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Gary B. Wilkerson and Arthur J. Nitz

Ankle proprioception is widely regarded as an important factor that affects susceptibility to ankle sprain, but the precise mechanisms by which proprioceptive abilities may enhance ankle stability are not well understood. Pertinent literature is reviewed and theoretical interrelationships among factors that may affect dynamic ankle function are discussed. Topics addressed include mechanoreceptor function, muscle spindle function, postural balance, ankle edema, joint capsule distension, synovial hypertrophy, capsuloligamentous laxity, anterolateral rotary instability, ankle giving way, reflexive muscle splinting, articular deafferentation, neurogenic inflammation, muscular de-efferentation, and enhancement of compensatory neuromuscular mechanisms. Recommendations for future research are presented in the form of questions that cannot be adequately answered at present concerning the role of proprioceptively mediated mechanisms in the maintenance of dynamic ankle stability.

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Shirleeah D. Fayson, Alan R. Needle and Thomas W. Kaminski

Context:

The use of Kinesio Tape among health care professional has grown recently in efforts to efficiently prevent and treat joint injuries. However, limited evidence exists regarding the efficacy of this technique in enhancing joint stability and neuromuscular control.

Objective:

To determine how Kinesio Tape application to the ankle joint alters forces and muscle activity during a drop-jump maneuver.

Design:

Single-group pretest– posttest.

Setting:

University laboratory.

Subjects:

22 healthy adults with no previous history of ankle injury.

Interventions:

Participants were instrumented with electromyography on the lower-leg muscles as they jumped from a 35-cm platform onto force plates. Test trials were performed without tape (BL), immediately after application of Kinesio Tape to the ankle (KT-I), and after 24 h of continued use (KT-24).

Main Outcome Measures:

Peak ground-reaction forces (GRFs) and time to peak GRF were compared across taping conditions, and the timing and amplitude of muscle activity from the tibialis anterior, peroneus longus, and lateral gastrocnemius were compared across taping conditions.

Results:

No significant differences in amplitude or timing of GRFs were observed (P > .05). However, muscle activity was observed to decrease from BL to KT-I in the tibialis anterior (P = .027) and from BL to KT-24 in the PL (P = .022).

Conclusions:

The data suggest that Kinesio Tape decreases muscle activity in the ankle during a drop-jump maneuver, although no changes in GRFs were observed. This is contrary to the proposed mechanisms of Kinesio Tape. Further research might investigate how this affects participants with a history of injury.

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Jeffrey D. Simpson, Ethan M. Stewart, Anastasia M. Mosby, David M. Macias, Harish Chander and Adam C. Knight

Context: Lateral ankle sprains are a common injury in which the mechanics of injury have been extensively studied. However, the anticipatory mechanisms to ankle inversion perturbations are not well understood. Objective: To examine lower-extremity kinematics, including spatial and temporal variables of maximum inversion displacement and maximum inversion velocity, during landings on a tilted surface using a new experimental protocol to replicate a lateral ankle sprain. Setting: Three-dimensional motion analysis laboratory. Participants: A total of 23 healthy adults. Interventions: Participants completed unexpected (UE) and expected (EXP) unilateral landings onto a tilted surface rotated 25° in the frontal plane from a height of 30 cm. Main Outcome Measures: Ankle, knee, and hip kinematics at each discrete time point from 150 ms pre-initial contact (IC) to 150 ms post-IC, in addition to maximum ankle inversion and maximum inversion velocity, were compared between UE and EXP landings. Results: The UE landing produced significantly greater maximum inversion displacement (P < .01) and maximum inversion velocity (P = .02) than the EXP landing. Significantly less ankle inversion and internal rotation were found during pre-IC, whereas during post-IC, significantly greater ankle inversion, ankle internal rotation, knee flexion, and knee abduction were observed for the UE landing (P < .05). In addition, significantly less hip flexion and hip adduction were observed for the UE landing during pre-IC and post-IC (P < .05). Conclusions: Differences in the UE and EXP landings indicate the experimental protocol presented a UE inversion perturbation that approximates the mechanism of a lateral ankle sprain. Furthermore, knowledge of the inversion perturbation elicited a hip-dominant strategy, which may be utilized to assist with ankle joint stabilization during landing to further protect the lateral ankle from injury.

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Javad Sarvestan and Zdeněk Svoboda

, tennis, and volleyball, also require cutting and turning in both the lateral and frontal planes. 15 For optimal performance, athletes in all of these sports require increased ankle stability. Agility tests demand quick deceleration, direction change, and reacceleration during the movements. 16 These 3

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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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Cornelius John, Andreas Stotz, Julian Gmachowski, Anna Lina Rahlf, Daniel Hamacher, Karsten Hollander and Astrid Zech

Context: In some patients, ankle sprains lead to chronic symptoms like pain or muscular weakness called chronic ankle instability (CAI). External ankle supports have shown to be effective in preventing sprains and reducing recurrence, but the underlying mechanisms are unclear. As sensorimotor variables are associated with injury incidence, an influence of external ankle support on landing performance and balance seems plausible. Objective: To analyze the effects of an elastic ankle support on jump landing performance and static and dynamic balance in patients with CAI and healthy controls. Design: Crossover study. Setting: Functional tests in a laboratory setting. Patients or Other Participants: Twenty healthy students and 20 patients with CAI were included for study participation based on their scores in ankle stability and function questionnaires. Intervention: Healthy and CAI participants performed each test with and without an elastic ankle support. Main Outcome Measures: (1) Jump landing performance was measured with the Landing Error Scoring System, (2) static balance was assessed with the Balance Error Scoring System, and (3) dynamic balance was assessed using the Y Balance Test. Linear mixed models were used to analyze the effects of the elastic ankle support on sensorimotor parameters. Results: Healthy controls performed significantly better in the Landing Error Scoring System (P = .01) and Y Balance Test anterior direction (P = .01). No significant effects of elastic ankle support on Landing Error Scoring System, Balance Error Scoring System, or Y Balance Test performance were observed in the CAI or control group. There were no significant group-by-ankle support interactions. Conclusions: In the current study, the acute use of elastic ankle support was ineffective for enhancing jump landing performance, and static and dynamic balance. Further research is needed to identify the underlying mechanisms of the preventive effects of elastic ankle support.

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Nili Steinberg, Roger Adams, Oren Tirosh, Janet Karin and Gordon Waddington

studies show improved functional ankle stability and dynamic balance in young athletes following proprioceptive training, and the inclusion of proprioceptive exercises in athletes’ daily training programs has been recommended. 19 Proprioceptive training has been found to be effective in reducing the rate

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Revay O. Corbett, Tyler R. Keith and Jay Hertel

attention to try and address the risk of recurrence. The CAIT was shown to have a positive moderate correlation with the VAS for confidence scores reported following the SEMO agility test. Higher scores on the CAIT represent greater self-reported ankle stability. Athletes that reported CAIT scores closer to

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Yumeng Li, He Wang and Kathy J. Simpson

Chronic ankle instability (CAI) is a very common sequela, after ankle sprains. 1 Individuals with CAI exhibit some ankle deficits, including reduced ankle stability, 2 ankle proprioception and muscle strength, 3 range of motion, 4 , 5 and potential changes to the mechanical properties of

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Emily E. Gerstle, Kristian O’Connor, Kevin G. Keenan and Stephen C. Cobb

, although a more inverted rear- and midfoot could improve rigidity of the foot, it may also decrease ankle stability resulting in an increased risk of inversion ankle sprain. To our knowledge, the current study is the first to investigate frontal plane midfoot kinematics during step descent; therefore, the