The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain.

INTRODUCTION: Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE: Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN: Randomized clinical trial; assessor-blind; before and after comparison. SETTING: Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S): Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS: Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS: Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION: The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

The effects of Kinesiology Tape on static postural control in individuals with functional ankle instability.

OBJECTIVE: To investigate if applying Kinesiology Tape (KT) on the unstable ankle may improve static postural control in individuals with Functional ankle instability. DESIGN: A repeated measured study. Participants performed a series of static quiet bipedal and unipedal stances on a force platform. Measurements were taken at three different times: baseline or no tape, immediately and 24 h after the taping application with the tape remaining on the ankle. SETTING: A university's psychomotor laboratory. PARTICIPANTS: Twenty young adults with Functional ankle instability aged from 18 to 30 years old. OUTCOME MEASURES: Postural control was assessed by four measures derived from the centre of pressure data: Area of 95% Confidence ellipse, standard deviation of displacements, mean velocity and mean power frequency. The analysis of variance (ANOVA) was performed to determine any significant improvement in postural control over time due to KT. RESULTS: Only minor changes in mean velocity and MPF in unipedal stances were observed immediately after KT application. However, the overall results indicated statistically insignificant improvements in postural control neither immediately after KT application nor after 24 h. CONCLUSION: Results suggest that the use of KT did not affect bipedal and unipedal stances of individuals with functional ankle instability.

Gait biofeedback and impairment-based rehabilitation for chronic ankle instability.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.

Effects of Walking With Talus-Stabilizing Taping on Passive Range of Motion, Timed Up and Go, Temporal Parameters of Gait, and Fall Risk in Individuals With Chronic Stroke: A Cross-sectional Study.

OBJECTIVE: The purpose of this study was to determine the effects of walking with talus-stabilizing taping on ankle dorsiflexion passive range of motion, the timed up-and-go test, temporal parameters of gait, and fall risk in individuals with chronic stroke. METHODS: In this cross-sectional design study, 20 participants with chronic stroke (9 female, 11 male), aged 60.5 ± 8.1 years, were included. Three conditions were evaluated: barefoot, immediately after applying talus-stabilizing taping, and after 5 minutes of walking with talus-stabilizing taping. One-way repeated-measures analysis of variance was used to determine the differences in ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk across the 3 conditions. RESULTS: Ankle dorsiflexion passive range of motion, walking speed, and single-limb support phase were significantly improved after 5 minutes of walking with talus-stabilizing taping compared to those in the barefoot and immediately-after-taping conditions. The timed up-and-go test, double-limb support phase, and fall-risk results significantly decreased more after 5 minutes of walking with talus-stabilizing taping compared to barefoot and immediately after taping. CONCLUSION: After the application of talus-stabilizing taping, ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk were reduced in individuals with chronic stroke.

Biomechanical Response to External Biofeedback During Functional Tasks in Individuals With Chronic Ankle Instability.

CONTEXT: Altered biomechanics displayed by individuals with chronic ankle instability (CAI) is a possible cause of recurring injuries and posttraumatic osteoarthritis. Current interventions are unable to modify aberrant biomechanics, leading to research efforts to determine if real-time external biofeedback can result in changes. OBJECTIVE: To determine the real-time effects of visual and auditory biofeedback on functional-task biomechanics in individuals with CAI. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Nineteen physically active adults with CAI (7 men, 12 women; age = 23.95 ± 5.52 years, height = 168.87 ± 6.94 cm, mass = 74.74 ± 15.41 kg). INTERVENTION(S): Participants randomly performed single-limb static balance, step downs, lateral hops, and forward lunges during a baseline and 2 biofeedback conditions. Visual biofeedback was given through a crossline laser secured to the dorsum of the foot. Auditory biofeedback was given through a pressure sensor placed under the lateral foot and connected to a buzzer that elicited a noise when pressure exceeded the set threshold. Cues provided during the biofeedback conditions were used to promote proper biomechanics during each task. MAIN OUTCOME MEASURE(S): We measured the location of center-of-pressure (COP) data points during balance with eyes open and eyes closed for each condition. Plantar pressure in the lateral column of the foot during functional tasks was extracted. Secondary outcomes of interest were COP area and velocity, time to boundary during static balance, and additional plantar-pressure measures. RESULTS: Both biofeedback conditions reduced COP in the anterolateral quadrant while increasing COP in the posteromedial quadrant of the foot during eyes-open balance. Visual biofeedback increased lateral heel pressure and the lateral heel and midfoot pressure-time integral during hops. The auditory condition produced similar changes during the eyes-closed trials. Auditory biofeedback increased heel pressure during step downs and decreased the lateral forefoot pressure-time integral during lunges. CONCLUSIONS: Real-time improvements in balance strategies were observed during both external biofeedback conditions. Visual and auditory biofeedback appeared to effectively moderate different functional-task biomechanics.

Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial.

Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.

Massage manipulation vs. low back muscle exercise for lumbar intervertebral instability: A preliminary randomized clinical trial.

This is a preliminary randomized clinical trial on patients conducted at Wuxi Hospital Affiliated with Nanjing University of Chinese Medicine from September 2015 to December 2016. The patients with intervertebral instability were randomized 1:1 for massage (20 min/day for 6 days) or exercise (3 sessions/day for 15 days). Japanese Orthopaedic Association (JOA) score, Oswestry disability score, and quantitative fluoroscopy (QF) were performed before and after the treatment and at 1 and 3 months thereafter. Improvement rates were noted to be 86.7% and 40.0% in the massage and exercise groups, respectively. Massage group showed significant changes in the JOA and Oswestry disability scores (p < 0.001 and p = 0.002), while the exercise group did not show any significant change (p > 0.05). Changes in the JOA and Oswestry disability scores were more important in the massage group (p < 0.05). All dynamic imaging parameters were improved in the massage group (all p < 0.05) but not in the exercise group (all p>0.05). These results suggest that the massage manipulation could be an appropriate way to treat intervertebral instability.

Exercise-Based Rehabilitation and Manual Therapy Compared With Exercise-Based Rehabilitation Alone in the Treatment of Chronic Ankle Instability: A Critically Appraised Topic.

Clinical Scenario: Patients with chronic ankle instability (CAI) commonly display lower levels of self-reported function and health-related quality of life. Several rehabilitation interventions, including manual therapy, have been investigated to help CAI patients overcome these deficits. However, it is unclear if the addition of manual therapy to exercise-based rehabilitation is more effective than exercise-based rehabilitation alone. Clinical Question: Does incorporating manual therapy with exercise-based rehabilitation improve patient-reported outcomes when compared with exercise-based rehabilitation alone? Summary of Key Findings: The literature was searched for articles that examined the difference in outcomes for patients with CAI between manual therapy with exercise-based rehabilitation and exercise-based rehabilitation alone. A total of 3 peer-reviewed randomized controlled trials were identified. Two articles demonstrated improved patient-reported outcome scores following the incorporation of manual therapy with exercise-based rehabilitation, whereas one study found no statistically significant differences between interventions. Clinical Bottom Line: The current evidence suggests that incorporating manual therapy in addition to exercised-based rehabilitation may improve patient-reported outcome scores in patients with CAI. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of A is recommended due to consistent evidence from high-quality studies.

Sport injury prevention in individuals with chronic ankle instability: Fascial Manipulation® versus control group: A randomized controlled trial.

