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Nili Steinberg, Roger Adams, Moshe Ayalon, Nadav Dotan, Shiri Bretter and Gordon Waddington

factor that may decrease the risk of ankle injury. 1 , 3 Proprioception is the ability to sense joint position and the movement of limb segments relative to one another. The receptors located in the joints, muscles, and skin provide the central nervous system with proprioceptive information relating to

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Ashley N. Marshall, Alison R. Snyder Valier, Aubrey Yanda and Kenneth C. Lam

Ankle injuries are common in the physically active 1 , 2 and general 3 – 5 populations. Lateral ankle sprains comprise 60% of all injuries suffered by high school and college athletes 1 , 2 and account for over 600,000 emergency department visits annually in the United States. 5 Although ankle

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Chris Brogden, Kelly Marrin, Richard Page and Matt Greig

, 3 , 4 postural stability, 5 and isokinetic strength. 6 Consequently, strategies such as screening of risk factors are commonplace in the assessment of ankle joint function, with multiple tests used to replicate the multifactorial nature of ankle injury occurrence. 7 The accurate interpretation

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Chia-Wei Lin, Fong-Chin Su and Cheng-Feng Lin

Ballet deep squat with legs rotated externally (grand plié) is a fundamental movement for dancers. However, performing this task is a challenge to ankle control, particularly for those with ankle injury. Thus, the purpose of this study was to investigate how ankle sprains affect the ability of postural and muscular control during grand plié in ballet dancers. Thirteen injured dancers and 20 uninjured dancers performed a 15 second grand plié consisting of lowering, squatting, and rising phases. The lower extremity motion patterns and muscle activities, pelvic orientation, and center of pressure (COP) excursion were measured. In addition, a principal component analysis was applied to analyze waveforms of muscle activity in bilateral medial gastrocnemius, peroneus longus, and tibialis anterior. Our findings showed that the injured dancers had smaller pelvic motions and COP excursions, greater maximum angles of knee flexion and ankle dorsiflexion as well as different temporal activation patterns of the medial gastrocnemius and tibialis anterior. These findings suggested that the injured dancers coped with postural challenges by changing lower extremity motions and temporal muscle activation patterns.

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Shannon David, Kim Gray, Jeffrey A. Russell and Chad Starkey

The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool.


To evaluate the measures of diagnostic accuracy of the OARs in the acute setting.


The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated.


The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18).


When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT’s decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

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Kelley E. Farwell, Cameron J. Powden, Meaghan R. Powell, Cailee W. McCarty and Matthew C. Hoch

Clinical Scenario:

Ankle injuries constitute a large number of injuries sustained by adolescent athletes participating in high school athletics. Prophylactic ankle bracing may be an effective and efficient method to reduce the incidence of ankle injuries in adolescent athletes in the secondary-school setting.

Clinical Question:

Do prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes?

Summary of Key Findings:

Two of the three included studies reported that prophylactic ankle braces reduced the incidence of ankle injuries compared with no ankle bracing.

Clinical Bottom Line:

There is moderate evidence to support the use of prophylactic ankle braces in adolescent athletes, particularly those who participate in football and basketball, to reduce the incidence of acute ankle injuries.

Strength of Recommendation:

Grade B evidence exists that prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes.

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Mitchell L. Cordova, Lisa S. Jutte and J. Ty Hopkins

Many types of rehabilitation exercises are used to reestablish lower extremity neuromuscular function and strength following ankle injuries. It has not been established which exercise induces the greatest leg muscle activity, which might allow patients to recover more quickly from their injuries. The purpose of this investigation was to establish which exercises induce the most muscle activity in the medial gastrocnemius (MG), peroneus longus (PL), and tibialis anterior (TA), as measured by integrated electromyography (I-EMG). Participants (N = 24, age = 22 ± .59, mass = 63.5 ± 2.1 kg, ht = 165.7 ± 1.2 cm) conducted five repetitions of each of four exercise conditions for 30 s: one-legged stance (OLS), OLS on trampoline (OLST), T-Band kicks (TBK), and OLS perturbations (OLSP). It was found that the TBK exercise induces greater I-EMG in all three muscles, the OLST exercise stimulates more I-EMG activity in the MG and TA, and the OLSP exercise induces greater I-EMG activity in the TA.

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John E. Kovaleski, Sheri J. Kovaleski and Albert W. Pearsall

Column-editor : R. Barry Dale

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Kazem Malmir, Gholam Reza Olyaei, Saeed Talebian, Ali Ashraf Jamshidi and Majid Ashraf Ganguie

There seems to be a relationship between poor postural control and ankle injuries. 1 Postural control is provided by interaction and coordination among sensory information, central processing, and motor outputs. Postural control system provides postural orientation and postural stability. Postural

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Amy R. Barchek, Shelby E. Baez, Matthew C. Hoch and Johanna M. Hoch

computerized search was completed in October 2018. The following search terms were used: • P atient/Group: Lower-extremity injury (knee OR ankle OR knee injury OR ankle injury OR knee pain OR ankle pain) • I ntervention: None • C omparison: Healthy controls OR healthy (not osteoarthritis OR arthritis OR