = 0.04).

CONCLUSION

During landing tasks, patients with CAI demonstrate increased hip extension moments and knee extension moments, decreased hip flexion angles, increased peak VGRF, and increased trunk lateral flexion angles. These biomechanical variables are associated with an elevated risk of ACL injuries.

Systematic Review Registration: Identifier CRD42024529349.

Visual Disruption and Neuromechanics During Landing-Cutting in Individuals With Chronic Ankle Instability

CONTEXT

Individuals with chronic ankle instability (CAI) demonstrate altered movement patterns when their vision is disturbed during simple tasks, such as single-legged standing and walking. However, it remains unclear whether visual disruption by stroboscopic glasses alters movement patterns during landing-cutting movements, considered highly demanding sport maneuvers that mimic a typical athletic movement.

OBJECTIVES

To identify altered lower extremity kinematics and muscle activation when vision is disrupted by stroboscopic glasses during landing-cutting tasks in individuals with CAI.

DESIGN

Case-control study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 individuals with CAI (age = 22.3 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 72.5 ± 9.8 kg) and 18 matched healthy controls (age = 21.7 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 71.9 ± 10.3 kg).

INTERVENTION(S)

All participants performed 5 trials of a landing-cutting task with (SV) and without (NSV) stroboscopic glasses.

MAIN OUTCOME MEASURE(S)

Frontal- and sagittal-plane lower extremity kinematics and 6 lower extremity muscle activations during the stance phase of a landing-cutting task in the SV and NSV conditions.

RESULTS

Individuals with CAI demonstrated more ankle-inversion angle from 18% to 22% and from 60% to 100% of the stance phase and more peroneus longus activation from initial contact to 18% of the stance phase under the SV condition than under the NSV condition. We observed no differences in knee- and hip-joint angles between the visual conditions for both groups.

CONCLUSIONS

When wearing stroboscopic glasses, individuals with CAI showed altered movement patterns, including increased ankle-inversion angle and peroneus longus activation during the stance phase of a landing-cutting task. The results suggest that they may lack the ability to reweight sensory information to adapt their movement to visual disruption.

Balance Training With Stroboscopic Glasses and Neuromechanics in Patients With Chronic Ankle Instability During a Single-Legged Drop Landing

CONTEXT

Therapeutic interventions for individuals with chronic ankle instability (CAI) are recommended to improve muscle strength, postural control, and range of motion. However, their effects on neuromechanics during a drop landing remain unclear. In addition, even though therapeutic interventions with stroboscopic glasses appear to effectively improve postural control, how they affect landing neuromechanics remains unclear.

OBJECTIVE

To identify the effect of balance training with stroboscopic glasses on neuromechanics during a single-legged drop landing in patients with CAI.

DESIGN

Randomized controlled clinical trial.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 50 participants with CAI were randomly assigned to 1 of 2 groups: strobe (n = 25; age = 22 ± 3 years, height = 174.7 ± 8.2 cm, mass = 71.8 ± 12.2 kg) or control (n = 25; age = 21 ± 2 years, height = 173.1 ± 8.3 cm, mass = 71.1 ± 13.5 kg).

INTERVENTION(S)

The 4-week rehabilitation (3 sessions per week) included hop-based tasks and single-legged stance. The strobe group wore stroboscopic glasses during the training, whereas the control group did not.

MAIN OUTCOME MEASURE(S)

Ankle-, knee-, and hip-joint kinematics and 4 lower extremity muscle activations 150 milliseconds before and after initial contact during a single-legged drop landing in the 2 groups.

RESULTS

The strobe group showed greater eversion (from 150 milliseconds before to 30 milliseconds after initial contact) and dorsiflexion (from 30 to 96 milliseconds after initial contact) angles and peroneal longus (from 35 milliseconds before to 5 milliseconds after initial contact) and tibialis anterior (from 0 to 120 milliseconds after initial contact) activation in the posttest than the pretest.

CONCLUSIONS

Patients with CAI who underwent a 4-week rehabilitation with stroboscopic glasses demonstrated changes in neuromechanics, including increased ankle-dorsiflexion and -eversion angles and tibialis anterior and peroneus longus activation, during a single-legged drop landing. This finding suggests that use of stroboscopic glasses during rehabilitation could help patients with CAI develop safe landing mechanics.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Lower limb squat biomechanics and select clinical measures in chronic ankle instability

BACKGROUND

Individuals with chronic ankle instability often present with clinical and biomechanical abnormalities, however squat biomechanics have not been investigated. The purpose of this study was to compare select clinical assessments and squat biomechanics between individuals with and without chronic ankle instability.

METHODS

Fifteen individuals with chronic ankle instability and a matched control group were studied. A weight-bearing dorsiflexion lunge test, foot posture, and an in-line half-kneeling motor control test for core stability were assessed. Lower limb 3D bilateral and unilateral squat biomechanics were captured. Groups, limbs and squat tasks were compared using an alpha of 0.05.

FINDINGS

Individuals with chronic ankle instability had less static weight-bearing dorsiflexion and failed the core stability test more frequently, but did not differ in foot morphology compared to the controls. When squatting, those with chronic ankle instability demonstrated reduced peak ankle dorsiflexion angles and moments in the involved limb (p < 0.04) during single limb squats and had interlimb differences in ankle dorsiflexion angle as well as hip and knee kinetics (p < 0.04) during double limb squats. In those with chronic ankle instability, there was less overall motion, but higher kinetic demands in single limb versus double leg squatting (p < 0.03).

INTERPRETATION

Individuals with chronic ankle instability had impaired weight-bearing dorsiflexion and showed impaired core stability more often, which accompanied altered squatting mechanics in both variations. Within the limbs with chronic ankle instability, single limb squats showed lesser kinematic demands but higher kinetic demands than double limb squatting.

