Laboratory Measures of Postural Control During the Star Excursion Balance Test After Acute First-Time Lateral Ankle Sprain

Abstract

Context:No researchers, to our knowledge, have investigated the immediate postinjury-movement strategies associated with acute first-time lateral ankle sprain (LAS) as quantified by center of pressure (COP) and kinematic analyses during performance of the Star Excursion Balance Test (SEBT).Objective: To analyze the kinematic and COP patterns of a group with acute first-time LAS and a noninjured control group during performance of the SEBT.Design: Case-control study. Intervention: Participants performed the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the SEBT.Main Outcome Measure(s): We assessed 3-dimensional kinematics of the lower extremity joints and associated fractal dimension (FD) of the COP path during performance of the SEBT.Results: The LAS group had decreased normalized reach distances in the ANT, PL, and PM directions when compared with the control group on their injured (ANT: 58.16% 6 6.86% versus 64.86% 6 5.99%; PL: 85.64% 6 10.62% versus 101.14% 6 8.39%; PM: 94.89% 6 9.26% versus 107.29 6 6.02%) and noninjured (ANT: 60.98% 6 6.74% versus 64.76% 6 5.02%; PL: 88.95% 6 11.45% versus 102.36% 6 8.53%; PM: 97.13% 6 8.76% versus 106.62% 6 5.78%) limbs (P , .01). This observation was associated with altered temporal sagittal-plane kinematic profiles throughout each reach attempt and at the point of maximum reach (P , .05). This result was associated with a reduced FD of the COP path for each reach direction on the injured limb only (P , .05).Conclusions: Acute first-time LAS was associated with bilateral deficits in postural control, as evidenced by the bilateral reduction in angular displacement of the lower extremity joints and reduced reach distances and FD of the COP path on the injured limb during performance of the SEBT.Key Words: ankle joint, biomechanics, kinematics, kinetics, postural balance Key PointsIndividuals with acute, first-time lateral ankle sprain injuries exhibited bilateral deficits in dynamic postural control as assessed using the reach distances achieved during the anterior, posterolateral, and posteromedial directions of the Star Excursion Balance Test. These deficits are underpinned by both local and global modifications in the movement patterns adopted at the point of maximum reach by the joints of the lower extremity. A trend toward reduced sagittal-plane range-of-motion displacement was also noted at the hip, knee, and ankle joints throughout each reach attempt in the injured group. These deficits were associated with an apparently reduced capacity to exploit the available base of support, as illustrated by a reduced fractal dimension of the stance-limb center-of-pressure path of the injured limb. Researchers need to determine if some deficits observed in the acute phase of lateral ankle sprain precede or predispose an athlete to the initial injury and to clarify whether these deficits are central to the onset of chronic injury.

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

“…Data previously published on these individuals combined measures of platform stabilometry and lower extremity joint kinematics to evaluate the sensorimotor control underpinning SEBT performance in the anterior (ANT) postero-lateral (PL) and postero-medial (PM) reach directions compared to healthy controls [6,7]. The current study pertains to data acquired from these participants one-year after sustaining their injury, thus allowing them to be classified as having chronic ankle instability or being an lateral ankle sprain coper.…”

“…However, despite the tendency for a high proportion of individuals to develop chronic ankle instability following an acute lateral ankle sprain (up to 74%) [1], some recover from this injury with no symptom progression. The existence of these individuals, who have been labelled lateral ankle sprain copers [34], has given rise to a hypothesis that recovery following lateral ankle sprain injury is dependent on the sensorimotor control strategies adopted post-injury [7,9].…”

“…The manifestations of functional instability include impairments in sensorimotor control [27,33], which have been previously quantified by means of static [18,26,35] and dynamic balance tasks [28]. The Star Excursion Balance Test (SEBT) is one of the most commonly utilised measures of dynamic balance in lateral ankle sprain populations, capably identifying those who are at an increased risk of sustaining an ankle sprain injury [4,30], who have a current acute lateral ankle sprain injury [7], who are proceeding along the recovery trajectory of this injury [6], and who develop the chronic sequalae of chronic ankle instability [2,13,14,16]. However, despite the tendency for a high proportion of individuals to develop chronic ankle instability following an acute lateral ankle sprain (up to 74%) [1], some recover from this injury with no symptom progression.…”

Sex differences in frontal and transverse plane hip and knee kinematics during the modified Star Excursion Balance Test

“…Gribble et al [27] found that women demonstrated increased reach distances as compared with men in all three reach directions and attained a greater degree of hip and knee flexion at the maximal displacement following a fatigue inducing protocol. In contrast, Doherty et al [26] compared performance on the mSEBT between men and women after acute lateral ankle sprain, and found no significant difference in reach performance. However, Gribble et al [17,29] do point out kinematic reach differences in hip, knee, and ankle flexion between injured and uninjured populations.…”

“…Previous studies comparing the sagittal, frontal, and transverse plane kinematics during the mSEBT between sexes were primarily devoted to fatigued or injured populations only [18,[24][25][26][27][28]. Although investigators have performed kinematic analysis on healthy, non-fatigued individuals during the mSEBT, they limited their analysis to lower extremity sagittal plane angles [27].…”