Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

McVey, Eric D.; Palmieri, Riann M.; Docherty, Carrie L.; Zinder, Steven M.; Ingersoll, Christopher D.

doi:10.1177/107110070502601210

Cited by 144 publications

(122 citation statements)

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“…43 This a-c coactivation is an autonomic process that maintains the muscle-spindle sensitivity needed for dynamic stability. Regarding neuromuscular dysfunction in individuals with CAI, researchers [44][45][46] have explored dynamic stability by measuring a motor-neuronpool excitability.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Feger

Donovan

Hart

et al. 2015

Journal of Athletic Training

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Context: Ankle sprains are among the most common musculoskeletal injuries, and many individuals with ankle sprains develop chronic ankle instability (CAI). Individuals with CAI exhibit proprioceptive and postural-control deficits, as well as altered osteokinematics, during gait. Neuromuscular activity is theorized to play a pivotal role in CAI, but deficits during walking are unclear.Objective: To compare motor-recruitment patterns as demonstrated by surface electromyography amplitudes between participants with CAI and healthy control participants during walking.Design: Descriptive laboratory study. Setting: Laboratory.Patients or Other Participants: Fifteen adults with CAI (5 men, 10 women; age ¼ 23 6 4.2 years, height ¼ 173 6 10.8 cm, mass ¼ 72.4 6 14 kg) and 15 matched healthy control adults (5 men, 10 women; age ¼ 22.9 6 3.4 years, height ¼ 173 6 9.4 cm, mass ¼ 70.8 6 18 kg).Intervention(s): Participants walked shod on a treadmill while surface electromyography signals were recorded from the anterior tibialis, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius muscles.Main Outcome Measure(s): Preinitial contact amplitude, postinitial contact amplitude, time of activation relative to initial contact, and percentage of activation time across the stride cycle were calculated for each muscle.Results: Time of activation for all muscles tested occurred earlier in the CAI group than in the control group. The peroneus longus was activated for a longer duration across the entire stride cycle in the CAI group (36.0% 6 10.3%) than the control group (23.3% 6 22.2%; P ¼ .05). No differences were noted between groups for measures of electromyographic amplitude at either preinitial or postinitial contact (P . .05).Conclusions: We identified differences between the CAI and control groups in the timing of muscle activation relative to heel strike in multiple lower extremity muscles and in the percentage of activation time across the entire stride cycle in the peroneus longus muscle. Individuals with CAI demonstrated neuromuscular-activation strategies throughout the lower extremity that were different from those of healthy control participants. Targeted therapeutic interventions for CAI may need to be focused on restoring normal neuromuscular function during gait.

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Section: Discussionmentioning

confidence: 99%

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Feger

Donovan

Hart

et al. 2015

Journal of Athletic Training

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“…Researchers 18,22 have reported decreased excitability in the fibularis longus of patients with chronic pathologic ankle conditions. They have suggested that decreased spinal reflex excitability of the fibularis longus is important, 18,32 as this muscle may slow ankle inversion and decrease the incidence or extent of injury related to lateral ankle sprains.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas differences between outcomes in spinal reflex excitability of the fibularis longus in previous studies commonly were hypothesized to be due to different lengths of time since injury, 46 these differences also may be due to variations in the nervous system response to injury in individual CAI patients. Many researchers 18,22,45,46 have evaluated spinal reflex excitability after ankle injury in relatively small cohorts of injured patients (N , 30). In future studies with larger sample sizes, investigators may be able to determine if subgroups that display particular clusters of similar neurophysiologic alterations, which may manifest in specific patterns of spinal reflexive and corticospinal adaptations, can be identified after ankle injury.…”

Section: Discussionmentioning

confidence: 99%

“…21 Patients with ankle instability have decreased spinal reflexive excitability of the fibularis longus and soleus muscles, measured via the Hoffmann reflex (H-reflex), compared with healthy counterparts. 22 Similarly, corticospinal excitability of the fibularis longus in CAI patients has been shown to be diminished when compared with healthy participants assessed using transcranial magnetic stimulation (TMS). 23 Neuromuscular control adaptations in joints proximal to the ankle also have been demonstrated in patients with CAI, manifesting as deficits in force production, 17,24 changes in kinematic patterns, 10,11,14,[25][26][27] and deficits in muscle-activation patterns 12,[28][29][30][31] about the knee and hip during slow and dynamic tasks.…”

mentioning

confidence: 99%

“…Pathologic ankle conditions result in spinal-level pathway alterations, 22,32 which can lead to feed-forward patterns that present as changes in knee and hip neuromuscular control. 11,14,27 Sedory et al 31 reported that the excitability of multiple muscle groups proximal to the ankle was altered in people with CAI, suggesting that higher brain centers may be influencing motor function.…”

