Randomized controlled trial on ankle biomechanics in the treatment of functional ankle instability with joint mobilization.

Functional ankle instability (FAI) patients often experience restricted ankle dorsiflexion, increased inversion angle, and elevated ground reaction forces during walking, all related to altered kinematics of the talocrural and subtalar joints. This study aimed to investigate the potential positive impact of joint mobilization on FAI patients from a biomechanical perspective. The experimental group (EG, n = 17; Age: 20.06 ± 1.34 years; Height: 1.74 ± 0.07 m; Weight: 69.79 ± 11.20 kg; BMI:22.88 ± 2.63 kg/m2; CAIT:15.59 ± 2.58; M/F: 15/2) received joint mobilization + routine rehabilitation training, while the control group (CG, n = 16; Age: 20.50 ± 0.73 years; Height: 1.73 ± 0.09 m; Weight: 64.59 ± 7.21 kg; BMI: 21.65 ± 2.47 kg/m2; CAIT: 16.75 ± 2.21; M/F: 14/2) only received regular rehabilitation training. Biomechanical tests were performed in both groups after the 4-week intervention. The spatial parameters during walking (including step length, stride length, step width, step time, cadence, step speed, support time, and swing time), ankle flexion and dorsiflexion angle, inversion, and eversion angles, internal and external rotation angles, ankle torque, as well as the vertical ground reaction force were measured before and after the intervention. The results of the two-way ANOVA showed that the main effect of time was significant for step length (P < 0.001), stride length (P = 0.008), step speed (P < 0.001), the sagittal plane angle at touchdown (P < 0.001), maximum dorsiflexion angle (P = 0.005), sagittal plane toe off-ground angle (P < 0.001), peak flexion-dorsiflexion torque (P = 0.033), the first peak vGRF (P = 0.013), and second peak vGRF (P = 0.011). The main effect of Time * Group was significant for step speed (P = 0.044). The EG demonstrated significant improvements in step speed (P = 0.047), maximum dorsiflexion angle (P = 0.047), and the first peak vGRF (P = 0.028) compared to the CG. This study reveals that joint mobilization intervention enhances gait spatiotemporal parameters, kinematics, and kinetics, particularly in step speed, maximum dorsiflexion angle, and the first vGRF peak for the EG compared to the CG. Therefore, the rehabilitation strategy for patients with functional ankle instability should appropriately increase the use of joint movement to promote the functional recovery of FAI patients.

Rehabilitation and Return to Sport following Operative and Nonoperative Treatment of Anterior Shoulder Instability.

There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.

The effect of joint mobilization of Maitland on chronic ankle instability: A randomized trial.

BACKGROUND: The aim of study was to observe the therapeutic effect of joint mobilization of Maitland on subjects with chronic ankle instability (CAI). METHODS: 76 subjects with CAI were recruited for this randomized, single-blinded trial and randomized divided into experimental group (EG) and control group (CG). The CG was received conventional rehabilitation, and the EG added 8-weeks treatment of Maitland technology based on the CG. The visual analogue scale, ankle range of motion, Y-balance test, and Foot and Ankle Ability Measure scores (the daily living part of Foot and Ankle Ability Measure scores and the sport part of Foot and Ankle Ability Measure scores) were measured before and 8 weeks after the intervention respectively. RESULTS: There was no significant difference on outcomes between the 2 groups before treatment (P > .05). After 8 weeks of intervention, the visual analogue scale, ankle range of motion (dorsiflexion, plantar flexion, and varus), the value of Y-balance test (forward extension distance, inner extension distance, and posterior extension distance), the daily living part of Foot and Ankle Ability Measure scores, and the sport part of Foot and Ankle Ability Measure scores of the 2 groups were significantly improved (P < .01), and the improvement of the EG showed remarkable than CG (P < .01). CONCLUSION: Maitland therapy is effective in the treatment of CAI. Conventional rehabilitation assisted by Maitland therapy were beneficial to improve pain and functional state in patients with CAI than only routine rehabilitation.

Meta-analysis of the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability.

