Prediction of Recurrent Lateral Ankle Sprain and Ankle Pain Using Applied Care Strategies and Patient-Reported Outcomes.

CONTEXT: Lateral ankle sprain (LAS) patients often have deficient patient-reported outcomes (PROs) at return-to-activity (RTA), potentially increasing risk for recurrent LAS and ankle pain. Additionally, applied care strategies are known to correct impairments, but their ability to mitigate risk for long-term consequences remains unknown. OBJECTIVE: To determine if applied care strategies and PRO scores at RTA and 6-months post-RTA predict recurrent LAS and ankle pain 12 months after an acute LAS. DESIGN: Prospective cohort study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: We enrolled 63 individuals within one week of sustaining an acute LAS. MAIN OUTCOME MEASURES: Participants completed online surveys about their health history and recent LAS. At RTA and 6 months post-RTA, participants completed online surveys regarding demographics, applied care strategies, and patient reported outcomes (PROs): Foot and Ankle Disability Index, Identification of Functional Ankle Instability, Godin Leisure-Time Exercise Questionnaire, Short Form-8. At 12 months post-RTA, we asked participants if they sustained recurrent LAS. Chi-squares determined if recurrent LAS and ankle pain at 12-months were related to applied care strategies or ankle pain at RTA. Independent t-tests compared demographics and PROs at RTA and 6-months between participants with and without a recurrent LAS or ankle pain at 12-months. Logistic regression and area under the receiver operating characteristic (AUROC) analyses determined if demographics, applied care strategies, ankle pain at RTA, and PRO scores at RTA and 6-months predicted recurrent LAS and ankle pain at 12-months. RESULTS: Participants with a recurrent LAS had a lower walking boot use (P=0.05) and were taller than those without (P=0.03). Increased height and lack of walking boot use were predictive of recurrent LAS (P<0.01, R2=0.33, AUROC=0.81[0.68, 0.95]). CONCLUSIONS: LAS patients who are taller and do not use a walking boot might have greater risk for a recurrent LAS withing 12 months of RTA.

Contralateral thalamocortical connectivity is related to postural control in the uninvolved limb of older adults with history of ankle sprain.

BACKGROUND: Sensorimotor brain connectivity is often overlooked when determining relationships between postural control and motor performance following musculoskeletal injury. Thalamocortical brain connectivity is of particular interest as it represents the temporal synchrony of functionally and anatomically linked brain regions. Importantly, adults over the age of 60 are especially vulnerable to musculoskeletal injury due to age-related declines in postural control and brain connectivity. RESEARCH QUESTION: Is there a relationship between thalamocortical connectivity and static postural control in older adults with a history of LAS? METHODS: Data were analyzed from twenty older adults (mean age = 67.0 ± 4.3 yrs; 13 females) with a history of LAS. The sensorimotor network (SMN) was identified from resting-state MRI data, and a priori thalamic and postcentral gyri regions of interest were selected in order to determine left and right hemisphere thalamocortical connectivity. Balance was assessed for the involved and non-involved limbs via center of pressure velocity (COPV) in the medial-lateral (ML) and anterior-posterior (AP) directions. RESULTS: Contralateral thalamocortical connectivity was significantly associated with COPV_ML COPV_ML (r = -0.474, P = 0.05) and COPV_AP (r = -0.622, P = 0.008) in the non-involved limb. No significant association was observed between involved limb balance and contralateral thalamocortical connectivity (COPV_ML: r = -0.08, P = 0.77; COPV_AP: r = 0.12, P = 0.63). SIGNIFICANCE: A significant relationship between thalamocortical connectivity and static postural control was observed in the non-involved, but not the involved limb in older adults with a history of LAS. Findings suggest that thalamocortical connectivity may lead to or be the product of LAS.

Association of Diaphragm Contractility and Postural Control in a Chronic Ankle Instability Population: A Preliminary Study.