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confidence: 99%

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Chronic Ankle Instability and Neural Excitability of the Lower Extremity

McLeod

Gribble

Pietrosimone

2015

Journal of Athletic Training

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Context: Neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control, is common in patients with chronic ankle instability (CAI). Understanding how CAI affects specific neural pathways may provide valuable information for targeted therapies.Objective: To investigate differences in spinal reflexive and corticospinal excitability of the fibularis longus and vastus medialis between limbs in patients with unilateral CAI and between CAI patients and participants serving as healthy controls.Design: Case-control study. Setting: Research laboratory. Patients or Other Participants: A total of 56 participants volunteered, and complete data for 21 CAI patients (9 men, 12 women; age ¼ 20.81 6 1.63 years, height ¼ 171.57 6 11.44 cm, mass ¼ 68.84 6 11.93 kg) and 24 healthy participants serving as controls (7 men, 17 women; age ¼ 22.54 6 2.92 years, height ¼ 172.35 6 10.85 cm, mass ¼ 69.15 6 12.30 kg) were included in the final analyses. Control participants were matched to CAI patients on sex, age, and limb dominance. We assigned ''involved'' limbs, which corresponded with the involved limbs of the CAI patients, to control participants.Main Outcome Measure(s): Spinal reflexive excitability was assessed via the Hoffmann reflex and normalized to a maximal muscle response. Corticospinal excitability was assessed using transcranial magnetic stimulation. Active motor threshold (AMT) was defined as the lowest transcranial magnetic stimulation intensity required to elicit motor-evoked potentials equal to or greater than 100 lV in 5 of 10 consecutive stimuli. We obtained motor-evoked potentials (MEPs) at percentages ranging from 100% to 140% of AMT.Results: Fibularis longus MEP amplitudes were greater in control participants than in CAI patients bilaterally at 100% AMT (control involved limb: 0.023 6 0.031; CAI involved limb: 0.014 6 0.008; control uninvolved limb: 0.021 6 0.022; CAI uninvolved limb: 0.015 6 0.007; F 1,41 ¼ 4.551, P ¼ .04) and 105% AMT (control involved limb: 0.029 6 0.026; CAI involved limb: 0.021 6 0.009; control uninvolved limb: 0.034 6 0.037; CAI uninvolved limb: 0.023 6 0.013; F 1,35 ¼ 4.782, P ¼ .04). We observed no differences in fibularis longus MEP amplitudes greater than 110% AMT and no differences in vastus medialis corticospinal excitability (P . .05). We noted no differences in the Hoffmann reflex between groups for the vastus medialis (F 1,37 ¼ 0.103, P ¼ .75) or the fibularis longus (F 1,41 ¼ 1.139, P ¼ .29).Conclusions: Fibularis longus corticospinal excitability was greater in control participants than in CAI patients.Key Words: transcranial magnetic stimulation, Hoffmann reflex, lateral ankle sprain Key PointsCorticospinal excitability in the fibularis longus at transcranial magnetic stimulation intensities of 100% and 105% of active motor threshold was higher in the healthy control group bilaterally than in the chronic ankle instability group. Transcranial magnetic stimulation intensities at 110% or more of the active motor threshold did not result ...

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Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability

Hoch

McKeon

2010

Journal Orthopaedic Research

158

177

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The purpose of this study was to examine the effects of a single joint mobilization treatment on dorsiflexion range of motion (DF ROM), posterior talar glide, and dynamic and static postural control in individuals with self-reported chronic ankle instability (CAI). In this randomized cross-over study, subjects received a Maitland Grade III anterior-to-posterior joint mobilization treatment and a control treatment of rest for 5 min. Weight-bearing DF ROM, instrumented posterior talar displacement and posterior stiffness, the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test (SEBT), and time-to-boundary (TTB) single-limb stance static postural control were assessed on both treatment days in 9 males and 11 females with CAI. The results indicated that the joint mobilization treatment was associated with significantly greater DF ROM (p ¼ 0.01) and TTB in the anterior-posterior direction with eyesopen (p < 0.05). Although not significant, trends were identified in posterior talar displacement (p ¼ 0.08) and the mean of TTB in the mediallateral (ML) direction (p ¼ 0.07). No significant differences were observed in the standard deviation of TTB in the ML direction, the SEBT, or posterior stiffness (p > 0.05). This indicates that a single joint mobilization treatment has mechanical and functional benefits for addressing impairments in sensorimotor function and arthrokinematic restrictions commonly experienced by individuals with CAI. ß

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Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

Cited by 144 publications

References 40 publications

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Chronic Ankle Instability and Neural Excitability of the Lower Extremity

Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability

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