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Altered Plantar-Receptor Stimulation Impairs Postural Control in Those With Chronic Ankle Instability

Patrick O. McKeon, Alex J. Stein, Christopher D. Ingersoll, and Jay Hertel

Context:

Postural control as assessed via time-to-boundary (TTB) measures has been shown to be impaired in those with chronic ankle instability (CAI). Foot orthotics have been shown to improve postural control, although it is not clear if this is via mechanical or sensorimotor mechanisms.

Objective:

To assess the effect of textured shoe inserts that provide no mechanical support on postural control as assessed by TTB measures in subjects with CAI.

Design:

A crossover design to examine the effects of a textured insole on postural control in individuals with unilateral CAI. The independent variables were vision (eyes open, eyes closed) and texture (textured insole, sham insole, control).

Setting:

Laboratory.

Participants:

20 physically active individuals, 12 men, 8 women, age 18–45 y (21.5 ± 5.51) with self-reported CAI.

Intervention:

Each subject balanced in shod single-limb stance with eyes open and eyes closed under 3 conditions (control, sham, and textured insole). The order of testing under the 3 shoe conditions and 2 vision conditions was counterbalanced.

Main Outcome Measures:

The mean of TTB minima and the standard deviation of TTB minima in the mediolateral (ML) and anteroposterior directions.

Results:

There were significant reductions in TTB ML magnitude and variability found in the textured condition compared with the control and sham conditions. In the textured condition, subjects failed significantly more trials than any other condition.

Conclusions:

Stimulating the plantar surface of the foot, via a textured insole, has an effect in the broad spectrum of postural-control maintenance in individuals with CAI.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 21 (2012): Issue 1 (Jan 2012)

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The Relationship of Ankle Temperature during Cooling and Rewarming to the Human Soleus H Reflex

B. Andrew Krause., J. Ty Hopkins, Christopher D. Ingersoll, Mitchell L. Cordova, and Jeffrey E. Edwards

Objective:

Correlate skin temperature and motoneuron-pool recruitment during cooling and rewarming.

Design:

Within-subjects, correlational analysis. H reflex was correlated to ankle-skin temperature over time using a Pearson product-moment correlation coefficient and a coefficient of determination (R2).

Subjects:

Ten healthy, physically active college students.

Measurements:

Soleus H reflex and ankle-skin interface temperature were measured during ice application and rewarming. Electrical stimulation was delivered to produce 75% of each subject's maximum H reflex.

Results:

Ankle cooling (r = −.95, P < .05) exhibited a strong inverse relationship with soleus H reflex. A positive correlation was observed between rewarming (r = .74, P < .05) and soleus H reflex.

Conclusions:

Temperature accounts for nearly 90% (R2 = .90) of the variability in the soleus H reflex during cooling and 55% (R2 = .55) during rewarming, suggesting that more motoneurons are recruited as temperature decreases. These interactions appear to involve both local and central nervous system functions.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 9 (2000): Issue 3 (Jan 2000)

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Knee-Extension Exercise’s Lack of Immediate Effect on Maximal Voluntary Quadriceps Torque and Activation in Individuals With Anterior Knee Pain

Jihong Park, Terry L. Grindstaff, Joe M. Hart, Jay N. Hertel, and Christopher D. Ingersoll

Context:

Weight-bearing (WB) and non-weight-bearing (NWB) exercises are commonly used in rehabilitation programs for patients with anterior knee pain (AKP).

Objective:

To determine the immediate effects of isolated WB or NWB knee-extension exercises on quadriceps torque output and activation in individuals with AKP.

Design:

A single-blind randomized controlled trial.

Setting:

Laboratory.

Participants:

30 subjects with self-reported AKP.

Interventions:

Subjects performed a maximal voluntary isometric contraction (MVIC) of the quadriceps (knee at 90°). Maximal voluntary quadriceps activation was quantified using the central activation ratio (CAR): CAR = MVIC/(MVIC + superimposed burst torque). After baseline testing, subjects were randomized to 1 of 3 intervention groups: WB knee extension, NWB knee extension, or control. WB knee-extension exercise was performed as a sling-based exercise, and NWB knee-extension exercise was performed on the Biodex dynamometer. Exercises were performed in 3 sets of 5 repetitions at approximately 55% MVIC. Measurements were obtained at 4 times: baseline and immediately and 15 and 30 min postexercise.

Main Outcome Measures:

Quadriceps torque output (MVIC: N·m/Kg) and quadriceps activation (CAR).

Results:

No significant differences in the maximal voluntary quadriceps torque output (F 2,27 = 0.592, P = .56) or activation (F 2,27 = 0.069, P = .93) were observed among the 3 treatment groups.

Conclusions:

WB and NWB knee-extension exercises did not acutely change quadriceps torque output or activation. It may be necessary to perform exercises over a number of sessions and incorporate other disinhibitory interventions (eg, cryotherapy) to observe acute changes in quadriceps torque and activation.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 21 (2012): Issue 2 (Jan 2012)

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Cryotherapy Does Not Affect Peroneal Reaction Following Sudden Inversion

Christine L. Berg, Joseph M. Hart, Riann Palmieri-Smith, Kevin M. Cross, and Christopher D. Ingersoll

Context:

If ankle joint cryotherapy impairs the ability of the ankle musculature to counteract potentially injurious forces, the ankle is left vulnerable to injury.