Chronic ankle instability (CAI) is one of the most common syndromes that occurs following an initial ankle sprain. Sprains are often correlated with recurrent sprains, loss of range of motion (ROM) and deficits in proprioception and postural control. The objectives were to evaluate the effectiveness of Fascial Manipulation® (FM) as a preventative measure in semi-professional athletes with CAI, and to monitor the symptomatology, equilibrium and ROM of the injured ankle. A single-blinded randomized controlled trial was conducted in the rehabilitation department of a medical centre. Twenty-nine semi-professional male footballers were recruited. Nine subjects with no previous symptomatology, were assigned to a baseline group, twenty symptomatic subjects were randomized into either the study or the control group. All three groups followed a specific training program. The control group followed normal training protocols and received standard medical care. The study group received an additional three FM treatment sessions. Symptomatology and ROM outcomes were recorded for all players at baseline, before each treatment for the treatment group, and at 1-, 3-, and 6-month follow-ups. At one year, an additional follow-up on was performed via phone. Four severe ankle traumas and one mild ankle trauma were reported in the control group during the trial period. The 6-month outcomes in the study group showed statistically significant improvements. The 1-year follow-up reported the absence of any reported trauma in the study group. FM was effective in improving ROM and symptomatology in footballers with CAI. FM intervention was effective in preventing injury in the study sample.

The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial.

OBJECTIVE: Proprioception, the perception of limb movements and spatial orientation derived from body stimuli, plays a critical role in maintaining joint stability. This study aimed to investigate the effect of combined exercise therapy (closed kinetic chain exercises and proprioception exercises) on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome. DESIGN: Single-blind randomized clinical trial. SETTING: Shiraz School of Rehabilitation Sciences. PARTICIPANTS: Twenty four patients with hypermobility syndrome. INTERVENTIONS: The patients were assigned to the control (no intervention) or intervention group (exercise therapy) by random allocation. MEASUREMENTS: Knee proprioception, pain intensity and quality of life were evaluated before and immediately after the intervention. Exercise sessions were held 3 days a week for 4 weeks. RESULTS: The results showed that knee proprioception improved significantly in the intervention group compared to the control group. Quality of life increased, and knee pain intensity decreased significantly in the intervention group compared to the control group. CONCLUSION: Combined exercise therapy can reduce pain intensity and increase knee proprioception and quality of life in patients with hypermobility syndrome.

Subjective health complaints and illness perception amongst adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-HypermobilityType - a cross-sectional study.

OBJECTIVE: To investigate the prevalence and severity of subjective health complaints and describe illness perception in a population of Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type. METHOD: This study was a postal survey with a questionnaire battery on demographic data, subjective health complaints inventory, and illness perception. A total of 110 individuals diagnosed with Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type from two specialized hospitals in Norway were offered participation. Further, 140 gender- and age-matched healthy controls from statistics Norway representing the general population were sent the questionnaire for reference. RESULTS: Overall response rate was 30.4% (n = 76), with 44.5% (n = 49) in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type and 19.3% (n = 27) in controls. Subjective health complaints were significantly higher in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type - than in the controls (32.06 vs. 11.08; p < 0.001). Further the brief illness perception questionnaire indicated that the adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type had low understanding of their illness and symptoms (understanding, mean: 3.93, SD 2.88), and reported to have moderate personal and treatment control over their illness. CONCLUSION: Adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported higher frequency and severity of subjective health complaints than the matched controls from the general adult population in Norway. Furthermore, Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported low understanding of their illness and associated symptoms, and moderate belief that their illness can be kept under control through self-management or treatment. This may indicate one of the reasons why prognosis for these patients is poor. Implications for rehabilitation Awareness of the complexity of the subjective health complaints and inquiry into illness perception could contribute with valuable information about these patients' perceptions of their condition. Such information could in its turn be of value for clinicians as they work towards facilitating a more holistic treatment approach, for example patient education and cognitive behavioural therapy.

The effect of sensory-targeted ankle rehabilitation strategies on single-leg center of pressure elements in those with chronic ankle instability: A randomized clinical trial.

