Prevention of Lateral Ankle Sprains

The Consistency of Primary, Secondary and Tertiary Prevention Definitions in the Context of Musculoskeletal Sports Injuries: A Rapid Review and Critical Exploration of Common Terms of Usage

BACKGROUND

Formal statements articulating the meaning of primary, secondary and tertiary prevention concepts are commonly used in the musculoskeletal sports injuries literature, but appear to be employed inconsistently and incorrectly. Standard definitions, appropriate to athletic health and performance practice, are required to systematically develop the state-of-the-art. To accomplish this, we summarized prevention definitions with the aim of improving conceptual clarity across the musculoskeletal sports injuries literature.

MAIN BODY

We used a rapid literature review method, searching Scopus, PubMed/Medline, Cochrane Library reviews/trials, Web of Science, Sports Medicine and Education Index, SPORTDiscus and CINAHL databases for titles/abstracts for available literature, published in English from database-inception to November 2023. Our search terms were: sport/athlete, injury, primary prevention, secondary prevention, and/or tertiary prevention. Definitions were extracted to create categories illustrating overlap and variation. We extracted definitions from 144 included studies (n). Primary prevention appears focused on mitigating injury risk (n = 52) and preventing initial injuries (n = 42). Secondary prevention appears to address five distinct concepts: preventing recurrences (n = 42), preventing sequelae (n = 41), preventing index injury worsening (n = 27), mitigating injury risk (n = 15), and restoring function (n = 12). Tertiary prevention appears focused on preventing sequelae (n = 17) and restoring function (n = 9).

CONCLUSIONS

From a definition viewpoint, the aim of primary prevention is narrowly conceptualized and consistent in the musculoskeletal sports injury research literature. However, secondary prevention definitions vary substantially, with at least three distinct conceptual aims observable. Tertiary prevention definitions appear infrequently in the literature and when observed tend to overlap with secondary prevention. Currently, researchers are likely to struggle with the formulation of clearly-defined and transferrable research questions relating to the aims of secondary prevention.

A prospective randomised controlled trial investigating the impact of a musculoskeletal injury prevention warm-up program for youth badminton: A preliminary study

There are warm-up programs designed to reduce injuries for various sports; however, no study has been conducted on the development of a protocol for preventing injuries in badminton. The purpose of this study was to investigate the effectiveness of a prevention warm-up program (PreventiBad) in reducing injury rates among youth badminton players. A cluster randomised controlled trial was conducted, involving 273 youth badminton players (13.81 ± 2.76 years). The intervention group incorporated the program as part of their warm-up during training sessions, while the control group adhered to their usual warm-up. The participants were monitored over an 8 weeks period, with primary outcome measures including the incidence of overall injuries, typology and severity. The rate of adherence to the intervention program was assessed as a secondary outcome. A total of 14 injuries were reported among 147 players in the control group in 3440.50 h of exposure (4.07 injuries/1000 h), and a total of 6 injuries were reported across 126 players within the intervention group in 4865.00 exposure hours (1.23 injuries/1000 h). The Injury Risk Ratio was 0.30 (95%CI 0.12 to 0.75). Results indicated that the use of PreventiBad in the intervention group led to a 70% reduction compared to the control group.

Beyond support: exploring the dynamic and static biomechanical changes induced by preventive ankle taping: a novel cross-sectional study

Introduction

In sports, 80% of all ankle injuries are sprains of the external compartment. Functional bandages are usually used preventively, specially in individuals with a history of lateral ankle injuries. To this day, the actual benefits of such taping remain unknown as important modifications are introduced in the ankle biomechanics.

Objective

The aim of the present study is to describe the biomechanical processes underlying these effects, such as modification during stance times, balance, contact surface and maximum and average pressures in the rearfoot, forefoot and midfoot, using a sprain preventive taping for the external ankle compartment.

Methods

An observational, analytic, cross-sectional study was designed. Data from static and dynamic plantar pressures with a pressure platform and balance data assessed with the Y Balance Test (YBT) were analysed in 50 participants (age = 21.00 ± 2.34 years, weight = 71.11 ± 13.12 kg, height = 1.75 ± 00.9 m, BMI = 22.94 ± 2.50 kg/m2, foot size = 41.60 ± 3.00) with and without preventive functional taping for lateral ankle sprain (LAS).

Results

A statistically significant decrease in YBT was observed in the taped participants toward anterior (p = 0.001) and posterolateral (p = 0.005) motion. On the static measures at the pressure platform, an increase in peak pressure at the midfoot (p = 0.001), a decrease in the maximum pressure in the forefoot (p = 0.003) and a decrease in the contact surface in the rearfoot (p = 0.003) were recorded. Dynamic measures at the pressure platform analysis showed a statistically significant decrease in contact surface at the rearfoot (p = 0.001), an increase in mean pressure in both the midfoot (p = 0.044) and forefoot (p = 0.001) and a significant decrease in velocity in the forefoot (p = 0.003).

Conclusions

In conclusion, we observed that ankle taping led to increased peak pressures in the midfoot and decreased maximum pressures in the forefoot, indicating a shift in load distribution within the plantar surface. Simultaneously, a significant reduction in the velocity at the forefoot during dynamic tasks suggests that taping may alter natural gait dynamics, potentially affecting movement efficiency and stride characteristics. In addition, the application of ankle taping significantly altered balance, as evidenced by a decrease of YBT scores anterior and posterolateral directions. Prophylactic taping in patients with no prior history of LAS is not recommended.

Attitudes and practices of Australian healthcare and sports workers on the use of ankle supports for management and prevention of lateral ankle sprains: A cross-sectional survey

OBJECTIVE

Explore attitudes and practices of Australian professionals using ankle taping or bracing for the management and prevention of lateral ankle sprains.

DESIGN

Cross-sectional study.