BACKGROUND: Altered reorganization of the sensorimotor system after an initial lateral ankle sprain may lead to a chronic neuromuscular maladaptation in multiple body locations. Specifically, decreased diaphragm contractility has been observed in patients with chronic ankle instability (CAI). The diaphragm has an essential role in postural control. Decreased diaphragm contractility could associate with diminished postural control commonly observed in patients with CAI. However, no study has determined if diaphragm contractility contributes to postural control in a CAI population. HYPOTHESIS: Decreased diaphragm contractility would be negatively associated with static postural control in patients with CAI. STUDY DESIGN: Cross-sectional study design. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 15 participants with CAI participated voluntarily. An ultrasonography assessment was performed to quantify the right and left hemidiaphragm thickness at the end of resting inspiration and expiration in supine while breathing quietly. The degree of diaphragm contractility was calculated from the diaphragm thickness. Participants performed 3 eyes-open trials of a 20-second single-leg balance task on the involved limb. Static postural control measures included the center of pressure velocity (COPV) and mean of time-to-boundary (TTB) minima in the anteroposterior (AP) and mediolateral directions. RESULTS: Moderate correlations of the right hemidiaphragm contractility were observed with COPV (ρ = -0.54) and TTB mean minima (ρ = 0.56) (P < 0.05) in the AP direction. The left hemidiaphragm contractility was moderately correlated with COPV (ρ = -0.56) and TTB mean minima (ρ = 0.60) (P < 0.05) in the AP direction. CONCLUSION: Lower diaphragm contractility may be associated with diminished static postural control in the AP direction in patients with CAI. CLINICAL RELEVANCE: This study highlights diaphragm contractility could be a potential connection with diminished static postural control in patients with CAI. Our data raise new avenues for future exploration including potential beneficial effects of implementation of diaphragm breathing exercises and techniques for restoring static postural control in patients with CAI.

Yoga as a balance intervention for middle-age and older adults with history of lateral ankle sprain: An exploratory study.

INTRODUCTION: Balance deficiencies are common among aging adults. Musculoskeletal injuries such as lateral ankle sprains (LAS) also contribute to compromised balance; potentially amplifying the postural insufficiencies in these age groups with a history of LAS. Yoga has emerged as an effective balance training intervention for aging adults; but limited application exists in these age cohorts with LAS history. This study may provide important guidance for the implementation of this intervention in these populations. METHODS: In this cohort design study, middle-age and older adults with a history of LAS completed an 8-week beginner-level yoga class. Balance was measured before and after the yoga intervention statically (force plate) and dynamically (star excursion balance test [SEBT]) using single-limb balance tasks. RESULTS: Following the yoga intervention, older adults improved static postural control in the anterior-posterior direction, as well as dynamic postural control in selected reach directions of the SEBT relative to the middle-age adults. CONCLUSION: This is an important step in exploring how to help the aging population that likely has amplifications in balance deficiencies due to a common musculoskeletal injury, LAS. While more work is needed to determine how to optimize and document balance improvements in aging adults with LAS history, yoga appears to be a promising form of intervention, particularly for older adults.

Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol.

BACKGROUND: Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS: This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION: The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).

The Relationship Between Health-Related Quality of Life and Lower-Extremity Visuomotor Reaction Time in Young Adult Women Following Ankle Sprain.

CONTEXT: Many individuals who sustain a lateral ankle sprain (LAS) fail to return to prior activity due to residual symptoms; and report elevated levels of injury-related fear, decreased function, and decreased health-related quality of life (HRQOL). Additionally, individuals with history of LAS exhibit deficits in neurocognitive functional measures like visuomotor reaction time (VMRT), which contributes to worse patient-reported outcome scores. The aim of this study was to examine the relationship between HRQOL and lower-extremity (LE) VMRT in individuals with LAS history. DESIGN: Cross-sectional. METHODS: Young adult female volunteers with history of LAS (n = 22; age = 24 [3.5] y; height = 163.1 [9.8] cm; mass = 65.1 [11.5] kg; and time since last LAS = 67.8 [50.5] mo) completed HRQOL outcomes including the following: (1) Tampa Scale of Kinesiophobia-11, (2) Fear-Avoidance Beliefs Questionnaire, (3) Penn State Worry Questionnaire, (4) modified Disablement in the Physically Active Scale, and (5) Foot and Ankle Disability Index (FADI). Additionally, participants completed a LE-VMRT task by responding to a visual stimulus using their foot to deactivate light sensors. Participants completed trials bilaterally. Separate Spearman rho correlations were performed to assess the relationship between patient-reported outcomes assessing constructs of HRQOL and LE-VRMT bilaterally. Significance was set at P < .05. RESULTS: There was a strong, significant negative correlation between FADI-Activities of Daily Living (ρ = -.68; P = .002) and FADI-Sport (ρ = -.76; P = .001) scores and injured limb LE-VMRT; moderate, significant negative correlations between the uninjured limb LE-VMRT and FADI-Activities of Daily Living (ρ = -.60; P = .01) and FADI-Sport (ρ = -.60; P = .01) scores; and moderate, significant positive correlations between the injured limb LE-VMRT and modified Disablement in the Physically Active Scale-Physical Summary Component (ρ = .52; P = .01) and modified Disablement in the Physically Active Scale-Total (ρ = .54; P = .02) scores. All other correlations were not statistically significant. CONCLUSIONS: Young adult women with history of LAS demonstrated an association between self-reported constructs of HRQOL and LE-VMRT. As LE-VMRT is a modifiable injury risk factor, future studies should examine the effectiveness of interventions designed to improve LE-VMRT and the impact on self-reported HRQOL.

