Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping

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386

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

Section: Motor-behavioral Impairmentsmentioning

confidence: 99%

An Updated Model of Chronic Ankle Instability

Hertel

Corbett

2019

444

386

“…The aforementioned hip-dominant gait strategy has also been documented in patients with CAI during landing and cutting. 34,45 They appear to rely more on the hip joint by increasing hip-joint stiffness, hip-flexion angle, hip-extension moments, and eccentric and concentric joint powers during jump landing and cutting to compensate for reduced ankle-joint stiffness, plantar-flexion moments, and eccentric and concentric powers. 34,45 One possible explanation for this hip-dominant movement strategy in patients with CAI may be sensorimotor deficits in proprioception, motorneuron pool excitability, reflex reactions, muscular strength, and postural control, as suggested by Hertel.…”

Section: Hip-dominant Gait Strategy (Kinetic and Kinematic)mentioning

confidence: 99%

“…34,45 They appear to rely more on the hip joint by increasing hip-joint stiffness, hip-flexion angle, hip-extension moments, and eccentric and concentric joint powers during jump landing and cutting to compensate for reduced ankle-joint stiffness, plantar-flexion moments, and eccentric and concentric powers. 34,45 One possible explanation for this hip-dominant movement strategy in patients with CAI may be sensorimotor deficits in proprioception, motorneuron pool excitability, reflex reactions, muscular strength, and postural control, as suggested by Hertel. 18 We believe that these sensorimotor deficits, along with mechanical deficits (ie, ligament laxity, arthrokinematic restrictions, and osteokinematic restrictions), could result in a maladaptive movement strategy, regardless of the task, 26 via the spinal or supraspinal sensorimotor pathways.…”

Section: Hip-dominant Gait Strategy (Kinetic and Kinematic)mentioning

confidence: 99%

Altered Walking Neuromechanics in Patients With Chronic Ankle Instability

Son

Kim

Seeley

et al. 2019

Self Cite

Context The literature on gait kinematics and muscle activation in chronic ankle instability (CAI) is limited. A comprehensive evaluation of all relevant gait measures is needed to examine alterations in gait neuromechanics that may contribute to recurrent sprain. Objective To compare walking neuromechanics, including kinematics, muscle activity, and kinetics (ie, ground reaction force [GRF], moment, and power), between participants with and those without CAI by applying a novel statistical analysis to data from a large sample. Design Controlled laboratory study. Setting Biomechanics laboratory. Patients or Other Participants A total of 100 participants with CAI (49 men, 51 women; age = 22.2 ± 2.3 years, height = 174.0 ± 9.7 cm, mass = 70.8 ± 14.4 kg) and 100 individuals without CAI serving as controls (55 men, 45 women; age = 22.5 ± 3.3 years, height = 173.1 ± 13.3 cm, mass = 72.6 ± 18.7 kg). Intervention(s) Participants performed 5 trials of walking (shod) at a self-selected speed over 2 in-ground force plates. Main Outcome Measure(s) Three-dimensional GRFs, lower extremity joint angles, internal joint moments, joint powers, and activation amplitudes of 6 muscles were recorded during stance. Results Compared with the control group, the CAI group demonstrated (1) increased plantar flexion or decreased dorsiflexion, increased inversion or decreased eversion, decreased knee flexion, decreased knee abduction, and increased hip-flexion angles; (2) increased or decreased inversion, increased plantar flexion, decreased knee extension, decreased knee abduction, and increased hip-extension moments; (3) increased vertical, braking, and propulsive GRFs; (4) increased hip eccentric and concentric power; and (5) altered muscle activation in all 6 lower extremity muscles. Conclusions The CAI group demonstrated a hip-dominant strategy by limiting propulsive forces at the ankle while increasing force generation at the hip. The different walking neuromechanics exhibited by the CAI group could represent maladaptive strategies that developed after the initial sprain or an injurious gait pattern that may have predisposed the participants to their initial injuries. Increased joint loading and altered kinematics at the foot and ankle complex during initial stance could affect the long-term health of the ankle articular cartilage.

“…[13][14][15] More specifically, proximal-segment alterations and reduced ankle neuromuscular control were observed when individuals who developed CAI performed dynamic movements, such as jump landings and side-cutting tasks. [15][16][17][18] This indicates that the chronically unstable ankle is unable to effectively attenuate impulse loads imposed on the ankle complex and results in an intralimb redistribution of impact-force attenuation in which greater reliance is placed on the proximal joints to protect the injured ankle during dynamic movements. 16,18 Researchers 13,15,19 have suggested that longitudinal alterations to spinal-and supraspinal-level motor-control strategies, which arise from the sensorimotor constraints of CAI, are likely an underlying mechanism in developing CAI and recurrent lateral ankle sprains.…”

mentioning

confidence: 99%

“…[15][16][17][18] This indicates that the chronically unstable ankle is unable to effectively attenuate impulse loads imposed on the ankle complex and results in an intralimb redistribution of impact-force attenuation in which greater reliance is placed on the proximal joints to protect the injured ankle during dynamic movements. 16,18 Researchers 13,15,19 have suggested that longitudinal alterations to spinal-and supraspinal-level motor-control strategies, which arise from the sensorimotor constraints of CAI, are likely an underlying mechanism in developing CAI and recurrent lateral ankle sprains. Therefore, an assessment of lower limb movement dynamics during sport-specific tasks that pose substantial risks for LAS in individuals with CAI is warranted.…”

mentioning

confidence: 99%

Lower Limb Joint Kinetics During a Side-Cutting Task in Participants With or Without Chronic Ankle Instability

Simpson

Stewart

Turner

et al. 2020

Context Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited. Objective To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI. Design Cohort study. Setting Motion-capture laboratory. Patients or Other Participants Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg). Intervention(s) Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed. Main Outcome Measure(s) Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables. Results The CAI group exhibited a reduced ankle-eversion moment (39%–81% of stance phase) and knee-abduction moment (52%–75% of stance phase) and a greater ankle plantar-flexion moment (3%–16% of stance phase) than the control group (P range = .009–.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t28 = 1.978, P = .03). Conclusions Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.