THE EFFECT OF KINESIO TAPING ON BALANCE IN INDIVIDUALS WITH CHRONIC ANKLE INSTABILITY

The purpose of this study was to evaluate the effect of a Kinesio tape (KT) technique on balance performance in subjects with chronic ankle instability 1. Thirty participants with CAI (12 males, 18 females, 20.4±2.0 yrs; 170.8±10.9 cm; 73.4±14.9 kg) from a large Division I institution participated in this study. The Identification of Functional Ankle Instability (IdFAI) questionnaire was used to measure ankle instability. A score of 11 or higher was used to identify who had CAI. Balance was assessed using the Balance Error Scoring System (BESS). The BESS consists of instructing participants to stand unassisted with eyes closed and hands on their hips for 20 seconds during six different conditions. There are two test surfaces, a hard flat surface, and a foam surface. There are also three stances, a double leg stance, a single leg stance, and a tandem stance. The participants were instructed to remain motionless during the balance tasks. The number of BESS errors were counted by the same clinician. All subjects participated in four days of testing. On the first day, participants filled out the informed consent and health history questionnaire, and completed two practice trials of the BESS. The next session was the first day of actual data collection. The participants completed the BESS as a pretest and were randomly assigned to one of two groups: control and KT. Subjects in the control group received no tape application while subjects in the KT group received a tape application. The KT technique consisted of 4 strips of tape pulled at approximately 20 to 35% of full stretch from origin to insertion of the tibialis posterior, tibialis anterior, peroneus longus, and across transverse arch. Subjects were instructed to leave the tape on their lower leg if they were in the KT group, and all subjects returned in 48 hours to complete the BESS again. The tape was then removed and the subjects returned 72 hours later to complete the BESS for a final time. Three repeated measures analysis of variance (RMANOVA) were used to determine if the use of KT had an effect on total BESS scores, flat total BESS scores, and foam total BESS scores. Each analysis included one within subjects factor (time at 3 levels: pretest, 48 hours post application of the tape, and 72 hours post removal of the tape) and one between subjects factor (KT group and control group). Alpha was set at p.05). Therefore, the application of KT for 48 hours can be beneficial in improving balance impairments in people with CAI. The results of this study are very different than most of the previous literature that has evaluated the effects of KT on balance. One of the reasons for the difference could be that we left the tape on for 48 hours which is significantly longer than all of the other research. All previous studies kept the tape on for 24 hours or less. One of the most clinically important findings of this study is that balance improvements were retained even after the tape was removed for 72 hours.Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Science in Kinesiology in the Department of Kinesiology Indiana Universit

OBJECTIVE EVALUATION OF FUNCTIONAL ANKLE INSTABILITY AND BALANCE EXERCISE TREATMENT

Functional ankle instability (FAI) is a poorly defined entity but commonly used to describe patients who sustain multiple ankle injuries with slight or no external provocation and have a subjective feeling of ankle "giving way". There have been conflicting results reported in literature regarding the role of suggested etiological factors of FAI including deficit in joint proprioception, strength, and stiffness (laxity). Diagnosis of FAI has been mainly relied on a subjective reporting, so is the assessment of FAI treatments. In spite of controversies regarding FAI factors, balance training has been widely used in sports medicine clinics for patients with FAI. Most of past studies reported its effect for FAI, but strong evidence with definitive result is still missing. Furthermore, the mechanism that explains the effect of balance training on FAI is still unclear. Recently, it was suggested that altered threshold to the unloading reaction may be behind ankle giving way episodes in patients with ankle instability. Therefore, we wanted to duplicate this finding in individuals with FAI during sudden ankle inversion test and examine the effects of a four-week balance training program on unloading reactions in individuals with FAI. Twenty four recreationally active individuals with unilateral FAI were evaluated for unloading reactions on the involved and uninvolved limbs using a sudden ankle inversion test. In seven out of twenty-four subjects, we observed a drastic reaction (hyper-reactivity) in that they were unable to maintain upright standing position when a combination of dynamic ankle stretching and nociceptive stimuli was applied on their affected ankles. The subjects were then randomized to either a control or intervention group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The control group received no intervention. The results suggested that balance training may desensitize the hyper-reactivity to unloading reaction in FAI subjects, suggesting a possible mechanism for reducing the ankle "giving way" episodes. In addition, balance training was found to improve the subjective self-reported ankle instability and passive ankle joint position sense. No effect was observed on isometric and isokinetic peroneal muscle strength and ankle stiffness (laxity). In summary, this dissertation work provides evidence that balance training is effective in patients with FAI, however a further study with more sample size and additional outcome measures is required to better understand the mechanism of balance training in these individuals. The findings of this work have implications for research/rehabilitation of not only individuals with FAI but also in individuals with functional joint instability, such as functional knee instability which shares many common symptoms with FAI