Postural control measured before and after simulated ankle inversion landings among individuals with chronic ankle instability, copers, and controls

BACKGROUND

Postural control measured during single-leg stance and single-leg hop stabilization has been used to estimate sensorimotor function in CAI individuals and copers. To date, studies have not used postural control tasks as a way of measuring responses to sudden changes in sensory information after simulated ankle inversion landings.

RESEARCH QUESTION

A cross-sectional study was performed to identify any differences in static and dynamic postural control before and after simulated ankle inversion landings among individuals with chronic ankle instability (CAI), copers, and healthy controls.

METHODS

Nineteen CAI individuals, 19 copers, and 19 controls participated in this study. Participants performed 3 static and dynamic balance tasks before and after simulated ankle inversion landings onto a 25° tilted platform from a height of 30 cm. The main outcome measures were the center of pressure (COP) velocity and range from the single-leg stance, as well as the dynamic postural stability index from the single-leg hop stabilization. The Wilcoxon signed-rank test was used to compare posttest and pretest differences in static and dynamic postural control between groups.

RESULTS

In the static postural control measures, the CAI group had a higher difference in COP velocity and COP range in the frontal plane (p < 0.05 and p < 0.05, respectively) than the coper group. In the dynamic postural control measures, the CAI group demonstrated a higher difference in the vertical stability index (p < 0.05) than the healthy control group.

SIGNIFICANCE

CAI individuals have persistent worse postural control after somatosensory modulation due to their inability to adapt to sudden somatosensory modulation. Relative to CAI individuals, copers may have different abilities not only the integration of somatosensory input about ankle inversion modulation, but also the adaptation of the entire motor control system, preventing recurrent ankle sprains after an initial LAS. Therefore, somatosensory modulation may be the indicator of understanding CAI and coper.

Compensatory Kinetics During the Side-Hop Test in Individuals With Chronic Ankle Instability

CONTEXT

Individuals with chronic ankle instability (CAI) exhibit altered movement strategies during side-cutting tasks. However, no researchers have assessed how altered movement strategies affect cutting performance.

OBJECTIVE

To investigate compensatory strategies in the side-hop test (SHT), with a focus on the entire lower extremity, among individuals with CAI.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 40 male soccer players comprising a CAI group (n = 20; age = 20.35 ± 1.15 years, height = 173.95 ± 6.07 cm, mass = 68.09 ± 6.73 kg) and a control group (n = 20; age = 20.45 ± 1.50 years, height = 172.39 ± 4.39 cm, mass = 67.16 ± 4.87 kg).

INTERVENTION(S)

Participants performed 3 successful SHT trials.

MAIN OUTCOME MEASURE(S)

We calculated SHT time, torque, and torque power in the ankle, knee, and hip joints during the SHT using motion-capture cameras and force plates. Confidence intervals for each group that did not overlap by >3 points consecutively in the time series data indicated a difference between groups.

RESULTS

Compared with the control group, the CAI group showed (1) no delayed SHT time; (2) lower ankle-inversion torque (range = 0.11-0.13 N·m/kg) and higher hip-extension (range = 0.18-0.72 N·m/kg) and -abduction torque (0.26 N·m/kg); (3) less concentric power in ankle dorsiflexion-plantar flexion (0.18 W/kg) and inversion-eversion (0.40 W/kg), more concentric power in hip flexion-extension (0.73 W/kg), and more eccentric power in knee varus-valgus (0.27 W/kg).

CONCLUSIONS

Individuals with CAI were likely to rely on hip-joint function to compensate for ankle instability and demonstrated no differences in SHT time compared with the control group. Therefore, the movement strategies of individuals with CAI could differ from those of individuals without CAI, even if SHT time is not different.

Lower Extremity Energy Dissipation and Generation During Jump Landing and Cutting in Patients With Chronic Ankle Instability

CONTEXT

Participants with chronic ankle instability (CAI) frequently display altered movement patterns during functional movements. However, it remains unclear how these altered joint kinematics during jump landing negatively affect ankle joint health in the CAI population. Calculating joint energetics may offer an important method to estimate the magnitude of lower extremity joint loading during functional movements in participants with CAI.

OBJECTIVE

To determine differences in energy dissipation and generation by the lower extremity during maximal jump landing and cutting among groups with CAI, copers, and controls.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty-four participants with CAI, 44 copers, and 44 controls.

MAIN OUTCOME MEASURES(S)

Kinematics and kinetics of the lower extremity and ground reaction force data were collected during a maximal jump-landing and cutting task. The product of angular velocity in the sagittal plane and joint moment data represented joint power. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve.

RESULTS

Participants with CAI displayed reduced ankle energy dissipation (35.9% ± 10.1%) and generation (31.6% ± 12.8%; P < .01) compared with copers (dissipation = 43.6% ± 11.1%; generation = 40.4% ± 12.0%) and controls (dissipation = 41.3% ± 11.1%; generation = 39.6% ± 12.0%) during maximal jump landing and cutting. Participants with CAI also displayed greater energy dissipation at the knee (45.1% ± 9.1%) than copers (39.7% ± 9.5%) during the loading phase and greater energy generation at the hip than controls (36.6% ± 16.8% versus 28.3% ± 12.8%) during the cutting phase. However, copers displayed no differences in joint energetics compared with controls.

CONCLUSIONS

Participants with CAI displayed differences in both energy dissipation and generation by the lower extremity during maximal jump landing and cutting. However, copers did not show altered joint energetics, which may represent a coping mechanism to avoid further injuries.

