Lower-Extremity Kinematics During Ankle Inversion Perturbations: A Novel Experimental Protocol That Simulates an Unexpected Lateral Ankle Sprain Mechanism.

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

Lower extremity joint kinematics of a simulated lateral ankle sprain after drop landings in participants with chronic ankle instability.

This study examined lower extremity joint kinematics in individuals with chronic ankle instability (CAI) and controls during unanticipated and anticipated single-leg drop landings onto a laterally inclined platform. Physically active adults with CAI 15 (n = 15) and controls (n = 15) performed an unanticipated and anticipated 30 cm single-leg drop landing onto a 20° laterally inclined platform. Three-dimensional ankle, knee and hip-joint kinematics were recorded 200 ms pre- to 200 post-landing and analysed with a 2 (group) × 2 (landing condition) SPM ANOVA (p < 0.05). Results revealed individuals with CAI displayed significantly greater ankle internal rotation post-landing across both landing conditions. Anticipated landings elicited significantly greater pre-landing ankle inversion and external rotation, knee abduction and hip adduction. Additionally, significantly less ankle inversion, knee and hip flexion, and knee adduction and hip abduction were present during post-landing of the anticipated landing. Greater ankle internal rotation during landing may contribute to the ankle 'giving way' in individuals with CAI. However, preparatory and reactive proximal-joint kinematics were similar in both groups during landing. This highlights the possible role of the knee and hip joints in assisting with ankle-joint stability during anticipated inversion perturbations.

Ankle kinematics, center of pressure progression, and lower extremity muscle activity during a side-cutting task in participants with and without chronic ankle instability.

This study assessed ankle kinematics, surface electromyography, and center-of-pressure (COP) progression relative to the medial border of the foot during a side-cutting task in individuals with and without chronic ankle instability (CAI). Thirty participants (CAI = 15; Controls = 15) performed a side-cutting task on a force platform while 3-dimentional ankle kinematics, COP position, and surface electromyography from the tibialis anterior, medial gastrocnemius, fibularis longus, fibularis brevis, vastus medialis, and semitendinosus were recorded on the testing leg. Ankle kinematics, root-mean-square muscle activity and COP position relative to the medial boarder of the foot were compared between CAI and healthy controls (p < 0.05). Significantly greater ankle internal rotation from 35-54% of the stance phase (p = 0.032) was found for the CAI group compared to controls. Furthermore, significantly greater tibialis anterior muscle activity from 86-94% of the stance phase (p = 0.022) and a more medial COP position from 81-100% (p < 0.05) and of the stance phase was also observed in the CAI group. Less lateral COP progression and increased tibialis anterior activation in the CAI group could reflect a protective movement strategy during anticipated side-cutting to avoid recurrent injury. However, greater ankle internal rotation during mid-stance highlights a potential 'giving way' mechanism in individuals with CAI.

Lower Limb Joint Kinetics During a Side-Cutting Task in Participants With or Without Chronic Ankle Instability.

CONTEXT: Individuals with chronic ankle instability (CAI) demonstrate altered lower limb movement dynamics during jump landings, which can contribute to recurrent injury. However, the literature examining lower limb movement dynamics during a side-cutting task in individuals with CAI is limited. OBJECTIVE: To assess lower limb joint kinetics and sagittal-plane joint stiffness during the stance phase of a side-cutting task in individuals with or without CAI. DESIGN: Cohort study. SETTING: Motion-capture laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifteen physically active, young adults with CAI (7 men, 8 women; age = 21.3 ± 1.6 years, height = 171.0 ± 11.2 cm, mass = 73.4 ± 15.2 kg) and 15 healthy matched controls (7 men, 8 women; age = 21.5 ± 1.5 years, height = 169.9 ± 10.6 cm, mass = 75.5 ± 13.0 kg). INTERVENTION(S): Lower limb 3-dimensional kinematic and ground reaction force data were recorded while participants completed 3 successful trials of a side-cutting task. Net internal joint moments, in addition to sagittal-plane ankle-, knee-, and hip-joint stiffness, were computed from 3-dimensional kinematic and ground reaction force data during the stance phase of the side-cutting task and analyzed. MAIN OUTCOME MEASURE(S): Data from each participant's stance phase were normalized to 100% from initial foot contact (0%) to toe-off (100%) to compute means, standard deviations, and Cohen d effect sizes for all dependent variables. RESULTS: The CAI group exhibited a reduced ankle-eversion moment (39%-81% of stance phase) and knee-abduction moment (52%-75% of stance phase) and a greater ankle plantar-flexion moment (3%-16% of stance phase) than the control group (P range = .009-.049). Sagittal-plane hip-joint stiffness was greater in the CAI than in the control group (t28 = 1.978, P = .03). CONCLUSIONS: Our findings suggest that altered ankle-joint kinetics and increased hip-joint stiffness were associated when individuals with CAI performed a side-cutting task. These lower limb kinetic changes may contribute to an increased risk of recurrent lateral ankle sprains in people with CAI. Clinicians and practitioners can use these findings to develop rehabilitation programs for improving maladaptive movement mechanics in individuals with CAI.

