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Kyle B. Kosik and Phillip A. Gribble

‘giving-way,’ and recurrent joint injury, which are the defining characteristics of chronic ankle instability (CAI). 2 Decreased dynamic postural control is a well-documented activity limitation observed among CAI individuals. 3 The Star Excursion Balance Test (SEBT) is a common clinical assessment tool

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Michael A. Samaan, Eric K. Greska, Matthew C. Hoch, Joshua T. Weinhandl, Sebastian Y. Bawab and Stacie I. Ringleb

Context:

ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.

Objective:

To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).

Participant:

One Division I female athlete.

Main Outcome Measure:

The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.

Results:

ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.

Conclusion:

Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

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Erik A. Wikstrom, Sajad Bagherian, Gary Allen and Kyeongtak Song

range of motion and dynamic postural control. 5 – 9 Recently, a Critically Appraised Topic (CAT) noted that ankle joint mobilizations improved dynamic postural control in CAI patients. 8 However, the conclusions of the CAT were based on statistical significance which do not allude to whether or not a

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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.

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Vincent J. Leavey, Michelle A. Sandrey and Greg Dahmer

Context:

There are few outcomes-based studies that address hip strategy and gluteus medius strength (GMS) for maintaining dynamic postural control.

Objective:

To determine whether GMS training, proprioception training, or a combination of the 2 has an effect on dynamic postural control.

Design:

Pretest-posttest, repeated measures.

Setting:

Sports-medicine clinic.

Participants:

48 healthy male and female college students obtained via sample of convenience.

Interventions:

Three 6-wk programs including exercises for proprioception, GMS, and combined.

Main Outcomes Measures:

Eight Star Excursion Balance Test (SEBT) reach distances and GMS for the dominant leg.

Results:

There was no significant difference between groups. The combination group demonstrated the most improvements in SEBT reach distances, whereas the GMS group demonstrated the most improvement in GMS.

Conclusion:

Use of exercises for proprioception, GMS, or a combination of the 2 will help improve dynamic postural control in healthy, active individuals.

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Mutlu Cug, Erik A. Wikstrom, Bahman Golshaei and Sadettin Kirazci

Context:

Both female athletes’ participation in soccer and associated injuries have greatly increased in recent years. One issue is the 2–9 times greater incidence of noncontact anterior cruciate ligament (ACL) injuries in female athletes relative to male athletes in comparable sports. Several factors such as limb dominance and sporting history have been proposed to play a role in ACL incidence rates between male and female athletes. However, evidence about the effects of these factors and how they interact with sex is mixed, and thus no consensus exists.

Objective:

To quantify the effects of sports participation, limb dominance, and sex on dynamic postural control and knee-joint proprioception.

Design:

Cross-sectional study.

Setting:

University research laboratory.

Participants:

19 male soccer players, 17 female soccer players, 19 sedentary men, and 18 sedentary women.

Intervention:

Joint-position sense was tested using reproduction of passive positioning on a Biodex isokinetic dynamometer (30°, 45°, and 60° from 90° of knee flexion). Three Star Excursion Balance Test directions were used to assess dynamic postural control.

Main Outcome Measure:

Normalized reach distance (% of leg length) in the anterior, posteromedial, and posterolateral directions on each leg quantified dynamic postural control. Average absolute error and constant error for both limbs quantified joint-position sense.

Results:

Posteromedial reach distance was significantly better in soccer players than sedentary individuals (P = .006). Anterior reach distance was significantly better (P = .04) in sedentary individuals than soccer players. No limb-dominance or sex differences were identified for dynamic postural control, and no differences in absolute- or constant-error scores were identified.

Conclusion:

Sporting history has a direction-specific impact on dynamic postural control. Sporting history, sex, and limb dominance do not influence knee-joint proprioception when tested in an open kinetic chain using passive repositioning.