Talar-Cartilage Deformation and Spatiotemporal Gait Patterns in Individuals With and Those Without Chronic Ankle Instability.

CONTEXT: Individuals with chronic ankle instability (CAI) present with alterations in the compositional structure of their talar articular cartilage. These alterations likely influence how the talar cartilage responds to the loading associated with activities of daily living, such as walking. Ultrasonography has emerged as an alternative imaging modality for assessing the amount of cartilage deformation in response to loading because it is clinically accessible and cost effective for routine measurements. OBJECTIVES: To (1) compare talar-cartilage deformation in response to a standardized exercise protocol between those with and those without CAI and (2) examine the association between spatiotemporal walking gait parameters and cartilage deformation. DESIGN: Case-control study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A volunteer sample of 24 participants with self-reported CAI (age = 23.2 ± 3.9 years, body mass index [BMI] = 25.1 ± 3.7 kg/m2) and 24 uninjured controls (age = 24.3 ± 2.9 years, BMI = 22.9 ± 2.8 kg/m2). MAIN OUTCOME MEASURE(S): Spatiotemporal walking gait was first assessed from 5 self-selected trials using an electronic walkway with data sampled at 120 Hz. An 8- to 13-MHz linear-array ultrasound transducer placed transversely in line with the medial and lateral malleoli captured 3 images before and after a standardized loading protocol consisting of 30 single- and double-limb squats, 2-minute single-limb balance, and 10 single-legged drops from a 40-cm-height box. RESULTS: After controlling for BMI, we found that the participants with CAI had greater deformation than the uninjured control participants (P = .034). No other between-groups differences were observed (P values > .05). No significant partial correlations were noted between talar-cartilage deformation and spatiotemporal gait parameters when controlling for BMI (P > .05). CONCLUSIONS: Individuals with CAI had greater talar-cartilage deformation in response to a standardized exercise protocol than control individuals. The amount of talar-cartilage deformation was not associated with the spatiotemporal walking gait.

Jump landing among chronic ankle instability individuals who did or did not attend rehabilitation at the time of injury.

OBJECTIVES: The purpose was to compare vertical ground reaction forces and sagittal-plane energy dissipation patterns of the lower extremity during a single-limb jump-stabilization task between individuals with chronic ankle instability who did or did not attend rehabilitation after their initial ankle sprain. DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: Eight participants with chronic ankle instability who did and 12 participants who did not attend rehabilitation were enrolled. MAIN OUTCOME MEASURES: Normalized vertical ground reaction force data were used to calculate the average loading rate, time to peak force, and the peak force. Sagittal plane kinematics and joint moments at the ankle, knee, and hip, were used to calculate each joint's relative energy dissipation at 50, 100, 150, and 200 ms post-landing. RESULTS: Participants who attended rehabilitation had a slower average loading rate (P = 0.025) and smaller peak vertical ground reaction force (P = 0.025). The average relative energy dissipation at the knee was higher in those who attended rehabilitation at the 100 ms (P = 0.041), 150 ms (P = 0.046), and 200 ms (P = 0.042) time intervals. CONCLUSIONS: Attending rehabilitation after an ankle sprain may have a beneficial effect on jump-stabilization outcomes among individuals with chronic ankle instability.

Exploratory factor analysis of the fear-avoidance beliefs questionnaire in patients with chronic ankle instability.