Effects of Weighted Vest Loading During Daily Living Activities on Countermovement Jump and Sprint Performance.

PURPOSE: Wearing a weighted vest (WV) during daily living and training can enhance jump and sprint performance; however, studies examining the efficacy of this method in female populations is limited. This study examined the effect of wearing a WV during daily living and training on countermovement jump (CMJ), change-of-direction, and sprint performance. METHODS: Trained females were separated into intervention (n = 9) and control (n = 10) groups. The intervention group wore WVs of ∼8% body mass 4 days per week for 8 hours per day (32 h/wk total), and 3 training sessions per week for the first 3 weeks. Subsequently, 3 weeks of regular training without WV stimulus was completed. The control group received no intervention and continued normal training for 6 weeks. Average and best performance was assessed on the single CMJ, four continuous CMJ, t-test change-of-direction drill, and a 25-m sprint at baseline, week 3, and week 6. RESULTS: No significant interactions or group effects were found. However, significant time main effects revealed increases in average rate of force development during the CMJ from baseline to week 3 (P = .048) and week 6 (P = .013), whereas peak vertical ground reaction force increased during the four continuous CMJ from baseline to week 3 (P = .048) and week 6 (P = .025) for both groups. CONCLUSIONS: The lower relative WV load used in this study failed to elicit significant improvements in jump and sprint performance in comparison with routine training, or that which have been found in past investigations with elite male athletes completing high-intensity performance tasks with greater WV loads.

Individuals with chronic ankle instability exhibit dynamic postural stability deficits and altered unilateral landing biomechanics: A systematic review.

OBJECTIVE: To evaluate the literature regarding unilateral landing biomechanics and dynamic postural stability in individuals with and without chronic ankle instability (CAI). METHODS: Four online databases (PubMed, ScienceDirect, Scopus, and SportDiscus) were searched from the earliest records to 31 January 2018, as well as reference sections of related journal articles, to complete the systematic search. Studies investigating the influence of CAI on unilateral landing biomechanics and dynamic postural stability were systematically reviewed and evaluated. RESULTS: Twenty articles met the criteria and were included in the systematic review. Individuals with CAI were found to have deficits in dynamic postural stability on the affected limb with medium to large effect sizes and altered lower extremity kinematics, most notably in the ankle and knee, with medium to large effect sizes. Additionally, greater loading rates and peak ground reaction forces, in addition to reductions in ankle muscle activity were also found in individuals with CAI during unilateral jump-landing tasks. CONCLUSIONS: Individuals with CAI demonstrate dynamic postural stability deficits, lower extremity kinematic alterations, and reduced neuromuscular control during unilateral jump-landings. These are likely factors that contribute recurrent lateral ankle sprain injuries during dynamic activity in individuals with CAI.

Neuromuscular control in individuals with chronic ankle instability: A comparison of unexpected and expected ankle inversion perturbations during a single leg drop-landing.

