Comparison of the Effect of Resistance and Balance Training on Isokinetic Eversion Strength, Dynamic Balance, Hop Test, and Ankle Score in Ankle Sprain

Effect of Limb Dominance on Chronic Ankle Instability: Does It Matter?

Our study aimed to examine preoperative differences in strength and balance between dominant foot (DF) and nondominant foot (non-DF) of individuals undergoing ligament stabilization surgery in the general population. Patients with records of preoperative evaluation, including isokinetic dynamometric strength evaluation, Y-balance test (YBT), and Foot and Ankle Outcome Score (FAOS), were included in the study. The DF was the preferred leg for accurately kicking a ball through a goal. Statistical analysis determined the differences between DF and non-DF and the correlations between muscle strength, balance, and FAOS. There was no statistically significant difference between DF and non-DF regarding evertor and invertor muscle strength (p=0.082-0.951). The YBT revealed no significant difference between the two groups (p=0.082-0.951). There was a significant correlation between the evertor peak torque and total work deficits at 30°/s (p=0.022), as well as the evertor peak torque deficit at 120°/s (p=0.048). No significant differences in muscle strength and balance were found between DF and non-DF in nonathletes with chronic ankle instability. Peroneal muscle strength deficit was associated with functional impairment. Tailored interventions are needed to address limb dominance and muscle strength deficits in CAI management.

The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability

Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and function in patients with chronic ankle instability. Materials and Methods: A total of 30 patients participated in the study and were randomly assigned to the two groups. Among the 30 participants, 14 were assigned to the hip joint-strengthening exercise group and 16 to the control group. The experimental group underwent a hip-strengthening exercise program and received training for 40 min per session twice a week for four weeks. The control group received the same frequency, duration, and number of sessions. Measurements were performed before and after the training period to assess changes in hip strength, balance, and function. Results: In the within-group and between-group comparisons, both groups showed significant differences in hip joint strength, static balance, dynamic balance, and function (FAAM; foot and ankle ability measures) (p < 0.05). Statistically significant differences were observed in the time × group interaction effects among the hip abductors and external rotation in hip joint strength, path length in static balance, posterolateral and posteromedial in dynamic balance, and FAAM-ADL and FAAM-SPORT functions (p < 0.05). Conclusions: Accordingly, this study confirmed that hip joint-strengthening exercises have a positive effect on the strength, balance, and function of patients with chronic ankle instability, and we believe that hip joint-strengthening exercises will be recommended as an effective intervention method for patients suffering from chronic ankle instability.

Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability

BACKGROUND

The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored.

METHODS

A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ.

CONCLUSION

Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

Effect of Low-Load Blood Flow Restriction Training on Patients With Functional Ankle Instability: A Randomized Controlled Trial

CONTEXT

Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients.

OBJECTIVE

To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Forty-six young adults with a history of FAI.

INTERVENTIONS

Participants in the LL-BFR and HLT groups performed 4 sets (30 × 15 × 15 × 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks.

MAIN OUTCOME MEASURE(S)

Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks.

RESULTS

Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05).

CONCLUSIONS

Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients.

Relationship of Chronic Ankle Instability With Foot Alignment and Dynamic Postural Stability in Adolescent Competitive Athletes

Background

Competitive adolescent athletes should be aware of the early signs of chronic ankle instability (CAI) and the connection between the condition and performance.

Purpose

To investigate whether CAI is related to foot alignment and morphology as well as dynamic postural stability after a jump landing among adolescent competitive athletes with and without a history of a lateral ankle sprain and CAI.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Between July 2020 and August 2021, adolescent competitive athletes (N = 85; n = 49 boys; n = 36 girls) were classified into 3 groups using Cumberland Ankle Instability Tool (CAIT) scores: healthy athletes (n = 55), coper athletes (n = 19), and athletes with CAI (n = 11). Results of foot alignment assessments involving the leg-heel angle (LHA) and navicular height, intrinsic foot muscle morphology, dynamic postural stability index (DPSI), and other parameters were compared among the 3 groups. The relationship between the CAIT score and the LHA and dynamic postural stability and instability were examined using multiple linear regression.