OBJECTIVE: To explore and compare the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI). METHODS: The PubMed, Embase, Web of Science, Medline, and Cochrane databases were searched up to December 2023. Quality assessment was carried out using the risk-of-bias guidelines of the Cochrane Collaboration, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were compute. RESULTS: Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis demonstrated that balance training was effective in enhancing ankle function with self-functional scores (SMD = 1.02; 95% CI, 0.61 to 1.43; p < 0.00001; I2 = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD = 5.88; 95% CI, 3.37 to 8.40; p < 0.00001; I2 = 84%), SEBT-PM (MD = 5.47; 95% CI, 3.40 to 7.54; p < 0.00001; I2 = 61%), and SEBT-PL (MD = 6.04; 95% CI, 3.30 to 8.79; p < 0.0001; I2 = 79%) of CAI patients. Meta-regression indicated that the intervention time might be the principal cause of heterogeneity (p = 0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 min and less than 30 min had the most favorable effect (MD = 1.21, 95% CI: 0.96 to 1.46, p < 0.00001, I2 = 55%); among the intervention period, 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, p < 0.00001, I2 = 78%) and 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, p < 0.00001, I2 = 71%) had significant effects; among the intervention frequency, 3 times (MD = 1.14, 95% CI: 0.89 to 1.38), p < 0.00001, I2 = 57%) had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20-30 min is the optimal combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability. CONCLUSION: Balance training proves beneficial for ankle function in patients with CAI. Intervention time constitutes a major factor influencing self-function in patients with CAI. It is recommended that the optimal dosage of balance training for CAI involves intervention three times a week, lasting for 20 to 30 min over a period of 4 to 6 weeks for superior rehabilitation.

Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability.

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.

The Effects of Augmenting Balance Training with Stroboscopic Goggles on Postural Control in Chronic Ankle Instability Patients: A Critically Appraised Topic.

CLINICAL SCENARIO: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted. FOCUSED CLINICAL QUESTION: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI? SUMMARY OF KEY FINDINGS: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies. CLINICAL BOTTOM LINE: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone. STRENGTH OF RECOMMENDATION: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI.

Effects of Balance and Strength Training for Ankle Proprioception in People with Chronic Ankle Instability: A Randomized Controlled Study.

BACKGROUND: After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that people with chronic ankle instability (CAI) commonly have deficits in joint position sense and reinjury risks. Joint position sense plays an important role in ankle control, thereby reducing the risk of injury. Therefore, this study aims to compare the effects of balance and strength training on ankle proprioception in people with CAI. METHODS: This single-blind randomized controlled study included 29 volunteer participants (21 women and eight men) aged 18 to 30 years. Participants with a Cumberland ankle instability scale score less than or equal to 24 were randomly divided into two treatment groups: strength training (n = 14) and balance training (n = 15). Y balance test, joint position, and vibration sense were evaluated at the beginning and end of the treatment. "Hop to stabilization" exercises were applied to the balance group and resistive bands exercises to the strength group, which were performed for 6 weeks, 35 minutes per day, two times per week. RESULTS: There was no significant difference between the two groups in the anterior, posterolateral, and posteromedial directions of the Y balance test (P = .89, P = .50, and P = .34, respectively), but the strength training group showed significant improvement in ankle proprioception (140°) and vibration sense (fifth finger) (P < .001), and the post hoc Cohen's d effect size values were medium (.52) and small (.25), respectively. CONCLUSIONS: The findings of this study show that strengthening and balance exercises have similar effects on dynamic balance, but strengthening exercises are more effective in improving joint position and vibration sense. Given the positive effects of both exercise programs, it is recommended to implement the two interventions separately or together for CAI rehabilitation.

Rehabilitation guidelines following arthroscopic shoulder stabilisation surgery for traumatic instability - a Delphi consensus.

BACKGROUND: There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice. METHOD: Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement. RESULTS: 11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined "safe zone." Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks. Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient's confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score. CONCLUSION: This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS. CONTRIBUTION OF THE PAPER.

