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Michael G. Dolan, Brian G. Pietrosimone, J. Ty Hopkins and Christopher D. Ingersoll

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Masafumi Terada, Megan Beard, Sara Carey, Kate Pfile, Brian Pietrosimone, Elizabeth Rullestad, Heather Whitaker and Phillip Gribble

This study aimed to compare time-to-boundary and sample entropy during a single-leg balance task between individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Twenty-two participants with CAI, 20 lateral ankle sprain copers, and 24 healthy controls performed a single-leg balance task during an eyes-closed condition. Participants with CAI exhibited lower time-to-boundary values compared with lateral ankle sprain copers and healthy controls. However, we did not find differences in sample entropy variables between cohorts. A decrease in time-to-boundary values in participants with CAI indicated that CAI may constrain the ability of the sensorimotor system to maintain the center of pressure within the boundaries of the base of support. However, the regularity of the center of pressure velocity time series appears not to be altered in the CAI cohort in this study.

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Nathaniel S. Nye, Drew S. Kafer, Cara Olsen, David H. Carnahan and Paul F. Crawford

: stress fractures; joint injuries (eg, patellofemoral syndrome, unspecified joint pain in the knee); soft tissue injuries (eg, achilles tendonitis, plantar fasciitis); and osteoarthritis. The use of 4 main categories was intended to better represent trends for conditions with similar pathogenesis. A

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J. Ty Hopkins and Christopher D. Ingersoll

Objectives:

To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.

Data Sources:

The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.

Conclusions:

AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.

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Thomas M. Lundin, Jon W. Feuerbach and Mark D. Grabiner

The purpose of this study was to determine the effect of plantar flexor and dorsiflexor fatigue on postural sway amplitude during unilateral, or one-legged, stance. It was hypothesized that plantar flexor and dorsiflexor fatigue would increase unilateral postural sway amplitude. Eight uninjured male subjects participated in pre- and postfatigue unilateral stability tests. Selected parameters describing medial-lateral (ML) and anterior-posterior (AP) postural sway were measured on a Chattecx Balance System before and after an isokinetic fatigue protocol. The fatigue protocol resulted in a significant increase in ML postural sway amplitude (p < 0.05) and an increase in AP sway amplitude (p = 0.065). Previously, links have been established between increased postural sway amplitude and ankle joint injury. Thus, fatigue of the plantar flexors and dorsiflexors, which increased postural sway amplitude, may render the ankle joint susceptible to injury. Induced ankle muscle fatigue may represent a valid paradigm to study the causes of traumatic ankle joint injury.

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Semyon Slobounov, William Kraemer, Wayne Sebastianelli, Robert Simon and Shannon Poole

The primary purpose of this paper was to demonstrate how modem motion tracking technologies, i.e., the Hock of Birds, and computer visualization graphics may be used in a clinical setting. The idea that joint injury reduces proprioception was investigated, and data for injured subjects were compared to data for noninjured subjects (subjects in all experiments were college students). Two experiments showed that there were no significant losses in joint position sense in knee-injured subjects, and both injured and noninjured groups visually overestimated knee movements. However, injured subjects showed no significant differences when visual reproduction data were compared with actual movement data. In addition, these data indicated that injured subjects may have greater potential for apprehension than noninjured subjects, at least in terms of visual estimation of movement ranges. This is an idea that needs further testing.

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Gregory M. Gutierrez and Thomas Kaminski

Lateral ankle sprains (LAS) are among the most common joint injuries, and although most are resolved with conservative treatment, others develop chronic ankle instability (AI). Considerable attention has been directed toward understanding the underlying causes of this pathology; however, little is known concerning the neuromuscular mechanisms behind AI. A biomechanical analysis of the landing phase of a drop jump onto a device that simulates the mechanism of a LAS may give insight into the dynamic restraint mechanisms of the ankle by individuals with AI. Furthermore, work evaluating subjects who have a history of at least one lateral ankle sprain, yet did not develop AI, may help elucidate compensatory mechanisms following a LAS event. Identifying proper neuromuscular control strategies is crucial in reducing the incidence of AI.

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Sangeetha Madhavan, Sarah Burkart, Gail Baggett, Katie Nelson, Trina Teckenburg, Mike Zwanziger and Richard K. Shields

Neuromuscular control strategies might change with age and predispose the elderly to knee-joint injury. The purposes of this study were to determine whether long latency responses (LLRs), muscle-activation patterns, and movement accuracy differ between the young and elderly during a novel single-limb-squat (SLS) task. Ten young and 10 elderly participants performed a series of resistive SLSs (~0–30°) while matching a computer-generated sinusoidal target. The SLS device provided a 16% body-weight resistance to knee movement. Both young and elderly showed significant overshoot error when the knee was perturbed (p < .05). Accuracy of the tracking task was similar between the young and elderly (p = .34), but the elderly required more muscle activity than the younger participants (p < .05). The elderly group had larger LLRs than the younger group (p < .05). These results support the hypothesis that neuromuscular control of the knee changes with age and might contribute to injury.

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Brittney A. Luc, Adam S. Lepley, Michael A. Tevald, Phillip A. Gribble, Donald B. White and Brian G. Pietrosimone

Context:

Alterations in corticomotor excitability are observed in a variety of patient populations, including the musculature surrounding the knee and ankle after joint injury. Active motor threshold (AMT) and motor-evoked-potential (MEP) amplitudes elicited through transcranial magnetic stimulation (TMS) are outcome measures used to assess corticomotor excitability and have been deemed reliable in upper-extremity musculature. However, there are few studies assessing the reliability of TMS measures in lower-extremity musculature.

Objective:

To determine the intersession reliability of AMT and MEP amplitudes over 14 and 28 d in the quadriceps and fibularis longus (FL).

Design:

Descriptive laboratory study.

Setting:

University laboratory

Participants:

20 able-bodied volunteers (10 men, 10 women; 22.35 ± 2.3 y, 1.71 ± 0.11 m, 73.61 ± 16.77 kg).

Main Outcome Measures:

AMT and MEP amplitudes were evaluated at 95%, 100%, 105%, 110%, 120%, 130%, and 140% of AMT in the dominant and nondominant quadriceps and FL. Interclass correlation coefficients (ICCs) were used to assess reliability for absolute agreement and internal consistency between baseline and 2 follow-up sessions at 14 and 28 d postbaseline. Each ICC was fit with the best-fit straight line or parabola to smooth out noise in the observations and best determine if a pattern existed in determining the most reliable MEP value.

Results:

All muscles yielded strong ICCs between baseline and both time points for AMT. MEPs in both the quadriceps and FL produced varying degrees of reliability, with the greatest reliability demonstrated on day 28 at 130% and 140% of AMT in the quadriceps and FL, respectively. The dominant FL muscle showed a significant pattern; as TMS intensity increased, MEP reliability increased.

Conclusion:

TMS can be used to reliably identify corticomotor alterations after therapeutic interventions, as well as monitor disease progression.