Intrinsic risk factors for inversion ankle sprains in females--a prospective study

Factors Associated With a Lateral Ankle Sprain in Young Female Soccer Players: A Prospective Cohort Study

Background

Previous studies have attempted to determine if certain risk factors can predict the occurrence of a lateral ankle sprain (LAS) in female soccer players. Unfortunately, there is limited evidence with regard to risk factors associated with an LAS in female soccer players.

Purpose

To identify intrinsic risk factors for an LAS among young female soccer players.

Study Design

Cohort study; Level of evidence, 2.

Methods

Participants were 161 young female soccer players in Japan who were evaluated for LAS risk factors during a preseason medical assessment. The assessment included anthropometric, joint laxity, joint range of motion, muscle flexibility, muscle strength, and balance measurements. Each athlete's history of LASs was also collected. The participants were monitored during a single-yearseason for LASs, as diagnosed by physicians.

Results

There were 26 instances of an LAS in 25 players (15.5%) during the season. Injured players were significantly more likely to have sustained a previous ankle sprain (P = .045) and demonstrated significantly worse balance than their peers without an LAS during the double- and single-leg balance tests (P = .008 for both). Athletes with lower hamstring-to-quadriceps muscle strength ratios were also significantly more likely to sustain an LAS (P = .02).

Conclusion

Poor balance, a low hamstring-to-quadriceps ratio, and a history of ankle sprains were associated with an increased risk of LASs in young female soccer players in the current study. These findings may be useful for developing a program to prevent LASs in this population.

Classification of chronic ankle instability using machine learning technique based on ankle kinematics during heel rise in delivery workers

Objective

Ankle injuries in delivery workers (DWs) are often caused by trips, and high recurrence rates of ankle sprains are related to chronic ankle instability (CAI). Heel rise requires joint angles and moments similar to those of the terminal stance phase of walking that the foot supinates. Thus, our study aimed to develop, determine, and compare the predictive performance of statistical machine learning models to classify DWs with and without CAI using ankle kinematics during heel rise.

Methods

In total, 203 DWs were screened for eligibility. Seven predictors were included in our study (age, work duration, body mass index, calcaneal stance position angle [CSPA] in the initial and terminal positions during heel rise, calcaneal movement during heel rise [CMHR], and plantar flexion angle during heel rise). Six machine learning algorithms, including logistic regression, decision tree, AdaBoost, Extreme Gradient boosting machines, random forest, and support vector machine, were trained.

Results

The random forest model (area under the curve [AUC], 0.967 [excellent]; F1, 0.889; accuracy, 0.925) confirmed the best predictive performance in the test datasets among the six machine learning models. For Shapley Additive Explanations, old age, low CMHR, high CSPA in the initial position, high PFA, long work duration, low CSPA in the terminal position, and high body mass index were the most important predictors of CAI in the random forest model.

Conclusion

Ankle kinematics during heel rise can be considered in the classification of DWs with and without CAI.

Differences in intra-foot movement strategies during locomotive tasks among chronic ankle instability, copers and healthy individuals

Individuals with chronic ankle instability (CAI) suffer from the resulting sequela of repetitive lateral ankle sprains (LAS), whilst copers appear to cope with initial LAS successfully. Therefore, the aim of this study was to explore the intra-foot biomechanical differences among CAI, copers, and healthy individuals during dynamic tasks. Twenty-two participants per group were included and required to perform cutting and different landing tasks (DL: drop landing; FL: forward jump followed a landing). A five-segment foot model with 8 degrees of freedom was used to explore the intra-foot movement among these three groups. Smaller dorsiflexion angles were found in copers (DL tasks and prelanding task) and CAI (DL and FL task) compared to healthy participants. Copers presented a more eversion position compared to others during these dynamic tasks. During the descending phase of DL task, greater dorsiflexion angles in the metatarsophalangeal joint were found in copers compared to the control group. Joint moment difference was only found in the subtalar joint during the descending phase of FL task, presenting more inversion moments in copers compared to healthy participants. Copers rely on more eversion positioning to prevent over-inversion of the subtalar joint compared to CAI. Further, the foot became more unstable when conducting sport-related movements, suggesting that foot stability seems to be sensitive to the task types. These findings may help in designing and implementing interventions to restore functions of the ankle joint in CAI individuals.

Risk factors for acute ankle sprains in field-based, team contact sports: a systematic review of prospective etiological studies

OBJECTIVE

The aim of this systematic review was to identify prospectively measured ankle sprain risk factors in field-based team contact sports.

METHODS

Eight databases including SPORTDiscus, CINAHL Complete, MEDLINE (EBSCO), Education Source, Web of Science, Scopus, Embase, and Pubmed were searched using specific Boolean terms. A modified-CASP diagnostic test assessed the quality of the included studies. Extensive data extraction included but was not limited to injury definition, protocols for injury diagnosis and recording, and outcomes associated with ankle sprain.

RESULTS

4012 records were returned from the online search and 17 studies met the inclusion criteria for this review. Twelve different risk factors including anatomic alignment of the foot and ankle, joint laxity, height, mass, BMI (body mass index), age, ankle strength, hip strength, single leg landing performance (ground reaction force, pelvic internal rotation, and knee varus), and single leg reach were all found to be associated with ankle sprain incidence. Injury definitions and methods of diagnosis and recording varied across the 17 studies.

CONCLUSION

This review updates the literature on prospective risk factors for ankle sprain in a specific population rather than heterogeneous cohorts previously studied. From more than 20 categories of risk factors investigated for ankle sprain association across 17 studies in field-based team contact sports, 12 variables were found to be associated with increased incidence of ankle sprain. In order to reduce the risk of ankle sprain, BMI, ankle plantar and dorsiflexion strength, hip strength, and single leg landing performance should be factored in to athlete assessment and subsequent program design. More studies utilizing standardized definitions and methods of recording and reporting are needed. Future prospective etiological studies will allow strength and conditioning coaches, physiotherapists, and physicians to apply specific training principles to reduce the risk and occurrence of ankle sprain injuries.