Mechanical ankle instability: relationship with active joint position sense

Current research defines chronic ankle instability (CAl) as the combination of mechanical ankle instability (MAl) and functional ankle instability (FAI). Previous research has found individuals with CAl and FAI to have deficits in proprioception, more specifically joint position sense (JPS). The purpose of this study was to examine the relationship between MAl and active JPS. Twelve participants (5 male, 7 female) were selected for this study based upon their subjective ankle instability as assessed by a score on the Cumberland Ankle Instability Tool (CAIT) and objective ankle instability as assessed by measurements taken using a portable ankle arthrometer. Eligible participant\u27s absolute error in JPS was assessed as a non-weight bearing, active-to-active joint replication, and measured with a Biodex System 3 dynamometer. The absolute error of each joint angle replication was averaged after a reliability analysis. Statistical analysis had planned on using a 2x2 and a 2x3 factorial ANOVA. The research question could not be assessed in the frontal and the sagittal plane. The pilot study showed that there was a population of individuals with unilateral MAl exclusive of functional ankle instability (FAI) --Document

Clinical Characteristics of Active Individuals with Chronic Ankle Instability

Ankle sprains, specifically to the lateral ligament complex, are one of the most common injuries seen during athletic participation and may lead to chronic ankle instability (CAI).1 Residual symptoms of CAI can include feelings of giving way and instability as well as, persistent weakness, pain during activity, and self-reported disability, which may affect postural control and functional performance.2 The purpose of this study was to determine if there was a relationship between perceived kinesiophobia and dorsiflexion range of motion (DROM), measures of dynamic postural control, and measures of functional performance, within active individuals with CAI. Thirty-seven physically active individuals with self-reported CAI, filled out the Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), Tampa Scale of Kinesiophobia 11 (TSK-11), and the NASA Physical Activity Scale (NASA-PAS). Of those, five qualified as having CAI based on the 5th International Ankle Consortium guidelines for CAI classification1 and completed one test session lasting approximately 45 minutes that included basic demographic data, leg length measurements, DROM, three directions of the Star Excursion Balance Test (SEBT), triple crossover hop test, and figure 8 hop test.Means and standard deviations were calculated and reported for all measures. Due to small sample size, only observational analysis could be performed between perceived kinesiophobia and dorsiflexion range of motion (DROM), measures of dynamic postural control, and measures of functional performance. Although only five participants classified as CAI, 36 of 37 participants reported some degree of kinesiophobia. Therefore we chose to examine the inclusionary questionnaires, and how they relate to our measure of kinesiophobia (TSK-11) and the number of reported ankle sprains. Pearson product-moment correlations were used to determine these relationships. Based on observational analysis there may be trends between kinesiophobia and DROM, and figure-8 hop test time. A strong positive relationship between the FAAM activities of daily living (FAAM-ADL) and FAAM-Sport subscales (r = 0.815, p ˂ 0.001), a moderate negative relationship between the FAAM-ADL subscale and TSK-11 scores (r = -0.509, p=0.001), and a moderate negative relationship between the FAAM-Sport subscale and TSK-11 scores (r= -0.599, p ˂ 0.001) were shown. There was also a moderate negative relationship between number of sprains and both the FAAM-ADL (r= -0.436, p= 0.007) and FAAM-Sport (r= -0.464, p=0.004) subscales. The current study showed potential trends between kinesiophobia and DROM, as well as functional performance specific to agility. Measures of functional performance and DROM in the current study when wearing ankle braces did not appear similar to previously published data. The TSK-11 was only moderately correlated to the FAAM. Therefore, perceived kinesiophobia may be independent of self-reported disability, and should be accounted for within the CAI population. Future research should further investigate the relationship between kinesiophobia and measures of dynamic postural control and functional performance

The effects of an ankle strengthening and proprioception exercise protocol on peak torque and joint position sense