PURPOSE: To perform an exploratory factor analysis of the Fear-Avoidance Beliefs Questionnaire in patients with chronic ankle instability. METHODS: A cross-sectional survey study was utilized. The Fear-Avoidance Beliefs Questionnaire was administered to patients with chronic ankle instability who met the inclusion criteria. Both an unrestricted and restricted factor analysis with varimax rotation were utilized to explore the factor structure of the instrument. Kaiser-Meyer-Olkin values were used to determine sampling adequacy. Bartlett's test of sphericity was used to justify that the correlations were suitable for the principal component analysis. RESULTS: The restricted two-factor analysis resulted in two factors with acceptable internal consistency values. The Keiser-Meyer-Olkin value was acceptable (0.81), and Bartlett's test of sphericity was significant (χ2 (55) = 515.59, p < 0.001). CONCLUSION: The ankle-specific Fear-Avoidance Beliefs Questionnaire consists of two stable factors and should be used to further examine fear-avoidance beliefs in people with chronic ankle instability.

What have we learnt from quantitative case reports of acute lateral ankle sprains injuries and episodes of 'giving-way' of the ankle joint, and what shall we further investigate?

Lateral ankle sprains are a commonly incurred injury in sports. They have a high recurrence rate and can lead to the development of persistent injury associated symptoms. We performed a quantitative synthesis of published case reports documenting the kinematics of acute lateral ankle sprains and episodes of 'giving-way' of the ankle joint to provide a comprehensive description of the mechanisms. A systematic literature search was conducted to screen records within MEDLINE® and EMBASE®. Additional strategies included manual search of specific journals, as well as contacting researchers in relevant communities to retrieve unpublished data. Twenty-four cases were included in the quantitative synthesis, 11 from individual case reports and 13 from four separate case series. Two authors independently reviewed all the articles and extracted ankle joint kinematic data. Excessive ankle inversion was the most pronounced kinematic pattern observed across all included cases, with a mean peak inversion angle of 67.5° (range 2.0 to 142) and a mean peak inversion velocity of 974°/s (range 468 to 1752). This was followed by internal rotation and plantar flexion, respectively. A homogeneous linear function revealed a mean inversion velocity across all cases of 337°/s (range 117 to 1400; R2 = 0.78; p < 0.0001).

Isometric Hip Strength and Patient-Reported Outcomes of Individuals With and Without Chronic Ankle Instability.

CONTEXT: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO) scores. OBJECTIVE: To compare isometric peak torque for hip-extension (H-EXT) and hip-abduction (H-ABD), as well as PRO scores between CAI, lateral ankle sprain copers (LAS copers), and uninjured controls (UC). The secondary purpose was to examine the relationship between isometric hip peak torque and PROs in participants with CAI. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Sixty-three individuals, 45 women (23.02 [3.83] y, 165.91 [7.55] cm, 67.28 [11.95] kg) and 18 men (26.28 [5.43] y, 179.28 [9.01] cm, 83.87 [13.26] kg), grouped as uninjured control (n = 26), LAS coper (n = 15), or CAI (n = 22). MAIN OUTCOME MEASURES: The Foot and Ankle Ability Measure was used to assess region-specific HRQL. The Fear Avoidance Beliefs Questionnaire was used to assess injury-related fear. The Disablement in Physically Active was used to assess global HRQL. Isometric peak torque was measured with a handheld dynamometer for H-EXT and H-ABD. RESULTS: No group differences were observed for H-ABD (P = .34) or H-EXT (P = .35). The CAI group had significantly worse scores on all PROs compared with LAS coper (P < .001) and HC (P < .001). Moderate-weak correlations were found between H-ABD and Foot and Ankle Ability Measure-activities of daily living (P = .047; ρ = .392) and Foot and Ankle Ability Measure-Sport (P = .013; ρ = .482) and H- EXT and Fear Avoidance Beliefs Questionnaire-Work (P = .007; ρ = -.517). CONCLUSIONS: Individuals with CAI displayed lower HRQL based on worse scores on generic, dimension-specific, and region-specific PROs compared with LAS copers and uninjured controls. There were no significant between-group differences for H-EXT and H-ABD isometric peak torque production, but there was a moderate positive relationship between isometric H-ABD and self-reported ankle disability in individuals with CAI.