Objective:

To compare peroneal reaction to sudden inversion following ankle joint cryotherapy.

Design:

Repeated measures design with independent variables, treatment (cryotherapy and control), and time (baseline, immediately post treatment, 15 minutes post treatment, and 30 minutes post treatment).

Setting:

University research laboratory.

Patients or Other Participants:

Twenty-seven healthy volunteers.

Intervention(s):

An ice bag was secured to the lateral ankle joint for 20 minutes.

Main Outcome Measures:

The onset and average root mean square amplitude of EMG activity in the peroneal muscles was calculated following the release of a trap door mechanism causing inversion.

Results:

There was no statistically significant change from baseline for peroneal reaction time or average peroneal muscle activity at any post treatment time.

Conclusions:

Cryotherapy does not affect peroneal muscle reaction following sudden inversion perturbation.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 16 (2007): Issue 4 (Jan 2007)

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The Effect of Traditional Bridging or Suspension-Exercise Bridging on Lateral Abdominal Thickness in Individuals With Low Back Pain

Rebecca J. Guthrie, Terry L. Grindstaff, Theodore Croy, Christopher D. Ingersoll, and Susan A. Saliba

Context:

Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor control of the lumbopelvic region. It is unknown if therapeutic exercise can acutely facilitate activation of lateral abdominal musculature.

Objective:

To investigate the ability of 2 types of bridging-exercise progressions to facilitate lateral abdominal muscles during an abdominal drawing-in maneuver (ADIM) in individuals with LBP.

Design:

Randomized control trial.

Setting:

University research laboratory.

Participants:

51 adults (mean ± SD age 23.1 ± 6.0 y, height 173.6 ± 10.5 cm, mass 74.7 ± 14.5 kg, and 64.7% female) with LBP. All participants met 3 of 4 criteria for stabilization-classification LBP or at least 6 best-fit criteria for stabilization classification.

Interventions:

Participants were randomly assigned to either traditional-bridge progression or suspension-exercise-bridge progression, each with 4 levels of progressive difficulty. They performed 5 repetitions at each level and were progressed based on specific criteria.

Main Outcome Measures:

Muscle thickness of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) was measured during an ADIM using ultrasound imaging preintervention and postintervention. A contraction ratio (contracted thickness:resting thickness) of the EO, IO, and TrA was used to quantify changes in muscle thickness.

Results:

There was not a significant increase in EO (F 1,47 = 0.44, P = .51) or IO (F 1,47 = .30, P = .59) contraction ratios after the exercise progression. There was a significant (F 1,47 = 4.05, P = .05) group-by-time interaction wherein the traditional-bridge progression (pre = 1.55 ± 0.22; post = 1.65 ± 0.21) resulted in greater (P = .03) TrA contraction ratio after exercise than the suspension-exercise-bridge progression (pre = 1.61 ± 0.31; post = 1.58 ± 0.28).

Conclusion:

A single exercise progression did not acutely improve muscle thickness of the EO and IO. The magnitude of change in TrA muscle thickness after the traditional-bridging progression was less than the minimal detectable change, thus not clinically significant.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 21 (2012): Issue 2 (Jan 2012)

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Quadriceps Concentric EMG Activity Is Greater than Eccentric EMG Activity during the Lateral Step-Up Exercise

Angie Selseth, Marilyn Dayton, Mitchell L. Cordova, Christopher D. Ingersoll, and Mark A. Merrick

Purpose:

To analyze vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle activity during the concentric and eccentric phases of a lateral step-up exercise.

Design:

Repeated-measures. Dependent variable: the integrated electromyogram measured as a percentage of the maximal voluntary isometric contraction of the VMO and VL muscles. Independent variable: muscle contraction with 2 levels (concentric and eccentric).

Subjects:

Twenty-three volunteers with no previous history of knee surgery or anterior knee pain.

Methods:

Surface electrodes were positioned over the VMO and VL, and electromyographic data were collected during the exercise.

Results:

The 2 muscle phases of contraction were different when both dependent variables were considered simultaneously (F2,7 = 33.2, P < .001). Concentric contractions produced greater muscle activity for VL (P < .05) and VMO (P < .05).