Abstract Ankle sprains are the most common injury seen in athletics. Because of this, devices such as external ankle supports have been developed to protect the ankle joint and prevent injury. Exercise protocols have also been developed to increase strength and proprioception at the joint, which has been shown to reduce injury risk. The purpose of this study was to examine changes in joint position sense (JPS) and peak plantar flexion and dorsiflexion torque following a six week strength and proprioception exercise protocol, as well as compare these results to those of a control group wearing ankle braces. The study consisted of 20 college aged students who had previously sprained one of their ankles twice. The subjects were divided into two groups, with one group performing exercises three times per week for six weeks while the other group wore ankle braces during physical activity. Testing was performed before the beginning of the protocol, after three weeks, and after completion of the six week protocol. A 3-way analysis of variance (ANOVA) was performed, with an alpha level of p = 0.05. This study found no significant changes in JPS following completion of the exercise group or compared to the brace group for the factors of time, group, and position (p = 0.57). There were significant improvements in peak plantar flexion (p = 0.014) and dorsiflexion (p = 0.033) torque for all subjects, but there was no significant difference between the two groups for either motion (p = 0.33, 0.349). Based on these results, the exercise protocol used in this study should not be used as a substitute for external ankle supports. However, more research should be done to determine if alterations to the exercise protocol can elicit significant results

THE EFFECT OF JOINT MOBILIZATION ON FUNCTIONAL OUTCOMES ASSOCIATED WITH CHRONIC ANKLE INSTABILITY

Ankle sprains are among the most common injuries sustained by physically active individuals. Although ankle sprains are often considered innocuous in nature, a large percentage of individuals experience repetitive sprains, residual symptoms, and recurrent ankle instability following a single acute sprain; otherwise known as chronic ankle instability (CAI). In addition to repetitive ankle trauma, those with CAI experience reductions in functional capacity over the life span. This indicates that current intervention strategies for CAI are inadequate and require further investigation. The objective of this dissertation was to explore differences in walking and running gait parameters between individuals with and without CAI; as well as, examine the effects of a 2-week Maitland Grade III anterior-to-posterior talocrural joint mobilization intervention on self-reported function, ankle mechanics, postural control, and walking and running gait parameters in a cohort of individuals with CAI. It was hypothesized that individuals with CAI would exhibit different gait kinematics and joint coupling variability patterns compared to healthy individuals and the joint mobilization intervention would improve patient-oriented, clinician-oriented, and laboratory-oriented measures of function in those with CAI. Several observations were made from the results. In the first study, alterations in single joint kinematics and joint coupling variability were found between those with CAI and healthy individuals. In the second study, it was determined that the joint mobilization intervention improved patient-oriented and clinician-oriented measures of function as indicated by improved Foot and Ankle Ability Measure scores, increased weight-bearing dorsiflexion range of motion, and increased reach distances on the Star Excursion Balance Test. However, there were no changes in measures of instrumented ankle arthrometry or laboratory measures of postural control. In the third study, there were no changes in single joint kinematics or joint coupling variability during walking and running associated with the joint mobilization intervention. It can be concluded that joint mobilizations had a significant positive impact on patient-, and clinician-oriented measures of function. Though the laboratory measures did not detect any improvements, joint mobilizations did not produce deleterious effects on function. Therefore, future investigation on the effects of joint mobilization in conjunction with other, more active, rehabilitation strategies is warranted