Intrarater Reliability and Analysis of Learning Effects in the Y Balance Test

While the general reliability of the Y balance test has been previously found to be excellent, earlier reviews highlighted a need for a more consistent methodology between studies. The purpose of this test-retest intrarater reliability study was to assess the intrarater reliability of the YBT using different methodologies regarding normalisation for leg length, number of repetitions, and score calculation. Sixteen healthy adult novice recreational runners aged 18-55 years, both women and men, were reviewed in a laboratory environment. Mean calculated scores, intraclass correlation coefficient, standard error of measurement, and minimal detectable change were calculated and analysed between different leg length normalisation and score calculation methods. The number of repetitions needed to reach a plateauing of results was analysed from the mean proportion of maximal reach per successful repetition. The intrarater reliability of the YBT was found to be good to excellent, and it was not affected by the method of score calculation or leg length measurement. The test results plateaued after the sixth successful repetition. Based on this study, it is suggested to use anterior superior iliac spine-medial malleolus length for leg length normalisation because this method was proposed in the original YBT protocol. At least seven successful repetitions should be performed to reach a result plateau. The average of the best three repetitions should be used to mitigate possible outliers and account for the learning effects seen in this study.

Assessment of Fatigue and Recovery in Sport: Narrative Review

Fatigue is a phenomenon associated with decreases in both physical and cognitive performances and increases in injury occurrence. Competitive athletes are required to complete demanding training programs with high workloads to elicit the physiological and musculoskeletal adaptations plus skill acquisition necessary for performance. High workloads, especially sudden rapid increases in training loads, are associated with the occurrence of fatigue. At present, there is limited evidence elucidating the underlying mechanisms associating the fatigue generated by higher workloads and with an increase in injury risk. The multidimensional nature and manifestation of fatigue have led to differing definitions and dichotomies of the term. Consequently, a plethora of physiological, biochemical, psychological and performance markers have been proposed to measure fatigue and recovery. Those include self-reported scales, countermovement jump performance, heart rate variability, and saliva and serum biomarker analyses. The purpose of this review is to provide an overview of fatigue and recovery plus methods of assessments.

Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis

Background

Ankle sprains remain prevalent across most team sports. However, despite divergent ankle sprain injury rates in male and female athletes, little is known about potential sex-specific risk factors for ankle sprain.

Objective

To systematically investigate the sex-specific risk factors for ankle sprain.

Methods

Combinations of the key terms were entered into PubMed, Web of Science, Embase and Cochrane Library databases, and prospective studies reporting ankle sprain risk factors in males or females were included for meta-analysis.

Results

Sixteen studies were eligible for inclusion, for a total of 3636 athletes (735 female) and 576 ankle sprains (117 female). Out of 21 prognostic factors, previous ankle sprain injury (odds ratio = 2.74, P < .001), higher body mass index (SMD = 0.50, P < 0.001), higher weight (SMD = 0.24, P = 0.02), lower isometric hip abduction strength (SMD = − 0.52, P < 0.0001) and lower dynamic balance performance (SMD = − 0.48 to − 0.22, P < 0.001–0.04) were identified as risk factors in male athletes. In female athletes, out of 18 factors eligible for meta-analysis, only lower concentric dorsiflexion strength was identified as a risk factor (SMD = − 0.48, P = 0.005).

Conclusion

This meta-analysis provides novel evidence for different risk factor profiles for ankle sprain injuries between female and male athletes. Further studies, particularly in female athletes, are needed to strengthen the evidence.

Misencoding of ankle joint angle control system via cutaneous afferents reflex pathway in chronic ankle instability

This study aimed to investigate how the cutaneous reflexes in the peroneus longus (PL) muscle are affected by changing the ankle joint position in patients with chronic ankle instability (CAI). We also investigated the correlation between the degree of reflex modulation and angle position sense of the ankle joint. The participants were 19 patients with CAI and 20 age-matched controls. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve at the ankle joint in the neutral standing and eversion/inversion standing positions. The suppressive middle latency cutaneous reflex (MLR; ~ 70-120 ms) and angle position sense of the ankle joint were assessed. During neutral standing, the gain of the suppressive MLR was more prominent in the CAI patients than in controls, although no significant difference was seen during 30° inversion standing. In addition, the ratios of the suppressive MLR and background electromyography in a neutral position were significantly larger than those at the 15°, 25°, and 30° inversion positions in CAI patients. No such difference was seen in control individuals. Furthermore, the correlations between reflex modulation degree and position sense error were quite different in CAI patients compared to controls. These findings suggest that the sensory-motor system was deteriorated in CAI patients due to changes in the PL cutaneous reflex pathway excitability and position sense of the ankle joint.

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature

BACKGROUND

Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.

METHODS

A systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.

RESULTS

SH1 fractures were found in 0-57.5% of the cases in all series and 0-3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2-80% and an osteochondral avulsion of the distal fibula in 6-28.1%. The most recent series report 76-80% and 62% for ATFL injury and osteochondral avulsion respectively.

CONCLUSIONS

There is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities.

Reference values of postural balance in preschoolers: Age and gender differences for 4-5 years old Tunisian children

BACKGROUND

Preschool age is a critical stage of postural balance development. Posturography normative data during this age are crucial for surveillance of postural balance and for the timely diagnosis of any dysfunction. The aim of this study was to provide normative data, specific to Tunisian preschoolers, according to age and gender, and to examine gender- and age-related differences in postural balance.

RESEARCH QUESTION

Are there postural balance gender- and age-related differences in Tunisian preschoolers?

METHODS

The study included 410 (205 boys and 205 girls) preschool children aged between 4- and 5-year-old selected within a large geographic area of Tunisia. Postural balance was assessed using a stabilometric platform under 4 sensory conditions. The mean center of pressure velocity (CoP-V) parameter was selected for analysis. Differences between gender and age groups were analysed using the Mann-Whitney U. Normative data were expressed in percentiles.

RESULTS

Significant gender effect was found in conditions where sensory inputs are most challenged with a significantly smaller mean CoP-V in girls compared to boys (p < 0.05). Moreover, 5-year-old children had significantly better postural balance than 4-year-old ones in almost all conditions (p < 0.05).

SIGNIFICANCE

The normative data established for Tunisian preschoolers provide useful comparative data for pediatricians, teachers and coaches for the early evaluation and monitoring of postural balance during this age. Gender and age-related differences should be considered in this population.

Risk Factors Influencing the Incidence of Ankle Sprain Among Elite Football and Basketball Players: A Prospective Study

Introduction. The objective of the present study was to investigate whether certain intrinsic factors (foot hyperpronation, generalized joint laxity) and clinical tests (anterior drawer and talar tilt tests, single-leg balance test and star excursion balance test, ankle and first metatarsophalangeal range of motion) could predict the incidence of lateral ankle sprains among elite football and basketball players during a full year. Method. In a prospective cohort study, 106 elite basketball and football players were recruited. During the preseason period, players underwent baseline measurements. Team physicians in following year reported occurrence of new ankle sprains. Results. Ankle sprain was more frequent among basketball players (P = .01). The history of recurrent (P = .001) and acute ankle sprain (P = .01) and each 5-year increase in age (P = .039) were predictive factors for ankle sprain. No evidence for relationship between other risk factors and occurrence of ankle sprain were achieved. Conclusion. In our study, the history of recurrent and acute ankle sprain was the strongest predictor for ankle injuries. Considering the limitations of this study, it seems mandatory to conduct more prospective studies with a larger sample size and longer follow-up period.Levels of Evidence: Level II: Prognostic.

Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis

INTRODUCTION

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI.

METHODS AND ANALYSIS

We will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review

The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear within the last 10 years. Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46-56.9 years). The weighted mean follow-up was 23.82 months (range 9.2-78 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.58 and a weighted mean postoperative score of 88.82. Six studies measured the VAS score showing an improvement from a mean weighted preoperative score of 4.68 to a mean weighted postoperative score of 1.2. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176). The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.

Foot Muscle Strengthening and Lower Limb Injury Prevention

Background and objectives: The active and passive structures of the foot act in unison to not only be compliant enough to assist in ground reaction force attenuation but also resist deformation to provide a stable base of support. A foot that is unable to adjust to the imposed demands during high-intensity sporting activities may alter the moments and forces acting on the joints, increasing the risk of non-contact anterior cruciate ligament ruptures (ACLR) and lateral ankle sprains (LAS). Prophylactic strengthening programs are often used to reduce the risk of these injuries, but at present, very few prophylactic programs include foot-specific strengthening strategies. The aim of this theoretical review is to ascertain the prophylactic role strengthening muscles acting on the foot may have on ACLR and LAS injury risk. Methods: Literature relating to risk factors associated with ACLR and LAS injury and the anatomy and biomechanics of normal foot function was searched. In addition, ACLR and LAS injury prevention programs were also sought. A theoretical, narrative approach was followed to synthesize the information gathered from the articles. Results: The foot segments are governed by the congruity of the articulations and the activity of the foot muscles. As such, there is a coupling effect between shank, calcaneus, midfoot, and hallux movement which play a role in both ACLR and LAS injury risk. Conclusions: Strengthening the muscles acting on the foot may have a significant impact on ACLR and LAS injury risk.

A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion

The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.

Effects of Whole-Body Vibration and Balance Training on Female Athletes with Chronic Ankle Instability

We explored the effects of 6-week whole-body vibration (WBV) and balance training programs on female athletes with chronic ankle instability (CAI). This randomized controlled study involved female athletes with dominant-leg CAI. The participants were randomly divided into three groups: WBV training (Group A), balance training (Group B), and nontraining (control group; Group C). Groups A and B performed three exercise movements (double-leg stance, one-legged stance, and tandem stance) in 6-week training programs by using a vibration platform and balance ball, respectively. The Star Excursion Balance Test (SEBT), a joint position sense test, and an isokinetic strength test were conducted. In total, 63 female athletes with dominant-leg CAI were divided into three study groups (all n = 21). All of them completed the study. We observed time-by-group interactions in the SEBT (p = 0.001) and isokinetic strength test at 30°/s of concentric contraction (CON) of ankle inversion (p = 0.04). Compared with the control group, participants of the two exercise training programs improved in dynamic balance, active repositioning, and 30°/s of CON and eccentric contraction of the ankle invertor in the SEBT, joint position sense test, and isokinetic strength test, respectively. Furthermore, the effect sizes for the assessed outcomes in Groups A and B ranged from very small to small. Female athletes who participated in 6-week training programs incorporating a vibration platform or balance ball exhibited very small or small effect sizes for CAI in the SEBT, joint position sense test, and isokinetic strength test. No differences were observed in the variables between the two exercise training programs.

Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions

CONTEXT

Lateral ankle sprains (LAS) have one of the highest recurrence rates of all musculoskeletal injuries. An emphasis on rapid return to sport (RTS) following LAS likely increases reinjury risk. Unfortunately, no set of objective RTS criteria exist for LAS, forcing practitioners to rely on their own opinion of when a patient is ready to RTS.

PURPOSE

To determine if there was consensus among published expert opinions that could help inform an initial set of RTS criteria for LAS that could be investigated in future research.

EVIDENCE ACQUISITION

PubMed, CINHL, and SPORTDiscus databases were searched from inception until October 2018 using a combination of keywords. Studies were included if they listed specific RTS criteria for LAS. No assessment of methodological quality was conducted because all included papers were expert opinion papers (level 5 evidence). Extracted data included the recommended domains (eg, range of motion, balance, sport-specific movement, etc) to be assessed, specific assessments for each listed domain, and thresholds (eg, 80% of the uninjured limb) to be used to determine RTS. Consensus and partial agreement were defined, a priori, as ≥75% and 50% to 75% agreement, respectively.

EVIDENCE SYNTHESIS

Eight domains were identified within 11 included studies. Consensus was reached regarding the need to assess sport-specific movement (n = 9, 90.9%). Partial agreement was reached for the need to assess static balance (n = 7, 63.6%). The domains of pain and swelling, patient reported outcomes, range of motion, and strength were also partially agreed on (n = 6, 54.5%). No agreement was reached on specific assessments of cutoff thresholds.

CONCLUSIONS

Given consensus and partial agreement results, RTS decisions following LAS should be based on sport-specific movement, static balance, patient reported outcomes, range of motion, and strength. Future research needs to determine assessments and cutoff thresholds within these domains to minimize recurrent LAS risk.

Greater knee varus angle and pelvic internal rotation after landing are predictive factors of a non-contact lateral ankle sprain

OBJECTIVES

This study aimed to clarify the kinematic, kinetic characteristics associated with lateral ankle sprain.

DESIGN

A 16-month prospective cohort study.

SETTING

Laboratory.

PARTICIPANTS

A total of 179 college athletes.

MAIN OUTCOME MEASURES

Joint kinematics, moment during single-leg landing tasks, and ankle laxity were measured. The attendance of each participating team, injury mechanism, existence of body contact, presence of orthosis, with or without medical diagnosis, and periods of absence were recorded.

RESULTS

Twenty-nine participants incurred lateral ankle sprain during non-contact motion. The Cox regression analysis revealed that greater knee varus peak angle (hazard ratio: 1.16 [95% confidence interval: 1.10-1.22], p < 0.001) and greater pelvic internal rotation peak angle toward the support leg were associated with lateral ankle sprain (hazard ratio: 1.08 [95% confidence interval: 1.02-1.15], p = 0.009). The cut-off values for each predictive factor were -0.17° (area under the curve = 0.89, p < 0.001) and 6.63° (area under the curve = 0.74, p < 0.001), respectively.

