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Variación de la velocidad del centro de presiones en deportistas con esguince lateral de tobillo Variation of the Velocity of the Center of Pressure in Athletes With Lateral Ankle Sprain
Abstract
Introducción. La inestabilidad crónica de tobillo es un cuadro clínico muy frecuente e incapacitante en deportistas. No se conoce con certeza la etiología de la misma siendo propuestas las alteraciones biomecánicas y déficit de equilibrio postural, por deterioro en los sistemas involucrados en la propiocepción. En este estudio se valoran las consecuencias biomecánicas en personas que padecieron esguince lateral de tobillo.
Material y métodos. Se han analizado los datos baropodométricos de 60 personas que practican deporte habitualmente (30 grupo esguinces, 30 grupo control) entre 18 y 40 años.
Se estudió la velocidad del CoP siguiendo las indicaciones del software de la plataforma FootScan®. Los datos han sido recopilados in situ, por 2 clínicos en diferente tiempo y lugar.
Resultados. Se han encontrado diferencias estadísticamente significativas (0,031 para un IC del 95%) en los valores de: inicio de antepié plano izquierdo y rocker de talón izquierdo.
No se han encontrado diferencias entre hombres y mujeres.
Conclusiones. Se han encontrado muy pocas diferencias entre el grupo esguince y el grupo control por lo que nuestra hipótesis se ha rechazado, no habiendo diferencias significativas en la biomecánica de la marcha de deportistas que han padecido esguince lateral de tobillo comparados con personas sanas. Futuros estudios son necesarios para conocer con mayor profundidad los factores de alteración biomecánica tras un esguince de tobillo, analizando diferentes factores biomecánicos, podobarométricos y diferencias de género.
... Es la lesión más frecuente del aparato locomotor en la población en general (Ruano, Zaforteza, Vila, & Fuster) y en particular, bailarines y deportistas son el colectivo que presenta un mayor riesgo (Russell, 2010). Los agentes causales propuestos son las alteraciones biomecánicas y déficit de equilibrio postural por deterioro de los sistemas involucrados en la propiocepción (Traba & Ouréns, 2014). Se ha demostrado que aquellos bailarines con una menor potencia de miembros inferiores sufren un mayor número de lesiones en esta zona, entre ellas esguinces de tobillo (Russell, 2010). ...
Clasic Ballet is a physical activity between art and elite sport where the body is used as their working tool. The purpose of this research is to make the dance collective aware of the necessity of carry out a physical training adequate to the physical demands of dancing fitness. The main objectives of this physical training were to improve the performance of the dancers and to reduce the high number of injuries that occur both in the formative life, as during the professional career and even after their career.
The theoretical framework is supported in a systematic observation and analysis of the daily work of the classical dancer and in a literature research of the existing scientific studies in the field of fitness and dance. In this way we wanted to examine the ballet as a sport, analyze its index of injury and develop a methodology to reduce the number of injuries and improve the performance of this collective.
Keywords: Ballet, physical training, injuries, periodization.
The Win-Track platform is an instrument used to measure plantar pressures and gait parameters during barefoot walking. The objective of this study was to determine the test-retest reliability of the system in assessing plantar pressures and temporal gait variables between 1-step and 3-step gait protocols. A total of 30 healthy participants (18 women and 12 men; age 23.7 ± 4.75 years) were recruited for the study. The 1-step gait protocol exhibited good reliability in terms of single stance, step duration and swing duration of the left foot; stride duration of the right foot; stride length; and step length of the right foot, with intraclass correlation coefficients (ICCs) ranging from 0.75 to 0.88. The 3-step gait protocol showed good reliability, with ICC values ranging between 0.75 and 0.90 in cadence; step duration of the right foot; double-stance duration and swing duration of the right foot; stride length of the right foot; step length and gait cycle length of the right and the left foot; and the area covered by the first, second, and third foot. The authors concluded that the Win-Track platform provided reliable plantar pressures and temporal gait measures, and the 3-step gait protocol showed better reliability compared with the 1-step gait protocol.
Level of Evidence: Diagnostic, Level IV
Previous plantar pressure research found increased loads and slower loading response on the lateral aspect of the foot during gait with chronic ankle instability compared to healthy controls. The studies had subjects walking barefoot over a pressure mat and results have not been confirmed with an in-shoe plantar pressure system. Our purpose was to report in-shoe plantar pressure measures for chronic ankle instability subjects compared to healthy controls.
Forty-nine subjects volunteered (25 healthy controls, 24 chronic ankle instability) for this case-control study. Subjects jogged continuously on a treadmill at 2.68 m/s (6.0 mph) while three trials of ten consecutive steps were recorded. Peak pressure, time-to-peak pressure, pressure-time integral, maximum force, time-to-maximum force, and force-time integral were assessed in nine regions of the foot with the Pedar-x in-shoe plantar pressure system (Novel, Munich, Germany).