SETTING

Anonymous online survey.

PARTICIPANTS

Australian healthcare or athletic workers, registered with an official governing body, involved in the management and/or prevention of lateral ankle sprains.

MAIN OUTCOME MEASURES

Quantitative data was collected from 20 close-ended questions. Qualitative data from 14 open-ended questions were categorized into topics using inductive thematic analysis. Data was analysed using descriptive statistics and presented in figures and tabular format.

RESULTS

A total 160 respondents answered the survey; the majority were podiatrists (42.5%), physiotherapists (23%), or sports/athletic trainers (13.8%). Ankle supports were overwhelmingly recommended and considered to be effective in the management (95% and 89% bracing and taping, respectively) and prevention (96% and 92% bracing and taping, respectively) of lateral ankle sprains. For management, semi-rigid brace with straps (26%) and figure eight taping technique (42%) were the most frequently used. For prevention, the most commonly used were soft brace with straps (30%) and the figure eight taping technique (37%).

CONCLUSIONS

Australian professionals expressed a positive attitude towards using ankle supports in the management and prevention of lateral ankle sprains.

Comparison of spring ankle braces versus splints and casts in treating ankle sprains in patients diagnosed with ankle sprains

BACKGROUND

Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains.

MATERIALS AND METHODS

This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26.

RESULTS

The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P < 0.05). Patients treated with plaster casts reported the lowest pain levels, with a significant relationship between pain levels and the two treatment methods (P < 0.05). Range of motion results were similar for both treatment methods, while the cast treatment showed the highest incidence of skin complications. A significant relationship was observed between spring ankle braces and plaster casts regarding skin complications (P < 0.05).

CONCLUSION

Treating ankle sprains with plaster casts leads to higher satisfaction and lower pain levels compared to using spring ankle braces.

Between 2008 and 2022, Lower-Extremity Injuries Declined in Male Rugby Players, Whereas Noncontact Knee Injuries Showed No Decline in Female Rugby Players

Purpose

To assess the distribution and mechanisms of lower-extremity injuries among high school and college age rugby players presenting to U.S. emergency departments (EDs) from 2008 to 2022.

Methods

The National Electronic Injury Surveillance System was queried for lower-extremity rugby injuries (ages 14-23 years) from January 2008 to December 2022. Patient demographics, injury location, diagnosis, and disposition were extracted for each case. Linear regression analysis assessed differences over time. Injury distribution for male versus female players was evaluated using Pearson χ2 analysis.

Results

An estimated 31,318 (845 National Electronic Injury Surveillance System cases) high school and college-age rugby players presented to U.S. EDs with a lower-extremity injury during the study period. Male players accounted for 66.9% of the injuries. Linear regression analysis revealed a significant decrease in the annual frequency of lower-extremity injuries presenting to U.S. EDs from 2008 to 2022 (P = .001). The most common injury mechanism was overwhelmingly a noncontact twisting motion (11,108, 35.5%) followed by a hit/collision (5,298, 16.9%). Strains/sprains were the most common diagnosis (17,243, 55.1%). Injuries most commonly occurred at the ankle (12,659, 40.4%) and knee (11,016, 35.2%). In a sex-specific linear regression analysis, there was a significant decrease in lower-extremity injuries sustained by male players (P = .001) but no significant decrease among female players (P = .112). Furthermore, χ2 analysis revealed that female players sustained a significantly greater proportion of knee injuries secondary to twists (15.9% for female vs 9.0% for male players, P = .01).

Conclusions

Lower-extremity injuries are declining among high school and college-age male rugby players. However, there has not been a corresponding decrease among female rugby players. Furthermore, female players are disproportionately affected by noncontact twisting knee injuries.

Level of Evidence

Level III, retrospective comparative study.

Soleus arthrogenic muscle inhibition following acute lateral ankle sprain correlates with symptoms and ankle disability but not with postural control

BACKGROUND

Acute lateral ankle sprains (ALAS) are associated with long-term impairments and instability tied to altered neural excitability. Arthrogenic muscle inhibition (AMI) has been observed in this population; however, relationships with injury-related impairments are unclear, potentially due to the resting, prone position in which AMI is typically measured. Assessing AMI during bipedal stance may provide a better understanding of this relationship.

METHODS

AMI was assessed in 38 young adults (19 ALAS within 72 h of injury: 10 males, 21.4 ± 2.7 years; 19 healthy controls: 10 males, 21.9 ± 2.2 years; mean ± SD) using the Hoffmann reflex (H-reflex) during bipedal stance. Electrical stimulation was administered to identify the maximal H-reflex (Hmax) and maximal motor response (Mmax) from the soleus, fibularis longus, and tibialis anterior muscles. The primary outcome measure was the Hmax/Mmax ratio. Secondary outcomes included acute symptoms (pain and swelling), postural control during bipedal stance, and self-reported function.

RESULTS

No significant group-by-limb interactions were observed for any muscle. However, a significant group main effect was observed in the soleus muscle (F(1,35) = 6.82, p = 0.013), indicating significantly lower Hmax/Mmax ratios following ALAS (0.38 ± 0.20) compared to healthy controls (0.53 ± 0.16). Furthermore, lower Hmax/Mmax ratios in the soleus significantly correlated with acute symptoms and self-reported function but not with postural control.

CONCLUSION

This study supports previous evidence of AMI in patients with ALAS, providing insight into neurophysiologic impacts of musculoskeletal injury. Our results suggest that assessing AMI in a standing position following acute injury may provide valuable insight into how AMI develops and guide potential therapeutic options to curb and offset the formation of joint instability.

Assistance force-line of exosuit affects ankle multidimensional motion: a theoretical and experimental study

BACKGROUND

The talocrural joint and the subtalar joint are the two major joints of the ankle-joint complex. The position and direction of the exosuit force line relative to these two joint axes can influence ankle motion. We aimed to understand the effects of different force-lines on ankle multidimensional motion.