CONCLUSIONS

A greater knee varus peak angle and pelvic internal rotation peak angle after single-leg landing are predictive factors for lateral ankle sprain.

Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes

OBJECTIVES

To investigate lower extremity muscle strength as risk factor for an acute ankle injury in youth athletes.

DESIGN

Cohort study.

SETTING

Basketball and floorball clubs.

PARTICIPANTS

188 youth (≤21) male and 174 female athletes.

MAIN OUTCOME MEASURES

1RM leg press, maximal concentric isokinetic quadriceps and hamstrings as well as maximal isometric hip abductor strength were measured and athletes were followed for an acute ankle injury up to three years. Cox regression models were used in statistical analyses.

RESULTS

In males, greater 1RM leg press and maximal quadriceps strength increased the risk of any type of acute ankle injury (Hazard ratio [HR] for 1 SD increase, 1.63 [95% CI, 1.12-2.39] and 1.43 [95% CI, 1.01-2.01], respectively). In females, greater 1RM leg press and difference between legs in hip abduction strength increased the risk of acute non-contact ankle injury (HR for 1 SD increase, 1.44 [95% CI, 1.03-2.02] and 1.44 [95% CI, 1.03-2.00], respectively). However, ROC curve analyses showed AUC:s of 0.57-0.64 indicating "fail" to "poor" combined sensitivity and specifity of these tests.

CONCLUSION

Greater strength in both sexes along with asymmetry in hip abductor strength in females increased the risk of acute ankle injury.

Lateral Ankle Sprains and Their Association with Physical Function in Young Soccer Players

Purpose

Lateral ankle sprain (LAS) in childhood can result in lateral malleolus avulsion fractures; additionally, bone nonunion may occur. Physical maturity relates to the development of bone morphology and physical functionality. It is unknown how changes in physical functionality attributable to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels.

Subjects and Methods

Two hundred and ninety young soccer players aged 6–15 years were included. The presence of ALM was assessed using ultrasonography. The subjects were allocated to three groups based on physical maturity (Pre-, Mid-, and Post-peak height velocity age [PHVA]). The prevalence of ALM and the relationship between ALM and physical maturity were examined for body composition, foot pressure distribution, foot alignment, ankle mobility, and single-leg balance.

Results

The prevalence of ALM was 17.6%. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the Pre-PHVA group (P < 0.05). In the ALM group, the center of pressure during heel raising was distributed laterally in the Post-PHVA (P < 0.01), and the weight-bearing dorsiflexion angle was decreased in the Mid- and Post-PHVA (P < 0.05).

Conclusion

In the Post-PHVA young soccer players, decreased ankle dorsiflexion and eversion and increased one-leg hop distance were observed. The ALM group exhibited lateral loading during heel raising in the Post-PHVA group and decreased weight-bearing ankle dorsiflexion angle in the Mid- and Post-PHVA groups. The findings indicate the importance of secondary prevention of LAS and ultrasonography. Prospective studies of LAS in young athletes are required in the future.

The "Ankle Instability Instrument": Cross-cultural adaptation and validation in French

BACKGROUND

Functional ankle instability affects 20-40% of individuals who have already suffered from a sprain. Such dysfunctions are difficult to diagnose. Therefore, the information provided by self-administered questionnaires is essential. Thus, the Ankle Instability Instrument (AII) was developed and initially validated in English. Our goal is to create a French version of the instrument, named AII-F, by scrupulously respecting the cultural adaptation phases and to make sure the new instrument has good psychometric properties.

METHODS

International recommendations have been rigorously followed for the cultural adaptation and the French-translation phase. Six steps are recommended: I) two initial translations from English to French; II) synthesis of the two versions; III) back-translations from French to English; IV) comparisons between the back-translations and the original questionnaire by the expert committee; V) pretest; and VI) approval of the final French version of the AII. In order to validate this French-translation, 91 subjects suffering from ankle instability matched to 91 healthy subjects were asked to complete the AII-F. The Short Form Health Survey (SF-36) was used as a comparative questionnaire as well as the French Cumberland Ankle Instability Tool (CAIT-F). The psychometric properties of the questionnaire were evaluated by determining the test-retest reliability after a 10-14-day interval, the internal consistency, construct validity, and the floor/ceiling effects.

RESULTS

The French-translation did not pose a problem and could be validated by the expert committee. The AII-F showed a very good test-retest reliability for the total score, with an Intra Class Coefficient of 0.983. The internal coherence is high with an alpha coefficient of Cronbach of 0.861. The association of the AII-F with the CAIT-F was high, for the summary of the physical component of the SF-36, meaning a great convergent validity. The other subscales of the SF-36 (mental health) were weakly correlated with the AII-F, reflecting good divergent validity. An optimal cut-off score was obtained to dissociate pathological patients from healthy subjects: when the subject responded to "yes" 5 times or more, he is considered, with a very high degree of confidence, to be pathological.

CONCLUSION

The AII-F is reliable and valid for evaluating and measuring functional ankle instability.

Altered Dynamic Postural Stability and Joint Position Sense Following British Army Foot-Drill

Impaired proprioceptive acuity negatively affects both joint position sense and postural control and is a risk factor for lower-extremity musculoskeletal injury in athletes and military personnel. British Army foot-drill is an occupational military activity involving cyclical high impact loading forces greater than those observed in athletes during high level plyometrics. Foot-drill may contribute to the high rates of lower-extremity overuse injuries observed in recruits during basic training. There is limited research investigating foot-drill specific injury risk factors in women, despite greater incidences of musculoskeletal injury reported in women (522 vs. 417 per 1,000 personnel, OR: 1.53) when compared to men during basic training. This study aimed to quantify changes in ankle joint proprioception and dynamic postural stability following a period of British Army foot-drill. Fourteen women of similar age to British Army female recruits underwent pre-post foot-drill measures of frontal plane ankle joint position sense (JPS) and dynamic postural stability using the dynamic postural stability index (DPSI). Passive ankle JPS was assessed from relative test angles of inversion 30% (IN30%) and eversion 30% (EV30%) and IN60% of participants range of motion using an isokinetic dynamometer. The DPSI and the individual stability indices (medio-lateral [MLSI], anterior-posterior [APSI], and vertical [VSI]) were calculated from lateral and forward jump-landing conditions using force plates. Foot-drill was conducted by a serving British Army drill instructor. Significantly greater absolute mean JPS error for IN30% and EV30% was observed post foot-drill (p ≤ 0.016, d ≥ 0.70). For both the lateral and forward jump-landing conditions, significantly greater stability index scores were observed for MLSI, APSI, and DPSI (p ≤ 0.017, d ≥ 0.52). Significantly greater JPS error and stability index scores are associated with the demands of British Army foot-drill. These results provide evidence that foot-drill negatively affects lower-extremity proprioceptive acuity in recruit age-matched women, which has implications for increased injury risk during subsequent military physical activity, occurring in a normal training cycle.

