The effect of dual tasking on foot biomechanics in people with functional ankle instability

Background: Some cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains. Objective: The purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability. Methods: 21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized. Results: During normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200ms pre and post initial contact in people with FAI compared to the control group (p<0.05). Dual task also significantly increased plantar flexion and inversion during the period 200ms pre and post initial contact in the FAI group (p<0.05). Conclusion: participants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people

Immediate Effect of Kinesio Taping on Functional Ankle Stability among Male Basketball Players

BACKGROUND: Ankle injury frequently occurs in basketball players, which can lead to a functional ankle instability. The application of kinesio taping on ankle may increase functional ankle stability. However, to date immediate effect of kinesio taping application on functional ankle stability has never been studied. The study aimed to examine the immediate effect of kinesio taping on functional ankle stability among male basketball players. SUBJECT AND METHODS: This was a quasi-experiment, before and after intervention with no control design. A sample of 15 male basketball players in Yogyakarta was selected for this study. The dependent was functional ankle stability (balance). The functional ankle stability was measured by Star Excursion Balance Test. The independent variable was kinesio taping application. The data was analyzed by paired t-test. RESULTS: The functional ankle stability (mean ± SD in cm) before kinesio taping application was as follows: antero lateral 69.53 ± 6.38, antero medial 68.73 ± 5.25, and posterior 67.13 ± 5.79. Twenty minutes after application of Kinesio taping, the functional ankle stability (mean ± SD) was as follows: antero lateral 72.07 ± 6.16, antero medial 71.33 ± 5.26, and posterior 69.60 ± 5.44. This increase in stability (balance) after application of kinesio taping was statistically significant (p<0.001). CONCLUSION: The application of kinesio taping can immediately increase functional ankle stability among male basketball players. Keywords: kinesio taping, functional ankle stability, Star Excursion Balance Tes

Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability

This document is the Accepted Manuscript version of the following article: Lynsey Northeast, Charlotte N. Gautrey, Lindsay Bottoms, Gerwyn Hughes, Andrew C. S. Mitchell, and Andrew Greenhalgh, ‘Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability’, Gait & Posture, Vol. 64: 114-118, July 2018. Under embargo until 7 June 2019. The final, definitive version is available online at doi: https://doi.org/10.1016/j.gaitpost.2018.06.001Background Chronic ankle instability (CAI) has previously been linked to altered lower limb kinematics and muscle activation characteristics during walking, though little research has been performed analysing the full time-series across the stance and swing phases of gait. Research Question The aim of this study was to compare trunk and lower limb kinematics and muscle activity between those with chronic ankle instability and healthy controls. Methods Kinematics and muscle activity were measured in 18 (14 males, 4 females) healthy controls (age 22.4 ± 3.6 years, height 177.8 ± 7.6 cm, mass 70.4 ± 11.9 kg, UK shoe size 8.4 ± 1.6), and 18 (13 males, 5 females) participants with chronic ankle instability (age 22.0 ± 2.7 years, height 176.8 ± 7.9 cm, mass 74.1 ± 9.6 kg, UK shoe size 8.1 ± 1.9) during barefoot walking trials, using a combined Helen Hayes and Oxford foot model. Surface electromyography (sEMG) was recorded for the tibialis anterior and gluteus medius. Full curve statistical parametric mapping was performed using independent and paired-samples T-tests. Results No significant differences were observed in kinematic or sEMG variables between or within groups for the duration of the swing phase of gait. A significantly increased forefoot-tibia inversion was seen in the CAI affected limb when compared to the CAI unaffected limb at 4–16% stance (p = 0.039). No other significant differences were observed. Significance There appears to be no differences in muscle activation and movement between CAI and healthy control groups. However, participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This may predispose those with CAI to episodes of giving way and further ankle sprains.Peer reviewedFinal Accepted Versio

The effect of variable rest intervals and chronic ankle instability on triplanar ankle motion during performance of the Star Excursion Balance Test