Comparison of surgical or non-surgical management for non-acute anterior cruciate ligament injury: the ACL SNNAP RCT.

Background: Anterior cruciate ligament injury of the knee is common and leads to decreased activity and risk of secondary osteoarthritis of the knee. Management of patients with a non-acute anterior cruciate ligament injury can be non-surgical (rehabilitation) or surgical (reconstruction). However, insufficient evidence exists to guide treatment. Objective(s): To determine in patients with non-acute anterior cruciate ligament injury and symptoms of instability whether a strategy of surgical management (reconstruction) without prior rehabilitation was more clinically and cost-effective than non-surgical management (rehabilitation). Design: A pragmatic, multicentre, superiority, randomised controlled trial with two-arm parallel groups and 1:1 allocation. Due to the nature of the interventions, no blinding could be carried out. Setting: Twenty-nine NHS orthopaedic units in the United Kingdom. Participants: Participants with a symptomatic (instability) non-acute anterior cruciate ligament-injured knee. Interventions: Patients in the surgical management arm underwent surgical anterior cruciate ligament reconstruction as soon as possible and without any further rehabilitation. Patients in the rehabilitation arm attended physiotherapy sessions and only were listed for reconstructive surgery on continued instability following rehabilitation. Surgery following initial rehabilitation was an expected outcome for many patients and within protocol. Main outcome measures: The primary outcome was the Knee Injury and Osteoarthritis Outcome Score 4 at 18 months post randomisation. Secondary outcomes included return to sport/activity, intervention-related complications, patient satisfaction, expectations of activity, generic health quality of life, knee-specific quality of life and resource usage. Results: Three hundred and sixteen participants were recruited between February 2017 and April 2020 with 156 randomised to surgical management and 160 to rehabilitation. Forty-one per cent (n = 65) of those allocated to rehabilitation underwent subsequent reconstruction within 18 months with 38% (n = 61) completing rehabilitation and not undergoing surgery. Seventy-two per cent (n = 113) of those allocated to surgery underwent reconstruction within 18 months. Follow-up at the primary outcome time point was 78% (n = 248; surgical, n = 128; rehabilitation, n = 120). Both groups improved over time. Adjusted mean Knee Injury and Osteoarthritis Outcome Score 4 scores at 18 months had increased to 73.0 in the surgical arm and to 64.6 in the rehabilitation arm. The adjusted mean difference was 7.9 (95% confidence interval 2.5 to 13.2; p = 0.005) in favour of surgical management. The per-protocol analyses supported the intention-to-treat results, with all treatment effects favouring surgical management at a level reaching statistical significance. There was a significant difference in Tegner Activity Score at 18 months. Sixty-eight per cent (n = 65) of surgery patients did not reach their expected activity level compared to 73% (n = 63) in the rehabilitation arm. There were no differences between groups in surgical complications (n = 1 surgery, n = 2 rehab) or clinical events (n = 11 surgery, n = 12 rehab). Of surgery patients, 82.9% were satisfied compared to 68.1% of rehabilitation patients. Health economic analysis found that surgical management led to improved health-related quality of life compared to non-surgical management (0.052 quality-adjusted life-years, p = 0.177), but with higher NHS healthcare costs (£1107, p < 0.001). The incremental cost-effectiveness ratio for the surgical management programme versus rehabilitation was £19,346 per quality-adjusted life-year gained. Using £20,000-30,000 per quality-adjusted life-year thresholds, surgical management is cost-effective in the UK setting with a probability of being the most cost-effective option at 51% and 72%, respectively. Limitations: Not all surgical patients underwent reconstruction, but this did not affect trial interpretation. The adherence to physiotherapy was patchy, but the trial was designed as pragmatic. Conclusions: Surgical management (reconstruction) for non-acute anterior cruciate ligament-injured patients was superior to non-surgical management (rehabilitation). Although physiotherapy can still provide benefit, later-presenting non-acute anterior cruciate ligament-injured patients benefit more from surgical reconstruction without delaying for a prior period of rehabilitation. Future work: Confirmatory studies and those to explore the influence of fidelity and compliance will be useful. Trial registration: This trial is registered as Current Controlled Trials ISRCTN10110685; ClinicalTrials.gov Identifier: NCT02980367. Funding: This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/140/63) and is published in full in Health Technology Assessment; Vol. 28, No. 27. See the NIHR Funding and Awards website for further award information.