Chronic ankle instability subjects demonstrated a slower loading response in the lateral rearfoot indicated by a longer time-to-peak pressure (16.5% +/- 10.1, p = 0.001) and time-to-maximum force (16.8% +/- 11.3, p = 0.001) compared to controls (6.5% +/- 3.7 and 6.6% +/- 5.5, respectively). In the lateral midfoot, ankle instability subjects demonstrated significantly greater maximum force (318.8 N +/- 174.5, p = 0.008) and peak pressure (211.4 kPa +/- 57.7, p = 0.008) compared to controls (191.6 N +/- 74.5 and 161.3 kPa +/- 54.7). Additionally, ankle instability subjects demonstrated significantly higher force-time integral (44.1 N/s +/- 27.3, p = 0.005) and pressure-time integral (35.0 kPa/s +/- 12.0, p = 0.005) compared to controls (23.3 N/s +/- 10.9 and 24.5 kPa/s +/- 9.5). In the lateral forefoot, ankle instability subjects demonstrated significantly greater maximum force (239.9N +/- 81.2, p = 0.004), force-time integral (37.0 N/s +/- 14.9, p = 0.003), and time-to-peak pressure (51.1% +/- 10.9, p = 0.007) compared to controls (170.6 N +/- 49.3, 24.3 N/s +/- 7.2 and 43.8% +/- 4.3).
Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging.
These findings may have implications in the etiology and treatment of chronic ankle instability.
The Hertel model of chronic ankle instability (CAI) is commonly used in research but may not be sufficiently comprehensive. Mechanical instability and functional instability are considered part of a continuum, and recurrent sprain occurs when both conditions are present. A modification of the Hertel model is proposed whereby these 3 components can exist independently or in combination.
To examine the fit of data from people with CAI to 2 CAI models and to explore whether the different subgroups display impairments when compared with a control group.
Cross-sectional study.
Community-dwelling adults and adolescent dancers were recruited: 137 ankles with ankle sprain for objective 1 and 81 with CAI and 43 controls for objective 2.
Two balance tasks and time to recover from an inversion perturbation were assessed to determine if the subgroups demonstrated impairments when compared with a control group (objective 2).
For objective 1 (fit to the 2 models), outcomes were Cumberland Ankle Instability Tool score, anterior drawer test results, and number of sprains. For objective 2, outcomes were 2 balance tasks (number of foot lifts in 30 seconds, ability to balance on the ball of the foot) and time to recover from an inversion perturbation. The Cohen d was calculated to compare each subgroup with the control group.
A total of 56.5% of ankles (n = 61) fit the Hertel model, whereas all ankles (n = 108) fit the proposed model. In the proposed model, 42.6% of ankles were classified as perceived instability, 30.5% as recurrent sprain and perceived instability, and 26.9% as among the remaining groups. All CAI subgroups performed more poorly on the balance and inversion-perturbation tasks than the control group. Subgroups with perceived instability had greater impairment in single-leg stance, whereas participants with recurrent sprain performed more poorly than the other subgroups when balancing on the ball of the foot. Only individuals with hypomobility appeared unimpaired when recovering from an inversion perturbation.
The new model of CAI is supported by the available data. Perceived instability alone and in combination characterized the majority of participants. Several impairments distinguished the sprain groups from the control group.
Sprain of the lateral ankle ligaments are one of the most common injuries encountered during athletic participation. Following initial injury there is an alarmingly high risk of re-injury and the development of residual symptoms such as pain, swelling and "giving way" of the ankle joint. These symptoms have been given the generic term chronic ankle instability (CAI). Two causes of CAI reported in the literature are mechanical instability (MI) and functional instability (FI). FI is a distinct phenomenon to MI with many neuromuscular contributing factors being reported. The purpose of this literature review is to describe those neuromuscular factors associated with FI.
Lateral ankle sprains have been shown to be one of the most common musculoskeletal injuries in both athletes and the recreationally active population. Moreover, it is estimated that approximately 30% of people who incur a lateral ankle sprain will sustain recurrent ankle sprains and experience symptoms of pain and instability that last > 1 year. Chronic ankle instability (CAI) is the term used to describe cases involving repetitive ankle sprains, multiple episodes of the ankle "giving way," persistent symptoms, and diminished self-reported function for > 1 year after the initial ankle sprain. The optimal conservative treatment for CAI is yet to be determined; however, comparison between patients with CAI and individuals showing no history of ankle sprain has revealed several characteristic features of CAI. These include diminished range of motion, decreased strength, impaired neuromuscular control, and altered functional movement patterns. We propose a new treatment paradigm for conservative management of CAI with the aim of assessing and treating specific deficits exhibited by individual patients with CAI.