Inadequate rest intervals may contribute to impaired performance during functional tests. However, the effect of different rest intervals on performance of the SEBT in individuals with and without CAI is not known. Our purposes were to determine whether different rest intervals impact ankle kinematics during the SEBT and whether there differences between those two populations. 24 controls and 24 CAI completed 3 trials in 3 reach directions (anteromedial; AM, medial; M, posteromedial; PM). The order of rest intervals and reach distance were randomized and counterbalanced. Three visits were required to complete the 3 rest interval conditions (10, 20, 40 s). Rest interval did not impact ankle kinematics between controls and CAI during the SEBT. Dorsiflexion (DF) (AM:partial eta(2) = 0.18; M:partial eta(2) = 0.23; PM:partial eta(2) = 0.23) for all directions and tibial internal rotation (TIR) excursions (AM:partial eta(2) = 0.20) for AM direction were greater in individuals with CAI regardless of rest interval length. Rest intervals ranging from 10 to 40 s did not influence ankle kinematics. Differences exist in DF and TIR between controls and CAI during the SEBT. These findings suggest that clinicians can use any rest interval between 10 and 40 s when administrating the SEBT. However, triplanar motion differs during a complex functional movement in controls compared to CAI

Is it possible to establish reference values for ankle muscle isokinetic strength? A meta-analytical study

BACKGROUND: The importance of measuring ankle muscle strength (AMS) has been demonstrated in a variety of clinical areas. Much data has been accumulated using the Cybex Norm isokinetic dynamometer but a uniform framework does not exist. OBJECTIVE: To identify pertinent studies which have used the Cybex Norm to measure AMS in order to establish reference values. METHODS: A narrative review of the literature was used to identify papers that have used the Cybex Norm to measure isokinetic concentric and eccentric AMS. RESULTS: Fifty five research papers were identified but each study used a different isokinetic protocol. CONCLUSIONS: It is not possible to produce AMS reference values due to the wide variation in data collection methods. This is therefore an area of research that needs further exploration

The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases

BACKGROUND Ankle sprains are common in sports and can sometimes result in a persistent pain condition. PURPOSE Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series. METHODS Over around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain. RESULTS 43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49%) and rugby (14%). The main subjective complaint was exertion ankle pain (93%). Effusion (75%) and joint line tenderness on palpation (92%) were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9). 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39%) and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months), 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks). However 43% still suffered minor symptoms. CONCLUSION Arthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion

Best practice statement : use of ankle-foot orthoses following stroke

NHS Quality Improvement Scotland (NHSQIS) leads the use of knowledge to promote improvement in the quality of health care for the people of Scotland and performs three key functions. It provides advice and guidance on effective clinical practice, including setting standards; drives and supports implementation of improvements in quality, and assessing the performance of the NHS, reporting and publishing findings

The test-retest reliability of different ankle joint center location techniques

Accurate and reliable joint identification is imperative for the collection of meaningful kinetic and kinematic data. Of the lower kinetic chain both the hip and knee joints have received a considerable amount of attention in 3D modelling. However, the reliability of methods to define the ankle joint center have received very little attention. This study investigated the reliability of the two marker method (TMM) and the functional ankle method (FAM) on estimating the ankle joint center. Furthermore, the effects of the two-marker method reliability for defining the ankle joint center when the ankle was covered with a brace or protector was investigated. 3D kinematic data was collected from ten participants (8 female and 2 male) whilst walking. The ankle joint center was defined twice using each test condition; TMM (WITHOUT), FAM (FUNCTIONAL), TMM when the ankle was covered with a brace (BRACE), and TMM when the ankle was covered with a protector (PROTECTOR). Intraclass correlations (ICC) were utilised to compare test and retest waveforms and paired samples t-tests were used to compare angular parameters. Significant differences were found in the test-retest angular parameters in the transverse and sagittal planes for the WITHOUT, BRACE, and FUNCTIONAL conditions. The strongest test-retest ICC’s were observed in the WITHOUT and PROTECTOR conditions. The findings of the current investigation indicate that there are fewer errors using the TMM when the ankle is uncovered or when covered with soft foam that is easy to palpate through