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Instrumented Ankle Arthrometry

John E. Kovaleski and J. Marcus Hollis

Column-editor : Thomas W. Kaminski

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Time to Stabilization: A Method for Analyzing Dynamic Postural Stability

Scott E. Ross and Kevin M. Guskiewicz

Column-editor : Thomas W. Kaminski

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Negligence Liability

Michael G. Dolan, Dan Connaughton, and Milledge Murphey

Column-editor : Thomas W. Kaminski

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Differential Assessment of Elbow Injuries

Thomas W. Kaminski, Michael E. Powers, and Bernadette Buckley

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Effect of Fatigue on Neuromuscular Function at the Ankle

Gregory M. Gutierrez, Nicole D. Jackson, Kristin A. Dorr, Sarah E. Margiotta, and Thomas W. Kaminski

Context:

Lateral ankle sprains occur more frequently than any other orthopedic injury. Athletes often report sustaining more injuries late in competition when fatigue is present.

Objective:

To evaluate neuromuscular function of the ankle musculature after fatigue. Design: Experimental, pretest-posttest.

Setting:

Research laboratory.

Participants:

Ten female and 9 male college-aged subjects.

Intervention:

Fatigue was induced via continuous concentric and eccentric muscle actions of the ankle: inversion (INV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF).

Main Outcome Measures:

Peak torque (PT), peak EMG, and median frequency (MF) were calculated prefatigue and postfatigue in the tibialis anterior (TA), peroneus longus (PER), and lateral gastrocnemius (GAS) muscles.

Results:

Main effects were noted for test (P < 0.0125) in all statistical tests performed indicating changes in PT, peak EMG, and MF after fatigue.

Conclusions:

A significant decrease in MF of the PER muscle after PF fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.

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Ankle Strength Deficits in a Cohort of College Athletes With Chronic Ankle Instability

Bethany Wisthoff, Shannon Matheny, Aaron Struminger, Geoffrey Gustavsen, Joseph Glutting, Charles Swanik, and Thomas W. Kaminski

Context: Lateral ankle sprains commonly occur in an athletic population and can lead to chronic ankle instability. Objective: To compare ankle strength measurements in athletes who have mechanical laxity and report functional instability after a history of unilateral ankle sprains. Design: Retrospective cohort. Setting : Athletic Training Research Lab. Participants: A total of 165 National Collegiate Athletic Association Division I athletes, 97 males and 68 females, with history of unilateral ankle sprains participated. Main Outcome Measures: Functional ankle instability was determined by Cumberland Ankle Instability Tool scores and mechanical ankle instability by the participant having both anterior and inversion/eversion laxity. Peak torque strength measures, concentric and eccentric, in 2 velocities were measured. Results: Of the 165 participants, 24 subjects had both anterior and inversion/eversion laxity and 74 self-reported functional ankle instability on their injured ankle. The mechanical ankle instability group presented with significantly lower plantar flexion concentric strength at 30°/s (139.7 [43.7] N·m) (P = .01) and eversion concentric strength at 120°/s (14.8 [5.3] N·m) (P = .03) than the contralateral, uninjured ankle (166.3 [56.8] N·m, 17.4 [6.2] N·m, respectively). Conclusion: College athletes who present with mechanical laxity on a previously injured ankle exhibit plantar flexion and eversion strength deficits between ankles.

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Evaluating Postural Control and Ankle Laxity Between Taping and High-Top Cleats in High School Football Players

Douglas A. Pizac, Charles B. Swanik, Joseph J. Glutting, and Thomas W. Kaminski

Context: Lateral ankle sprains are the most common injuries in high school sports. While ankle taping is a preferred method of external prophylactic support, its restrictive properties decline during exercise. The Under Armour® Highlight cleat is marketed on the premise that it provides added support without the need for additional ankle taping. Objective: To determine if differences in ankle joint laxity and postural control exist between football players wearing the Under Armour® Highlight cleat (Under Armour Inc, Baltimore, MD) as compared to a low/mid-top cleat with ankle tape. Design: Crossover trial. Setting: Athletic training room and football practice field sideline. Patients: 32 interscholastic football players (15.8 ± 1.0 y; 178.9 ± 7.4 cm; 87.1 ± 21.4 kg). Interventions: Ankle laxity was assessed using an instrumented ankle arthrometer (Blue Bay Research Inc, Milton, FL), while postural control testing was performed on the Tekscan MobileMat™ Balanced Error Scoring System (BESS; South Boston, MA). The 2 treatments included Under Armour® Highlight cleats and a low/mid-top cleat with ankle tape applied to the nondominant ankle only. Measurements were taken before and immediately after practice. Main Outcome Measures: The independent variable was treatment (Highlight vs low/mid-top cleat with ankle tape). Dependent variables included ankle arthrometry measures of anterior displacement (mm), inversion/eversion rotation (deg), and the modified BESS error scores. A linear mixed-effects model was used for analysis. Results: The low/mid-top cleat with tape condition had significantly higher inversion range-of-motion (ROM) and inversion/eversion rotation postexercise when compared to the Highlight cleat (P < 0.05). Conclusions: The results of this study provide some evidence that the Under Armour® Highlight cleat restricts ankle ROM following a training session better than the taped low/mid-top cleat. Further study is warranted to determine if this high-top style of football cleat can reduce the incidence of ankle sprains and how it might compare to spat taping.

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The Reliability and Validity of Ankle Inversion and Everson Torque Measurements from the Kin Com II Isokinetic Dynamometer

Thomas W. Kaminski, David H. Perrin, Carl G. Mattacola, Joseph E. Szczerba, and Julie N. Bernier

This study examined the test-retest reliability of a prototype device used to measure ankle inversion and eversion isokinetic average torque values. The purpose of this paper was to illustrate a situation where common isokinetic measures were reliable but not valid. Concentric and eccentric average torque was assessed at 90 deg/s on the Kin Com II dynamometer using 14 healthy subjects in two sessions; a manufactured prototype ankle inversion/eversion attachment device was used. Reliability was assessed by performing separate intraclass correlations (ICC 2,1) on the results. The data indicated that the average torque calculated from the clockwise direction was consistently higher than those values from the counterclockwise direction, regardless of ankle movement or side measured. The validity of this prototype device to accurately measure average torque for these two ankle motions is questionable. This finding demonstrates a situation where the measures appear to be reliable while the validity of the device used to obtain the measures is suspect.

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Six Weeks of Strength and Proprioception Training Does Not Affect Muscle Fatigue and Static Balance in Functional Ankle Instability

Michael E. Powers, Bernadette D. Buckley, Thomas W. Kaminski, Tricia J. Hubbard, and Cindy Ortiz

Context:

The combined effects of strength and proprioception training, especially in individuals with ankle instability, have not been studied extensively.

Objective:

To examine the influence of 6 weeks of strength and proprioception training on measures of muscle fatigue and static balance in those with unilateral functional ankle instability (FAI).

Design:

Pretest–posttest, randomized groups.

Setting:

A climate-controlled sports-medicine research laboratory.

Subjects:

38 subjects with self-reported unilateral FAI.

Measurements:

Muscle fatigue was determined using the median power frequency (f med) from an electromyographic signal, and static balance was assessed using center-of-pressure values obtained from a triaxial force plate.

Results:

There were no significant effects of the strength or proprioception training on our measures of muscle fatigue and static balance.

Conclusions:

Strength training, proprioception training, and the combination of the 2 failed to improve postural-stability characteristics in a group of subjects with FAI.

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The Ottawa Ankle Rules and the “Buffalo” Rule, Part 1: Overview and Background

Rebecca L. Northrup, Brian G. Ragan, and Gerald W. Bell

Column-editor : Thomas W. Kaminski