Anatomical risk factors of lateral ankle sprain in adolescent athletes: A prospective cohort study

OBJECTIVES

The purpose of this study was to identify prospectively the anatomical and functional intrinsic risk factors for lateral ankle sprain (LAS) in adolescent athletes participating in team sports.

DESIGN

A prospective cohort study.

SETTING

University research laboratory.

PARTICIPANTS

A total of 152 adolescent male athletes (age: 14.45 ± 2.96 years; height: 165.63 ± 15.33 cm; weight: 55.60 ± 16.56 kg; body mass index: 19.97 ± 3.58 kg/m²) participated in this study.

MAIN OUTCOME MEASURES

The participants were assessed during the preseason for previous ankle sprain history, navicular drop, tibia vara, Q angle, tibia torsion, knee recurvatum, and ankle ROM. LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months).

RESULTS

Previous ankle sprain history (odds ratio [OR] = 60.911, p < 0.001), increased navicular drop (OR = 1.767, p < 0.001), and knee recurvatum (OR = 1.881, p = 0.002) were positively associated with the incidence of LAS. The receiver operating characteristic (ROC) analyses revealed the predictive potentials of previous ankle sprain history (the area under the ROC [AUROC] = 0.706, p < 0.001), navicular drop (AUROC = 0.906, p < 0.001), and knee recurvatum (AUROC = 0.724, p < 0.001).

CONCLUSION

Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury. The data from this study can help therapists and trainers to identify people with a higher risk of LAS.

The coordination patterns of the foot segments in relation to lateral ankle sprain injury mechanism during unanticipated changes of direction

Preventing lateral ankle sprain injuries (LAS) in females competing in court sports is a high priority, as an athlete's risk for re-injury and developing long term dysfunction increases significantly after sustaining an acute LAS. Stability to the ankle joint is passively provided by the joint congruity and ligaments, and actively by the muscles acting on the foot. The ankle joint is most stable when loaded and dorsiflexed. However, during unanticipated changes of direction, typical in court sports, the foot is often in a vulnerable unloaded, plantarflexed position. Stability of the forefoot and controlling rearfoot movement to avoid excessive ankle inversion and adduction thus becomes imperative. Information regarding the coupling relationship between the forefoot (hallux and metatarsal segments) and the rearfoot (calcaneus segment) during unanticipated changes of direction is lacking. The aim of this study was to supplement current LAS prophylactic knowledge by describing and quantifying hallux-calcaneus and metatarsal-calcaneus coupling. The coupling angles between sagittal plane hallux, tri-planar metatarsal and frontal- and transverse plane calcaneus movement, respectively, were calculated with a modified vector coding technique which used segmental velocities in a local, anatomical reference frame instead of segmental angles in a global reference frame. Coupling relationships revealed anti-phase movement between sagittal- metatarsal and frontal plane calcaneus movement throughout stance. During loading, sagittal- and frontal plane metatarsal acceleration/deceleration were coupled with frontal-transverse plane calcaneus acceleration/deceleration respectively. The remainder of the braking phase was characterized by calcaneus eversion deceleration. During propulsion, the hallux and metatarsal segments increased plantar flexion velocity in response to calcaneus inversion and adduction acceleration. As the forefoot was the only point of contact during stance, the coupling between segments were most likely neuromuscular. Strengthening intrinsic and extrinsic foot muscles may thus contribute to foot and ankle stability, adding to current prophylactic LAS strategies.

Neuromuscular Control of Ankle-stabilizing Muscles-specific Effects of Sex and Menstrual Cycle

The purpose of this study was to examine the differences in neuromuscular control and mechanical properties of the ankle-stabilizing muscles between men and women, and during different phases of menstrual cycle in women. Fifteen women with regular menstrual cycles and 17 male counterparts were included in this study. Electromyographic signals were recorded from the peroneus longus (PL) and tibialis anterior (TA) muscles while performing three balance tasks. Muscle tone, stiffness, and elasticity of muscles were measured using a MyotonPRO in the resting position. Outcomes were measured twice (ovulation and early follicular phases) for women, while measurements were acquired only once for men. Significantly higher tibialis anterior-peroneus longus co-contraction (TA/PL ratio) was observed in all balance tasks in women than in men (p< 0.05); however, significant differences between phases of the menstrual cycle were noted only in the 2 most difficult tasks (p< 0.05). A similar pattern was observed in the postural sway. These results highlight the importance of sex-specific hormonal effects on neuromuscular control and mechanical properties, and as well as the differences during phases of the menstrual cycle. These insights assume significance in the context of developing neuromuscular strategies for the purpose of preventing lower extremity injuries during sports activities.

Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures

BACKGROUND

Lateral ankle injuries are one of the most common musculoskeletal injuries sustained by pediatric and adolescent athletes. These injuries can result in significant time lost from competition, affect performance when returning to play, and represent a significant burden on the health care system as a whole. The purpose of this study was to systematically review the literature on the diagnosis, treatment, and prevention of acute lateral ankle injuries and their chronic effects in pediatric and adolescent athletes (younger than 19 y).

METHODS

This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines between September and December 2018. PubMed and Google Scholar were systematically searched using the search terms: ("distal fibula fracture" OR "ankle sprain") AND ("youth" OR "pediatric" OR "adolescent"). All authors participated in article review (N=172) for relevance and age restrictions in which 30 met the inclusion criteria.

RESULTS

Thirty articles met inclusion criteria [Levels of Evidence I to IV (I: n=4, II: n=16, III: n=9, and IV: n=1)] including distal fibula fracture diagnosis and treatment, and risk factors, prevention, and chronic sequela of lateral ankle injuries in pediatric and adolescent patients.

CONCLUSIONS

Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and minimize the effect of acute lateral ankle injuries.

LEVELS OF EVIDENCE

Level III-Systematic review.

