An Updated Model of Chronic Ankle Instability

Hertel, Jay; Corbett, Revay O.

doi:10.4085/1062-6050-344-18

Cited by 493 publications

(458 citation statements)

References 157 publications

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“…Future studies need to clarify whether different degrees of severity of MAI also show different degrees of the functional deficits reported in this study. Potentially, this will also allow to estimate the risk for associated injuries following lateral ankle instability and therefore increase the therapeutic value [1,28,51,52]. To achieve this, however, a reproducible manner of quantitively assessing MAI is indispensable.…”

Section: Rommentioning

confidence: 99%

“…Perceived or subjective instability with feelings of giving way, pain, and recurrent sprains defines the clinical presentation of chronic ankle instability (CAI). This widespread phenomenon can be divided into the two etiologies of functional (FAI) and mechanical instability (MAI) [1]. The choice of the appropriate therapeutic approach for CAI patients requires the distinction between these two etiologies: functional deficits may best be addressed by functional, conservative therapy, since deficits in the sensorimotor system and postural control respond well to focused exercise regimes [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Functional deficits in chronic mechanical ankle instability

Gehring

Mauch³

et al. 2020

J Orthop Surg Res

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Background: The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization. Methods: We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles. Results: Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20°vs. 14°of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02). Conclusions: This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.

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Section: Rommentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional deficits in chronic mechanical ankle instability

Gehring

Mauch³

et al. 2020

J Orthop Surg Res

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“…According to our findings after first injury athletes are more predisposed to the repetition of the same injury, and also a significate relation was found between the repetition of the sprain and further sensation of giving away and instability, enhancing the existence of a chain of events towards a chronic ankle instability. In Hertel's new model for instability, the author states that repeated [17].…”

Section: Discussionmentioning

confidence: 99%

“…Also, individual personal factors, such as a history of musculoskeletal injury and level of self-efficacy, will affect perceptions and behaviors [17]. How a pa-tient responds to impairments, influences his or her perception of the injury and behavior, including motor output, in the presence and aftermath of the injury [17]. [23], and position in the field [22].…”

Section: Introductionmentioning

confidence: 99%

Functional Ankle Instability Prevalence and Associated Risk Factors in Male Football Players

Cruz¹,

Oliveira²,

Silva³

2020

OJO

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Background: The injuries sustained in football most frequently occur to the lower extremity, with ankle and knee being the most affected joint segments. Many studies have defined ankle sprain as one of the most common sports injuries with an annual incidence rate of 15% to 45%, however, there's a lack of studies in football regional leagues. Risk factors like anthropometric measures, field position, dominant limb, previous injury have been described as being associated with ankle injuries in the elite sports context. The primary aim of this study was to determine prevalence rates of self-reported ankle instability in regional leagues. A secondary aim was to explore the presence of extrinsic factors affecting ankle instability in these football players. Methods: The heads of all clubs (n = 66) from Coimbra and Aveiro (Portugal) regional male senior football divisions during season 2016/2017 were contacted by e-mail or telephone to enter the study, and 58 gave their permission to include their athletes. Then, all players from each of these 58 teams were invited to enter the study (n = 1044) and a total of 589 athletes participated. Demographic and anthropometric data were recorded concerning age, height, weight, years of training, mean number of training hours, position in camp along with specific questions related to an ankle injury. All participants were asked about their previous history of injury, reinjury, feeling of giving-away and where also asked to fill the Cumberland Ankle Instability Tool. Results: A total of 290 (49.2%) athletes reported a history of at least one previous sprain and, from these, 170 (58.6%) repeated the injury and 112 (19%) reported sensation of "giving-away". A significant association was found be-tween injury, recurrence and subjective feeling of giving away (p < 0.05). The player field's position was found to be associated with ankle instability, with defenders and forwards having higher rates of self-reported instability. No other significant associations were found. Conclusion: Along with intrinsic factors (age and injury repetition), some extrinsic factors were found to be associated with instability rates in professional regional football players (exposure time, and position on the field) suggesting the need for specific prevention strategies.

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“…FAI stems from insufficient muscle strength and impaired neuromuscular control, and is associated with a wide range of problems, including proprioception deficits, delayed muscle reaction, damaged ligaments, and impaired sensation (Wikstrom et al, 2006). Furthermore, FAI can lead to restricted motion, diminished self-reported function, activity disorders, muscle weakness, poor stability, and pain over prolonged periods (Williams et al, 2007;Hertel and Corbett, 2019). As a result, effective FAI treatments are essential in restoring the balance ability and proprioception of athletes.…”

Section: Introductionmentioning

confidence: 99%

Effect of Novel Remodeled Bicycle Pedal Training on Balance Performance in Athletes With Functional Ankle Instability

Chang

Arefin

You

et al. 2020

Front. Bioeng. Biotechnol.

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Context: Appropriate training without risk of injury is a critical concern for athletes. Remodeled bicycle pedal training with multi-directional challenges may be effective in improving the balance performance of athletes with functional ankle instability (FAI). Objective: To evaluate the effects of 6-week modified bicycle pedal training on the balance ability and proprioception of athletes with FAI. Design: Randomized controlled trial. Setting: University motion analysis laboratory. Participants: Fourteen healthy athletes (healthy group) and twenty-six athletes with FAI and an age of 18 to 30 years old. The participants with FAI were randomly distributed to two groups, designated as the training group (AI-T group) and non-training group (AI-NT group), respectively. The athletes in the AI-T group received 6-week remodeled bicycle pedal training, while those in the AI-NT group received no intervention at all. Intervention: A 6-week training using modified bicycle pedal capable of moving freely during loading cycle vs no intervention. Main Outcome Measures: The passive ankle joint position sense (JPS) in four angles and the center of pressure (COP) parameters were analyzed during single-leg standing with and without vision, respectively. Results: A 6-week remodeled pedal training: (1) significantly improved the passive JPS of ankle in all directions (P < 0.05); (2) reduced the excursion of the COP in the mediallateral (ML) direction (p < 0.05), the velocity of the COP in the ML direction (p < 0.05), and the RMS of the COP in the ML direction (P < 0.05) during single-leg standing both with and without vision. Conclusion: The remodeled bicycle pedal training improved the passive JPS and reduced the postural sway in single-leg standing both with and without vision. Therefore, remodeled bicycle pedal training can be considered for inclusion in rehabilitation programs for athletes with FAI to restore the proprioception and balance ability.

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An Updated Model of Chronic Ankle Instability

Cited by 493 publications

References 157 publications

Functional deficits in chronic mechanical ankle instability

Functional deficits in chronic mechanical ankle instability

Functional Ankle Instability Prevalence and Associated Risk Factors in Male Football Players

Effect of Novel Remodeled Bicycle Pedal Training on Balance Performance in Athletes With Functional Ankle Instability

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