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Alecia Puls and Phillip Gribble

Context:

Thera-Band™ (TB) exercises are commonly utilized in ankle rehabilitation, but previous studies have shown inconsistent results.

Objective:

To compare two TB protocols among healthy subjects in improving postural control.

Design:

Mixed model design.

Setting:

Research laboratory.

Participants:

Thirty healthy subjects divided into a control (CON), three times/week (TB3) or five times/week (TB5) group.

Intervention:

Training groups completed TB quick-kick protocols for six weeks either three (TB3) or five times (TB5) per week.

Main Outcome Measure:

Center of pressure velocity in the anterior/posterior (COPVX) and medial/lateral (COPVY) directions.

Results:

There were no differences related to Group or Side. COPVX in the eyes open (EO) condition increased pre-post. COPVY decreased pre-post.

Conclusion:

The lack of differences between Groups and Side indicates these specific TB training protocols did not impact static postural control differently among healthy subjects.

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Richard Robinson and Phillip Gribble

Context:

The Star Excursion Balance Test (SEBT) is composed of 8 reaching directions that are potentially measuring the same functional component, leading to the suggestion that the number of reach directions could be reduced without compromising the assessment of dynamic postural control.

Objective:

To determine whether the relationship of stance-leg angular displacement on normalized reach distance is a source of dynamic-postural-control measurement redundancy.

Design:

Single-session within-subjects design.

Setting:

Athletic training research laboratory.

Participants:

10 women and 10 men.

Interventions:

None.

Main Outcome Measures:

Normalized reach distance and angular displacement at the knee and hip.

Results:

Stepwise regression revealed that hip flexion and knee flexion, separately and in combination, accounted for 62% to 95% of the variance in reach distances.

Conclusion:

Similarity in lower extremity function could account for the previously observed measurement redundancy in the SEBT.

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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.

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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.

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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.

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Phillip Gribble

Column-editor : Thomas W. Kaminski

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Ryan McCann, Kyle Kosik, Masafumi Terada and Phillip Gribble

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.

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Phillip Gribble, Jay Hertel, Craig Denegar and William Buckley

Context:

The SMART™ software system offers low-cost kinematic analysis through digitization of video from a single camera. The reliability and validity of this product have not been reported.

Objective:

To assess the reliability and validity of the SMART software during a simple static task and dynamic task.

Design:

Test–retest to compare assumed neutral and goniometrically measured joint angles in the sagittal plane of the lower extremity.

Setting:

Research laboratory.

Participants:

7 in a static task, 16 young, physically active in a dynamic task.

Results:

Measurement error of the SMART system ranged from 0.29° ± 1.98° to 11.07° ± 1.77°. The interrater reliability (ICC2,1) values ranged from .60 to .92 for the static task and from .76 to .89 for the dynamic task.

Conclusions:

Based on the results of both studies, the SMART system offers a low-cost alternative for reporting single-plane kinematics during an individual frame of video during static stances and slow dynamic tasks with strong reliability and reasonable validity.

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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.

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Ryan S. McCann and Phillip A. Gribble