METHODS

In this article, three assistance force line schemes for ankle exosuits were proposed: perpendicular to the talocrural joint axis (PT), intersecting with the subtalar joint axis (IS), and parallel to the triceps surae (PTS). A theoretical model was proposed to calculate the exosuit's assistance moment. Seven participants completed four experimental tests of ankle plantarflexion, including three passive motions assisted by the PT, PTS and IS schemes, and one active motion without exosuit assistance (Active).

RESULTS

The simulation results demonstrated that all three exosuits were able to produce significant moments of ankle plantarflexion. Among these, the PT scheme exhibited the highest moments in all dimensions, followed by the PTS and IS schemes. The experimental findings confirmed the effectiveness of all three exosuit schemes in assisting ankle plantarflexion. Additionally, as the assistive force lines approached the subtalar joint, there was a decrease in ankle motion assisted by the exosuits in non-plantarflexion directions, along with a reduction in the average distance of ankle angle curves relative to active ankle motion. Furthermore, the linear correlation coefficients between inversion and plantarflexion, adduction and plantarflexion, and adduction and inversion gradually converged toward active ankle plantarflexion motion.

CONCLUSIONS

Our research indicates that the position of the exosuit force line to the subtalar joint has a significant impact on ankle inversion and adduction. Among all three schemes, the IS, which has the closest distance to the subtalar joint axes, has the greatest kinematic similarity to active ankle plantarflexion and might be a better choice for ankle assistance and rehabilitation.

Integrated Rehabilitation Approach Utilizing Swiss Ball Training, Mulligan Taping, and Mobilization With Movement for Simultaneous Management of Sacroiliac Joint Dysfunction and Lateral Ankle Sprain in a Badminton Athlete: A Case Study

This case report details an integrated rehabilitation plan implemented for a professional badminton player who presented with issues of sacroiliac joint (SIJ) dysfunction and a lateral ankle sprain. The integrated approach aimed to address both musculoskeletal issues, considering their potential reciprocal influences on biomechanics and functional performance. The athlete underwent a thorough initial assessment, including clinical examination, imaging, and biomechanical analysis. Treatment began with targeted interventions for acute ankle sprain management, such as rest, ice, compression, and elevation (RICE) followed by progressive exercises to restore ankle stability and range of motion (ROM). Concurrently, a specialized program was devised to address the underlying sacroiliac joint dysfunction through manual therapy, therapeutic exercises, and core stabilization routines. Throughout the rehabilitation process, the focus remained on integrated exercises that targeted both the ankle and sacroiliac joint, promoting optimal neuromuscular coordination and joint function specific to badminton demands. Regular reassessments guided the progression of interventions, ensuring a personalized and athlete-centric approach. The positive outcome highlights the importance of a holistic rehabilitation strategy in managing complex musculoskeletal conditions in athletes, facilitating efficient recovery, and reducing the risk of recurrence. This case report highlights the effectiveness of an integrated approach in enhancing performance and preventing reinjury in badminton athletes facing multifaceted musculoskeletal challenges.

Effects of shoe collar height and limb dominance on landing knee biomechanics in female collegiate volleyball players

Volleyball-specific footwear with higher collar heights (a mid-cut shoe) are worn to restrict ankle motion. Reduced ankle dorsiflexion has been associated with increased frontal plane motion and injury risk at the knee. With the high frequency of unilateral landings in volleyball, the purpose of this study was to determine the effect of volleyball-specific shoes and limb dominance on knee landing mechanics in collegiate volleyball players. It was hypothesized that participants would exhibit smaller sagittal plane and greater frontal plane knee joint mechanics in mid-cut and dominant limb and that vertical and posterior directed ground reaction forces would be greater wearing mid-cut, yet similar between limbs. Seventeen female volleyball players performed unilateral landings on each limb in mid-cut and low-top volleyball shoes. For shoe main effects, smaller peak dorsiflexion angle and internal peak plantarflexion moment and greater peak medial ground reaction force were found in the mid-cut but with no impact on knee mechanics. For limb main effects, the internal peak knee abduction moment was greater in the dominant limb. Greater peak lateral ground reaction force was found in the interaction between the non-dominant limb and low-top. Further research is warranted to better understand shoe and limb impact in volleyball players.

Players', Head Coaches', And Medical Personnels' Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women's Football in Ireland

BACKGROUND

To manage injuries effectively, players, head coaches, and medical personnel need to have excellent knowledge, attitudes, and behaviours in relation to the identification of risk factors for injuries, the implementation of injury prevention initiatives, as well as the implementation of effective injury management strategies. Understanding the injury context, whereby specific personal, environmental, and societal factors can influence the implementation of injury prevention initiatives and injury management strategies is critical to player welfare. To date, no qualitative research investigating the context of injuries, has been undertaken in elite-level women's football. The aim of our study was to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish Women's National League (WNL) to injury prevention and injury management.

METHODS

We used qualitative research methods to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel, and 7 head coaches in the Irish WNL. The data were analysed using thematic analysis. Our study is located within an interpretivist, constructivist research paradigm.

RESULTS

The participants had incomplete knowledge of common injuries in elite-level football, and many held beliefs about risk factors for injuries, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce the risk of injuries but evidence-based injury prevention exercises and programmes such as the Nordic hamstring curl, Copenhagen adduction exercise, and the FIFA 11+ were rarely mentioned. Overall, there was dissatisfaction amongst players with their medical care and strength and conditioning (S & C) support, with resultant inadequate communication between players, head coaches, and medical personnel.