Joint Stabilization Surgery for Chronic Ankle Instability and Medial Ankle Osteoarthritis: A Critically Appraised Topic.

Clinical Scenario: Patients with chronic ankle instability (CAI) who require surgical intervention are often diagnosed with medial ankle osteoarthritis (OA). Lateral joint stabilization procedures are commonly performed among this patient population to restore bony alignment and improve cartilage loading patterns to increase patient-reported function and mitigate further degenerative changes. Focused Clinical Question: What is the available evidence to support joint stabilization procedures on patient-reported outcomes and progression of radiographic OA among patients with CAI who have medial ankle OA? Summary of Key Findings: An electronic search of relevant databases was performed to identify peer-reviewed articles examining preoperative and postoperative clinical outcomes and radiographic evidence of ankle OA. A total of 3 peer-reviewed articles were retrieved. All 3 articles employed a retrospective case series study design. All 3 articles demonstrated improved patient-reported outcomes at the final follow-up visit. Two articles demonstrated that between 11% and 27% of patients progressed in at least 1stage of radiographic ankle OA between the preoperative assessment and the final follow-up visit (40-56 mo). Clinical Bottom Line: Joint stabilization surgery for patients with CAI and medial ankle OA is associated with improved clinical outcomes and a low rate of worsening radiographic joint degeneration within the first 5 years. Strength of Recommendation: Consistent evidence exists across all 3 articles. However, this evidence is based on a low-quality study design. Therefore, there is a grade-C level of evidence to support joint stabilization for improving patient-reported and radiographic outcomes within the first 5 years after surgery for patients with CAI and medial ankle OA.

Psychological impairments in individuals with history of ankle sprain: a systematic review.

Patient-reported outcomes (PROs) can be used to assess and monitor psychological health following musculoskeletal injury. Studies have reported decreased psychological health after lateral ankle sprain (LAS) using numerous PROs. The purpose of this systematic review was to critically evaluate individual studies, summarize PROs utilized to quantify psychological health, and examine the effect of ankle injury on psychological health between groups (1 LAS, >1 LAS, and healthy controls). Databases searched included: CINAHL, MEDLINE, SPORTDiscus, APA, Psychinfo and PubMed Central. All case-control studies were critically appraised using the modified Downs and Black. Effect sizes (ES) were calculated between the groups (1 LAS, >1 LAS, healthy control) for each of the identified studies, for each included PRO used to quantify psychological impairments. Nine high-quality manuscripts were included. Overall, individuals with history of > 1 LAS self-reported greater psychological impairments compared to healthy controls (ES range = -0.37-12.16), while those with 1 LAS had similar psychological health to healthy control groups (ES rang e = -0.65-0.65). Conclusion: The main findings from this systematic review were individuals with > 1 LAS have increased levels of injury-related fear and decreased psychological health compared to healthy controls. PROs can aid clinicians in identifying psychological health concerns during rehabilitation.

Reliability of Manually Segmenting T1ρ Magnetic Resonance Sequences of Talar Articular Cartilage.

CONTEXT: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. OBJECTIVE: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. DESIGN: Descriptive observational study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. INTERVENTION: None. MAIN OUTCOME MEASURES: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). RESULTS: For T1ρ relaxation time, intraobserver (ICC = .994-.997, RMSCV = 1.31%-1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975-.980, RMSCV = 3.88%-4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. CONCLUSIONS: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.

Corticospinal activity during a single-leg stance in people with chronic ankle instability.

PURPOSE: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. METHODS: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task. RESULTS: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to lateral ankle sprain copers (CSP100%: p = 0.003; MEP120%: p = 0.044) and controls (CSP100%: p = 0.041; MEP120%: p = 0.006). CONCLUSION: This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI. Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.

Acceleration and Jerk After a Jump Stabilization Task in Individuals With and Without Chronic Ankle Instability.