Postural control is altered in females with excessive medial knee displacement

Knee valgus motion observed during landing tasks has been proposed as a predictor of future knee injury. It mainly involves excess motion in the frontal plane and is known to be greater in individuals with excessive medial knee displacement (MKD). This affects postural control during sports manoeuvres. Previous sports medicine-related research suggests that the nature of these fluctuations provide rich and more sensitive information to identify risk of (re)injury. We aimed to investigate the fluctuations of the centre of pressure (CoP) in individuals with and without excessive MKD. Twenty females (12 controls; 8 excessive MKD) were instructed to perform single-leg landing tasks from three different directions. The participants landed on a force plate and stayed still for 20 seconds. The fluctuations of the anterior-posterior and medial-lateral directions of the CoP were determined through the calculation of Sample Entropy. Mixed-model ANOVAs (3 [Landing Direction] x 2 [Group]) were used. We have found that only the entropy of the medial-lateral direction was different between groups. Individuals with excessive MKD exhibited an increase in entropy values, indicating greater randomness in CoP fluctuations. This suggests a decreased ability to adapt to environmental demands that likely result in an increased risk of injury.

Effectiveness of clinician- and patient-applied mobilisation with movement technique to increase ankle dorsiflexion range of motion

Background/aims

Restricted ankle dorsiflexion has the potential to cause acute and chronic injuries. One method for increasing dorsiflexion range of motion is the application of joint mobilisation with movement. An alternative to clinician-applied mobilisation with movement is self-applied mobilisation with movement; however, this technique has not been previously studied. The objective of this study was to evaluate the effectiveness of self-applied and clinician-applied mobilisation with movement technique for improving dorsiflexion range of motion in participants with ≤34° of dorsiflexion.

Methods

A total of 42 typically healthy participants qualified and were randomly assigned to the control, self-applied, or clinician-applied mobilisation with movement group. Closed chain ankle dorsiflexion range of motion was assessed using a modified weight-bearing lunge test.

Results

Both mobilisation groups showed significant increases in standing and kneeling dorsiflexion range of motion when compared to the control group, with no differences between treatment groups.

Conclusions

These findings suggest clinicians can teach patients to apply mobilisation with movement and receive similar benefits to a clinician-applied mobilisation with movement treatment.

Immediate effect of kinesiology tape on ankle stability

Background

Lateral ankle sprain is one of the most common musculoskeletal injuries, particularly among the sporting population. Due to such prevalence, many interventions have been tried to prevent initial, or further, ankle sprains. Current research shows that the use of traditional athletic tape can reduce the incidence of sprain recurrence, but this may be at a cost to athletic performance through restriction of motion. Kinesiology tape, which has become increasingly popular, is elastic in nature, and it is proposed by the manufacturers that it can correct ligament damage. Kinesiology tape, therefore, may be able to improve stability and reduce ankle sprain occurrence while overcoming the problems of traditional tape.

Aim

To assess the effect of kinesiology tape on ankle stability.

Methods

27 healthy individuals were recruited, and electromyography (EMG) measurements were recorded from the peroneus longus and tibialis anterior muscles. Recordings were taken from the muscles of the dominant leg during induced sudden ankle inversion perturbations using a custom-made tilting platform system. This was performed with and without using kinesiology tape and shoes, creating four different test conditions: barefoot(without tape), shoe(without tape), barefoot(with tape) and shoe(with tape). For each test condition, the peak muscle activity, average muscle activity and the muscle latency were calculated.

Results

No significant difference (p>0.05) was found by using the kinesiology tape on any of the measured variables while the wearing of shoes significantly increased all the variables.

Conclusion

Kinesiology tape has no effect on ankle stability and is unable to nullify the detrimental effects that shoes appear to have.

Lower Extremity Biomechanical Examination of Athletes

A comprehensive lower extremity examination is a critical examination component for any type of injury in an athlete but should also be part of a preseason or preventive care program. Identification and treatment of biomechanical abnormalities and association with evidence-based risk factors for lower extremity disorders can be incorporated to potentially reduce risk or prevent acute and chronic injuries.

The predictive value of the multiple hop test for first-time noncontact lateral ankle sprains

The predictive value of the multiple hop test for first-time noncontact lateral ankle sprains.

BACKGROUND

Lateral ankle sprains (LAS) are very common sports injuries, cause high health care costs and are associated with postural control deficits. From a preventive point of view, clinicians should dispose valid field tests to identify athletes at risk for a LAS. The aim of this study is to evaluate the predictive value of the multiple hop test (MHT) for first-time noncontact LAS.

METHODS

Non-elite athletes (n = 232) performed the MHT at baseline. During a 12-month follow-up period, all noncontact LAS related to health care costs were recorded. Outcomes of the MHT (completion time, balance errors and perceived difficulty) between the injured and uninjured group were compared and odds ratios (OR) and relative risks (RR) were calculated using a logistic regression analysis.

RESULTS

Ten first-time noncontact LAS were recorded (4.3%). Injured athletes made significantly more change-in-support strategy (CSS) errors when compared to uninjured athletes (p = .04). The OR of the number of CSS errors was 1.14 (p = .03), the RR 4.1 (p = .04).

CONCLUSIONS

Athletes scoring > 12 CSS errors, have a four times increased risk for a first-time noncontact LAS. The MHT is a valid field test to identify athletes at risk for a first-time noncontact LAS.

Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis

IMPORTANCE

Lateral ankle sprains (LAS) are common in the general population and may lead to chronic ankle instability (CAI). If patients at risk could be identified, they could receive adequate and on-time treatment.

OBJECTIVE

The purpose of the current review was to identify all reported intrinsic factors associated with sustaining a LAS or progressing to CAI after an initial sprain.

EVIDENCE REVIEW

PubMed, Embase, MEDline, Cochrane and PEDro were searched for studies published until July 2019. Articles were selected if they included intrinsic factors related to LAS or CAI, subjects of at least 16 years old, and contained a minimum of 10 patients and 10 controls. Studies were excluded if they concerned reviews or case reports, included patients with previous surgical interventions, concomitant injuries or joint pathology other than ankle instability. Quality of included studies was assessed using the Quality in Prognostic Studies tool and quality of evidence was assessed using the GRADEpro tool. In case outcomes were described by at least three studies, data were pooled and assessed by performing a meta-analysis. Based on the pooled data, either a fixed-effects model or random-effects model was selected to correct for the degree of heterogeneity.

FINDINGS

The search resulted in a total of 4154 studies. After title and abstract screening and subsequent full-text screening, 80 relevant studies were included. Results of the meta-analyses indicated that, compared with healthy controls, patients with LAS had a higher mean body mass index (BMI). In patients with CAI, a higher weight and a longer time to stabilise after performing a task (eg, jumping) were found compared with healthy controls. Other outcomes could not be compared using a meta-analysis due to heterogeneity in outcome measurement and the great number of different outcomes reported. Identification of the risk factors when patients present themselves after a LAS may help to determine which patients are at risk of recurrent sprains or developing CAI.