Unexpected inversion perturbation during a single-leg landing in patients with chronic ankle instability

It remains unclear how unexpected perturbations during single-leg landings affect lower extremity kinematics and muscle activations in patients with chronic ankle instability (CAI). The purpose of this study was to identify the differences in lower extremity movement patterns among CAI subjects, copers, and healthy controls. Sixty-six people including 22 CAI subjects, 22 copers, and 22 healthy controls volunteered to participate in the study. Lower extremity joint kinematics and EMG activations from 200-ms pre to 200-ms post the initial contact during unexpected tilted landings were measured. Functional data analysis was used to evaluate between-group differences for outcome measures. Relative to copers and healthy controls, CAI subjects showed more inversion from 40-ms to 200-ms after initial contact. Relative to healthy controls, CAI subjects and copers showed more dorsiflexion. Relative to healthy controls, CAI subjects and copers showed more muscle activation in tibialis anterior and peroneus longus, respectively. In conclusion, CAI subjects demonstrated greater inversion angles and muscle activation before initial contact compared to LAS copers and healthy controls. This suggests that CAI subjects and copers prepare for their landing with protective movements, but the prepared movements shown by CAI subjects may be insufficient to reduce risk of recurrent injury.

Less impact absorption at the ankle joint is related to the single-leg landing stability deficit in patients with chronic ankle instability

Single-leg landing (SLL) stability deficits are common dysfunctions after lateral ankle sprain (LAS), and are associated with reinjury and needs to be addressed. SLL stability deficits could be associated with impact absorption ability. Thus, we evaluated these relationships. We recruited 46 patients with chronic ankle instability (CAI) and 64 control patients and measured their kinematics, SLL stability, and impact absorption ability. The SLL stability was evaluated by calculating the anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI). The impact absorption ability was evaluated by calculating the energy absorption (EA). The large negative value of the EA indicated the absorption of a large amount of energy. The Japanese version of identification of functional ankle instability (IdFAI-J) score (P < 0.001), MLSI value (P = 0.004), and sagittal plane ankle EA value (less EA at ankle joint) (P < 0.001) were significantly high in CAI, and sagittal plane knee EA value (more EA at knee joint) (P < 0.041) was significantly low in CAI than in the control group. Multiple regression analysis showed that the APSI was associated with sagittal plane ankle EA (β = 0.275, P = 0.004). The MLSI was associated with sagittal plane ankle EA (β = 0.204, P = 0.034) and the idFAI score (β = 0.234, P = 0.015). The SLL stability impairment after LAS was related to decreased impact absorption ability at the ankle joint.

Test-retest reliability of the single leg stance on a Lafayette stability platform

The validity and reliability of the Lafayette stability platform are well-established for double leg testing. However, no evaluation of single leg (SL) stance on the platform was discovered yet. Therefore, this study aimed to investigate the reliability of conducting the SL stance on the Lafayette platform. Thirty-six healthy and active university students (age 23.2 ± 3.2 years; BMI 21.1 ± 3.1 kg/m2) were tested twice, one week apart (week 1; W1, week 2; W2). They stood on their dominant leg with eyes-open (EO) and eyes-closed (EC) in random order. Three successful trials of 20 seconds each were recorded. The duration during which the platform was maintained within 0° of tilt was referred to as time in balance (TIB). At all-time points, TIB was consistently longer in EO (EOW1: 17.02 ± 1.04s; EOW2: 17.32 ± 1.03s) compared to EC (ECW1: 11.55 ± 1.73s; ECW2: 13.08 ± 1.82s). A ±10 seconds difference was demonstrated in the Bland-Altman analysis in both EO and EC. Lower standard error of measurement (SEM) and coefficient of variation (CV) indicated consistent output. High intraclass correlation coefficient (ICC) values were seen between weeks (EO = 0.74; EC = 0.76) and within weeks (EOW1 = 0.79; EOW2 = 0.86; ECW1 = 0.71; ECW2 = 0.71). Although statistical measures (i.e., SEM, CV, and ICC) indicated good reliability of Lafayette for SL tasks, the wide agreement interval is yet to be clinically meaningful. Factors underlying the wide variation need to be identified before Lafayette is used for TIB assessment.

Chronic ankle instability modifies proximal lower extremity biomechanics during sports maneuvers that may increase the risk of ACL injury: A systematic review

The biomechanical changes in the lower extremity caused by chronic ankle instability (CAI) are not restricted to the ankle joint, but also affect the proximal joints, increasing the risk of joint injury. This study aimed to systematically review the research on CAI and lower extremity angle and movements during side-cutting, stop jumping, and landing tasks, to provide a systematic and basic theoretical basis for preventing lower extremity injury. Literature published from exception to April 2022 were searched in the PubMed, Web of Science, and SPORTDiscus databases using the keywords of "chronic ankle instability," "side-cut," "stop jump," and "landing." Only studies that compared participants with chronic ankle instability with healthy participants and assessed lower extremity kinetics or kinematics during side-cutting, stop jumping, or landing were included. The risk of bias assessment was conducted using a modified version of the Newcastle-Ottawa checklist. After title, abstract, and full text screening, 32 studies were included and the average score of the quality evaluation was 7 points (range 6-8). Among them five studies were related to the side-cut task, three studies were the stop-jump task, and twenty-four studies were related to landing. Although the results of many studies are inconsistent, participants with CAI exhibit altered lower extremity proximal joint movement strategies during side cut, stop jump, and landings, however, such alterations may increase the risk of anterior cruciate ligament injury.

Lower limb kinematics during single leg landing in three directions in individuals with chronic ankle instability

OBJECTIVES

To compare the lower limb kinematics of participants with chronic ankle instability (CAI) and healthy participants during forward, lateral, and medial landings.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PARTICIPANTS

Eighteen athletes with CAI and 18 control athletes.