This investigation identifies the center of pressure (COP) progression characteristics under the plantar region for elderly adults during barefoot walking. A total of 60 healthy adults (30 young and 30 old) were recruited. The young and elderly participants had average ages of 23.6 (SD=2.7) and 70.8 (SD=4.1) years old, respectively. All subjects had normal foot arch and no relevant musculoskeletal disease in the lower extremities. The foot pressure measurement system (RS-scan(®) system) was used to measure the center of pressure coordinates (COP), progression angle and COP velocity. Four sub-phases of the stance phase were calculated. The initial contact (ICP) and forefoot contact phase (FFCP) corresponded to the loading response. The foot flat phase (FFP) coincided with the mid-stance. The forefoot push-off phase (FFPOP) corresponded to the terminal stance and pre-swing phases. The analytical results revealed that age effects were found in the relative time percentages for the initial contact, foot flat and forefoot push-off phases during foot movement. The elderly subjects exhibited significant medial COP curve and faster COP velocity during the initial contact phase and more pronated mid-foot posture and slower COP velocity during the mid-stance. The older adults tended to have a more pronated foot and displayed a significant medial COP curve compared to young adults. These COP progression characteristics can provide further insight into relevant foot function and gait performance evaluations for older adults.
The COP progression is the trajectory of the center of foot pressure. Thirty healthy young adults were recruited to participate in this study. All subjects were asked to walk randomly at four different speeds (3km/h, preferred walking speed, 4km/h and 5km/h). A foot pressure measurement system (RS-scan(®) system) was used to collect the center of pressure (COP) coordinates, COP progression angle and the COP velocity. Four sub-phases of the stance phase were calculated. The initial contact (ICP) and forefoot contact phase (FFCP) corresponded to the loading response. The foot flat phase (FFP) coincided with the mid-stance. The forefoot push-off phase (FFPOP) corresponded to the terminal stance and pre-swing phases. The results of this study indicate that the percentage of time (% time) of COP progression on the ICP, FFCP, FFP and FFPOP were approximately 7.0%, 4.8%, 48.8% and 39.4%, respectively. The COP progression angle was 4.1 (SD=1.6)° with an inward curve and the average COP velocity was 31.6cm/s (SD=5.3). The walking speed influenced the % time in the FFP and FFPOP. As the walking speed increased, the % time of COP progression decreased in mid-stance and increased in the terminal and pre-swing stances. Moreover, gender affected the COP progression angle. Men had a significantly larger deviating angle than women during FFCP, FFP and FFPOP. The COP characteristics can offer useful information for clinical rehabilitation in foot functional and structural evaluation.
This study evaluates foot pressure and center of pressure (COP) patterns in individuals with ankle instability during running and lateral shuffling. Eleven participants with ankle instability (AI) and 11 normal subjects (Normal) performed running and lateral shuffling tasks. The outcome measures were foot progression angle, peak pressure, and displacement of COP during stance phase. During running, the foot progression angle, that is, the angle of foot abduction, was lower in the AI group (Normal: 13.46° ± 4.45°; AI: 8.78° ± 3.91°), and the 1st metatarsal contact pressure (Normal: 0.76 ± 0.47 N/cm(2)·kg; AI: 1.05 ± 0.70 N/cm(2)·kg) and the 3rd metatarsal peak pressure were higher in the AI (Normal: 0.96 ± 0.60 N/cm(2)·kg; AI: 1.54 ± 0.68 N/cm(2)·kg). The medial-lateral (M-L) COP in the late-stance phase of running for the AI group transferred faster from lateral to medial foot than the Normal group. For lateral shuffling, the AI group had greater peak pressure at the 1st (Normal: 0.76 ± 0.67 N/cm(2)·kg; AI: 1.49 ± 1.04 N/cm(2)·kg), 2nd (Normal: 0.57 ± 0.39 N/cm(2)·kg; AI: 0.87 ± 0.68 N/cm(2)·kg), 3rd (Normal: 0.70 ± 0.54 N/cm(2)·kg; AI: 1.42 ± 0.87 N/cm(2)·kg), and 4th (Normal: 0.52 ± 0.38 N/cm(2)·kg; AI: 1.12 ± 0.78 N/cm(2)·kg) metatarsal areas than the Normal group. The M-L COP located more laterally from the early to mid-stance phase in the AI compared with the Normal group. The findings suggest that COP displacement during lateral shuffle may be a factor in ankle instability while the foot progression angle during running may be a compensatory strategy.
The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles.
Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing.
Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care.
An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach.