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: 5.04). 02/2009; 39(3):207-24. DOI: 10.2165/00007256-200939030-00003
Source: PubMed


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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Available from: Eamonn Delahunt
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    • "This mechanism, which in fact is preloading, contributes to maintain postural stability. Muscle weaknesses and proprioceptive deficits, such as alleged in CAI, may both alter this mechanism (Holmes and Delahunt, 2009; Kennedy et al., 2012); likely by increasing the duration of the period of force development and by decreasing the maximal level of strength available for joint protection. "
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    ABSTRACT: Background The assessment of muscle function is a cornerstone in the management of subjects who have sustained a lateral ankle sprain. The ankle range of motion being relatively small, the use of preloading allows to measure maximal strength throughout the whole amplitude and therefore to better characterize ankle muscles weaknesses. This study aimed to assess muscle strength of the injured and uninjured ankles in subjects with a lateral ankle sprain, to document the timeline of strength recovery, and to determine the influence of sprain grade on strength loss. Methods Maximal torque of the periarticular muscles of the ankle in a concentric mode using a protocol with maximal preloading was tested in 32 male soldiers at 8 weeks and 6 months post-injury. Findings The evertor muscles of the injured ankles were weaker than the uninjured ones at 8 weeks and 6 months post-injury (P < 0.0001, effect size = 0.31-0.42). Muscle weaknesses also persisted in the plantarflexors of the injured ankles at 8 weeks (P = 0.0014, effect size = 0.52-0.58) while at 6 months, only the subjects with a grade II sprain displayed such weaknesses (P < 0.0001, effect size 0.27-0.31). The strength of the invertor and dorsiflexor muscles did not differ between sides. Interpretation The use of an isokinetic protocol with preloading demonstrates significant but small strength deficits in the evertor and plantarflexor muscles. These impairments may contribute to the high incidence of recurrence of lateral ankle sprain in very active individuals.
    Full-text · Article · Dec 2014 · Clinical Biomechanics
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    • "These authors measured static balance by means of postural sway on a forceplate, which may not be the most sensitive for detecting postural stability deficits in CAI subjects (McKeon & Hertel, 2008). Holmes and Delahunt (2009) reported that the SEBT is more sensitive than other tests for measuring postural control in CAI subjects . With regard to this, Delahunt et al. (2010) investigated the effects of FRT on SEBT in A, PM and PL directions in CAI subjects. "
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    ABSTRACT: Objective To determine whether fibular repositioning tape influenced the postural control performance in athletes with and without chronic ankle instability (CAI). Setting Research laboratory. Design A cross-sectional study, within subjects experimental study design between 4 ankle conditions (taped and untaped: CAI and healthy athletes). Participants Sixteen volunteer professional athletes with unilateral CAI (10 men and 6 women; age 23.2±3 y, height 175.4±10.3 cm, and weight 73±14.5 kg) and sixteen volunteer healthy professional athletes (10 men and 6 women; age 22.8±1.7 y, height 173.6±12.2 cm, and weight 66.4±11.4 kg). Interventions Fibular repositioning taping (FRT). Main Outcome Measurements Star excursion balance test (postural control) in anteromedial (AM), medial (M), and posteromedial (PM) directions were measured for the both group in two conditions: tape and untape. Results FRT improved significantly postural control (M, AM and PM) in both groups (p < 0.05). Conclusion We observed that FRT can significantly improve postural control in athletes with CAI and healthy athletes. Therefore, FRT can be an effective management for athletes who suffer from CAI. Also, this type of taping can apply immediately prior to activity and sport event to increase joint awareness of ankle.
    Full-text · Article · Aug 2014 · Physical Therapy in Sport
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    • "Balance improvement is one of the most important therapeutic goals in a wide range of conditions like lower limb surgeries, joint sprains, amputations, risk of falls etc. In therapeutic settings, proprioception rehabilitation programs often prescribe balance training devices such as unstable balance platforms or exercises such as single-leg stances or single-leg hops in order to partly restore proprioceptive deficits and the functional stability of the ankle (Holmes and Delahunt, 2009; You et al., 2009). Particularly, in lower limb amputation rehabilitation , balance upon the intact limb is emphasized to ensure safe mobility without the use of a prosthesis and to prepare for gait training. "
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    ABSTRACT: Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account.
    Full-text · Article · Apr 2012 · Journal of bodywork and movement therapies
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