MAIN OUTCOME MEASURES

Hip, knee, and ankle joint kinematics during forward, lateral, and medial single-leg landings were compared between the groups using two-way ANOVA for discrete values and statistical parametric mapping two-sample t-tests for time-series data.

RESULTS

The CAI group had significantly greater ankle dorsiflexion than the control group (P ≤ 0.013), which was observed from the pre-initial contact (IC) for lateral and medial landings and post-IC for forward landing. The CAI group showed greater knee flexion than the control group from the IC for lateral landing and post-IC for forward landing (P ≤ 0.014). No significant differences in ankle inversion kinematics were found between the CAI and control groups. Lateral landing had a greater peak inversion angle and velocity than forward and medial landings (P < 0.001). Medial landing had a greater inversion velocity than forward landing (P < 0.001).

CONCLUSIONS

This study suggests that individuals with CAI show feedforward protective adaptations in the pre-landing phase for lateral and medial landings.

Altered Visual Reliance Induced by Stroboscopic Glasses during Postural Control

Little is known about how disrupted vision affects visual reliance during postural control. postural control. Twenty-four physically active adults volunteered to participate in the study. Static postural control was quantified with center of pressure measures during a one-legged balance test with four different visual inputs (eyes-open (EO), high frequency of strobe vision (HSV), low frequency of strobe vision (LSV), and eyes-closed (EC)) and on two different surfaces (firm and foam). Dynamic postural control was calculated by the dynamic postural stability index and the Y-Balance test for three different visual inputs (EO, HSV, and LSV) and the two different surfaces. Romberg ratios (HSV/EO, LSV/EO, and EC/EO) were then calculated and used for statistical analysis to assess visual contribution during postural control. In the results, Romberg ratios were higher when people were on the foam surface than the firm surface in center of pressure total path in medial-lateral and anterior-posterior directions (p < 0.05, both directions). Similarly, Romberg ratios were higher on the foam surface than the firm surface in dynamic stability index in medial-lateral and anterior-posterior directions (p < 0.05, both directions). Stroboscopic glasses could alter visual reliance when the somatosensory system is disturbed by a foam pad during both static and dynamic postural control. Clinicians could use the glasses to manipulate visual reliance during dynamic balance training for patients with musculoskeletal injuries.

Energy dissipation during single-leg landing from three heights in individuals with and without chronic ankle instability

Inadequate energy dissipation during landing may increase the risk of ankle sprain. Mechanical demands (landing height) in landing tasks may affect the biomechanical differences between individuals with and without chronic ankle instability (CAI). However, energy dissipation strategies during landing from various heights in individuals with CAI are unclear. The purpose of this study was to compare the effect of landing height on lower extremity biomechanics between individuals with and without CAI. Eleven participants in each of the CAI and Control group performed a single-leg landing from three heights (30, 40, and 50 cm). We calculated the contribution of each joint to total energy dissipation at 50-ms intervals during 0-200 ms post-initial contact (IC). Peak joint angles and moments and joint stiffnesses were calculated during 0-200 ms post-IC. Two-way mixed analysis of variance revealed significant group-by-height interactions for hip energy dissipation at 101-150 ms post-IC and peak ankle plantarflexion and hip extension moment. These significant interactions suggested that the effects of landing height on the ankle and hip joints differ between individuals with and without CAI. The effect of mechanical demands on altered landing biomechanics among CAI populations should be considered in biomechanical studies and clinical practice.

Effect of dynamic tape on postural sway in individuals with chronic ankle instability

OBJECTIVE

To examine the effects of dynamic tape on balance control in subjects with chronic ankle instability (CAI).

METHODS

This two group experimental pre- and post-treatment design included 18 individuals with CAI and 18 controls. The single-limb stance test with eyes open and closed, standing on a force plate (Accusway Plus; AMTI) for 30 s, was conducted before, 10 min (T1) and 24 h (T24) after a dynamic tape application over the gastrocnemius muscle. Outcome measurements were: mean sway velocity, sway area (circular area), and standard deviation of the body center of pressure path length in both mediolateral and anteroposterior directions. Individuals with poor (unable to perform a single leg test for at least 30 s, eyes closed) vs. good postural stability, were also compared.

RESULTS

In both groups, a repeated analysis of variance demonstrated a significant time main effect on sway velocity (F = 14.95; p < 0.001) and path length (F = 14.95; p < 0.001) during eyes closed. Post-hoc analysis revealed a significant decrease in T1 values compared to baseline. When comparing individuals with poor vs good stability amongst the CAI group, a statistically significant interaction was observed between group, time on sway velocity and path length (F = 3.92; p < 0.05) during eyes closed. In the poor postural group, most T1 values were significantly lower than baseline.

CONCLUSIONS

Dynamic tape when applied to posterior calf muscles, enhanced balance control with no difference between CAI individuals and controls. The contribution of the tape was greater in those with poor postural stability.

Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

Background

Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system.

Methods

The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex.

Results

The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion.

Conclusion

Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.

The Influence of Kinesio Tape and an Ankle Brace on the Lower Extremity Joint Motion in Fatigued, Unstable Ankles during a Lateral Drop Landing

BACKGROUND

An unstable ankle along with plantar flexor muscle fatigue may exacerbate landing performance. External support may be an option to control the ankle motion and protect joints from injuries. Research goal: To investigate the immediate changes in the joint motion of a lower extremity under ankle plantar flexors fatigue conditions in athletes with unstable ankles using different external supports.

METHODS

A total of 44 participants were allocated to a control (Cn) group, an ankle brace (AB) group, and a kinesio tape (KT) group, and were asked to perform a lateral drop landing before and after a fatigue protocol. The outcome measures were fatigue-induced changes in the maximal joint angle and changes in the angle ranges of the hip, knee, and ankle.