CONCLUSIONS AND RELEVANCE

Based on the findings in this review, a higher BMI, and a higher weight and neuromuscular stability deficits may be regarded risk factors for sustaining a LAS or developing CAI, respectively.

LEVEL OF EVIDENCE

III.

The influence of fatigue in evertor muscles during lateral ankle sprain

Ankle sprain in plantarflexion and inversion is one of the most common injuries occurring in daily activities and sports. Although acute symptoms may resolve quickly, many individuals have reported persistent pain and instability. Thus, understanding the factors that contribute to the occurrence of this type of injury is extremely important. Although sprains are multifactorial, a relationship can be established between sprain and fatigue. Therefore, the present study examined the latency and intensity of activation of the peroneus longus and brevis muscles under conditions of fatigue. Twenty-three women participated in the study, including 12 with functional instability of the ankle and 11 without a history of sprain. To induce fatigue, the volunteers maintained the force of eversion and plantarflexion at 70% of the maximum voluntary isometric contraction for as long as possible until a 10% decline in the rated force occurred. Ten simulations of ankle sprains were performed before and after fatigue at random for each side, with simultaneous recordings of the electromyographic signals, using a simulator platform for inversion sprain and plantarflexion. As a result, after fatigue, no change in latency was observed. However, a reduction in the intensity of contraction of the muscles analyzed in both groups was observed. Neuromuscular control was concluded to be compromised in situations of fatigue, while differences in muscle behavior were not observed between stable and unstable ankles.

Systematic Review of the Association Between Physical Fitness and Musculoskeletal Injury Risk: Part 3-Flexibility, Power, Speed, Balance, and Agility

de la Motte, SJ, Lisman, P, Gribbin, TC, Murphy, K, and Deuster, PA. Systematic review of the association between physical fitness and musculoskeletal injury risk: part 3-flexibility, power, speed, balance, and agility. J Strength Cond Res 33(6): 1723-1735, 2019-We performed a systematic review and evaluation of the existing scientific literature on the association between flexibility, power, speed, balance, and agility, and musculoskeletal injury (MSK-I) risk in military and civilian populations. MEDLINE, EBSCO, EMBASE, and the Defense Technical Information Center were searched for original studies published from 1970 to 2015 that examined associations between these physical fitness measures (flexibility, power, speed, balance, and agility) and MSK-I. Methodological quality and strength of the evidence were determined after criteria adapted from previously published systematic reviews. Twenty-seven of 4,229 citations met our inclusion criteria. Primary findings indicate that there is (a) moderate evidence that hamstring flexibility, as measured by performance on a sit-and-reach test or active straight leg raise test assessed with goniometry, and ankle flexibility, assessed with goniometry, are associated with MSK-I risk; (b) moderate evidence that lower body power, as measured by performance on a standing broad jump or vertical jump with no countermovement, is associated with MSK-I risk; (c) moderate evidence that slow sprint speed is associated with MSK-I risk; (d) moderate evidence that poor performance on a single-leg balance test is associated with increased risk for ankle sprain; and (e) insufficient evidence that agility is associated with MSK-I risk. Several measures of flexibility, power, speed, and balance are risk factors for training-related MSK-I in military and civilian athletic populations. Importantly, these findings can be useful for military, first responder, and athletic communities who are seeking evidence-based metrics for assessing or stratifying populations for risk of MSK-I.

ANKLE SPRAIN RISK FACTORS: A 5-MONTH FOLLOW-UP STUDY IN VOLLEY AND BASKETBALL ATHLETES

ABSTRACT Introduction Ankle sprain is a frequent sports injury among volley and basketball players, and identifying risk factors is necessary to prevent injuries and prolong their careers. Objective To identify intrinsic and extrinsic factors in basketball and volleyball players related to the risk of ankle sprain injury over a five-month follow-up period. Methods Ninety-four Brazilian young competitive athletes (15.8±1.7 years, 47 basketball and 47 volleyball players) participated in this study. They were evaluated for intrinsic risk factors (previous history of ankle sprain, dominant lower limb, ankle ligament laxity, range of motion of the ankle-foot complex, electromyographic response time of ankle evertors, postural control and muscular torque of ankle invertors and evertors) and extrinsic risk factors (type of shoes worn, use of orthosis, previous injuries while training or competing, and the players’ position). Results During the study period, 18 (19%) athletes suffered unilateral sprains. Multivariate logistic regression analysis gave a final regression with four factors: dominant leg (p=0.161), type of shoes worn (p=0.049), player’s position (p=0.153), and peroneus brevis muscle reaction time (p=0.045). There was an 86.1% probability of an ankle sprain if the athlete had a left dominant leg, wore shoes without vibration dampeners, or played in the small forward, wing/hitter spiker, middle blocker, or opposite spiker positions, and had a peroneus muscle reaction time longer than 80ms. However, only the player’s position was significantly (p=0.046) associated with lesion occurrence. Conclusion The player’s position appeared to be a risk factor in both sports, and this result may help professionals to prevent ankle sprains. Level of Evidence I; High quality randomized clinical trial with or without statistically significant difference but with narrow confidence intervals.

Postural stability deficit could predict ankle sprains: a systematic review

PURPOSE

To perform a systematic review aimed to determine (1) if the postural stability deficit represents a risk factor for ankle sprains; (2) the most effective postural stability evaluation to predict ankle sprains and (3) eventual confounding factors that could influence postural stability and ankle sprain risk.

METHODS

A systematic electronic search was performed in MEDLINE, EMBASE and CINAHL using the search terms (balance) OR (postural stability) matched with (lower limb) OR (ankle) OR (foot) and (sprain) OR (injury) on October 2 2017. All prospective studies that evaluated postural stability as risk factor for ankle sprains were included. The PRISMA Checklist guided the reporting and data abstraction. Methodological quality of all included papers was carefully assessed.

RESULTS

Fifteen studies were included, evaluating 2860 individuals. Various assessment tools or instruments were used to assess postural stability. The injury incidence ranged from 10 to 34%. Postural stability deficit was recognized as risk factor for ankle sprain (OR = 1.22-10.2) in 9 cases [3 out of 3 with Star Excursion Balance Test (SEBT)]. Among the six studies that measured the center-of-gravity sway, five were able to detect worse postural stability in athletes that sustained an ankle sprain. In nine cases, the measurement of postural stability did not show any statistical relationship with ankle sprains (four out of five with examiner evaluation). In the studies that excluded patients with history of ankle sprain, postural stability was reported to be a significant risk factor in five out of six studies.