Results

Compared with the healthy group, the CAI group had a significantly greater LHA (8.73°± 3.22° vs 6.09°± 3.26°; P < .05), higher DPSI (0.336 ± 0.046 vs 0.298 ± 0.035), and higher vertical stability index (0.303 ± 0.048 vs 0.264 ± 0.037; P < .05 for all). Multiple regression analysis showed that the LHA (β = -0.228; P = .033) and DPSI (β = -0.240; P = .025) were significantly associated with the CAIT score .

Conclusion

Valgus rearfoot alignment and poorer dynamic postural control were associated with CAI among adolescent athletes.

Peroneal muscle activity during stable and unstable load exercises. A cross-sectional study

OBJECTIVE

To evaluate the muscle activity of the peroneus longus during the execution of different unstable load exercises compared to stable load exercises.

DESIGN

Cross-sectional study.

SETTING

Functional Anatomy Laboratory.

PARTICIPANTS

28 healthy athletes.

MAIN OUTCOME MEASURES

Surface electromyography (sEMG), unstable load (water tank), Stable Load (Sandbag), type of exercise (Isometric single leg stance, single-leg Romanian deadlift, front rack forward lunge and lateral lunge).

RESULTS

The repeated measures ANOVA revealed significant Group ∗ Time interaction in Root Mean Square (RMS) (F = 51.307, P < 0.001, ŋ² = 0.70). In the between-group analysis there were statistically significant differences in RMS isometric single leg stance in favor to unstable load (P < 0.001, ŋ² = 0.07). In the within-group analysis of RMS statistically significant differences were found in the stable load group between isometric single leg stance and single-leg Romanian deadlift (P < 0.001, ŋ² = 0.05).

CONCLUSIONS

Single leg stance exercise with unstable load showed higher peroneus muscle activity than stable load. However, no peroneus muscle activity differences were found between unstable and stable loads for single-leg Romanian deadlift, frontal rack forward lunge and lateral lunge. Single-leg Romanian deadlift with stable load showed higher peroneus muscle activity than isometric single leg stance with stable load.

Kinetic Effects of 6 Weeks' Pilates or Balance Training in College Soccer Players with Chronic Ankle Instability

Lateral ankle sprain (LAS) is a common sports injury that frequently occurs in active individuals. LAS is characterized by a high recurrence rate, with a large proportion of patients progressing to chronic ankle instability (CAI). Pilates exercises have provided positive results in health care and in rehabilitation. This study compared Pilates training (PT) with traditional balance training (BT) in patients with CAI. Fifty-one college football players with CAI, divided into PT (n = 26) and BT (n = 25) groups, were included in the study. The groups performed PT or BT training as assigned, three times per week for 6 weeks. Isokinetic ankle strength, one-leg hop tests, Y-balance test (YBT), and foot and ankle outcome score (FAOS) were evaluated before and after training. There were considerable improvements in both the PT and BT groups after training. Group and time comparisons revealed that the PT group achieved better triple hop test results than the BT group, whereas the BT group exhibited a greater improvement in YBT posteromedial and posterolateral reach distances. In athletes with CAI, both PT and BT effectively improved symptoms and function. These findings suggest that ankle strength, balance, and core stability should be comprehensively evaluated and targeted in CAI rehabilitation programs.