RESULTS

Smaller changes in the maximal hip abduction were found in the AB group (p = 0.025), and the KT group exhibited smaller changes in the maximal ankle dorsiflexion (p = 0.009). The AB group landed with a smaller change in the range of hip flexion and knee flexion (p = 0.008 and 0.006). The Cn group had greater fatigue-induced changes in the COM range than AB and KT group (p = 0.002 and 0.028).

SIGNIFICANCE

Despite the beneficial effect in the postural control in the frontal plane, the use of AB might constrain the distal joint motion which might lead to an extended knee landing posture resulting in secondary injuries to the knee joint. Therefore, the use of AB in conjunction with an additional training of landing strategy might be recommended from the injury prevention perspective.

Clinical outcomes of concurrent surgery with weight bearing after modified lasso-loop stitch arthroscopic ankle stabilization

PURPOSE

To determine the effects of unilateral and bilateral ankle stabilization surgery with or without additional concurrent procedures for other pathologies on return to activity in patients who were allowed unrestricted weight bearing postoperatively.

METHODS

Ninety-three athletes underwent 120 ankle stabilization surgeries including 27 that underwent bilateral simultaneous surgery using the all-inside arthroscopy-modified lasso-loop technique and were divided into two groups: arthroscopic ligament repair alone without concurrent procedures (group A) and with simultaneous procedures for other pathologies (group B). Group A was further subdivided into unilateral (group A1) and simultaneous bilateral ankle surgery (group A2), and group B into ankle stabilization surgery with simultaneous procedures not requiring weight bearing postoperatively (Group B1) and with concurrent procedures allowing weight bearing (Group B2). Return to activity postoperatively was assessed by recording the time to walk without any support, jog, and return to full athletic activities. Clinical outcomes were assessed preoperatively and 12 months postoperatively using a subjective clinical score.

RESULTS

The average time between surgery and unsupported walk, jog, and return to full athletic activities was 1.6 ± 2.5, 16.9 ± 3.7, and 42.4 ± 19.3 days in group A, 17.2 ± 19.6, 34.5 ± 20.8, and 60.9 ± 22.8 days in group B, 1.7 ± 2.9, 16.1 ± 2.4, and 41.6 ± 18.2 days in group A1, 1.3 ± 0.6, 18.9 ± 5.5, and 44.6 ± 22.5 days in group A2, 25.3 ± 20.2, 43.3 ± 21.1, and 70.7 ± 23.1 days in group B1, and 4.8 ± 11.7, 20.7 ± 11.7, and 45.0 ± 13.7 days in group B2, respectively. These results indicate that the patients in group B2 showed a statistically significant faster time to return to activity than did those restricted from weight bearing. Differences in ankle stabilization alone between patients in groups A1 and A2 as well as groups B2 and A were not statistically significant. Clinical outcomes were similar for patients in groups B2 and A1 versus group A2.

CONCLUSION

Time to return to activity and clinical outcomes after ankle stabilization surgery using the modified lasso-loop technique were negatively affected if simultaneous bilateral surgery or simultaneous concurrent procedures were added or if weight bearing was unrestricted. However, a delay in return to athletic activity was observed when ankle stabilization surgery was performed using the modified lasso-loop technique with concurrent procedures that require non-weight bearing postoperatively.

LEVEL OF EVIDENCE

Level III.

Submaximal Force Steadiness and Accuracy in Patients With Chronic Ankle Instability

CONTEXT

Patients with chronic ankle instability (CAI) have demonstrated sensorimotor impairments. Submaximal force steadiness and accuracy measure sensory, motor, and visual function via a feedback mechanism, which helps researchers and clinicians comprehend the sensorimotor deficits associated with CAI.

OBJECTIVE

To determine if participants with CAI experienced deficits in hip and ankle submaximal force steadiness and accuracy compared with healthy control participants.

DESIGN

Case-control study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-one patients with CAI and 21 uninjured individuals.

MAIN OUTCOME MEASURE(S)

Maximal voluntary isometric contraction (MVIC) and force steadiness and accuracy (10% and 30% of MVIC) of the ankle evertors and invertors and hip abductors were assessed using the central 10 seconds (20%-87% of the total time) of the 3 trials.

RESULTS

Relative to the control group, the CAI group demonstrated less accuracy of the invertors (P < .001). Across all motions, the CAI group showed less steadiness (P < .001) and less accuracy (P < .01) than the control group at 10% of MVIC. For MVIC, the CAI group displayed less force output in hip abduction than the uninjured group (P < .0001).

CONCLUSIONS

Patients with CAI were unable to control ongoing fine force (10% and 30% of MVIC) through a feedback mechanism during an active test. These findings suggested that deficits in sensorimotor control predisposed patients with CAI to injury positions because they had difficulty integrating the peripheral information and correcting their movements in relation to visual information.

Lower extremity joint kinematics of a simulated lateral ankle sprain after drop landings in participants with chronic ankle instability

This study examined lower extremity joint kinematics in individuals with chronic ankle instability (CAI) and controls during unanticipated and anticipated single-leg drop landings onto a laterally inclined platform. Physically active adults with CAI 15 (n = 15) and controls (n = 15) performed an unanticipated and anticipated 30 cm single-leg drop landing onto a 20° laterally inclined platform. Three-dimensional ankle, knee and hip-joint kinematics were recorded 200 ms pre- to 200 post-landing and analysed with a 2 (group) × 2 (landing condition) SPM ANOVA (p < 0.05). Results revealed individuals with CAI displayed significantly greater ankle internal rotation post-landing across both landing conditions. Anticipated landings elicited significantly greater pre-landing ankle inversion and external rotation, knee abduction and hip adduction. Additionally, significantly less ankle inversion, knee and hip flexion, and knee adduction and hip abduction were present during post-landing of the anticipated landing. Greater ankle internal rotation during landing may contribute to the ankle 'giving way' in individuals with CAI. However, preparatory and reactive proximal-joint kinematics were similar in both groups during landing. This highlights the possible role of the knee and hip joints in assisting with ankle-joint stability during anticipated inversion perturbations.