CONCLUSION

Poor quality and availability of medical care and S & C support were considered to be a major obstacle in the effective implementation of injury risk reduction strategies and successful return-to-sport practices. More original research is required in elite-level women's football to explore injury risk factors, injury prevention initiatives, and contextual return-to-sport strategies, so that players, head coaches, and medical personnel can use evidence that is both up-to-date and specific to their environment.

The Effects of Ankle Taping on Measures of Ground Reaction Forces and Jump Height During a Sport-Specific Vertical Jump in Youth Basketball Players

The purpose of this study was to investigate the effects of ankle taping using zinc oxide tape versus no tape to measure ground reaction forces (GRF) and vertical jump height during a sport-specific vertical jump test in youth basketball players. Participants were recruited through purposive sampling and completed a basketball specific vertical jump test with and without zinc oxide tape. Mean sway velocity, 95% ellipse area, and path length were measured using the AMTI© force platform and vertical jump height using a Vertec© device. A paired t-test with a significance level of p < .05 was used for analysis. 23 individuals participated (11 females, 12 males; aged M = 15.22 years; height M = 171.43 cm; mass M = 64.72 kg). There was a statistically significant decrease in jump height with tape (M = 57.33 cm) compared to without tape (M = 58.84 cm), 95% CI [2.74, 0.28], t (20) = -2.56, p < .05, d = .56; statistically significant decrease in 95% ellipse area with tape (M = 2.64 cm.cm) compared to without tape (M = 3.30 cm.cm), 95% CI [0.50, 0.02], t (22) = -2.26, p < .05, d = .47; statistically significant decrease in sway velocity with tape (M = 2.82 m/sec) compared to without tape (M = 4.08 m/sec), 95% CI [7.47, 0.27], t (22) = -2.22, p < .05, d = .46; and a statistically significant decrease in path length with tape (M = 120.93 cm) compared to without tape (M = 170.10 cm), 95% CI [37.37, 1.33], t (22) = -2.23, p < .05, d = .46, with a medium effect size for all variables. The application of taping the ankles resulted in increased ankle stability at landing, however, basketball jumping performance may be negatively affected as taping resulted in a decreased vertical jump height.

External Ankle Support and Ankle Biomechanics in Chronic Ankle Instability: Systematic Review and Meta-Analysis

OBJECTIVE

To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks.

DATA SOURCES

A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021.

STUDY SELECTION

Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support.

DATA EXTRACTION

Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings.

DATA SYNTHESIS

A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient.

CONCLUSIONS

Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

Injury to the anterior talofibular ligament (ATFL) is a common acute injury of the lateral foot ligament. Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients. The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL. The clinical manifestations of acute injury to the ATFL include pain, swelling, and dysfunction. At present, non-surgical treatment is the first choice for acute injury of the ATFL. The standard treatment strategy involves the "peace and love" principle. After initial treatment in the acute phase, personalized rehabilitation training programs can be followed. These may involve proprioception training, muscle training, and functional exercise to restore limb coordination and muscle strength. Static stretching and other techniques to loosen joints, acupuncture, moxibustion massage, and other traditional medical treatments can relieve pain, restore range of motion, and prevent joint stiffness. If the non-surgical treatment is not ideal or fails, surgical treatment is feasible. Currently, arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice. Although open Broström surgery provides good results, the modified arthroscopic Broström surgery has many advantages, such as less trauma, rapid pain relief, rapid postoperative recovery, and fewer complications, and is more popular with patients. In general, when treating acute injury to the ATFL, treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.

Age and Sex Comparisons in Pediatric Track and Field Hurdle Injuries Seen in Emergency Departments of the US

There is limited literature analyzing pediatric hurdle injuries based on sex and age. This study compares hurdle-related injury types, injured body parts, and injury mechanisms by age and sex in pediatrics. Hurdle-related injury data from the National Electronic Injury Surveillance System were used to retrospectively review the injuries of hurdlers 18 years and under. Differences in injured body parts, injury types, and mechanisms were analyzed by age (pre-high school vs. high school) and sex (male vs. female). A total of 749 cases were extracted. Fractures were more common in pre-high schoolers (34.1% vs. 21.5%, p = 0.001), while more sprains were identified in high schoolers (29.6%) than pre-high schoolers (22.8%, p = 0.036). Males suffered more fractures than females (35.1% vs. 24.3%, p = 0.001). Females sustained more joint sprains (29.1% vs. 21.0%, p = 0.012) and contusions/hematomas (12.7% vs. 7.5%, p = 0.020). Ankle injuries were more common in females (24.0%) than males (12.0%, p = 0.001), while wrist injuries were more prevalent in males (11.7% vs. 7.2%, p = 0.034). The most common injury mechanism was apparatus-related, with no differences based on age or sex. Injury types and injured body parts differed depending on age and sex in pediatric hurdle injuries seen in emergency departments. These findings may be helpful for injury prevention and medical care for pediatric hurdlers.

Ankle instability as a prognostic factor associated with the recurrence of ankle sprain: A systematic review

DESIGN

Systematic review using PRISMA guidelines.

PURPOSE

To explore Relationship between ankle instability and ankle sprain recurrence in preventing recurrence of ankle sprains and to provide appropriate treatment.

METHODS

MEDLINE (the Cochrane Library) and the Physiotherapy Evidence Database (PEDro) were explored using key words related to ankle instability and ankle sprains in for April 2022. According to the inclusion criteria, studies that 1) targeted patients with ankle sprains, 2) assessed ankle instability, and 3) investigated ankle sprain recurrence rates, were extracted. The author names, publication year, patient characteristics, comparison groups, intervention methods, and outcome data (ankle instability and recurrence) were extracted. A correlation analysis between recurrence rate and ankle instability was conducted. In addition, A meta-analysis was performed on the correlation coefficients within each article.