Conclusions:

Because concentric contractions produce greater activity than eccentric contractions do during the lateral step-up exercise, they provide a stronger stimulus for muscle activation, which might result in greater muscle strength gains.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 9 (2000): Issue 2 (Jan 2000)

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Understanding Athletic Trainers’ Knowledge, Intervention, and Barriers Toward Arthrogenic Muscle Inhibition

Justin L. Rush, David A. Sherman, David M. Bazett-Jones, Christopher D. Ingersoll, and Grant E. Norte

Context: Arthrogenic muscle inhibition (AMI) is a common neurophysiological response to joint injury. While athletic trainers (ATs) are constantly treating patients with AMI, it is unclear how clinicians are using the available evidence to treat the condition. Objective: To investigate ATs’ general knowledge, clinical practice, and barriers for treating AMI. Methods: A cross-sectional web-based survey was utilized. The survey was distributed to a random sample of 3000 ATs from the National Athletic Trainers’ Association and through social media. 143 board certified ATs (age: 34.6 [10.3] y; experience: 11.7 [9.8] y) from various clinical settings and educational backgrounds were included in the analysis. Results: One hundred one respondents were able to correctly identify the definition of AMI. The majority of these respondents correctly reported that joint effusion (n = 95, 94.1%) and abnormal activity from joint receptors (n = 91, 90.1%) resulted in AMI. Of the 101 respondents, only 58 (57.4%) reported using disinhibitory interventions to treat AMI. The most frequently used evidence supported interventions were transcutaneous electrical nerve stimulation (n = 38, 65.5%), neuromuscular electrical stimulation (n = 33, 56.9%), and focal joint cooling (n = 25, 43.1%). The interventions used correctly most often based on current evidence were neuromuscular electrical stimulation (n = 29/33, 87.9%) and transcutaneous electrical nerve stimulation (n = 26/38, 68.4%). Overall, difficulty quantifying AMI (n = 62, 61.24%) and lack of education (n = 71, 76.2%) were most frequently perceived as barriers. Respondents that did not use disinhibitory interventions perceived lack of experience treating AMI, understanding the terminology, and access to therapeutic modalities more often than the respondents that reported using disinhibitory interventions. Conclusion: Further education about concepts and treatment about AMI is warranted for ATs. Continued understanding of ATs’ clinical practice in regard to AMI may help identify gaps in athletic training clinical education.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 31 (2022): Issue 6 (Aug 2022): Special Section: Arthrogenic Muscle Inhibition

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Center-of-Pressure Parameters Used in the Assessment of Postural Control

Riann M. Palmieri, Christopher D. Ingersoll, Marcus B. Stone, and B. Andrew Krause

Objective:

To define the numerous center-of-pressure derivatives used in the assessment of postural control and discuss what value each might provide in the assessment of balance.

Data Sources:

MEDLINE and SPORTDiscus were searched with the terms balance, postural control, postural sway, and center of pressure. The remaining citations were collected from references of similar papers. A total of 67 references were studied.

Conclusions:

Understanding what is represented by each parameter used to assess postural control is crucial. At the present time the literature has failed to demonstrate how the variables reflect changes made by the postural-control system. Until it can be shown that the center of pressure and its derivatives actually reveal changes in the postural-control system, the value of using these measures to assess deficits in postural control is minimized.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 11 (2002): Issue 1 (Jan 2002)

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Altered Ankle Kinematics and Shank-Rear-Foot Coupling in Those with Chronic Ankle Instability

Lindsay K. Drewes, Patrick O. McKeon, Gabriele Paolini, Patrick Riley, D. Casey Kerrigan, Christopher D. Ingersoll, and Jay Hertel

Context:

Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).

Objective:

To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.

Design:

Case control.

Setting:

Motion-analysis laboratory.

Participants:

7 participants (3 men, 4 women) suffering from CAI (age 24.6 ± 4.2 y, height 172.6 ± 9.4 cm, mass 70.9 ± 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 ± 4.5 y, height 168.2 ± 5.9 cm, mass 66.5 ± 9.8 kg).

Interventions:

Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.

Main Outcome Measures:

The positions of rear-foot inversion–eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.

Results:

The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.

Conclusions:

Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 18 (2009): Issue 3 (Jan 2009)

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Certified Athletic Trainers' Perceptions of Exercise-Associated Muscle Cramps

Marcus B. Stone, Jeffrey E. Edwards, Catherine L. Stemmans, Christopher D. Ingersoll, Riann M. Palmieri, and B. Andrew Krause

Context:

Despite recent evidence to suggest that exercise-associated muscle cramps (EAMC) might be primarily of neuromuscular origin, the authors surmise that most information available to certified athletic trainers (ATCs) emphasizes the role of dehydration and electrolyte imbalance in EAMC.

Objective:

To investigate ATCs' perceptions of EAMC.

Design:

7-question, Web-based, descriptive, cross-sectional survey.

Subjects:

997 ATCs.

Main Outcome Measures:

Responses to 7 questions regarding the cause, treatment, and prevention of EAMC.

Results:

Responders indicated humidity, temperature, training, dehydration, and electrolyte imbalance as causative factors of EAMC. Fluid replacement and stretching the involved muscle were identified as very successful in treating and preventing EAMC. Proper nutrition and electrolyte replacement were also perceived as extremely successful prevention strategies.

Conclusions:

ATCs' perceptions of the cause, treatment, and prevention of EAMC are primarily centered on dehydration and electrolyte imbalance. Other prominent ideas concerning EAMC should be implemented in athletic training education.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 12 (2003): Issue 4 (Jan 2003)