Considering the high recurrent injury rates, athletes may receive clearance for return to play (RTP) from a lateral ankle sprain (LAS) before impairments and activity limitations are resolved. The purpose of this study was to examine residual structural and functional impairments and activity limitations at RTP in athletes with a LAS. We found that athletes demonstrated increased ankle ligamentous laxity and reduced self-reported function, dorsiflexion range of motion, and dynamic postural control at RTP. Athletes with a LAS likely require more extensive care to resolve impairments and activity limitation before RTP.
Ryan McCann, Kyle Kosik, Masafumi Terada, and Phillip Gribble
Matthew Harkey, Michelle M. McLeod, Masafumi Terada, Phillip A. Gribble, and Brian G. Pietrosimone
Spinal-reflexive and corticomotor excitability may have a critical role in altering muscle function needed to stabilize the ankle in people with chronic ankle instability (CAI).
To determine the association between self-reported disability and both spinal-reflexive and corticomotor excitability in people with CAI.
Descriptive laboratory study.
30 participants with CAI.
Main Outcome Measures:
Soleus spinal-reflexive excitability was measured with normalized Hoffmann reflexes (H:M ratio), and corticomotor excitability was measured with transcranial magnetic stimulation and quantified by normalized motor-evoked-potential (MEP) amplitudes at 120% of active motor threshold (120%MEP). Self-reported disability was quantified with the activities-of-daily-living and sport subscales of the Foot and Ankle Ability Measure (FAAM-ADL and FAAM-S). Separate linear Pearson product–moment correlations and nonlinear quadratic correlations were used to determine associations between the neural-excitability and disability variables.
Thirty participants were included in the spinal-reflexive-excitability analysis, while only 19 were included in the corticomotor analysis. There was a significant, weak linear association between H:M ratio and FAAM-ADL (R = .39, P = .03) and a nonsignificant, weak linear association between H:M ratio and FAAM-S (R = .36, P = .06). There were significant, moderate quadratic associations between H:M ratio and both FAAM-ADL (R = .48, P = .03) and FAAM-S (R = .50, P = .02). There was a significant, moderate linear association between 120%MEP and FAAM-ADL (R = –.48, P = .04) and a nonsignificant, moderate negative linear association between FAAM-S (R = –.42, P = .07). There was a significant, moderate quadratic association between 120%MEP and FAAM-ADL (R = .57, P = .046) and a significant, strong quadratic correlation between 120%MEP and FAAM-S (R = .71, P = .004).
There are significant quadratic associations between self-reported disability and both spinal-reflexive and corticomotor excitability of the soleus. CAI participants with low or high neural excitability present with lower function.
Masafumi Terada, Megan Beard, Sara Carey, Kate Pfile, Brian Pietrosimone, Elizabeth Rullestad, Heather Whitaker, and Phillip Gribble
This study aimed to compare time-to-boundary and sample entropy during a single-leg balance task between individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Twenty-two participants with CAI, 20 lateral ankle sprain copers, and 24 healthy controls performed a single-leg balance task during an eyes-closed condition. Participants with CAI exhibited lower time-to-boundary values compared with lateral ankle sprain copers and healthy controls. However, we did not find differences in sample entropy variables between cohorts. A decrease in time-to-boundary values in participants with CAI indicated that CAI may constrain the ability of the sensorimotor system to maintain the center of pressure within the boundaries of the base of support. However, the regularity of the center of pressure velocity time series appears not to be altered in the CAI cohort in this study.
Matthew Harkey, Michelle McLeod, Ashley Van Scoit, Masafumi Terada, Michael Tevald, Phillip Gribble, and Brian Pietrosimone
Altered neuromuscular function and decreased dorsiflexion range of motion (DFROM) have been observed in patients with chronic ankle instability (CAI). Joint mobilizations are indicated for restoring DFROM and dynamic postural control, yet it remains unknown if a mobilization can alter neuromuscular excitability in muscles surrounding the ankle.
To determine the immediate effects of a Maitland grade III anterior-to-posterior joint mobilization on spinal-reflex and corticospinal excitability in the fibularis longus (FL) and soleus (SOL), DFROM, and dynamic postural control.
Single-blinded randomized control trial.
30 patients with CAI randomized into a mobilization (n = 15) or control (n = 15) group.
Maitland grade III anterior-to-posterior joint mobilization.
Main Outcome Measures:
Spinal-reflex excitability was measured with the Hoffmann reflex, while corticospinal excitability was evaluated with transcranial magnetic stimulation. DFROM was measured seated with the knee extended, and dynamic postural control was quantified with the Star Excursion Balance Test. Separate 2 × 2 repeated-measures ANOVAs were performed for each outcome measure. Dependent t tests were used to evaluate individual differences within groups in the presence of significance.
Spinal-reflex and corticospinal excitability of the SOL and FL were not altered in the mobilization or control group (P > .05). DFROM increased immediately after the mobilization (P = .05) but not in the control group, while dynamic postural control was unchanged in both groups (P > .05).
A single joint-mobilization treatment was efficacious at restoring DFROM in participants with CAI; however, excitability of spinal reflex and corticospinal pathways at the ankle and dynamic postural control were unaffected.
Ryan S. McCann, Kyle B. Kosik, Masafumi Terada, Megan Q. Beard, Gretchen E. Buskirk, and Phillip A. Gribble
The Star Excursion Balance Test (SEBT) and Functional Movement Screen (FMS) are functional performance measures capable of predicting lower-extremity injury risk. While suboptimal SEBT and FMS performances are influenced by multiple factors, the contribution of hip strength and flexibility to these tests is mostly unknown. Examination of hip strength and flexibility influences on the SEBT and FMS may direct clinicians to better methods of correcting functional deficits.
Determine the relationships of isometric hip strength and hip passive range of motion (PROM) with functional performance measures.
Athletic training facility.
43 NCAA Division I women’s soccer players (19.65 ± 1.12 y; 166.93 ± 3.84 cm; 60.99 ± 4.31 kg) volunteered.
Data Collection and Analysis:
All participants were tested bilaterally in the SEBT; the deep squat, in-line lunge, hurdle step, and straight leg raise, comprising a lower-extremity FMS (FMS-LE); hip internal and external rotation PROM; and isometric hip extension strength (HEXT). The mean of the 3 averaged, normalized SEBT scores was used as a composite score. Pearson product moment correlations assessed relationships of SEBT and FMS-LE scores with PROM and HEXT. Significance was set a priori at P < .05.
Pearson correlations revealed anterior (ANT) SEBT scores had a low negative association with HEXT (r = –0.33,P = .004) and a low positive association with hip internal rotation PROM (PROM-IR) (r = .43,P = .003). All other correlations were negligible.
Flexibility training aimed at PROM-IR may contribute to improved ANT scores. Targeting HEXT and hip external rotation PROM are likely not preferred means of correcting deficits in SEBT and FMS-LE performance.
Daichi Tomita, Tadashi Suga, Hiromasa Ueno, Yuto Miyake, Takahiro Tanaka, Masafumi Terada, Mitsuo Otsuka, Akinori Nagano, and Tadao Isaka
This study examined the relationship between Achilles tendon (AT) length and 100-m sprint time in sprinters. The AT lengths at 3 different portions of the triceps surae muscle in 48 well-trained sprinters were measured using magnetic resonance imaging. The 3 AT lengths were calculated as the distance from the calcaneal tuberosity to the muscle–tendon junction of the soleus, gastrocnemius medialis, and gastrocnemius lateralis, respectively. The absolute 3 AT lengths did not correlate significantly with personal best 100-m sprint time (r = −.023 to .064, all Ps > .05). Furthermore, to minimize the differences in the leg length among participants, the 3 AT lengths were normalized to the shank length, and the relative 3 AT lengths did not correlate significantly with personal best 100-m sprint time (r = .023 to .102, all Ps > .05). Additionally, no significant correlations were observed between the absolute and relative (normalized to body mass) cross-sectional areas of the AT and personal best 100-m sprint time (r = .012 and .084, respectively, both Ps > .05). These findings suggest that the AT morphological variables, including the length, may not be related to superior 100-m sprint time in sprinters.
Katherine L. Helly, Katherine A. Bain, Matthew C. Hoch, Nicholas R. Heebner, Phillip A. Gribble, Masafumi Terada, and Kyle B. Kosik
Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P = .030), and higher TTB anterior–posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.
Ryan S. McCann, Kyle B. Kosik, Masafumi Terada, and Phillip A. Gribble
Several investigators have aimed to predict recurrent injuries following acute ankle sprains, but none has done so in high school or collegiate athletes. The purpose of this study was to determine the ability of demographic, anthropometric, and disease- and patient-oriented outcomes to predict recurrent ankle sprains in athletes during the same competitive season following return to play from an ankle sprain. Only increased patient height and mass were associated with increased odds of sustaining a recurrent ankle sprain. Thus, taller and heavier patients might have the greatest risk of sustaining a recurrent ankle sprain in the same season as a previous ankle sprain.