The study aimed to find out whether it is better to offer surgical reconstruction or rehabilitation first to patients with a more long-standing injury of their anterior cruciate ligament in their knee. This injury causes physical giving way of the knee and/or sensations of it being wobbly (instability). The instability can affect daily activities, work, sport and can lead to arthritis. There are two main treatment options for this problem: non-surgical rehabilitation (prescribed exercises and advice from physiotherapists) or an operation by a surgeon to replace the damaged ligament (anterior cruciate ligament reconstruction). Although studies have highlighted the best option for a recently injured knee, the best management was not known for patients with a long-standing injury, perhaps occurring several months previously. Because the surgery is expensive to the NHS (around £100 million per year), it was also important to look at the costs involved. We carried out a study recruiting 316 non-acute anterior cruciate ligament-injured patients from 29 different hospitals and allocated each patient to either surgery or rehabilitation as their treatment option. We measured how well they did with special function and activity scores, patient satisfaction and costs of treatment. Patients in both groups improved substantially. It was expected that some patients in the rehabilitation group would want surgery if non-surgical management was unsuccessful. Forty-one per cent of patients who initially underwent rehabilitation subsequently elected to have reconstructive surgery. Overall, the patients allocated to the surgical reconstruction group had better results in terms of knee function and stability, activity level and satisfaction with treatment than patients allocated to the non-operative rehabilitation group. There were few problems or complications with either treatment option. Although the surgery was a more expensive treatment option, it was found to be cost-effective in the UK setting. The evidence can be discussed in shared decision-making with anterior cruciate ligament-injured patients. Both strategies of management led to improvement. Although a rehabilitation strategy can be beneficial, especially for recently injured patients, it is advised that later-presenting non-acute and more long-standing anterior cruciate ligament-injured patients undergo surgical reconstruction without necessarily delaying for a period of rehabilitation.

Lower leg muscle activation during the ebbets foot drills.

Lateral ankle sprains (LAS) often lead to chronic ankle instability (CAI). The Ebbets foot drills were created to strengthen the lower leg muscles and reduce the risk of LAS. The current study aimed to explore the activation of the lower leg muscles during the Ebbets foot drills. Twenty-two (22) college students without LAS participated in the study. Surface electromyography (sEMG) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) was collected during each of the Ebbets foot drills and a normal walking trial. The sEMG mean root mean square (RMS) was calculated for each walking and Ebbets foot drill trial duration. The mean RMS was higher during the Ebbets foot drills compared to normal walking for all muscles. The TA sEMG mean RMS was greater (4.0-68.3%, P = 0.001-0.023) during all the Ebbets foot drills than during the walking trial. The TP had greater mean RMS during the toe-in (50.4%, P < 0.001), toe-out (55.0%, P < 0.001), and backward walking (47.3%, P < 0.001) drills, than during the walking trial. The PL had greater mean RMS during all Ebbets foot drills (19.4-53.7%, P < 0.001) except for the heel walking and inversion drills. Ebbets foot drills higher muscle activity than regular walking, suggesting that the Ebbets foot drills could aid in the strengthening of the TA, TP, and PL muscles. These results build evidence on Ebbets' theory and indicate that these drills may be used to rehabilitate LAS and CAI.

Effects of ankle joint mobilization on dynamic balance muscle activity and dynamic balance in persons with chronic ankle instability - Feasibility of a cross-over study.