RESULTS

Eight studies were extracted from 149 studies. A correlation analysis was conducted on five studies and meta-analysis was on three studies with the same post-intervention follow-up period and the same assessment methods for ankle instability and recurrence rate. Strong positive correlations were found for the same follow-up periods (r = 0.95: 95%CI [0.62-0.99]; 3-month, r = 0.97: 95%CI [0.75-0.10]; 1 year, p < .05). The correlation became stronger as the follow-up period increased. Furthermore, the meta-analysis showed that ankle instability as well as the main symptoms of sprain, such as pain and swelling, tended to be positively correlated with the recurrent rate of ankle sprains. These results suggest that ankle instability is strongly related to recurrence, and the longer the time since onset, the stronger the relationship.

CONCLUSIONS

Ankle instability was a prognostic factor associated with recurrence of ankle sprains in patients with ankle sprains. Therefore, ankle instability is one of important factor in preventing recurrence of ankle sprains.

A lateral ankle sprain during a lateral backward step in badminton: A case report of a televised injury incident

BACKGROUND

This study presents a kinematic analysis of an acute lateral ankle sprain incurred during a televised badminton match. The kinematics of this injury were compared to those of 19 previously reported cases in the published literature.

METHODS

Four camera views of an acute lateral ankle sprain incurred during a televised badminton match were synchronized and rendered in 3-dimensional animation software. A badminton court with known dimensions was built in a virtual environment, and a skeletal model scaled to the injured athlete's height was used for skeletal matching. The ankle joint angle and angular velocity profiles of this acute injury were compared to the summarized findings from 19 previously reported cases in the published literature.

RESULTS

At foot strike, the ankle joint was 2° everted, 33° plantarflexed, and 18° internally rotated. Maximum inversion of 114° and internal rotation of 69° was achieved at 0.24 s and 0.20 s after foot strike, respectively. After the foot strike, the ankle joint moved from an initial position of plantarflexion to dorsiflexion-from 33° plantarflexion to 53° dorsiflexion (range = 86°). Maximum inversion, dorsiflexion, and internal rotation angular velocity were 1262°/s, 961°/s, and 677°/s, respectively, at 0.12 s after foot strike.

CONCLUSION

A forefoot landing posture with a plantarflexed and internally rotated ankle joint configuration could incite an acute lateral ankle sprain injury in badminton. Prevention of lateral ankle sprains in badminton should focus on the control and stability of the ankle joint angle during forefoot landings, especially when the athletes perform a combined lateral and backward step.

Incidence, burden, and pattern of injuries in Spanish male youth soccer players: A prospective cohort study

OBJECTIVES

To explore the incidence, burden, and pattern of injuries in Spanish male youth soccer players during a 9-month competitive season (from September to May-June).

DESIGN

Prospective cohort study.

PARTICIPANTS

314 young (10-19 years) soccer players.

MAIN OUTCOME MEASURES

Incidence, burden, location, type, severity, mechanism, and circumstance of injuries, as well as potential differences by tactical position, month of the year, age group, and maturity status.

RESULTS

A total of 146 time-loss injuries were sustained by 101 different players. This resulted in an overall injury incidence of 3.1 injuries per 1000 h, a training injury incidence of 1.8 injuries per 1000 h, and a match injury incidence of 11.2 injuries per 1000 h. The probability of injury over the season was 34%. Most of the injuries affected the lower extremity and were classified as muscle/tendon injuries, with hamstring muscle injuries representing the most burdensome diagnosis. The incidence of injuries increased with age and maturation, but a heightened risk of overuse injuries during periods around peak height velocity was also identified.

CONCLUSIONS

These findings suggest a need for implementing specific injury prevention measures. Due to the high burden shown, these measures should mainly focus on reducing the number and severity of hamstring muscle injuries.

In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report

We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.

Innovative Medial Cushioning Orthoses Affect Peroneus Longus Electromyographic Activity during Running

Background: Over-supination processes of the foot and ankle involving peroneus longus (PL) damage during running sports have been treated conservatively with passive control tools, such as tapes, braces, or external ankle supports, but the effect of orthoses with typical lateral wedging orthoses (TLWO) on the muscular activity of PL during running remains unclear. Here we investigate the effects of innovative medial cushioning orthoses (IMCO) on PL activity during the full running gait cycle. In addition, we wished to ascertain the effects of innovative medial cushioning orthoses (IMCO) on PL activity during running. Methods: Thirty-one healthy recreational runners (mean age 34.5 ± 3.33) with neutral foot posture index scores, were selected to participate in the present study. They ran on a treadmill at 9 km/h wearing seven different orthoses (NRS, IMCO 3 mm, IMCO 6 mm, IMCO 9 mm, TLWO 3 mm, TLWO 6 mm and TLWO 9 mm), randomly performed on the same day while electromyographic activity of the PL muscle was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was carried out and the Wilcoxon test with Bonferroni’s correction was developed to analyze the differences between the conditions. Results: the reliability of all assessments showed data higher than 0.81, that is, “almost perfect reliability”; all EMG PL values wearing either TLWO or IMCO showed a statistically significant reduction versus NRS during the fully analyzed running gait cycle; the highest difference was set on NRS 23.08 ± 6.67 to TLWO 9 mm 17.77 ± 4.794 (p < 0.001). Conclusions: Muscular EMG activity of the PL during the full running gait cycle decreases when wearing either TLWO or IMCO relative to NRS; therefore, these orthoses could be prescribed to treat the strain and overload pathologies of PL. In addition, IMCO—as it less thick, compared with TLWO—can be used when aiming to achieve better running economy.