The Influence of Gender and the Specificity of Sports Activities on the Performance of Body Balance for Students of the Faculty of Physical Education and Sports

A sense of balance is required in sports activities, conditioning the quality of movements and physical performance. (1) The purpose of the study is to investigate the influence of gender and the specificity of sports activities on body balance. The investigated participants are 157 students of the Faculty of Physical Education and Sports/Bachelor’s degree: 109 men (age = 20.49 ± 2.03, body mass index, BMI = 22.96 ± 3.20), and 48 women (age = 20.21 ± 1.51, BMI = 21.05 ± 2.78). (2) Design: Cross-sectional study, with the definition of the variables gender and sport activity with three stages (non-athletes/NA, team sports games/TSG, and individual sports/IS). The evaluation was based on four dynamic balance tests (Bass test/points, Functional reach test/cm, Fukuda test/degrees of rotation, and Walk and turn field sobriety test/errors) and three static balance tests (Flamingo test/falls, Stork test, and One-leg standing test with eyes closed/s). (3) Results: The variance analysis (multivariate and univariate tests) indicates the superiority of women in most tests applied, but with significantly better values (p < 0.05) only for the Flamingo test and Bass test. Men have superior results only for vestibular stability (Fukuda test) and One-leg standing test, but it is statistically insignificant (p > 0.05). The TSG group has slightly better values than the IS group for the whole set of tests conducted, but these are not statistically significant (p > 0.05), so we cannot highlight the certain superiority of TSG practitioners over those involved in IS. Both the TSG and the IS group outperformed all tests compared to the NA group, with significant differences (p < 0.05), especially for the TSG. Conclusion: Women have better values than men on most tests, and performance sports students have higher average scores than those in the NA group, which demonstrates the beneficial influence of specific training on static and dynamic postural stability.

Evaluation of the Limb Symmetry Index: The Side Hop Test

The main objective of present study was to evaluate inter-rater reliability and concurrent validity of Side Hop Test stopwatch vs. force plates timing, and to determine the number of sessions and trials required to minimize the effects of learning on Side Hop Test total time and limb symmetry index. Fifteen healthy male physical education students (mean ± SD: age, 23 ± 3 years; height, 181 ± 9 cm; and weight 72 ± 6 kg) participated. Side Hop Test total time (stopwatch and force plates) of left and right leg, and limb symmetry index (force plates) were obtained over seven sessions conducted 5–7 days apart. Time recordings of two raters were similar (t = −0.56, p &gt; 0.05) with high reliability (all ICC &gt;0.99 and CV% &lt;0.1) and no systematic bias when compared to force plate data (p &gt; 0.05; for rater 1 and 2, respectively). Total time improved across the Sessions (F = 25.87, p &lt; 0.01, ω2 = 0.18) and Trials (F = 68.15, p &lt; 0.01, ω2 = 0.10), with no significant interaction between factors. No between-leg differences were detected (F = 0.52, p &gt; 0.05, ω2 = 0.001). Limb symmetry index ranged from 0.999 to 1.055 across all sessions and trials (all p &gt; 0.05 and ω2 &lt; 0.00). Due to low coefficient of correlation, high interclass correlation coefficient, and the lack in heteroscedasticity, stopwatch measurements are valid to measure total time in the Side Hop Test. Moreover, stopwatch measurements could be reliably used to measure total time in the Side Hop Test, while the test could be administrated with only one experienced rater. Unlike total times, findings on limb symmetry index suggest it could be reliably assessed after seven familiarization sessions.

Prabhakar A, Eapen C, Keogh JW. Ability of functional performance assessments to discriminate athletes with and without chronic ankle instability : a case-control study

Background

The decline in motor function associated with chronic ankle instability (CAI) can be assessed using Functional Performance tests. Ankle muscular strength, endurance and range of motion (ROM) has been assessed in previous studies but functional activities such as sprinting and change of direction are less well studied in athletes with CAI. Hence the aim of this study was to determine how sprint, change of direction, ankle isometric strength, endurance and ROM measures may be associated with discriminate athletes with and without CAI.

Methods

One hundred and six participants (CAI: n = 53 or no CAI: n = 53) provided informed consent to participate in this study. Participants performed three functional performance tests, (30-m sprint test, Modified Illinois change of direction test (MICODT)) and change of direction test. Range of motion for dorsiflexion was measured using weight bearing lunge test and inversion, eversion and plantarflexion using Saunders® digital inclinometer. Strength was assessed using Baseline® hand-held dynamometer for plantarflexors, dorsiflexors, invertors and evertors. Muscular endurance was assessed by single heel raise test and Modified single heel raise test. Between-group comparisons utilised Student's t-test and Mann-Whitney U-tests, with a number of unique variable and multivariable binomial logistic regression performed to determine which performance measures may discriminate participants with CAI.