The Utility of Functional Data Analyses to Reveal Between-Limbs Asymmetries in Those With a History of Anterior Cruciate Ligament Reconstruction

CONTEXT

Researchers have traditionally used motion capture to quantify discrete biomechanical data points (peak values) during hop testing. However, these analyses restrict the evaluation to a single time point (ie, certain percentage of stance) and provide only a narrow view of movement. Applying more comprehensive analyses may help investigators identify important characteristics that are masked by the discrete analyses often used to screen patients for activity.

OBJECTIVE

To examine the utility of functional data analyses to reveal asymmetries that are undetectable using discrete (ie, single time point) evaluations in participants with a history of anterior cruciate ligament reconstruction (ACLR) who achieved clinical hop symmetry.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifteen participants with unilateral ACLR (age = 21 ± 3 years, time from surgery = 4 ± 3 years) and 15 control participants without ACLR (age = 23 ± 2 years).

INTERVENTION(S)

Lower extremity biomechanics during the triple-hop-for-distance task for the ACLR and contralateral limbs of patients and a representative limb of control participants were measured.

MAIN OUTCOME MEASURE(S)

Peak sagittal-plane joint power, joint work, and power profiles were determined.

RESULTS

Using discrete analyses, we identified lower peak knee power and work in the ACLR limb compared with the contralateral and control limbs (P < .05) but were unable to demonstrate differences at the ankle or hip. Using functional data analyses, we observed asymmetries at the ankle, knee, and hip between the ACLR and contralateral or control limbs throughout stance (P < .05) and revealed that these asymmetries stemmed from knee power deficits that were prominent during early loading.

CONCLUSIONS

Despite achieving hop-distance symmetry, the ACLR limbs absorbed less power. Although this information was revealed using the discrete analyses, underlying asymmetries at the ankle and hip were masked. Using functional data analyses, we found interlimb asymmetries at the ankle, knee, and hip throughout ground contact and more fully elucidated the extent and source of asymmetries that can be used by clinicians and researchers alike to guide clinical decision making.

Biomechanics Differ for Individuals With Similar Self-Reported Characteristics of Patellofemoral Pain During a High-Demand Multiplanar Movement Task

CONTEXT

Patellofemoral pain (PFP) is often categorized by researchers and clinicians using subjective self-reported PFP characteristics; however, this practice might mask important differences in movement biomechanics between PFP patients.

OBJECTIVE

To determine whether biomechanical differences exist during a high-demand multiplanar movement task for PFP patients with similar self-reported PFP characteristics but different quadriceps activation levels.

DESIGN

Cross-sectional design.

SETTING

Biomechanics laboratory.

PARTICIPANTS

A total of 15 quadriceps deficient and 15 quadriceps functional (QF) PFP patients with similar self-reported PFP characteristics.

INTERVENTION

In total, 5 trials of a high-demand multiplanar land, cut, and jump movement task were performed.

MAIN OUTCOME MEASURES

Biomechanics were compared at each percentile of the ground contact phase of the movement task (α = .05) between the quadriceps deficient and QF groups. Biomechanical variables included (1) whole-body center of mass, trunk, hip, knee, and ankle kinematics; (2) hip, knee, and ankle kinetics; and (3) ground reaction forces.

RESULTS

The QF patients exhibited increased ground reaction force, joint torque, and movement, relative to the quadriceps deficient patients. The QF patients exhibited: (1) up to 90, 60, and 35 N more vertical, posterior, and medial ground reaction force at various times of the ground contact phase; (2) up to 4° more knee flexion during ground contact and up to 4° more plantarflexion and hip extension during the latter parts of ground contact; and (3) up to 26, 21, and 48 N·m more plantarflexion, knee extension, and hip extension torque, respectively, at various times of ground contact.

CONCLUSIONS

PFP patients with similar self-reported PFP characteristics exhibit different movement biomechanics, and these differences depend upon quadriceps activation levels. These differences are important because movement biomechanics affect injury risk and athletic performance. In addition, these biomechanical differences indicate that different therapeutic interventions may be needed for PFP patients with similar self-reported PFP characteristics.

A novel prophylactic Chinese parachute ankle brace

Background

The objective is to compare the effects of a self-designed and self-manufactured novel prophylactic ankle brace [Chinese parachute ankle brace (CPAB)] and two ordinary ankle braces on the ankle joint during a half-squat parachute landing (HSPL) via biomechanical assessment.

Methods

Twenty elite paratroopers were in four different conditions: no brace, elastic brace, semi-rigid brace, and CPAB. Each participant was instructed to jump off a platform with three different heights, 40, 80, and 120 cm, and land on the force plate in a half-squat posture. The vertical ground reaction forces (vGRFs), joint angles, moments, powers, and works were calculated. After the experiment, every participant completed the questionnaires designed for this study.

Results

Increasing the dropping height increased all of the parameters significantly (P<0.01), except for time to peak vGRF (T-PvGRF). Applying three braces can all slightly increase vGRF (P=0.237) and reduce T-PvGRF by 6–10 ms, as well as decrease the joint angles, velocities, and moments on the sagittal and coronal planes. Wearing CPAB and a semi-rigid brace more efficiently restricted dorsiflexion and inversion (P<0.05), and they both significantly reduced ankle work (t=5.107, P<0.01; t=3.331, P<0.01) and peak power (t=7.237, P<0.01; t=6.711, P<0.01) at 120 cm. The total scores from low-to-high were semi-rigid brace (19.20±2.99), elastic brace (21.91±3.25), and CPAB (23.37±3.08).