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Srikant Vallabhajosula, Beverly L. Roberts and Chris J. Hass

Tai Chi intervention has been shown to be beneficial for balance improvement. The current study examined the effectiveness of Tai Chi to improve the dynamic postural control among older adults with mobility disability. Six sedentary older adults with mobility disability participated in a 16-week Tai Chi intervention consisting of one hour sessions three times a week. Dynamic postural control was assessed pre- and post intervention as participants initiated gait in four stepping conditions: forward; 45° medially, with the stepping leg crossing over the other leg; 45° and 90° laterally. The center of pressure (CoP) displacement, velocity, and its maximum separation distance from the center of mass in the anteroposterior, mediolateral, and resultant directions were analyzed. Results showed that in the postural phase, Tai Chi increased the CoP mediolateral excursions in the medial (13%) and forward (28%) conditions, and resultant CoP center of mass distance in the medial (9%) and forward (19%) conditions. In the locomotion phase, the CoP mediolateral displacement and velocity significantly increased after the Tai Chi intervention (both by > 100% in the two lateral conditions). These results suggest that through alteration in CoP movement characteristics, Tai Chi intervention might improve the dynamic postural control during gait initiation among older adults.

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Lauren C. Olmsted and Jay Hertel

Context:

The effects of custom-molded foot orthotics on neuromuscular processes are not clearly understood.

Objective:

To examine these effects on postural control in subjects with different foot types.

Design:

Between-groups, repeated-measures design.

Setting:

Athletic training laboratory.

Subjects:

30 healthy subjects assigned to groups by foot type: planus (n = 11), rectus (n = 12), or cavus (n = 7).

Interventions:

Custom-fit semirigid orthotics.

Main Outcome Measures:

Static postural control was measured on a force plate. Dynamic postural control was measured using the Star Excursion Balance Test. Both measurements were assessed with and without orthotics at baseline and 2 weeks later.

Results:

For static postural control, a significant condition-by-group interaction was found. Subjects with cavus feet had a decreased center-of-pressure velocity while wearing orthotics. For dynamic postural control, a significant condition-by-direction-by-group interaction was found. Subjects with cavus feet had increased reach distances in 3 of 8 directions while wearing orthotics.

Conclusions:

Custom orthotics were associated with some improvements in static and dynamic postural control in subjects with cavus feet.

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Nathan J. Crockett and Michelle A. Sandrey

Context:

Few studies have evaluated the long-term effects of prophylactic ankle-brace use during a sport season.

Objective:

To determine the effects of prophylactic ankle-brace use during a high school basketball season on dynamic postural control and functional tests.

Design:

Prospective repeated-measures design.

Setting:

High school athletic facility.

Participants:

21 healthy high school basketball athletes (13 girls, 8 boys).

Interventions:

The order of testing was randomized using the Star Excursion Balance Test (SEBT) for posteromedial (PM), medial (M), and anteromedial (AM) directions and 3 functional tests (FT) consisting of the single-leg crossover hop, single-leg vertical jump, and the single-leg 6-m hop for time at pre-, mid-, and postseason. After pretesting, the ankle brace was worn on both limbs during the entire 16-wk competitive basketball season.

Main Outcome Measures:

SEBT for PM, M, and AM and 3 single-leg FTs.

Results:

Dynamic postural control using the SEBT and the 3 FTs improved over time, notably from pretest to posttest. The left limb was different from the right limb during the single-leg vertical jump. Effect sizes were large for pretest to posttest for the 3 SEBT directions and 2 of the 3 FTs.

Conclusions:

The 16-wk basketball prophylactic ankle-brace intervention significantly improved dynamic postural control and single-limb FTs over time.

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Shiho Goto, Naoko Aminaka and Phillip A. Gribble

among these measures. A published literature review demonstrated that the star excursion balance test (SEBT) is a reliable and effective tool to quantify lower-extremity dynamic postural control. 23 The SEBT has been used to detect deficits in reach distance in individuals with PFP. 24 Although a