Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury

Abstract

lateral ankle sprain copers, 1-year following a first-time lateral ankle sprain injury. AbstractPurpose: To quantify the dynamic balance deficits that characterize a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes.Methods: Forty-two participants with chronic ankle instability and twenty-eight ankle sprain copers were initially recruited within 2-weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory one-year following to complete the current studyprotocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the Star Excursion Balance Test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the center of pressure path were also acquired. Results:Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared to controls bilaterally, and in the posterior-lateral direction compared to ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the center of pressure path. Conclusion:In comparison to ankle sprain copers and controls, participants with chronic ankle instability were characterized by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. Level of evidence: Level III

Ultrasound Imaging of the Gluteal Muscles During the Y-Balance Test in Individuals With or Without Chronic Ankle Instability

“…11 One such task that involves muscles throughout the lower extremity is the modified Star Excursion Balance Test, otherwise known as the Y-Balance Test (YBT). This clinical tool is commonly used to assess sensorimotor adaptations, and multiple researchers 12,13 have suggested that individuals with CAI present with impairments in YBT performance. This task involves multiple lower extremity structures for successful performance and specifically requires dynamic single-limb stabilization while participants maintain a semi-squatting position and reach outside the base of support in the anterior, posteromedial, and posterolateral directions.…”

“…Alterations in hip kinematics, 13 hip-muscle fatigue, 16,17 and decreased hip-extension strength 18,19 have been identified and shown to be related to decreased YBT performance, particularly in the posterior-reach directions. Although all of these aspects have been explored, little information is available about the functional-activation patterns of the gluteal muscles during the YBT as they influence task performance in the population with CAI.…”

“…Although all of these aspects have been explored, little information is available about the functional-activation patterns of the gluteal muscles during the YBT as they influence task performance in the population with CAI. Using surface electromyography (EMG) in healthy participants, authors 13,20 have found increased gluteal activation in select YBT directions that have been frequently reported as impaired in cohorts with CAI. Therefore, proximal alterations may contribute to dysfunction in this patient population.…”

Evaluating and Differentiating Ankle Instability

“…1,2 Between 50% and 70% of the people who sustain an LAS will develop chronic ankle instability (CAI), a condition characterized by lingering pain, instability, injury recurrence, and persistent functional disability. 3 Chronic symptoms and reinjury have been shown to occur rapidly, with recent authors [4][5][6][7][8] demonstrating the onset of CAI symptoms as early as 6 to 12 months after the initial acute LAS. The steps for determining the status of an LAS through clinical examination are well established and can be supplemented with advanced imaging.…”

Inertial Sensor Technology Can Capture Changes in Dynamic Balance Control during the Y Balance Test

“…Thus, clinicians often rely on subjective visual observations of the individuals’ “steadiness” while completing the task. As a result, there is potential that these traditional measures of dynamic balance may not capture subtle sensorimotor deficits possessed by individuals with conditions such as acute lateral ankle sprain [1], chronic ankle instability [12], and concussion [13, 14]. …”