Conclusions

The CPAB was more effective at restricting ankle joint motion on the coronal and sagittal planes than the other two prophylactic ankle braces. Therefore, the CPAB had the advantages of a novel appearance, high efficiency, and superior comfort, providing a reliable choice for parachute jumping and training in China.

Joint Coordination and Stiffness During Landing in Individuals With Chronic Ankle Instability

The purpose of the present study was to examine the effect of chronic ankle instability (CAI) on lower-extremity joint coordination and stiffness during landing. A total of 21 female participants with CAI and 21 pair-matched healthy controls participated in the study. Lower-extremity joint kinematics were collected using a 7-camera motion capture system, and ground reaction forces were collected using 2 force plates during drop landings. Coupling angles were computed based on the vector coding method to assess joint coordination. Coupling angles were compared between the CAI and control groups using circular Watson-Williams tests. Joint stiffness was compared between the groups using independent t tests. Participants with CAI exhibited strategies involving altered joint coordination including a knee flexion dominant pattern during 30% and 70% of their landing phase and a more in-phase motion pattern between the knee and hip joints during 30% and 40% and 90% and 100% of the landing phase. In addition, increased ankle inversion and knee flexion stiffness were observed in the CAI group. These altered joint coordination and stiffness could be considered as a protective strategy utilized to effectively absorb energy, stabilize the body and ankle, and prevent excessive ankle inversion. However, this strategy could result in greater mechanical demands on the knee joint.

Lower-Extremity Motor Synergies in Individuals With and Without Chronic Ankle Instability

Current theoretical models suggest that ankle sprain copers exhibit movement adaptations contributing to the avoidance of chronic ankle instability. However, few studies have examined adaptations at the level of biomechanical motor synergies. The purpose was to examine characteristics of the support moment synergy between individuals with chronic ankle instability, copers, and healthy individuals. A total of 48 individuals participated in the study. Lower-extremity kinetics and variability in the moment of force patterns were assessed during the stance phase of walking trials. The copers exhibited reductions in the support moment during the load response and preswing phase compared with the chronic ankle instability group, as well as during the terminal stance and preswing phase compared the healthy group. The copers also exhibited reductions in the hip extensor moment and ankle plantarflexion moment compared with healthy and chronic ankle instability groups during intervals of stance phase. Variability of the support moment and knee moment was greater in the copers compared with the chronic ankle instability group. Dampening of the support moment and select joint moments exhibited by the copers may indicate an adaptive mechanism to mitigate loading perturbations on the previously injured ankle. Heightened motor variability in copers may be indicative of a more adaptable motor synergy compared with individuals with chronic ankle instability.

Improved Performance After Gluteus Complex Activation in a CrossFit Athlete Presenting With Knee Pain

Objective

To describe the case management of a female CrossFit athlete presenting for a functional movement assessment. She had knee pain after 2 months of training for a competition.

Clinical Features

After her assessment, it was determined that the patient had difficulty using her gluteus maximus musculature in various positions including standing, lying, and quadruped positions despite being a competitive athlete. It was determined via biomechanical testing that the patient's posterior chain firing pattern was predominantly erector spinae vs gluteus complex and hamstrings muscles.

Intervention and Outcome

Continuation of reactive neuromuscular training gluteus medius/activation exercise was prescribed to establish motor control, endurance, and preactivation while decreasing erector spinae overload for this patient.

Conclusion

This patient was someone with exceptional strength but poor motor control. Regressing back to the most basic activation exercises, we were able to simulate the proper activation and motor control to decrease pain and improve performance. The athlete's function seemed to improve after a course of care that included basic exercises.

Lower Limb Joint Kinetics During a Side-Cutting Task in Participants With or Without Chronic Ankle Instability

CONTEXT

Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited.

OBJECTIVE

To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI.

DESIGN

Cohort study.

SETTING

Motion-capture laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg).

INTERVENTION(S)

Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed.

MAIN OUTCOME MEASURE(S)

Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables.

RESULTS

The CAI group exhibited a reduced ankle-eversion moment (39%-81% of stance phase) and knee-abduction moment (52%-75% of stance phase) and a greater ankle plantar-flexion moment (3%-16% of stance phase) than the control group (P range = .009-.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t₂₈ = 1.978, P = .03).

CONCLUSIONS

Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.

Ankle Coordination in Chronic Ankle Instability, Coper, and Control Groups in Running

PURPOSE

Coordination and coordination variability have been used as a measure of the function and flexibility of the sensorimotor system during running. Chronic ankle instability (CAI) is associated with altered sensorimotor system function compared with individuals without CAI. Copers may have adopted protective sensorimotor adaptations to prevent repeated ankle sprains; however, their coordination strategies between the foot and shank have not been investigated. We compared joint coupling angles and coordination variability using vector coding between individuals with CAI, copers, and controls.

METHODS

Seventeen individuals with CAI, 17 copers, and 17 controls ran on the treadmill at a fixed speed of 2.68 m·s. A 10-s trial of continuous data was collected for kinematic analysis. The first five complete strides were used for vector coding. Means of the vector coding angles and variability of frontal plane ankle motion/transverse plane tibia motion and sagittal plane ankle motion/transverse plane tibia motion (SAK/TT) were calculated. A curve analysis with 90% confidence intervals was performed to detect differences between groups.

RESULTS

Controls demonstrated greater angles of SAK/TT than individuals with CAI and greater angles of FAK/TT than copers during the second half of stance. In general, the control group demonstrated greater variability than individuals with CAI and copers, and copers demonstrated greater variability than individuals with CAI.