INTRODUCTION: Studies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose of this study was to evaluate the feasibility of a planned cross-over study to assess efficacy of manual therapy techniques applications in patients with chronic ankle instability. METHODS: This feasibility study used a randomized controlled, blinded assessor cross-over design. Criteria of success under evaluation were adherence and attrition rates and adverse events. while preliminary treatment effects of manual therapy techniques on muscular activity (measured by surface electromyography) and on dynamic balance (measured by time to stabilization test) were secondary aims. RESULTS: Thirteen participants (mean age: 24.4 ± 3.8 years) with chronic ankle instability volunteered in this feasibility study. Success criteria showed a high adherence (98.7%) and low attrition (0%). No missing data were reported but four out of 26 data sets could not be used for statistical analysis because of non-readability of the recorded data. Preliminary treatment effect showed divergent results for surface electromyography and time to stabilization. One significant result (p = 0.03, ES = 1.48) in peroneus longus muscle activity after jump landing between 30 and 60 ms could be determined. CONCLUSIONS: This study showed that the study protocol is feasible but should be modified by offering participants the opportunity to familiarize to the jumps and to the test repetitions. This study generates better understanding of manual therapy techniques for patients with chronic ankle instability.

Effect of whole-body vibration on postural stability in young adults with generalized joint hypermobility: A comparative study.

BACKGROUND: Whole-body vibration (WBV) is being used in rehabilitation and sport. Studies confirm its positive impact on muscle strength and power or regulating muscle hypertension. However, there are some uncertainties regarding its influence on postural stability. This issue seems particularly interesting in the case of individuals with generalized joint hypermobility (GJH), for whom proprioceptive training and muscle strengthening exercises are recommended while techniques that decrease muscle tension are not advised. OBJECTIVE: The aim of the study was to evaluate the acute effect of WBV on postural stability in adults with GJH. METHODS: 60 participants were categorized into the groups: 1) hypermobility with vibration (GJH+WBV), 2) hypermobility without vibration (GJH-WBV), 3) control group with vibration (CTRL+WBV), 4) control group without vibration (CTRL-WBV). The first and the third group completed WBV (frequency: 15 Hz and 30 Hz, amplitude 3 mm, 3 × 3 min). The second and fourth groups participated only in measurement sessions. GJH was assessed using the Beighton test. Postural stability was measured as the overall stability index (OSI) on the Biodex Balance System on the stable and unstable platform with open and closed eyes. Measurements were taken before and after WBV for two weeks. RESULTS: At a frequency of 15 Hz, a significant time effect was observed for measurements Before and After in CTRL-WBV on the stable platform with open eyes (p= 0.012) and on the unstable platform with closed eyes (p= 0.000) for the GJH+WBV and CTRL+WBV groups. There were no significant interactions (p> 0.05) between factors. At a frequency of 30 Hz, there was a significant time effect Before and After (p= 0.047) on the stable platform with open eyes, but no interaction was found between factors (p= 0.835). CONCLUSION: There is no positive acute effect of WBV on postural stability in adults with and without GJH.

Neuromuscular Electrical Stimulation Improves Frontal Ankle Motor Control in Individuals With Chronic Ankle Instability During Drop Landing.

OBJECTIVE: This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing. DESIGN: This was a randomized, controlled, double-blind trial. Thirty-six individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week 0 and week 6 . A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week 6 , with the outcome variables at week 0 as covariates. RESULTS: Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (-16.05, -78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week 6 . CONCLUSIONS: Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control.

The use and effectiveness of exercise for managing postural orthostatic tachycardia syndrome in young adults with joint hypermobility and related conditions: A scoping review.

