Search Results

You are looking at 1 - 10 of 30 items for

  • Author: Phillip A. Gribble x
  • Refine by Access: All Content x
Clear All Modify Search
Restricted access

Kathryn A. Webster and Phillip A. Gribble

Context:

Functional rehabilitation is often employed for ankle instability, but there is little evidence to support its efficacy, especially in those with chronic ankle instability (CAI).

Objective:

To review studies using both functional rehabilitation interventions and functional measurements to establish the effectiveness of functional rehabilitation for both postural control and self-reported outcomes in those with CAI.

Evidence Acquisition:

The databases of Medline, SPORTDiscus, and PubMed were searched between the years 1988 and 2008. Inclusion criteria required articles to have used a clinical research trial involving at least 1 functional rehabilitation intervention, have at least 1 outcome measure of function and/or functional performance, and to have used at least 1 group of subjects who reported either repeated lateral ankle sprains or episodes of “giving way.” The term functional was operationally defined as dynamic, closed-kinetic-chain activity other than quiet standing.

Evidence Synthesis:

Six articles met the inclusion criteria. The articles reviewed used multiple functional means for assessment and training, with a wobble board or similar device being the most common. Despite effect sizes being inconsistent for measures of dynamic postural control, all interventions resulted in improvements. Significant improvements and strong effect sizes were demonstrated for self-reported outcomes.

Conclusions:

The reviewed studies using functional rehabilitation interventions and functional assessment tools were associated with improved ankle stability for both postural control and self-reported function, but more studies may be needed with more consistent effect sizes and confidence intervals to make a definitive conclusion.

Restricted access

Shiho Goto, Naoko Aminaka, and Phillip A. Gribble

Context : Altered lower-extremity muscle activity has been associated with lower-extremity kinematics in individuals with patellofemoral pain (PFP). However, few studies have examined these relationships, and the results are inconsistent. Objective: To compare the lower-extremity muscle activity, kinematics, pain level, and reach distance during the anterior reach of the star excursion balance test (SEBT) between participants with PFP and healthy individuals (control [CON] group). Design: Case control. Setting: Research laboratory. Participants: Twenty-eight (PFP = 14 and CON = 14) participants volunteered. Intervention: Each participant performed 3 maximal voluntary isometric contractions of the gluteus maximus, gluteus medius (GMED), adductor longus (AL), and vastus medialis, and 5 anterior reaches of the SEBT. Main Outcome Measures: Three-dimensional joint kinematics of the hip and knee at the time of touchdown of the SEBT and integrated electromyography of each muscle were recorded during the descent phase of the SEBT. Coactivation ratios between the GMED and AL were calculated (GMED/AL). Pain level was assessed at the baseline and during performance of the SEBT, using a visual analog scale. Results: Participants with PFP demonstrated decreased GMED/AL coactivation ratio (P = .01) and shorter reach distance (P = .01) during anterior reach of the SEBT compared with the CON group. Participants with PFP demonstrated higher pain levels at baseline (P = .03) and during test performance (P < .001) compared with the CON group and increased pain level during the test performance compared with the baseline (P < .001). No other significant differences were observed. Conclusions: There were alterations in muscle activity during SEBT performance, suggesting that overactivity of AL relative to GMED is a unique neural recruitment pattern in those with PFP. However, hip and knee joint kinematics did not seem to contribute to deficits in the anterior reach distance, suggesting a need for continued assessment of these deficiencies.

Restricted access

Kyle B. Kosik and Phillip A. Gribble

Clinical Scenario: Dorsiflexion range of motion is an important factor in the performance of the Star Excursion Balance Test (SEBT). While patients with chronic ankle instability (CAI) commonly experience decreased reach distances on the SEBT, ankle joint mobilization has been suggested to be an effective therapeutic intervention for targeting dorsiflexion range of motion. Clinical Question: What is the evidence to support ankle joint mobilization for improving performance on the SEBT in patients with CAI? Summary of Key Findings: The literature was searched for articles examining the effects of ankle joint mobilization on scores of the SEBT. A total of 3 peer-reviewed articles were retrieved, 2 prospective individual cohort studies and 1 randomized controlled trial. Only 2 articles demonstrated favorable results following 6 sessions of ankle joint mobilization. Clinical Bottom Line: Despite the mixed results, the majority of the available evidence suggests that ankle joint mobilization improves dynamic postural control. Strength of Recommendation: In accordance with the Centre of Evidence Based Medicine, the inconsistent results and the limited high-quality studies indicate that there is level C evidence to support the use of ankle joint mobilization to improve performance on the SEBT in patients with CAI.

Open access

Katherine L. Helly, Katherine A. Bain, Phillip A. Gribble, and Matthew C. Hoch

Clinical Scenario: Patients with chronic ankle instability (CAI) demonstrate deficits in both sensory and motor function, which can be objectively evaluated through static postural control testing. One intervention that has been suggested to improve somatosensation and, in turn, static postural control is plantar massage. Clinical Question: Does plantar massage improve static postural control during single-limb stance in patients with CAI relative to baseline? Summary of Key Findings: A search was performed for articles exploring the effect of plantar massage on static postural control in individuals with CAI. Three articles were included in this critically appraised topic including 1 randomized controlled trial and 2 crossover studies. All studies supported the use of plantar massage to improve static postural control in patients with CAI. Clinical Bottom Line: There is currently good-quality and consistent evidence that supports the use of plantar massage as an intervention that targets the somatosensory system to improve static postural control in patients with CAI. Future research should focus on incorporating plantar massage as a treatment intervention during long-term rehabilitation protocols for individuals with CAI. Strength of Recommendation: In agreement with the Center of Evidence-Based Medicine, the consistent results from 2 crossover studies and 1 randomized controlled trial designate that there is level B evidence due to consistent, moderate- to high-quality evidence.

Restricted access

Megan Q. Beard, Samantha A. Boland, and Phillip A. Gribble

Decreased hip strength is often present in patients with chronic overuse lower extremity injuries. The hand-held dynamometer (HHD) can be used in a clinical setting to quantify hip strength; however, reliability of the device remains unclear. The purpose of this study was to determine the interexaminer and intersession reliability of a HHD when measuring isometric hip abduction (HABD) and external rotation (HER) strength, both with and without a fixed strap. The HHD had good to high reliability regardless of examiner, session, or stabilization when measuring HABD (ICC = 0.885–0.977) and HER (ICC = 0.879–0.958) isometric strength. HHD is an appropriate instrument for measuring isometric hip strength.

Open access

Bridget M. Walsh, Katherine A. Bain, Phillip A. Gribble, and Matthew C. Hoch

Clinical Scenario: Patients with chronic ankle instability (CAI) commonly display lower levels of self-reported function and health-related quality of life. Several rehabilitation interventions, including manual therapy, have been investigated to help CAI patients overcome these deficits. However, it is unclear if the addition of manual therapy to exercise-based rehabilitation is more effective than exercise-based rehabilitation alone. Clinical Question: Does incorporating manual therapy with exercise-based rehabilitation improve patient-reported outcomes when compared with exercise-based rehabilitation alone? Summary of Key Findings: The literature was searched for articles that examined the difference in outcomes for patients with CAI between manual therapy with exercise-based rehabilitation and exercise-based rehabilitation alone. A total of 3 peer-reviewed randomized controlled trials were identified. Two articles demonstrated improved patient-reported outcome scores following the incorporation of manual therapy with exercise-based rehabilitation, whereas one study found no statistically significant differences between interventions. Clinical Bottom Line: The current evidence suggests that incorporating manual therapy in addition to exercised-based rehabilitation may improve patient-reported outcome scores in patients with CAI. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of A is recommended due to consistent evidence from high-quality studies.

Restricted access

Kyeongtak Song, Kyle B. Kosik, Phillip A. Gribble, and Erik A. Wikstrom

Context: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. Objective: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. Design: Descriptive observational study. Setting: Laboratory. Patients or Other Participants: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. Intervention: None. Main Outcome Measures: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). Results: For T1ρ relaxation time, intraobserver (ICC = .994–.997, RMSCV = 1.31%–1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975–.980, RMSCV = 3.88%–4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. Conclusions: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.

Restricted access

Phillip A. Gribble, Kevin M. Guskiewicz, William E. Prentice, and Edgar W. Shields

The purposes of this study were to determine the effects of static and hold-relax stretching on hamstring range of motion and to examine the reliability of the FlexAbility LE1000 compared with the goniometrically measured active knee-extension test. Forty-two participants (18–25 years old) were assigned to either a control, static, or hold-relax training group. Participants were stretched four times a week over a 6-week period, with four 30-s stretches per session using a straight-leg-raise method on the FlexAbility LE1000. It was determined that both static and hold-relax techniques significantly improved hamstring flexibility (ISLR: +33.08° ± 9.08° and +35.17° ± 10.39°, respectively). Participants of both techniques reached a plateau in flexibility improvement between Weeks 4 and 5. Thus, static and hold-relax stretching are equally effective in improving hamstring ROM. The FlexAbility LE1000 and the goniometer were both found to be highly reliable. Therefore, either measurement technique could be used successfully to measure hip-flexion ROM.

Restricted access

Phillip A. Gribble, Richard H. Robinson, Jay Hertel, and Craig R. Denegar

Context:

Deficits in static postural control related to fatigue have been investigated previously, but there is little evidence to link fatigue to performance measures of dynamic postural control.

Objective:

To investigate the effects of fatigue and gender on performance measures of the Star Excursion Balance Test (SEBT).

Design:

Mixed-model design.

Setting:

Research laboratory.

Participants:

16 healthy young adults.

Intervention:

Subjects performed the SEBT before and after 4 different fatiguing conditions.

Main Outcome Measures:

The normalized reach distances and sagittal-plane kinematics of the knee and hip were recorded.

Results:

Fatigue produced deficits in normalized reach distances and decreased knee flexion in all 3 reaching directions. Overall, women were able to reach farther than men while simultaneously demonstrating a greater amount of knee flexion.

Conclusions:

Gender differences were observed during performance of the SEBT, with women demonstrating greater reach distances and knee flexion, and fatigue amplified these differences.

Restricted access

Kyle Kosik, Masafumi Treada, Ryan McCann, Samantha Boland, and Phillip A. Gribble

Proximal neuromuscular alterations are hypothesized to contribute to the patient- and disease-oriented deficits observed in CAI individuals. The objective was to compare the efficacy of two 4-week intervention programs with or without proximal joint exercises. Twenty-three individuals with CAI completed this single-blinded randomized controlled trial. Outcome measures included the Star Excursion Balance Test (SEBT) and the Foot and Ankle Ability Measure (FAAM). A time main effect was observed for the FAAM-ADL (p = .013), FAAM-Sport (p = .012), and posteromedial (p = .04) and posterolateral (p = .003) SEBT reach directions. No group main effect or time by group interaction was found. Four weeks of supervised rehabilitation improved self-reported function and dynamic balance in people with CAI.