Lower extremity injuries in the baseball athlete

Baseball is unique in its multiple facets: pitching, hitting, base rounding, and fielding are distinct activities that require different athletic skills to perform at a high level. Likewise, these different aspects of the game can contribute to a multitude of varying injuries. While high-velocity overhead throwing, along with batting, can produce a plethora of upper extremity injuries that often garner attention, injuries to the lower extremity can severely impact a player’s performance and ability to compete. The rigors of the short, explosive sprinting required for base running, as well as the dynamic movement required for fielding, create ample opportunity for lower limb injury, and even subtle pathology can affect a pitcher’s ability to perform or increase their long-term risk of injury. Chronic injury from conditions such as femoroacetabular impingement and hip labral tears can also occur. The purpose of the present review is to summarize the relevant epidemiology, pathophysiology, and treatment of lower extremity injuries in baseball athletes, with reference to current research into the prevention and management of such injuries.

Current ankle sprain prevention and management strategies of netball athletes: a scoping review of the literature and comparison with best-practice recommendations

BACKGROUND

Ankle sprains are the most commonly reported injury in netball. Approximately four in five netball athletes will sustain an ankle sprain, up to half will go on to sustain recurrent ankle sprains, and nine in ten report perceived ankle instability. Historically, prevention and management strategies of ankle sprains and injuries have been investigated for a variety of sports, however, no literature reviews have investigated these in netball athletes, or compared these with current best-practice within the literature. Therefore, this scoping review aims to understand how netball athletes currently prevent and manage ankle sprains and to compare these approaches with best-practice recommendations.

METHODS

A literature search was conducted using MEDLINE, CINAHL, and SPORTDiscus databases using keywords to capture studies with data or information related to the prevention and management of ankle sprains and injuries in netball.

RESULTS

The search strategy captured 982 studies across all databases, with 30 netball studies included in this scoping review. Studies suggest netball athletes are not commonly referred to health professionals, do not undertake adequate rehabilitation, and almost immediately return to court following an ankle sprain or injury. Current best-practices suggest injury prevention programs and external ankle support effectively reduce ankle sprains and injuries; however, poor compliance and implementation may be a significant barrier. Currently, there is a lack of evidence that netball-specific footwear reduces the risk of ankle sprains.

CONCLUSION

The findings suggest netball athletes do not implement current best-practice prevention and management strategies following an ankle sprain. This is despite evidence of the effectiveness of injury prevention programs, external ankle support, and adequate rehabilitation in reducing ankle sprain rates. Current-best practice prevention and management of ankle sprains should be considered by clinicians, coaches, and athletes to reduce the prevalence and chronicity of ankle sprains in netball.

In Silico Finite Element Analysis of the Foot Ankle Complex Biomechanics: A Literature Review

Computational approaches, especially finite element analysis (FEA), have been rapidly growing in both academia and industry during the last few decades. FEA serves as a powerful and efficient approach for simulating real-life experiments, including industrial product development, machine design, and biomedical research, particularly in biomechanics and biomaterials. Accordingly, FEA has been a "go-to" high biofidelic software tool to simulate and quantify the biomechanics of the foot-ankle complex, as well as to predict the risk of foot and ankle injuries, which are one of the most common musculoskeletal injuries among physically active individuals. This paper provides a review of the in silico FEA of the foot-ankle complex. First, a brief history of computational modeling methods and finite element (FE) simulations for foot-ankle models is introduced. Second, a general approach to build an FE foot and ankle model is presented, including a detailed procedure to accurately construct, calibrate, verify, and validate an FE model in its appropriate simulation environment. Third, current applications, as well as future improvements of the foot and ankle FE models, especially in the biomedical field, are discussed. Finally, a conclusion is made on the efficiency and development of FEA as a computational approach in investigating the biomechanics of the foot-ankle complex. Overall, this review integrates insightful information for biomedical engineers, medical professionals, and researchers to conduct more accurate research on the foot-ankle FE models in the future.

Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability - the later, the worse: a retrospective analysis

Background

The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI.

Methods

Between 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus.

Results

The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1–3 recurrent sprains or 4–5 recurrent sprains (p < .001).

Conclusions

Females over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Soccer: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association held the first women's soccer championship in 1982; sponsorship and participation have greatly increased since.

BACKGROUND

Routine examinations of athlete injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.33 per 1000 athlete-exposures. Lateral ligament complex tears (ankle sprains) (8.6%), concussions (8.3%), and quadriceps tears (5.0%) were the most commonly reported injuries. Rates of lateral ligament complex tears followed an increasing trajectory during the study period, whereas quadriceps tear rates fluctuated during the early years, and concussion rates decreased then increased.

SUMMARY

The findings of this study were mostly consistent with existing evidence; notable temporal patterns were observed with regard to lateral ligament complex tears and concussions.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Soccer: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has sponsored men's soccer programs since 1959, and the popularity of the sport has grown over time.

BACKGROUND

Routine examinations of athlete injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.51 per 1000 athlete exposures. Lateral ligament complex tears (ankle sprains) (9.2%), hamstring tears (7.0%), and concussions (5.2%) were the most commonly reported injuries. Rates of lateral ligament complex tears remained stable from 2014-2015 through 2018-2019, whereas hamstring tear rates decreased and concussion rates increased.

SUMMARY

The findings of this study were in line with the existing epidemiological evidence, although notable temporal patterns were observed. Incidence trajectories of commonly observed injuries warrant particular attention in the future.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Basketball: 2014-2015 Through 2018-2019

CONTEXT

Frequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women's basketball student-athletes is valuable for identifying injury-related patterns.

BACKGROUND

Emerging patterns in epidemiology of NCAA women's basketball injuries are unknown though general sports medicine practices, and playing rules and regulations have evolved in recent years.

METHODS

Athlete exposures (AEs) and injury incidence data were reported to the NCAA Injury Surveillance Program between 2014-2015 and 2018-2019. Injury counts, rates, and proportions were used to examine injury characteristics, and injury rate ratios (IRRs) were used to assess injury rate differences.