PURPOSE: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia. It may occur in isolation, but frequently co-exists in individuals with hypermobile variants of Ehlers-Danlos Syndrome (EDS) and related conditions (chronic fatigue syndrome [CFS] and fibromyalgia). Exercise is recommended for non-pharmacological POTS management but needs to be individualised. This scoping review explores the current literature on use and effectiveness of exercise-based management for POTS, with specific focus on individuals with joint hypermobility and related conditions who experience hypermobility, and/or pain, and/or fatigue. METHODS: A systematic search, to January 2023, of Medline, EMBASE, AMED, CINAHL and the Cochrane library was conducted. Studies that reported on adolescents and adults who had been diagnosed with POTS using standard criteria and underwent an exercise-based training intervention were included. RESULTS: Following full-text screening, 10 articles were identified (2 randomised control trials, 4 comparative studies and 4 case reports). One comparative study reported a small subset of participants with EDS and one case report included an individual diagnosed with CFS; the remainder investigated a wider POTS population. Overall, 3 months of endurance followed by resistance exercise, graduating from the horizontal-to-upright position reduced POTS symptoms and improved quality-of-life. CONCLUSION: The findings highlight a paucity of higher-level studies documenting exercise for POTS management in people with joint hypermobility and related conditions. Results from the wider POTS population demonstrate exercise is safe and effective. Large, well-designed clinical studies exploring exercise for POTS management adapting to meet the complex musculoskeletal and non-musculoskeletal features of symptomatic joint hypermobility are needed.

Assessing the use of the frequency, etiology, direction, and severity classification system for shoulder instability in physical therapy research - A scoping review.

OBJECTIVE: The aim of this study is to review the implementation of the Frequency, Etiology, Direction, and Severity (FEDS) classification for shoulder instability by the physical therapy scientific community since its publication in 2011. METHODS: A systematic search was conducted on January 10, 2024 in the MEDLINE, EMBASE, SPORTDiscus, Scopus, Web of Science, Cochrane, and SciELO databases, as well as Google Scholar. Studies investigating physical therapy interventions in people with shoulder instability, and reporting selection criteria for shoulder instability were considered eligible. A narrative synthesis was conducted. RESULTS: Twenty-six studies were included. None reported using the FEDS classification as eligibility criteria for shoulder instability. Only 42% of the studies provided data of all four criteria of the FEDS classification. The most reported criterion was direction (92%), followed by etiology (85%), severity (65%), and frequency (58%). The most common reported descriptor for profiling shoulder instability was "dislocation" (83.3%), followed by "first-time" (66.7%), "anterior" (62.5%), and "traumatic" (59.1%). Regarding other instability classifications, only one study (4%) used the Thomas & Matsen classification, and two (8%) the Stanmore classification. CONCLUSIONS: The FEDS classification system has not been embraced enough by the physical therapy scientific community since its publication in 2011.

Intrinsic graft laxity variation with open kinetic chain exercise after anterior cruciate ligament reconstruction: A non-randomized controlled study.

OBJECTIVES: To determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3, and 6 months after anterior cruciate ligament reconstruction (ACLR). DESIGN: Retrospective study. METHODS: Two groups (n = 53) of ACLR patients (combination of OKC and CKC exercises group compared to a CKC exercise group) were recruited. OKC protocol was introduced at 2 weeks post-operatively without external resistance and progressed at 4 weeks with load. Comparative ACL graft laxity measurement and isokinetic strength testing were prospectively performed up to 6 months in both groups. RESULTS: No significant differences were observed in the knee laxity at 1 (p = 0.263), 3 (p = 0.263), and 6 months (p = 0.256) follow up between the groups. Similarly, no significant results were observed in within-group knee laxity between 1 and 6 months after ACLR in the intervention (p = 0.155) and control group (p = 0.690). CONCLUSION: The early initiation of OKC along with CKC exercises doesn't seem to increase the ACLR graft laxity as compared to a rehabilitation program with only CKC exercises.

Individuals with chronic ankle instability show altered regional activation of the peroneus longus muscle during ankle eversion.

