Study DesignCross-sectional.ObjectivesTo determine the effect of ankle sprain on self-reported physical activity (PA) among rural high school students.BackgroundAnkle sprains and their long-term sequelae are believed to deter individuals from PA, negatively affecting health. College-aged individuals with chronic ankle instability (CAI) have demonstrated decreased PA; however, no evidence exists describing PA levels of high school-aged individuals with ankle injuries.Methods and MeasuresAn electronic survey was distributed to students at a high school in northwestern North Carolina. The instrument collected demographics, ankle injury history, Identification of Functional Ankle Instability (IdFAI), International Physical Activity Questionnaire, functional questionnaires, and participation in recreational activities. Respondents were stratified into 4 groups in accordance with International Ankle Consortium guidelines: uninjured (no history of ankle sprain), unstable (history of sprain and IdFAI ≥11); copers (history of sprain and IdFAI ≤10); and recently injured (history of ankle sprain within previous year). Body mass index (BMI), total MET-minutes per week, and activity choices were compared across groups using analysis of variance, Kruskal-Wallis test, or Pearson’s chi-squared (α=0.05).ResultsBMI was not significantly different across groups (F=0.41, p=0.74); however, significant differences were detected for total MET-minutes per week (χ2=11.65, p<0.01) as unstable respondents reported more PA than uninjured respondents (unstable=4706.1±4610.6; uninjured=2592.9±2946.0), with no differences between other groups. Groups were not significantly different for participation in high school sports (χ2=4.38, p=0.22); however respondents with a history of ankle injury reported greater participation in jogging and running activities (χ2=3.99, p=0.04); team sports (χ2=8.37, p<0.01); and motor sports (χ2=4.99, p=0.03).ConclusionDespite a history of injury and sensations of instability in the ankle, respondents with CAI reported higher activity levels than uninjured participants. As this is contrary to pre-existing hypotheses, it is possible continued PA after injury may serve to heighten sensations of instability assessed by self-reported questionnaires.

BackgroundAnkle sprains are associated with detrimental long-term sequelae tied to neuromechanical alterations. Neurological adaptations occurring in the initial weeks after injury may be responsible for long-term adaptations resultant in altered movement patterns; however, few studies have quantified neuromechanical and functional adaptations following acute ankle sprains.ObjectiveThis study aims to quantify cortical and reflexive excitability following ankle sprain with concurrent changes in function.DesignPilot cohort study.SettingUniversity laboratory.Participants6 male subjects (age = 20.8 ± 0.8 years, height = 181.2 ± 3.5 cm, body mass = 84.8 ± 9.0 kg) with history of recent ankle sprain volunteered for this investigation.InterventionsParticipants were tested at 1, 2, 4, and 8 weeks from injury. During each session clinical measures of ankle volume, balance (Y-balance test), and dorsiflexion range-of-motion (weight-bearing lunge) were assessed. Electromyography sensors were placed on tibialis anterior (TA), peroneus longus (PL), and soleus (SOL) and cortical and reflexive excitability were assessed bilaterally using transcranial magnetic stimulation (TMS), and Hoffmann reflex, respectively.Main outcome measurementsStimulus- response curves from TMS were used to determine active motor threshold (AMT, %output) and maximal response (MEPmax, %Mmax). Side differences were assessed using descriptive statistics.ResultsDifferences in ankle volume, balance, and dorsiflexion were observed at week 1, and, except dorsiflexion, were no longer present at week 8. Notable side-to-side alterations in cortical excitability were noted for TA AMT and PL and SOL MEPmax. These findings indicated decreased TA excitability, but increased PL and SOL excitability at 1-week (TAINJ = 33.4 ± 15.7%, TANON = 27.7 ± 4.0%; PLINJ = 70.5 ± 35.1%, PLNON = 45.7 ± 34.1%; SOLINJ = 10.6 ± 11.6%, SOLNON = 12.1 ± 5.1%) but the opposite effect 8-weeks after injury (TAINJ = 38.8 ± 2.8%, TANON = 35.6 ± 12.0%; PLINJ = 35.6 ± 9.2%, PLNON = 48.7 ± 9.0%; SOLINJ = 10.5 ± 7.2, SOLNON = 8.1 ± 5.9%). Generally, the H-reflex was slightly elevated for all muscles and time-points on the injured side.ConclusionsChanges in neurological function were observed among this small cohort of participants that reflect both acute and long-term adaptations due to injury. Further analysis is required to determine how these variables might affect functional measures.

Study DesignCross-sectional.ObjectivesTo quantify the prevalence of ankle sprain among a population of rural high school students.BackgroundThe healthcare burden of ankle sprains and their sequelae have been highlighted, largely due to the substantial volume of injuries observed. Although injury rates are frequently presented, a paucity of evidence exists describing the prevalence of ankle sprain and instability among high school-aged students.Methods and MeasuresA survey was distributed via electronic mail to students at a high school in northwestern North Carolina. Participating students provided demographic information and answered questions regarding their ankle injury history, and completed instruments including the Identification of Functional Ankle Instability (IdFAI), Foot and Ankle Ability Measure (FAAM) with sport subscale, and Disablement in the Physically Active (DPA). Differences in FAAM, FAAM-sport, and DPA subscales were compared with Student’s t-tests between previously injured and uninjured subjects (α=0.05).Results201 students completed the survey. 115 respondents (57.2%) indicated a history of ankle sprain (Males 56.3%; Females 58.3%). Of those indicating sprain history, 40 individuals (19.9%) reported a history of injury within the past year, while among those more than a year from injury, 59 respondents (78.6%) reported chronic ankle instability (IdFAI ≥11), and 16 respondents (21.3%) met criteria of ankle copers (IdFAI ≤10). Pearson’s chi-squared revealed no significant differences in frequency of injury across ages (χ2=0.18, p=0.27). No significant differences were observed between FAAM (t147=1.52, p=0.13), FAAM-sport (t148=0.19, p=0.85), or DPA (t150=0.62, p=0.54) between injured and uninjured respondents.ConclusionPrevalence of ankle sprain history in a rural high school population is consistent with injury rates observed among college students and the general population, despite age differences. The rates of chronic ankle instability in this population is notably higher than previously reported in literature, suggesting the potential importance of interventions among this population.