Studies have demonstrated that individuals with chronic ankle instability (CAI) have diminished dynamic stability. Jerk-based measures have been utilized to examine dynamic balance because of their ability to quantify changes in acceleration and may provide an understanding of the postural corrections that occur during stabilizing following a jumping task. The purpose of this study was to compare acceleration and jerk following a jump stabilization task between individuals with CAI and the uninjured controls. Thirty-nine participants volunteered to participate in this case control study. Participants completed a jump stabilization task requiring them to jump off 2 feet, touch a marker set at 50% of their maximal vertical jump height, land on a single limb, and maintain balance for 3 seconds. Acceleration was calculated as the second derivative, and jerk was calculated as the third derivative of the displacement of the resultant vector position. Participants with CAI had greater acceleration (mean difference = 55.6 cm/s2; 95% confidence interval, 10.3 to 100.90; P = .017) and jerk compared with the uninjured controls (mean difference = 1804.5 cm/s3; 95% confidence interval, 98.7 to 3510.3; P = .039). These results suggest that individuals with CAI made faster and more frequent active postural control corrections to regain balance following a jump compared with the uninjured controls.

The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability.

CONTEXT: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. OBJECTIVE: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. DESIGN: Retrospective cohort. SETTING: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. INTERVENTION(S): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. MAIN OUTCOME MEASURES: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. RESULTS: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior-posterior direction (P = .030), and higher TTB anterior-posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. CONCLUSIONS: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.

Pain Medication Administered and Prescribed to Patients With an Ankle Sprain Treated in an Emergency Department: A Record-Based Cohort Study.

INTRODUCTION: Recent data indicate that patients treated in the emergency department for an ankle sprain receive multiple medications. However, research has not been able to accurately identify all the medications because of study limitations. The primary purpose of this study was to document the type of medication, number of doses, and number of encounters given a prescription at discharge or instructions to take over-the-counter medication. The secondary purpose was to determine if the proportion of encounters given each type of medication varied on the basis of age, sex, race, and year. METHODS: A retrospective record-based cohort study design was used to review the electronic medical records (N = 1740) of encounters reporting to a southeast academic level 1 trauma center and diagnosed with an ankle sprain between 2013 and 2017. All relevant data were extracted for nonsteroidal anti-inflammatory drugs, muscle relaxants, opioids, and nonopioid analgesics. RESULTS: Fifty-eight percent of the encounters had at least 1 dose of medication administered in the emergency department. Twenty-eight percent received a prescription at discharge, and 54.5% were instructed to take over-the-counter medication. Cumulatively, opioids accounted for most of the medications, but the yearly rates declined from 2013 to 2017. A greater proportion of patients aged ≤15 years received nonsteroidal anti-inflammatory drugs or nonopioid analgesics. Most of the patients aged >15 years received opioid medication. DISCUSSION: Patients are primarily given an opioid or nonsteroidal anti-inflammatory drug in the emergency department. Fewer patients receive a prescription at discharge but are regularly instructed to take over-the-counter medication.

Physical therapy referral and medication for ankle sprain visits to physician offices: an analysis of the national ambulatory medical care survey.

OBJECTIVES: Supervised physical therapy is the recommended care for an ankle sprain. Yet, recent evidence indicates some ankle sprain patients may not receive the recommended care, and instead, prescribed medication to alleviate symptoms. Therefore, the purpose of this study is to describe the percentage of patients reporting to an office-based physician in the U.S. that were or were not referred to physical therapy. Secondly, to describe the percentage of ankle sprain patients with or without medication administered, supplied or ordered. METHODS: This was a secondary analysis of the cross-sectional National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. The NAMCS is a multi-stage probability sample survey of visits to office-based physicians. The percentage and associated 95% confidence intervals (CI) were calculated for visits that had a physical therapy referral or a non-steroidal anti-inflammatory drug (NSAID), opioid and non-opioid analgesics administered, supplied or ordered. Sampled data were weighted to produce national-level estimates. RESULTS: A physical therapy referral was given for 16.8% (95% CI: 13.2, 21.2) of ankle sprain visits. Approximately 34.5% (95%CI: 30.5, 38.7) of all ankle sprain visits had a medication administered, supplied or ordered. NSAIDs (72.1%; 95% CI: 66.9,76.8) and opioids (21.0%; 95% CI: 16.3, 26.5) were the two most common types of medication. CONCLUSIONS: NSAIDs and opioid medication combined were administered, supplied or ordered more frequently than a referral to physical therapy. These findings provide evidence that suggests many ankle sprain patients reporting to an office-based physician are not receiving the recommended care; physical therapy. Rather, medication appears to be the primary type of care provided to patients. These data are important because it gives a focused area to improve the treatment of an ankle sprain by developing strategies that ensure all patients are provided the recommended care from the onset of entering the healthcare system.