Individuals with chronic ankle instability (CAI) present muscular weakness and potential changes in the activation of the peroneus longus muscle, which likely explains the high recurrence of ankle sprains in this population. However, there is conflicting evidence regarding the role of the peroneus longus activity in CAI, possibly due to the limited spatial resolution of the surface electromyography (sEMG) methods (i.e., bipolar sEMG). Recent studies employing high-density sEMG (HD-sEMG) have shown that the peroneus longus presents differences in regional activation, however, it is unknown whether this regional activation is maintained under pathological conditions such as CAI. This study aimed to compare the myoelectric activity, using HD-sEMG, of each peroneus longus compartment (anterior and posterior) between individuals with and without CAI. Eighteen healthy individuals (No-CAI group) and 18 individuals with CAI were recruited. In both groups, the center of mass (COM) and the sEMG amplitude at each compartment were recorded during ankle eversion at different force levels. For the posterior compartment, the sEMG amplitude of CAI group was significantly lower than the No-CAI group (mean difference = 5.6% RMS; 95% CI = 3.4-7.6; p = 0.0001). In addition, it was observed a significant main effect for group (F1,32 = 9.608; p = 0.0040) with an anterior displacement of COM for the CAI group. These findings suggest that CAI alters the regional distribution of muscle activity of the peroneus longus during ankle eversion. In practice, altered regional activation may impact strengthening programs, prevention, and rehabilitation of CAI.

Adding Neurofeedback Training to Neuromuscular Training for Rehabilitation of Chronic Ankle Instability: A 3-Arm Randomized Controlled Trial.

BACKGROUND: Neurofeedback training (NFT) can aid in the treatment of the abnormal patterns of the brain brought on by physical injury, enhancing cognitive and behavioral abilities. The present study aimed to compare the effectiveness of combining neuromuscular training (NMT) and NFT (NMT+NFT) with NMT alone in rehabilitating athletes with chronic ankle instability (CAI). HYPOTHESIS: NMT+NFT will be more effective than NMT alone. STUDY DESIGN: A 3-arm, single-blind randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total number of 62 athletes, aged 18 to 25 years, with CAI, participated in this study. The study subjects were allocated randomly to 3 groups: 21 cases in the control group, 21 cases in the combination group (CG) receiving NMT+NFT, and 20 cases in the neuromuscular group (NG) practicing NMT alone, undergoing exercises related to their groups for 8 weeks. Data were recorded and analyzed before and after the 8-week training program. The primary outcome measures were postural sway indices; secondary outcomes included ankle proprioception and biopsychosocial indices. RESULTS: NMT+NFT was more effective than NMT alone in terms of improving postural control during single- and 2-legged standing positions under the conditions of eyes closed and eyes open, proprioception at 20° of plantar flexion, as well as anxiety and depression in athletes with CAI. However, the findings revealed that NMT+NFT and NMT alone could both improve such indices. CONCLUSION: NMT+NFT as a treatment protocol improved postural control, ankle proprioception, anxiety, and depression greater than NMT alone. CLINICAL RELEVANCE: A combined protocol of NFT and NMT led to greater improvement compared with NMT alone. NFT was recommended as an adjunct therapy in the rehabilitation of athletes suffering from CAI.

Immediate effects of local muscle vibration on static and dynamic balance control in individuals with chronic ankle instability.

OBJECTIVES: To investigate the immediate effects of local muscle vibration (LMV) on static and dynamic balance control in individuals with and without chronic ankle instability (CAI). DESIGN: Quasi-experimental study. SETTING: Research laboratory. PARTICIPANTS: Twenty-six individuals with CAI and 26 healthy controls. MAIN OUTCOME MEASURES: Center of pressure variables (mean total velocity and displacement in anteroposterior (AP) and mediolateral (ML) directions) during single-leg standing with eyes open and eyes closed and also reach distances in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions of the modified star excursion balance test (MSEBT) were assessed before and after LMV. RESULTS: Statistical analyses showed a significant decrease in mean total velocity and displacement in AP direction from before to after LMV in eyes open condition for both individuals with CAI (p = 0.025, p = 0.041, respectively) and healthy controls (p = 0.001, p = 0.003, respectively). Similar results were observed in eyes closed condition for both individuals with CAI (p < 0.001, p < 0.001, respectively) and healthy controls (p = 0.040, p = 0.014, respectively). The results also showed increased reach distances in ANT (p < 0.001), PM (p < 0.001), and PL directions (p < 0.001) in all participants after LMV. CONCLUSION: Our results suggest that LMV may be a useful tool in rehabilitation of static and dynamic balance deficits in individuals with CAI.