While neuromuscular control deficits during inversion perturbations in chronic ankle instability (CAI) cohorts are well documented in the literature, anticipatory motor control strategies to inversion perturbations in CAI are largely unknown. The purpose of this study was to examine neuromuscular control and ankle kinematics in individuals with CAI (n = 15) and matched controls (n = 15) during unexpected and expected single leg drop-landings onto a tilted surface rotated 20° in the frontal plane. Muscle activity from 200 ms pre- to post-landing was recorded from the tibialis anterior (TA), medial gastrocnemius (MG), peroneus longus (PL) and peroneus brevis (PB). Mean muscle activity, co-contraction index (CCI), and peroneal latency was analyzed. Ankle inversion angle at initial contact, time to maximum inversion angle, maximum inversion angle and velocity were also assessed. Significantly longer PL latency, less time to maximum inversion and greater maximum inversion angle was found in CAI compared to controls. Regarding landing condition, significantly greater maximum inversion angle, less inversion at initial contact, longer PB latency, less TA activity and frontal plane CCI during the post-landing phase was found during the unexpected perturbation. Prolonged PL latency and altered ankle kinematics suggests reduced frontal plane ankle stabilization in CAI. However, similar motor control strategies were utilized in both groups during the ankle inversion perturbations.

Anticipating ankle inversion perturbations during a single-leg drop landing alters ankle joint and impact kinetics.

Anticipatory responses to inversion perturbations can prevent an accurate assessment of lateral ankle sprain mechanics when using injury simulations. Despite recent evidence of the anticipatory motor control strategies utilized during inversion perturbations, kinetic compensations during anticipated inversion perturbations are currently unknown. The purpose of this investigation was to examine the influence of anticipation to an inversion perturbation during a single-leg drop landing on ankle joint and impact kinetics. Fifteen young adults with no lateral ankle sprain history completed unanticipated and anticipated single-leg drop landings onto a 25° laterally inclined platform from a height of 30 cm. One-dimensional statistical parametric mapping (SPM) was used to analyze net ankle moments and ground reaction forces (GRF) during the first 150 ms post-landing, while peak GRFs, time to peak GRF, peak and average loading rates were compared using a dependent samples t-test (p ≤ 0.05). Results from the SPM analysis revealed significantly greater plantar flexion moment from 58 to 83 ms post-landing (p = 0.004; d = 0.64-0.77), inversion moment from 89 to 91 ms post-landing (p = 0.050; d = 0.58-0.60), and medial GRF from 62 to 97 ms post-landing (p < 0.001; d = 1.00-2.39) during the unanticipated landing condition. Moreover, significantly greater peak plantarflexion (p < 0.001; d = 1.10) and peak inversion moment (p = 0.007; d = 0.94), as well as greater peak (p = 0.002; d = 1.03) and average (p = 0.042; d = 0.66) medial loading rates, were found during the unanticipated landing condition. Our findings suggest alterations to ankle joint and impact kinetics occur during a single-leg drop landing when inversion perturbations are anticipated. Researchers and practitioners using drop-landings onto a tilted surface to assess lateral ankle sprain injury risk should consider implementing protocols that mitigate anticipatory responses.

Bilateral spatiotemporal postural control impairments are present in participants with chronic ankle instability.

OBJECTIVES: This study evaluated center-of-pressure (COP) and time-to-boundary (TTB) measures of postural control during a Lateral Step-Down Test in participants with chronic ankle instability (CAI). DESIGN: Cohort study. SETTING: Biomechanics laboratory. PARTICIPANTS: Physically active adults with CAI (n = 15) and matched controls (n = 15). MAIN OUTCOME MEASURES: Traditional COP and TTB measures of postural control were computed in the medial/lateral (ML) and anterior/posterior (AP) directions. RESULTS: No significant results were found for the traditional COP measures (p > 0.05). The CAI group exhibited a lower TTB ML absolute minimum on their affected limb compared to the matched limb of the control group (p < 0.001). Additionally, on average the CAI group displayed significantly lower TTB ML mean of minima (p = 0.004) and TTB standard deviation of minima in the ML (p < 0.001) and AP directions (p = 0.002) regardless of limb. CONCLUSIONS: Sensorimotor impairments associated with CAI negatively alter spatiotemporal postural control and may cause a maladaptive reorganization of centrally mediated motor control strategies that results in bilateral postural control deficits during the Lateral Step-Down Test. In addition, traditional COP measures did not reveal any postural control deficits suggesting that a spatiotemporal analysis should be used when assessing postural control in participants with CAI.