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Troy Blackburn, Kevin M. Guskiewicz, Meredith A. Petschauer and William E. Prentice

Objectives:

To determine whether proprioception or muscular strength is the dominant factor in balance and joint stability and define what type of ankle rehabilitation is most effective for these purposes.

Setting:

The University of North Carolina Sports Medicine Research Laboratory.

Subjects:

Thirty-two healthy volunteers free of head injury, dominant leg injury, and vestibular deficits.

Design:

Subjects were divided into control, strength-training, proprioceptive-training, and strength-proprioception combination training groups. Balance was assessed before and after 6-week training programs.

Measurements:

Static, semidynamic, and dynamic balance were assessed.

Results:

Subjects showed no improvement for static balance but improved significantly for semidynamic (P = .038) and dynamic (P = .002) balance. No significant differences were observed between groups.

Conclusions:

Enhancement of proprioception and muscular strength are equally effective in promoting joint stability and balance maintenance. In addition, no 1 type of training program is superior to another for these purposes.

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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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Matt Greig, Hannah Emmerson and John McCreadie

Context: Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. Objective: To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Design: Repeated measures. Setting: University athletic facilities. Participants: Twenty-two female intermittent team sports players. Intervention: All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. Main Outcome Measures: GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. Results: There was a significant main effect for drill type (P < .001) in the mediolateral (η 2 = .436), anteroposterior (η 2 = .480), and vertical planes (η 2 = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P < .001, η 2 ≥ .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. Conclusions: The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention.

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Brian Killinger, Jakob D. Lauver, Luke Donovan and John Goetschius

mediating the training-related muscle adaptations that have been observed with BFR. The presence of these acute responses in CAI patients supports further research examining BFR as a potential ankle rehabilitation tool. Acknowledgment The intervention device used in this study was loaned by the manufacturer

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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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Cynthia J. Wright, Shelley W. Linens and Mary S. Cain

Context:

There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability (CAI). In addition, clinicians aiming to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy.

Objective:

To assess the comparative efficacy of 2 common ankle rehabilitation techniques (wobble-board [WB] balance training and ankle strengthening using resistance tubing [RT]) using patient-oriented outcomes.

Design:

Randomized controlled trial.

Setting:

Laboratory.

Patients:

40 patients with CAI randomized into 2 treatment groups: RT and WB. CAI inclusion criteria included a history of an ankle sprain, recurrent “giving way,” and a Cumberland Ankle Instability Tool (CAIT) score ≤25.

Interventions:

Participants completed 5 clinician-oriented tests (foot-lift test, time-in-balance, Star Excursion Balance Test, figure-of-8 hop, and side-hop) and 5 patient-oriented questionnaires (CAIT, Foot and Ankle Ability Measure [FAAM], Activities of Daily Living [ADL] and FAAM Sport scale, Short-Form 36 [SF-36], and Global Rating of Function [GRF]). After baseline testing, participants completed 12 sessions over 4 wk of graduated WB or RT exercise, then repeated baseline tests.

Main Outcome Measures:

For each patient- and clinician-oriented test, separate 2 × 2 RMANOVAs analyzed differences between groups over time (alpha set at P = .05).

Results:

There was a significant interaction between group and time for the FAAM-ADL (P = .04). Specifically, the WB group improved postintervention (P < .001) whereas the RT group remained the same (P = .29). There were no other significant interactions or significant differences between groups (all P > .05). There were significant improvements postintervention for the CAIT, FAAM-Sport, GRF, SF-36, and all 5 clinician-oriented tests (all P < .001).

Conclusions:

A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI. Limited evidence indicates that WB training was more effective than RT.

Level of Evidence:

Therapy, level 1b.

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.3.184 Effects of Static and Hold-Relax Stretching on Hamstring Range of Motion Using the FlexAbility LE1000 Phillip A. Gribble * Kevin M. Guskiewicz * William E. Prentice * Edgar W. Shields * 8 1999 8 3 195 208 10.1123/jsr.8.3.195 EMG Comparison of Selected Ankle Rehabilitation Exercises Mitchell L

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Exercise-Associated Muscle Damage Amanda L. Zaleski * Linda S. Pescatello * Kevin D. Ballard * Gregory A. Panza * William Adams * Yuri Hosokawa * Paul D. Thompson * Beth A. Taylor * 1 09 2019 28 7 724 728 10.1123/jsr.2018-0060 jsr.2018-0060 Quantifying Functional Ankle Rehabilitation

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M. Spencer Cain, Kyeongtak Song, J. Troy Blackburn, Kimmery Migel and Erik A. Wikstrom

ID: 17685695 17685695 17. McKeon PO , Wikstrom EA . Sensory-targeted ankle rehabilitation strategies for chronic ankle instability . Med Sci Sports Exerc . 2016 ; 48 ( 5 ): 776 – 784 . PubMed ID: 26717498 doi: 10.1249/MSS.0000000000000859 26717498 18. Hoch MC , Andreatta RD

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Erik A. Wikstrom and Patrick O. McKeon

stretching. Methods Design and Participants The original study, titled Sensory-Targeted Ankle Rehabilitation Strategies (STARS), was a noninferiority trial to test the effectiveness of ankle joint mobilization, plantar massage, or triceps surae stretching relative to a control condition for improving patient