CONCLUSIONS

Chronic ankle instability and copers demonstrated different coordination strategies than controls during loading and propulsion, adding evidence to support a sensorimotor deficit or compensation. Further, limited variability in people with history of CAI during impact and midstance may contribute to higher risk of reinjury, and be an important area for further research.

Characterization of Multiple Movement Strategies in Participants With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) is characterized by multiple sensorimotor deficits, affecting strength, postural control, motion, and movement. Identifying specific deficits is the key to developing appropriate interventions for this patient population; however, multiple movement strategies within this population may limit the ability to identify specific movement deficits.

OBJECTIVE

To identify specific movement strategies in a large sample of participants with CAI and to characterize each strategy relative to a sample of uninjured control participants.

DESIGN

Descriptive laboratory study.

SETTING

Biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 200 individuals with CAI (104 men, 96 women; age = 22.3 ± 2.2 years, height = 174.2 ± 9.5 cm, mass = 72.0 ± 14.0 kg) were selected according to the inclusion criteria established by the International Ankle Consortium and were fit into clusters based on movement strategy. A total of 100 healthy individuals serving as controls (54 men, 46 women; age = 22.2 ± 3.0 years, height = 173.2 ± 9.2 cm, mass = 70.7 ± 13.4 kg) were compared with each cluster.

MAIN OUTCOME MEASURE(S)

Lower extremity joint biomechanics and ground reaction forces were collected during a maximal vertical jump landing, followed immediately by a side cut. Data were reduced to functional output or curves, kinematic data from the frontal and sagittal planes were reduced to a single representative curve for each plane, and representative curves were clustered using a Bayesian clustering technique. Estimated functions for each dependent variable were compared with estimated functions from the control group to describe each cluster.

RESULTS

Six distinct clusters were identified from the frontal-plane and sagittal-plane data. Differences in joint angles, joint moments, and ground reaction forces between clusters and the control group were also identified.

CONCLUSIONS

The participants with CAI demonstrated 6 distinct movement strategies, indicating that CAI could be characterized by multiple distinct movement alterations. Clinicians should carefully evaluate patients with CAI for sensorimotor deficits and quality of movement to determine the appropriate interventions for treatment.

Bilateral spatiotemporal postural control impairments are present in participants with chronic ankle instability

OBJECTIVES

This study evaluated center-of-pressure (COP) and time-to-boundary (TTB) measures of postural control during a Lateral Step-Down Test in participants with chronic ankle instability (CAI).

DESIGN

Cohort study.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Physically active adults with CAI (n = 15) and matched controls (n = 15).

MAIN OUTCOME MEASURES

Traditional COP and TTB measures of postural control were computed in the medial/lateral (ML) and anterior/posterior (AP) directions.

RESULTS

No significant results were found for the traditional COP measures (p > 0.05). The CAI group exhibited a lower TTB ML absolute minimum on their affected limb compared to the matched limb of the control group (p < 0.001). Additionally, on average the CAI group displayed significantly lower TTB ML mean of minima (p = 0.004) and TTB standard deviation of minima in the ML (p < 0.001) and AP directions (p = 0.002) regardless of limb.

CONCLUSIONS

Sensorimotor impairments associated with CAI negatively alter spatiotemporal postural control and may cause a maladaptive reorganization of centrally mediated motor control strategies that results in bilateral postural control deficits during the Lateral Step-Down Test. In addition, traditional COP measures did not reveal any postural control deficits suggesting that a spatiotemporal analysis should be used when assessing postural control in participants with CAI.

An Updated Model of Chronic Ankle Instability

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

Altered Walking Neuromechanics in Patients With Chronic Ankle Instability

CONTEXT

The literature on gait kinematics and muscle activation in chronic ankle instability (CAI) is limited. A comprehensive evaluation of all relevant gait measures is needed to examine alterations in gait neuromechanics that may contribute to recurrent sprain.

OBJECTIVE

To compare walking neuromechanics, including kinematics, muscle activity, and kinetics (ie, ground reaction force [GRF], moment, and power), between participants with and those without CAI by applying a novel statistical analysis to data from a large sample.

DESIGN

Controlled laboratory study.

SETTING

Biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 100 participants with CAI (49 men, 51 women; age = 22.2 ± 2.3 years, height = 174.0 ± 9.7 cm, mass = 70.8 ± 14.4 kg) and 100 individuals without CAI serving as controls (55 men, 45 women; age = 22.5 ± 3.3 years, height = 173.1 ± 13.3 cm, mass = 72.6 ± 18.7 kg).

INTERVENTION(S)

Participants performed 5 trials of walking (shod) at a self-selected speed over 2 in-ground force plates.

MAIN OUTCOME MEASURE(S)

Three-dimensional GRFs, lower extremity joint angles, internal joint moments, joint powers, and activation amplitudes of 6 muscles were recorded during stance.

RESULTS

Compared with the control group, the CAI group demonstrated (1) increased plantar flexion or decreased dorsiflexion, increased inversion or decreased eversion, decreased knee flexion, decreased knee abduction, and increased hip-flexion angles; (2) increased or decreased inversion, increased plantar flexion, decreased knee extension, decreased knee abduction, and increased hip-extension moments; (3) increased vertical, braking, and propulsive GRFs; (4) increased hip eccentric and concentric power; and (5) altered muscle activation in all 6 lower extremity muscles.

CONCLUSIONS

The CAI group demonstrated a hip-dominant strategy by limiting propulsive forces at the ankle while increasing force generation at the hip. The different walking neuromechanics exhibited by the CAI group could represent maladaptive strategies that developed after the initial sprain or an injurious gait pattern that may have predisposed the participants to their initial injuries. Increased joint loading and altered kinematics at the foot and ankle complex during initial stance could affect the long-term health of the ankle articular cartilage.