RESULTS

Practice and competition injury rates were 5.93 and 10.35 per 1000 AEs, respectively. Preseason injury rates were higher than regular (IRR = 1.41; 95% CI = 1.31, 1.53) and postseason (IRR = 3.12; 95% CI = 2.39, 4.07). Ankle sprains (14.3%), concussions (7.5%), and anterior cruciate ligament tears (2.5%) were the most commonly reported injuries.

SUMMARY

Higher rates of practice and competition injuries, as well as ankle sprains, were observed relative to previous reports; continuous monitoring is necessary to identify potential contributing factors to these trends.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Track and Field: 2014-2015 Through 2018-2019

CONTEXT

Women's track and field events at the National Collegiate Athletic Association level have grown in popularity in recent years, and track and field athletes are vulnerable to a broad range of potential injuries.

BACKGROUND

Routine examination of track and field injuries is important for identifying emerging patterns in injury incidence.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 to 2018-2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 2.20 per 1000 athlete exposures; the competition injury rate was higher than the practice injury rate (injury rate ratio = 1.73; 95% confidence interval = 1.51, 1.97). Hamstring tears (8.9%), medial tibial stress syndrome (5.4%), and lateral ligament complex tears (4.2%) were the most reported injuries.

CONCLUSIONS

Given the results of this study, further attention may be directed toward factors associated with noncontact injury risk in the competitions. The changing injury rates of most reported injuries also warrant monitoring post 2018-2019.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Volleyball: 2014-2015 Through 2018-2019

CONTEXT

Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level.

BACKGROUND

Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 athletic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 6.73 per 1000 athlete-exposures. Knee (14.6%) and ankle (13.8%) injuries accounted for the largest proportion of all reported injuries, and most injuries were attributed to overuse (26.1%) or noncontact (22.7%) mechanisms. Lateral ankle ligament complex tears (11.1%) and concussions (7.3%) were the most commonly reported specific injury.

SUMMARY

Results indicate an increasing burden of practice-related injuries and the need to further examine overuse injuries. Lower-extremity injury prevention strategies and mechanisms of concussion also warrant further attention.

Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol

Background

Ankle sprains are one of the most common musculoskeletal injuries, accounting for up to 5% of all Emergency Department visits in the United Kingdom. Ankle injury may be associated with future ankle osteoarthritis. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury. There is limited research regarding the association between ankle sprain and ankle osteoarthritis development. The current study aims to phenotype those who suffer significant ankle ligament injuries, identify potential risk factors for ankle injuries and subsequent poor recovery, examine why individuals may develop osteoarthritis, and what factors influence this chance.

Methods

In this multicentre cohort study participants were recruited from nine Emergency Departments and two Urgent Care Centres in the United Kingdom. Participants (aged 18–70 years old) were defined as those who had suffered an isolated acute ankle sprain, which was Ottawa Ankle Rules positive, but negative for a significant ankle fracture on x-ray. Age and sex matched controls were also recruited. The controls were individuals who had not suffered a significant ankle injury, including ankle pain, function affected for more than 7 days, or the ankle caused them to report to an Emergency Department. Data is collected through a series of seven questionnaires (at baseline, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years later). The questionnaires include four sections (demographic questions; index injury, and injury history questions; functional assessment questions; and quality of life questions) and are designed to collect detailed information about the individual, their injury, potential risk factors for ankle sprains and ankle osteoarthritis, plus their medical history and any medication consumed.

Discussion

The Significant Ankle Ligament Injury (SALI) study aims to add to the limited knowledge regarding which factors can predict ankle sprains, complaints, and osteoarthritis. This is important because despite ankle sprains being regarded as a benign injury that resolves quickly, residual symptoms are not uncommon months and years after the injury.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04230-8.

Acute Effect of Ankle Kinesio™ Taping on Lower-Limb Biomechanics During Single-Legged Drop Landing

CONTEXT

Chronic ankle instability is documented to be followed by a recurrence of giving away episodes due to impairments in mechanical support. The application of ankle Kinesiotaping (KT) as a therapeutic intervention has been increasingly raised among athletes and physiotherapists.

OBJECTIVES

This study aimed to investigate the impacts of ankle KT on the lower-limb kinematics, kinetics, dynamic balance, and muscle activity of college athletes with chronic ankle instability.

DESIGN

A crossover study design.

PARTICIPANTS

Twenty-eight college athletes with chronic ankle sprain (11 females and 17 males, 23.46 [2.65] y, 175.36 [11.49] cm, 70.12 [14.11] kg) participated in this study.

SETTING

The participants executed 3 single-leg drop landings under nontaped and ankle Kinesio-taped conditions. Ankle, knee, and hip kinematics, kinetics, and dynamic balance status and the lateral gastrocnemius, medial gastrocnemius, tibialis anterior, and peroneus longus muscle activity were recorded and analyzed.

RESULTS

The application of ankle KT decreased ankle joint range of motion (P = .039) and angular velocities (P = .044) in the sagittal plane, ground reaction force rate of loading (P = .019), and mediolateral time to stability (P = .035). The lateral gastrocnemius (0.002) and peroneus longus (0.046) activity amplitudes also experienced a significant decrease after initial ground contact when the participants' ankles were taped, while the application of ankle KT resulted in an increase in the peroneus longus (0.014) activity amplitudes before initial ground contact.

CONCLUSIONS

Ankle lateral supports provided by KT potentially decreases mechanical stresses applied to the lower limbs, aids in dynamic balance, and lowers calf muscle energy consumption; therefore, it could be offered as a suitable supportive means for acute usage in athletes with chronic ankle instability.

CAN PROXIMAL HIP STRENGTH AND DYNAMIC CONTROL DIFFERENTIATE FUNCTIONAL ANKLE STABILITY CLASSIFICATIONS?