CLINICAL AND NEUROPHYSIOLOGICAL EFFECTS OF DRY NEEDLING ON INDIVIDUALS WITH CHRONIC ANKLE INSTABILITY

Ankle sprains are generally considered innocuous injuries; however, as many as 74% of patients will develop chronic symptoms. 1-3 Chronic ankle instability (CAI) is defined by a history of ankle sprain accompanied by ongoing bouts of giving way, residual ankle sprain symptoms, and a decrease in patient-perceived function. As understanding of sensorimotor deficits in individuals with CAI have advanced, treatment strategies have evolved to include a robust focus on balance training to mitigate dynamic and static postural control impairments exhibited in individuals with CAI. A problem arises as these improvements have not been conclusively linked to a decrease in CAI. Additionally, acknowledging the need for improved feed-forward postural control and the associated deficits in peripheral mechanoreceptors, treatments that directly affect peripheral receptors are lacking in current practices. Dry needling (DN) is a neurophysiological treatment tool that directly affects the neurophysiology of muscle, thereby likely affecting local muscle spindle receptors and feed forward postural control mechanisms. Currently, the effect of DN in the lower extremity on clinical and neurophysiologic components of balance is unknown. The long-term goal of this line of research is to improve health outcomes for individuals suffering a lateral ankle sprain. The first step toward this aim is understanding the neurophysiologic and sensorimotor effects of DN in both healthy individuals and those with CAI. Secondly, the appropriate dosage of DN treatment is currently unknown. Finally, identifying patient factors that may predict success with this treatment is clinically relevant and currently lacking. We hypothesized that 1) individuals with CAI would demonstrate larger immediate improvements in postural control compared to healthy controls 2) weekly, cumulative DN would demonstrate greater improvements in postural control and proprioception when compared to a single treatment and 3) baseline patient factors exist that predict individuals with CAI that will respond to DN treatment. The results of our first study illustrated that individuals with CAI indeed do have larger immediate improvements in postural control than healthy controls after a single DN treatment. While both groups demonstrated within group improvements in static and dynamic balance, individuals with CAI demonstrated greater improvements in dynamic balance measured with the Star Excursion Balance Test (SEBT). In our second study, weekly DN treatment produced immediate, but not greater improvements with cumulative treatments in dynamic postural control and inversion kinesthesia sense. However, cumulative treatments did produce improvements in eversion kinesthesia sense and static postural control in the mediolateral direction with eyes open, but with small to moderate effect sizes. In our final study, the Global Rating of Change (GROC) scale, a patient-oriented measure of overall improvement in symptoms, and the reach distance in the posteromedial direction of the SEBT as a clinician-oriented measure, were separately used to predict responders to DN treatment. Using the GROC, treatment expectation was found to be the single best predictor of treatment response. However, if the posteromedial direction of the SEBT was used to determine responders to DN treatment, both treatment expectation and a score ≥23.5 on the Identification of Functional Ankle Instability scale were found to be predictive of positive treatment response. In conclusion, DN individuals with CAI has demonstrated immediate improvement in dynamic postural control and proprioception, more than healthy controls. However, this improvement is not significantly augmented by subsequent treatments. Finally, baseline patient factors exist to predict responders to DN treatments. Factors predicting response to treatment differ based on patient or clinician-oriented determinants of treatment response to DN. These results are of an exploratory nature and thus should be interpreted with caution. Additional research is necessary to further elucidate aspects of this work, specifically response to various dosages to DN treatment, patient response when combining DN treatment with other rehabilitation treatments, baseline predictive factors and mechanistic explanations for improvements in postural control

The effects of a randomized four-week Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) dynamic balancing-training program on individuals with chronic ankle instability

Context. Despite case reports and clinical studies, there have been no experimental studies conducted on Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) technique and the effects on chronic ankle instability. Most of the clinical studies and case reports that have been conducted have used animals and human subjects for lateral epicondylitis, and patellar, rotator cuff and achilles tendinopathy. Since only a case report exists in the literature for chronic ankle instability using GISTM, the intent of this study is to further evaluate the effects of GISTM and dynamic postural balance on improvements in healing and function. Objective. The present study aims to investigate the affects of GISTM technique and the influence on improving range of motion, neovascularization, collagen alignment, pain and disability in individuals experiencing chronic ankle instability. Design. Subjects were randomly assigned to the GISTM/Dynamic Balance-Training (DBT), GISTM-S/DBT, or C/DBT group. All groups participated in a 4wk DBT program consisting of four exercises and a lower extremity dynamic stretching protocol using a Flex band twice a week throughout the training period. The GISTM/DBT and GISTM-S/DBT groups received the GISTM treatment of sham treatment twice a week before performing the DBT program throughout the training period. Setting. A AAA High School in North Central West Virginia. Patients or other participants. This study included 36 healthy, physically active individuals (5 female, 31 male; age=17.771+/-1.972 years; ht=69.403+/-5.775; 30 right, 6 left foot; 28 six sessions, 8 seven sessions completed of rehab) with a history of CAI volunteered to be in this study from a North Central High School in WV and a DI Mid-Atlantic University. Interventions . The DBT program that was performed twice a week for 4-wks included a battery of exercises that was advanced from week to week for all three experimental groups. The 4-wk GISTM treatment protocol for the GISTM and GISTM-S groups also was performed twice a week. Pre- and Post-test measurements were taken using the Foot and Ankle Ability Measures (FAAM), FAAM Sport, the Visual Analog Scale (VAS), ankle range of motion (ROM) in four directions, ultrasonography (US), and the Star Excursion Balance Test (SEBT) in three directions. Outcomes measures. A greater increase will be found in the talocrural range of motion, neovascularization, and collagen alignment between groups pre- and post-test. And also a decrease in the FAAM, FAAM Sport and VAS will be found; with a significant difference in pre- and post-test results between groups. Results. There was a significant difference for test with FAAM (F1,33=47.963, P=0.01, ES=0.592, 1-beta=1.00), FAAM Sport (F1,33=18.377, P\u3c0.001, ES=0.358, 1-beta=0.932), VAS (F1,33=55.564, P\u3c0.001, ES=0.590, 1-beta=1.000), ROM (F1,33=40.087, P\u3c0.001, ES=0.548, 1-beta=1.000), and SEBT (F1,33=58.493, P=0.000, ES=0.639, 1-beta=1.000) with post-test results greater except for VAS, which decreased. There were also significant differences for movement (F3,33=196.721, P\u3c0.001, ES=0.856, 1-beta=1.000) with ROM and direction (F1,33=71.355, P0.01). Conclusion. The 4-wk GISTM and dynamic balance-training program could be used to increase ROM, sensorimotor facilitation, and stability for the ankle musculature, along with postural stability and endurance in all athletes suffering from chronic ankle instability

