Treatment of common deficits associated with chronic ankle instability.

School of Physiotherapy and Performance Science, University College Dublin, Health Sciences Centre, Belfield, Dublin, Ireland.
Sports Medicine (Impact Factor: 5.32). 02/2009; 39(3):207-24. DOI: 10.2165/00007256-200939030-00003
Source: PubMed

ABSTRACT Lateral ankle sprains are amongst the most common injuries incurred by athletes, with the high rate of reoccurrence after initial injury becoming of great concern. Chronic ankle instability (CAI) refers to the development of repetitive ankle sprains and persistent residual symptoms post-injury. Some of the initial symptoms that occur in acute sprains may persist for at least 6 months post-injury in the absence of recurrent sprains, despite the athlete having returned to full functional activity. CAI is generally thought to be caused by mechanical instability (MI) or functional instability (FI), or both. Although previously discussed as separate entities, recent research has demonstrated that deficits associated with both MI and FI may co-exist to result in CAI. For clinicians, the main deficits associated with CAI include deficits in proprioception, neuromuscular control, strength and postural control. Based on the literature reviewed, it does seem that subjects with CAI have a deficit in frontal plane ankle joint positional sense. Subjects with CAI do not appear to exhibit any increased latency in the peroneal muscles in response to an external perturbation. Preliminary data suggest that feed-forward neuromuscular control may be more important than feed-back neuromuscular control and interventions are now required to address deficits in feed-forward neuromuscular control. Balance training protocols have consistently been shown to improve postural stability in subjects with CAI. Subjects with CAI do not experience decreased peroneus longus strength, but instead may experience strength deficits in the ankle joint invertor muscles. These findings are of great clinical significance in terms of understanding the mechanisms and deficits associated with CAI. An appreciation of these is vital to allow clinicians to develop effective prevention and treatment programmes in relation to CAI.

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    ABSTRACT: In this paper, we present the design, analysis, and testing of an ankle rehabilitation device (ARD), the purpose of which is to improve the efficacy of ankle joint complex (AJC) injury diagnosis and treatment. The ARD enables physicians to quantitatively measure the severity of an injury. This is done by measuring deficiencies in the joint's range of motion, as well as force, torque, and power output. Evaluation of the relative degree of recovery over time can also reduce the error associated with current methodologies for rehabilitation, which rely on measurements based on the patient's verbal response. A Wheatstone bridge circuit is used for the measurement of the various parameters as applied to the blades of complementary rotational flexures; the device is designed to measure motion about three axes of rotation in the ankle joint: pitch, roll, and yaw. A full bridge circuit is applied to each axis of rotation, and the use of multiple axes increases anatomically accurate measurement, enabling characterization of coupled motions. The device has flexibility and a range of motion such that it can be adjusted to take measurements of multiple different degrees of plantar or dorsiflexion of the AJC. The ARD is able to measure both range of motion, force, and torque output simultaneously. Experimental results show that there is significant coupled motion among the ankle joint rotations but that it is highly dependent on a subject's own physical development. [DOI: 10.1115/1.4002901]
    Journal of Medical Devices 03/2011; 5(1):011001. DOI:10.1115/1.4002901 · 0.62 Impact Factor

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