Background

Ankle instability can be problematic in an active population with multiple risk factors associated with recurrence.

Purpose

The aim of this study was to determine if deficits in weight-bearing and non-weight bearing assessment of hip strength or dynamic balance in lower extremity reaching tasks from flat and inclined surfaces can differentiate subjects classified as controls, ankle sprain copers, or those with chronic, recurrent ankle sprains.

Study Design

Quasiexperimental, Ex post facto.

Methods

A convenience sample of 60 subjects was classified into control, coper, or chronic ankle sprain groups based on the results of the Identification of Functional Ankle Instability Questionnaire. Subjects were tested for peak force production of their hip extensors, hip abductors, and a composite of hip extension and external rotation while in a standing position using a hand-held dynamometer. Additionally, each subject performed a modified Star Excursion Balance Test in anterior, posterolateral, and posteromedial directions from both a flat and 15 ° inverted stance position. One-way analysis of variance was calculated for between group differences of hip strength and balance reach ability and ankle stability classification. Pearson product-moment correlation coefficients were derived to evaluate relationships between hip strength and dynamic balance tests.

Results

Twenty-one subjects were assigned to the control group, 23 to the coper group, and 16 to the chronic group. There were no significant differences between groups in self-report of Foot and Ankle Ability Measures or Tegner activity levels. Mean hip strength was not significantly different between ankle sprain classification groups (p = 0.66 - 0.82). The mean limb symmetry index for hip strength comparing injured and uninjured ankles was nearly symmetrical in all ankle stability groups (p = 0.34 - 0.97). The same symmetry was present when comparing injured and uninjured abilities for all dynamic balance reach tasks from both flat and inclined surfaces. (p = 0.16 - 0.62). There was a fair relationship between hip extension and weight-bearing hip extension/external rotation strength and the posteromedial and posterolateral reach tasks with correlation coefficients in the range of 0.33 - 0.43.

Conclusion

Performance measures of tri-planar, static, isometric hip strength and lower extremity reach in dynamic balance tasks could not differentiate subjects without a history of injury from those subjects with one or more lateral ligamentous ankle sprains.

Level Of Evidence

2b; Ex post facto.

Restricting ankle dorsiflexion does not mitigate the benefits of external focus of attention on landing biomechanics in healthy females

PURPOSE

Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns in the presence of a mechanical restriction on the ankle. Therefore, our purpose was to determine whether restricting ankle dorsiflexion by use of bracing mitigated the effects of attentional foci on landing biomechanics in healthy females.

METHODS

We used a crossover design to investigate lower extremity biomechanics in 19 healthy females between the ages of 18-35 during a series of jump-landing tasks. Participants completed 6 blocks of 3 jump-landings on separate force platforms in a randomized order based on brace condition (brace, no brace) and mode of attentional foci (neutral, internal focus [IF], external focus [EF]). Attentionally focused instructions were provided immediately prior to 3 practice jump-landings, followed by 5 test jump-landings with self-controlled feedback only.

RESULTS

Ankle bracing decreased peak dorsiflexion and sagittal range of motion (ROM) (mean difference: 5.7-5.8°), and peak inversion and frontal ROM (mean difference: 2.4-3.0°). However, hip flexion ROM (mean difference: 1.8°) increased compared to the no brace condition. Regardless of ankle bracing, EF instruction increased peak hip flexion (mean difference: 4.9°) and hip flexion range of motion (mean difference: 3.8-4.6°), while decreasing peak knee valgus (mean difference: 0.8-1.0°) and knee valgus moment (mean difference: 0.04 Nm/kg). Additionally, EF instruction increased peak hip abduction to a similar degree when braced (mean difference: 3.6-4.0°) and not braced (mean difference: 2.1-2.5°). Lastly, EF instruction increased hip abduction ROM only when braced (mean difference: 2.3-2.4°), but decreased peak knee valgus power only when not braced (mean difference: 0.18 W/kg).

CONCLUSIONS

Our findings indicate that mechanically restricting ankle dorsiflexion does not mitigate the ability of EF instruction to enhance jump-landing performance by means of improving hip and knee biomechanics in healthy females. However, our findings suggest an improved ability to control the rate of knee valgus loading when not braced. Therefore, we conclude that EF instruction remains a viable clinical strategy to improve landing patterns in the presence of restricted ankle dorsiflexion, yet this approach may be ineffective to reduce the rate of knee joint loading.

Ankle-knee coupling responses to ankle Kinesio™ taping during single-leg drop landings in collegiate athletes with chronic ankle instability

BACKGROUND

Ankle Kinesio-taping (KT) is being globally used an intervention to provide the ankle joint complex with sufficient support against sudden excessive mechanical stress during various activities. However, its effects on proximal joints are unclear. This study investigated the impact of ankle KT on ankle-knee joint coupling in sagittal, frontal and transverse planes.

METHODS

Adopting a pretest post-test study design, 30 collegiate athletes with chronic ankle instability performed 3 single-leg drop landings in each non-taped and Kinesio-taped conditions and their movement kinematics were recorded using 6 optoelectronic cameras.

RESULTS

The ankle angular velocities in sagittal (P=0.038, d=0.64) and transverse planes (P=0.001, d=0.95) decreased after KT application, while the knee internal rotation velocities increased (P=0.020, d=0.51). The coupling angles revealed that the ankle movement ratios significantly decreased in 3 planes in comparison with knee movement ratios.

CONCLUSIONS

Outcomes of this study illustrated that application of ankle KT leaves the individuals with a stiffer ankle joint, which increases the mechanical stresses to this joint and decreases its stiffness in absorbing the applied shocks. Further, ankle KT application resulted in more knee internal rotation moments and may increase the risk of knee injuries during landing after a long-term usage in patients with instability ankle sprain.