Results

The CAI participants performed significantly worse in the three functional performance tests as well as multiple measures of ankle ROM, isometric strength and muscular endurance (p < 0.008). While several measures of ROM (plantarflexion and dorsiflexion), strength (inversion and eversion) and both muscular endurance tests were significantly associated with CAI in the univariable analysis, the strongest association was the functional performance tests, especially MICDOT time (odds ratio (95% CI): 0.06 [0.02-0.17], sensitivity 94.3%, specificity 88.7%). Multivariable regression analyses indicated that performance across the functional performance tests were more strongly associated with CAI than any ankle ROM, muscular strength or endurance test. Further, the inclusion of the best ankle range of motion, strength or muscular endurance tests did not significantly improve upon the association of the MICDOT with CAI.

Conclusions

Chronic ankle instability in athletic populations appears to be highly associated with declines in functional performance and to a somewhat lesser extent, ankle range of motion, strength and muscle endurance measures. This may suggest that optimal rehabilitation for athletes with CAI may require a greater focus on improving sprinting speed and change of direction ability in the mid to latter stages of rehabilitation, with regular assessments of these functional performance tests necessary to guide the progression and overload of this training.

Effects of Mobile-Based Rehabilitation in Adolescent Football Players with Recurrent Lateral Ankle Sprains during the COVID-19 Pandemic

Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile–based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.

The Effects of Proprioceptive Training on Balance, Strength, Agility and Dribbling in Adolescent Male Soccer Players

The aim of the study was to determine the effects of proprioceptive training (PT) on balance, strength, agility and dribbling in adolescent soccer players. In this research, we included an experimental (n = 48) and a control (n = 48) group (CG) with 14 years old players. The experimental group (EG) participated in an 8 week PT program, with four 30 min sessions per week. The experimental program included 12 bosu ball exercises to improve balance, stability and strength which were grouped into two subprograms: the first not using the soccer ball, the second subprogram using the soccer ball. The subprograms were implemented alternately during 16 proprioceptive training sessions, on two types of firm and foam surfaces. Pre- and post-tests included the static balance [Balance Error Scoring System (BESS)], vertical, horizontal, and lateral jumping, and the completion of agility (“arrowhead”) and dribbling (“short dribbling”) tests. Regarding the total BESS score, the CG has demonstrated progress between the pre- and the post-test, with 0.780 ± 0.895, fewer errors, while the EG had 5.828 ± 1.017 fewer errors. The difference between the two groups was of 5.148 fewer errors for the EG who had practiced the proposed program of proprioceptive training. The highest difference registered between the pre- and the post-test was at the test “single-leg forward jump with the right leg”, with a result of 1.083 ± 0.459 cm for the CG and of 3.916 ± 0. 761 cm for the EG. Through the analysis of average differences between the pre- and the post-tests, we observe that, regarding the “Agility right side test”, the EG has progressed with 0.382 s in comparison with the CG; regarding the “Agility left side test”, the EG has progressed with 0.233 s compared to the CG; regarding the “Agility right and left side test”, the EG has progressed with 0.196 s compared to the CG; in the “Short dribbling test”, the EG has progressed with 0.174 s compared to the CG. The highest progress was made at the “Agility right side test”, of 0.402 s for the EG, while the CG registered 0.120 s. Most of the results in all tests for both experimental groups show an effect size ranging from small to medium. The progress made by the experimental group in all tests was statistically significant, while in the control group the progress was mostly statistically insignificant for p < 0.05. The results suggest that a PT program performed at about 14 years of age could be successfully implemented in the training regime of soccer players to improve components of fitness along with dribbling skills. The results of the study revealed that sports training on the foam surfaces determined a superior progress of the development of proprioception compared to the increased training on the firm surfaces.