OBJECTIVES: To determine the effects of sensory-targeted ankle rehabilitation strategies on laboratory-oriented measures of single-leg balance in those with chronic ankle instability. DESIGN: Non-inferiority randomized controlled trial. METHODS: Seventy-seven participants with self-reported chronic ankle instability were randomized into 4 treatment groups: Ankle joint mobilization, plantar massage, triceps surae stretching, and a control group. All participants performed 3 trials of single-leg balance on a force plate with eyes open and closed at 3 time points (baseline, immediately after the first treatment, and following 6 treatments over 2 weeks). The spatial (standard deviation), temporal (velocity), and spatiotemporal (time-to-boundary) elements of center of pressure excursions in single-leg balance were evaluated with eyes open and eyes closed at each time point. Immediate and final change scores were calculated for each group from the baseline values on these variables. RESULTS: Joint mobilization produced immediate improvements in the temporal elements with eyes open and closed that exceeded the minimum detectable changes for these measures. Plantar massage and triceps surae stretching also enhanced the temporal element after a single treatment, but only with eyes closed. No substantial benefit of any of the interventions were found after 2-weeks of treatment, regardless of treatment group. CONCLUSIONS: Sensory-targeted ankle rehabilitation strategies substantially improve single-leg postural control after one treatment, but these changes are short-lived. Future research is needed to determine whether combinations of sensory-targeted ankle rehabilitation strategies with other therapeutic interventions potentially improve single-leg balance stability in those with CAI compared to use in isolation. CLINICAL TRIAL REGISTRATION NUMBER: NCT01541657.

A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes.

CONTEXT: Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated. OBJECTIVE: To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI. DESIGN: Controlled laboratory study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of "giving way" in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24. INTERVENTION(S): Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily. MAIN OUTCOME MEASURE(S): Dorsiflexion range of motion (weight-bearing-lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure-Activities of Daily Living and Foot and Ankle Ability Measure-Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire-Physical Activity and Fear-Avoidance Beliefs Questionnaire-Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up). RESULTS: Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure-Activities of Daily Living score, the modified Disablement in the Physically Active scale-physical summary component score, and the Fear-Avoidance Beliefs Questionnaire-Physical Activity score were improved at postintervention (P < .001; effect-size range = 0.72-1.73) and at the 2-week follow-up (P < .001; effect-size range = 0.73-1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P < .04; effect-size range = 0.61-0.78) and postintervention (P < .04) during the eyes-open condition. CONCLUSION: A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.

Effects of Self-Myofascial Release on Shoulder Function and Perception in Adolescent Tennis Players.

CONTEXT: Tennis induces a decreased internal rotation range of motion at the dominant glenohumeral joint. The effects of self-myofascial release have not yet been investigated to restore glenohumeral range of motion. OBJECTIVE: This study aimed at investigating the effects of self-myofascial release on shoulder function and perception in adolescent tennis players. DESIGN: Test-retest design. SETTING: Tennis training sport facilities. PARTICIPANTS: Eleven male players participated in this study (age: 15 [3] y; height: 173.1 [11.1] cm; mass: 56.0 [15.1] kg; International Tennis Number: 3). INTERVENTION: During 5 weeks, the players performed their regular tennis training. During 5 additional weeks, self-myofascial release of the infraspinatus and pectoralis muscles was implemented 3 times per week after the warm-up of the regular training session. MAIN OUTCOME MEASURES: The primary outcome was glenohumeral internal rotation range of motion. The secondary outcomes were perceived shoulder instability and tennis serve accuracy and velocity. RESULTS: Adding self-myofascial release allowed an increase of 11° (2°) of internal rotation range of motion at the dominant glenohumeral joint (P < .001) and a decreased perception of shoulder instability (P = .03), while maintaining tennis serve velocity and accuracy. CONCLUSIONS: Implementing self-myofascial release on infraspinatus and pectoralis muscles 3 times per week during 5 weeks improved dominant glenohumeral internal rotation range of motion in tennis players. It can be used as a strategy to preserve the mobility of this joint.

Comparison of the Therapeutic Effects of a Sling Exercise and a Traditional Stabilizing Exercise for Clinical Lumbar Spinal Instability.