CONCLUSIONS

The ultimate role of postural stability as risk factor for ankle sprains was not defined, due to the high heterogeneity of results, patient's populations, sports and methods of postural stability evaluation. Regarding assessment instruments, measurement of center-of-gravity sway could detect athletes at risk, however, standardized tools and protocols are needed to confirm this finding. The SEBT could be considered a promising tool that needs further investigation in wider samples. History of ankle sprains is an important confounding factor, since it was itself a source of postural stability impairment and a risk factor for ankle sprains. These information could guide clinicians in developing screening programs and design further prospective cohort studies comparing different evaluation tools.

LEVEL OF EVIDENCE

I (systematic review of prospective prognostic studies).

Range of motion and ankle injury history association with sex in pediatric and adolescent athletes

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries among young athletes, and there remains a gap in the literature regarding susceptibility to such injuries among physically active youth.

OBJECTIVE

The primary purpose of this study was to determine the associations between sex, a history of ankle sprain, and ankle range of motion (ROM) in pediatric and adolescent athletes.

METHODS

Athletes under the age of 18 years old who presented to a sports injury prevention center underwent ankle ROM measurements including plantarflexion (PF), inversion (IV), and eversion (EV). A two-way analysis of covariance (ANCOVA) was performed to examine effect of sex and a history of ankle sprain on ROMs. Also, a binary logistic regression was performed to investigate variables that are associated with a history of ankle injury.

RESULTS

Among 452 pediatric and adolescent athletes [268 females (13.6 ± 2.3 years old) and 184 males (13.3 ± 2.5 years old)], 128 reported a history of previous ankle sprain. Females demonstrated significantly increased ROMs (PF and IV bilaterally, and right EV) compared to males while there was no effect of a history of ankle sprain on ROMs. Female sex was independently associated with a history of ankle sprain.

CONCLUSION

There was a strong effect of female sex on ROMs rather than a history of ankle injury history. Additionally, pediatric and adolescent females have greater odds of a history of ankle sprain when compared to their male counterparts.

Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion

CONTEXT

  Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited.

OBJECTIVE

  To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM.

DESIGN

  Randomized controlled trial.

SETTING

  Laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Participants were 44 physically active people (53 limbs) with less than 30° of DF.

INTERVENTION(S)

  Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken.

MAIN OUTCOME MEASURE(S)

  Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted.

RESULTS

  A difference between groups was found in the standing ( F_2,52 = 13.78, P = .001) and kneeling ( F_2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005).

CONCLUSIONS

  Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

The effect of ankle tape on joint position sense after local muscle fatigue: a randomized controlled trial

Background

Ankle tape is widely used by athletes to prevent ankle sprain. Although there is growing evidence that ankle tape improve joint position sense, but yet it is not clear even if tape improve joint position sense after muscle fatigue, because fatigue impair joint position sense and raise the risk of ankle sprain. The aim of this study is to examine the effect of ankle tape on joint position sense after local muscle fatigue.

Method

This trial is a randomized controlled trial. 34 healthy subjects participated in this trial. Subjects were randomized distributed into two groups: with tape and without tape. Active and passive absolute error and variable error mean values for two target positions of the ankle joint (15° inversions and inversion minus 5°) before and after fatigue protocol consisted of 30 consecutive maximal concentric/concentric contractions of the ankle evertors and invertors. In this trail joint position sense for all subjects was assessed using The Biodex System isokinetic dynamometer 3, this system is used also for fatigue protocol.

Results

For the variable error (VE), significant mean effect was found for active joint position sense in 15° of inversion after muscle fatigue (P < 0, 05). It was a significant decrease in the work in the last third of inversion detected (P < 0, 05). There was no significant main effect found for fatigue index of eversion.

Conclusion

Ankle tape can improve joint position sense at the fatigue session when joint position sense becomes worse. As a result, ankle tape may be useful to prevent ankle sprain during playing sports. We suggest athletes and individuals at risk of ankle sprain to apply taping before high-load activity.

Trial registration

The study was retrospectively registered on the ISRCTN registry with study ID ISRCTN30042335 on 12th December 2017.

Balance, Proprioception, and Gross Motor Development of Chinese Children Aged 3 to 6 Years

The authors' aim was to find the features of balance, proprioception, and gross motor development of Chinese children 3-6 years old and their correlations, provide theoretical support for promoting children's motor development, and enrich the world theoretical system of motor development. This study used a Tekscan foot pressure measurement instrument (Tekscan, Inc., Boston, MA), walking on a balance beam, Xsens 3-dimensional positional measuring system (Xsens Technologies, Enschede, the Netherlands), and Test of Gross Motor Development-2 to assess static balance, dynamic balance, knee proprioception, and levels of gross motor development (GMD) of 3- to 6-year-old children (n = 60) in Beijing. The results are as follows: children had significant age differences in static balance, dynamic balance, proprioception, and levels of GMD; children had significant gender differences in static balance, proprioception, and levels of GMD; children's static balance, dynamic balance, and proprioception had a very significant positive correlation with GMD (p < .01), but no significant correlation with body mass index.

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability

BACKGROUND

Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients.

OBJECTIVES

The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients.

STUDY DESIGN

Cross-sectional study.

METHODS

An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform.

RESULTS

The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support.

CONCLUSION

The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis

Context:

Lateral ankle ligamentous sprain (LAS) is one of the most common injuries in recreational activities and competitive sports. Many studies have attempted to determine whether there are certain intrinsic factors that can predict LAS. However, no consensus has been reached on the predictive intrinsic factors.

Objective:

To identify the intrinsic risk factors of LAS by meta-analysis from data in randomized control trials and prospective cohort studies.

Data Sources:

A systematic computerized literature search of MEDLINE, CINAHL, ScienceDirect, SPORTDiscus, and Cochrane Register of Clinical Trials was performed.

Study Selection:

A computerized literature search from inception to January 2015 resulted in 1133 studies of the LAS intrinsic risk factors written in English.

Study Design:

Systematic review.

Level of Evidence:

Level 4.

Data Extraction:

The modified quality index was used to assess the quality of the design of the papers and the standardized mean difference was used as an index to pool included study outcomes.

Results:

Eight articles were included in this systematic review. Meta-analysis results showed that body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and peroneus brevis reaction time correlated with LAS.

Conclusion:

Body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and the reaction time of the peroneus brevis were associated with significantly increased risk of LAS.