CHRONIC ANKLE INSTABILITY AND AGING

Lateral ankle sprains are the most common musculoskeletal injury among the general population and U.S. military personnel. Despite the common perception of being a minor injury, at least 1 out of 3 individuals with a previous ankle sprain will develop chronic ankle instability (CAI). This clinical phenomenon creates a significant barrier for patients to return to their prior level of physical function. Specifically, CAI is associated with reductions in physical activity level, leading to decreases in lower health-related quality of life and increase risk of developing of post-traumatic ankle osteoarthritis. Current evidence has largely focused on characterizing the mechanical and sensorimotor insufficiencies associated with CAI in adolescent and young-adult populations, with little attention on middle- and older-aged adults. This restricts our understanding of how these insufficiencies associated with CAI that develop in early adulthood progress over time and contribute to other chronic diseases such as post-traumatic osteoarthritis. Therefore, the overall objective of this study was to compare self-reported and physical function between three age groups: 1) young, 2) middle-aged, and 3) older-aged adults with and without CAI. We hypothesized participants with CAI would have age-related changes in self-reported and physical function compared to non-injured individuals across the lifespan. The objective of this dissertation was to compare regional and global health- related quality of life (HRQoL), static and dynamic balance, spinal reflex excitability of the soleus muscle, open- and closed-kinetic chain dorsiflexion range of motion and spatiotemporal gait parameters between those with and without CAI across the lifespan. Her callIt was hypothesized that all self-reported and physical characteristics would be decrease with age, but significantly more in those with CAI compare to non-injured individuals. Results from the first study demonstrated participants with CAI had worse regional HRQoL compared to healthy-controls as evidenced by the lower Foot and Ankle Disability Index scores. Likewise, participants with CAI reported having worse overall physical function and pain interference during activity compared to healthy-controls. There was no significant interaction for Injury (CAI and healthy-control) and Age group (young, middle, and old) for any dependent variable. In the second, it was determined that static and dynamic balance, spinal reflex excitability, ankle (dorsiflexion and plantarflexion) and hip extension torque were all lower in the older-aged participants compared to the younger-aged adults. In addition, it was determined that participants with CAI had decreased dorsiflexion range of motion, ankle (dorsiflexion and plantar flexion) and hip extension peak isometric torque compared to the healthy-control group. However, no significant interaction was found for Injury (CAI & healthy-control) and Age (young, middle, old) for any dependent variable. In the third study, there were no differences in spatiotemporal gait parameters between groups (CAI vs. healthy-controls) or age categories. It can be concluded from this dissertation that regardless of the age, individuals with CAI have worse region-specific HRQoL, lower overall physical function, greater pain interference, limited dorsiflexion range of motion, and decreased ankle and hip peak isometric torque compared to healthy-controls. Several age-related observations were found including decreased static and dynamic balance, ankle and hip strength, and spinal reflex excitability. Though no relationship was found between CAI and age, several interactions were found to be trending towards significance. Therefore, future work is needed to better understand the consequences of CAI on middle- and older-aged adults