CONTEXT: Specific muscle-stabilization training can be relevant to patients with clinical spinal instability symptoms. The authors hypothesized that performing sling exercise using an elastic band in patients with clinical spinal instability would lead to pain reduction and improved lumbar spine stability. OBJECTIVE: To compare supervised sling exercise with an elastic band with traditional stabilizing exercise in chronic lower back pain (LBP) patients with clinical spinal instability. DESIGN: Randomized assessor-blind controlled trial. SETTING: University rehabilitation hospital. MAIN OUTCOME MEASURES: The participants were evaluated thrice at baseline, immediately after, and 3 mo after the last treatment session with the Numeric Pain Rating Scale (NPRS) and by the Oswestry Disability Index (ODI). INTERVENTIONS: Participants were randomly assigned to 1 of 2 treatment groups: a traditional trunk-muscle-stabilizing exercise group or a sling-exercise with elastic bands group. The participants in all treatment groups attended treatment twice a week for 12 wk. RESULTS: The NPRS at immediately and 3 mo after treatments showed significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). The ODI at immediately and 3 mo after treatment showed a significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). CONCLUSION: A sling exercise with elastic bands leads to a reduction in pain and disability compared with a traditional stabilizing exercise, although traditional stabilizing exercise also shows good results in chronic LBP patients with clinical spinal instability. A sling exercise with an elastic band could be a useful treatment for chronic LBP with clinical spinal instability.

The immediate effect of talocrural joint manipulation on functional performance of 15-40 years old athletes with chronic ankle instability: A double-blind randomized clinical trial.

OBJECTIVE: To evaluate the immediate effect of talocrural joint manipulation (TCJM) on functional performance of athletes with chronic ankle instability (CAI). PARTICIPANTS: Forty athletes (18males, 22females) with CAI divided into TCJM group (n = 20) and sham manipulation group (n = 20). INTERVENTION: TCJM was performed as a quick thrust on the involved talus, in the posterior direction. Sham manipulation was maintaining the same position, without any thrust. MAIN OUTCOME MEASURES: Functional performance of athletes was assessed with single leg hop; speed and Y balance tests, before and after the interventions. RESULTS: All functional tests evaluated in this study improved significantly after TCJM (p-value<0.05). These findings were not seen in the control group. Between-group comparisons also showed significant changes for all the measurements after the interventions (p < 0.05). CONCLUSIONS: TCJM can significantly increase the functional performance of athletes with CIA and can be an effective supplementary treatment for these subjects. However, this was a pre-post study and future studies with long-term follow-ups may provide more reliable results about the long-term effectiveness of this type of treatment.

Predicting balance improvements following STARS treatments in chronic ankle instability participants.

OBJECTIVES: Sensory Targeted Ankle Rehabilitation Strategies that stimulate sensory receptors improve postural control in chronic ankle instability participants. However, not all participants have equal responses. Therefore, identifying predictors of treatment success is needed to improve clinician efficiency when treating chronic ankle instability. Therefore, the purpose was to identify predictors of successfully improving postural control in chronic ankle instability participants. DESIGN: Secondary data analysis. METHODS: Fifty-nine participants with self-reported chronic ankle instability participated. The condition was defined as a history of at least two episodes of "giving way" within the past 6 months; and limitations in self-reported function as measured by the Foot and Ankle Ability Measure. Participants were randomized into three treatment groups (plantar massage, ankle joint mobilization, calf stretching) that received 6, 5-min treatment sessions over a 2-week period. The main outcome measure was treatment success, defined as a participant exceeding the minimal detectable change score for a clinician-oriented single limb balance test. RESULTS: Participants with ≥3 balance test errors had a 73% probability of treatment success following ankle joint mobilizations. Participants with a self-reported function between limb difference <16.07% and who made >2.5 errors had a 99% probability of treatment success following plantar massage. Those who sustained ≥11 ankle sprains had a 94% treatment success probability following calf stretching. CONCLUSIONS: Self-reported functional deficits, worse single limb balance, and number of previous ankle sprains are important characteristics when determining if chronic ankle instability participants will have an increased probability of treatment success.

Balance Training Versus Balance Training With STARS in Patients With Chronic Ankle Instability: A Randomized Controlled Trial.

CONTEXT: Both balance training and selected interventions meant to target sensory structures (STARS) have been shown to be effective at restoring deficits associated with chronic ankle instability (CAI). Clinicians often use multiple treatment modalities in patients with CAI. However, evidence for combined intervention effectiveness in CAI patients remains limited. OBJECTIVE: To determine if augmenting a balance-training protocol with STARS (BTS) results in greater improvements than balance training (BT) alone in those with CAI. DESIGN: Randomized-controlled trial. SETTING: Research laboratory. PATIENTS: 24 CAI participants (age 21.3 ± 2.0 y; height 169.8 ± 12.9 cm; mass 72.5 ± 22.2 kg) were randomized into 2 groups: BT and BTS. INTERVENTIONS: Participants completed a 4-week progression-based balance-training protocol consisting of 3 20-min sessions per week. The experimental group also received a 5-min set of STARS treatments consisting of calf stretching, plantar massage, ankle joint mobilizations, and ankle joint traction before each balance-training session. MAIN OUTCOME MEASURES: Outcomes included self-assessed disability, Star Excursion Balance Test reach distance, and time-to-boundary calculated from static balance trials. All outcomes were assessed before, and 24-hours and 1-week after protocol completion. Self-assessed disability was also captured 1-month after the intervention. RESULTS: No significant group differences were identified (P > .10). Both groups demonstrated improvements in all outcome categories after the interventions (P < .10), many of which were retained at 1-week posttest (P < .10). Although 90% CIs include zero, effect sizes favor BTS. Similarly, only the BTS group exceeded the minimal detectable change for time-to-boundary outcomes. CONCLUSIONS: While statistically no more effective, exceeding minimal detectable change scores and favorable effect sizes suggest that a 4-week progressive BTS program may be more effective at improving self-assessed disability and postural control in CAI patients than balance training in isolation.

Effects of Achilles tendon vibration, surface and visual conditions on lower leg electromyography in young adults with and without recurrent ankle sprains.

Functional ankle instability is associated with decreased ankle muscle function. Compliant surfaces and eyes-closed training are commonly used for rehabilitation and prevention of ankle sprains. Brief Achilles tendon vibration is commonly used in the study of postural control. To test the level of activation of tibialis anterior (TIB) and fibularis longus (FIB), bilateral Achilles tendon vibration was applied for the middle 20 s in a series of 60-s trials, when 10 healthy young adults and 10 adults with history of repeated ankle sprains were standing bipedal: on floor, on memory foam, or on a Both Sides Up (BOSU) ball, with eyes open, and on floor and foam with eyes closed. Differences in Integrated surface electromyography (IEMG) of TIB and FIB were significant for both groups pre, during, and post vibration (Friedman Tests, p < 0.001 for all). In both groups, the highest IEMG for TIB was obtained during vibration when standing on foam with eyes closed, whereas the highest IEMG for FIB was obtained during vibration when standing on the BOSU. Bipedal stance on BOSU and brief Achilles tendon vibration may be a useful intervention when a session's goal is to facilitate lower leg muscles activation. Future research should explore training effects as well as the effect of FIB tendon vibration.

[Rehabilitation of Ligamentous Elbow Instability in Athletes]. / Rehabilitation ligamentärer Ellenbogeninstabilitäten beim Sportler.

Ligamentous instability of the elbow is a common pathology affecting athletes in different types of sports. It may lead to a permanent impairment of an athlete's ability to train and compete. The advancements made in arthroscopic, biomechanical and clinical diagnostic procedures allow for a better understanding of the etiology of elbow discomfort. As a result, ligamentous instability has been increasingly identified as a reason for acute and chronic pain in athletes. This article provides an overview of the etiology as well as diagnostic and rehabilitative procedures for ligamentous instability of the elbow in athletes and presents principles of rehabilitation in patients with symptomatic elbow instability.