Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews

Thompson, Cassandra; Schabrun, Siobhan M; Romero, Rick J; Bialocerkowski, Andrea; Dieën, Jaap H. van; Marshall, P.W.

doi:10.1007/s40279-017-0781-4

Cited by 153 publications

(132 citation statements)

References 100 publications

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“…28 Recent meta-analyses demonstrated evertor weakness was one of the strongest risk factors contributing to CAI. 29 Our findings of increased PL activation at initial ground contact are consistent with the result by Delahunt et al 30 who also found increased PL activation during the stance phase of gait. Patients with CAI also exhibited more PL activation in the post-landing phase of double-leg stop-jump task.…”

Section: Discussionsupporting

confidence: 92%

“…Peroneal muscles are the primary, proximate resistance to ankle inversion . Recent meta‐analyses demonstrated evertor weakness was one of the strongest risk factors contributing to CAI . Our findings of increased PL activation at initial ground contact are consistent with the result by Delahunt et al who also found increased PL activation during the stance phase of gait.…”

Section: Discussionsupporting

confidence: 92%

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Altered movement strategies during jump landing/cutting in patients with chronic ankle instability

Kim

Son

Seeley

et al. 2019

Scandinavian Med Sci Sports

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Centrally mediated changes in sensorimotor function have been reported in patients with chronic ankle instability (CAI). However, little is known regarding supraspinal/spinal adaptations during lower‐extremity dynamic movement during a multiplanar, single‐leg landing/cutting task. The purpose of this study was to investigate the effect of CAI on landing/cutting neuromechanics, including lower‐extremity kinematic, electromyography (EMG) activation, and ground reaction force (GRF) characteristics. One hundred CAI patients and 100 matched healthy controls performed five trials of a jump landing/cutting task. Sagittal‐ and frontal‐plane ankle, knee and hip kinematics, EMG activation in eight lower‐extremity muscles, and 3D GRF were collected during jump landing/cutting. Functional analyses of variance (FANOVA) were used to evaluate between‐group differences for dependent variables throughout the entire ground contact of the task. Relative to the control group, the CAI group revealed (a) reduced dorsiflexion, increased knee and hip flexion angles, (b) increased inversion and hip adduction angles, (c) increased EMG activation of medial gastrocnemius, peroneus longus, adductor longus, vastus lateralis, gluteus medius, and gluteus maximus, and (d) increased posterior and vertical GRF during initial landing, and reduced medial, posterior, and vertical GRF during mid‐landing and mid‐cutting. CAI patients demonstrated alterations in landing/cutting movement strategies as demonstrated by a higher susceptibility of foot placement for lateral ankle sprains, and more flexed positions of the knee and hip with higher EMG activation of knee and hip extensors to modulate GRF to compensate for the unstable ankle. This apparent compensation may be due to mechanical (limited dorsiflexion angle) and/or sensorimotor deficits in the ankle.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Altered movement strategies during jump landing/cutting in patients with chronic ankle instability

Kim

Son

Seeley

et al. 2019

Scandinavian Med Sci Sports

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“…22 Our results suggested that the CAI group may have had a positive cortical adaptation with greater variations in SMA activation, resulting in similar static postural outcomes as the control and coper groups. Whereas static postural control was not different among the 3 groups in our study, the findings of a recent metaanalysis 23 supported alterations in movement strategies during dynamic tasks relative to static balance among those with CAI. Authors of many of these studies have pointed to altered preparation for movement or feed-forward movement planning, and altered SMA activity indicates that such feed-forward control is affected.…”

Section: Discussionsupporting

confidence: 69%

Alterations in Cortical Activation Among Individuals With Chronic Ankle Instability During Single-Limb Postural Control

Rosen

Yentes

McGrath

et al. 2019

Journal of Athletic Training

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Context Chronic ankle instability (CAI) is characterized by repetitive ankle sprains and perceived instability. Whereas the underlying cause of CAI is disputed, alterations in cortical motor functioning may contribute to the perceived dysfunction. Objective To assess differences in cortical activity during single-limb stance among control, coper, and CAI groups. Design Cross-sectional study. Setting Biomechanics laboratory. Patients or Other Participants A total of 31 individuals (10 men, 21 women; age = 22.3 ± 2.4 years, height = 169.6 ± 9.7 cm, mass = 70.6 ± 11.6 kg), who were classified into control (n = 13), coper (n = 7), and CAI (n = 11) groups participated in this study. Intervention(s) Participants performed single-limb stance on a force platform for 60 seconds while wearing a 24-channel functional near-infrared spectroscopy system. Oxyhemoglobin (HbO2) changes in the supplementary motor area (SMA), precentral gyrus, postcentral gyrus, and superior parietal lobe were measured. Main Outcome Measure(s) Differences in averages and standard deviations of HbO2 were assessed across groups. In the CAI group, correlations were analyzed between measures of cortical activation and Cumberland Ankle Instability Tool (CAIT) scores. Results No differences in average HbO2 were present for any cortical areas. We observed differences in the standard deviation for the SMA across groups; specifically, the CAI group demonstrated greater variability than the control (r = 0.395, P = .02; 95% confidence interval = 0.34, 0.67) and coper (r = 0.38, P = .04; 95% confidence interval = −0.05, 0.69) groups. We demonstrated a strong correlation that was significant in the CAI group between the CAIT score and the average HbO2 of the precentral gyrus (ρ = 0.64, P = .02) and a strong correlation that was not significant between the CAIT score and the average HbO2 of the SMA (ρ = 0.52, P = .06). Conclusions The CAI group displayed large differences in SMA cortical-activation variability. Greater variations in cortical activation may be necessary for similar static postural-control outcomes among individuals with CAI. Consequently, variations in cortical activation for these areas provide evidence for an altered neural mechanism of postural control among populations with CAI.

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“…Ankle strength among patients with CAI has been studied extensively using isokinetic dynamometry. Meta-analy-ses 111,112 have shown consistent eversion concentricstrength deficits in patients with CAI. Deficits have also been reported in concentric inversion 113,114 and plantarflexion 115,116 strength and eccentric eversion, 117,118 inversion, 118,119 plantar-flexion, 120 and dorsiflexion 121 strength.…”

Section: Motor-behavioral Impairmentsmentioning

confidence: 93%

An Updated Model of Chronic Ankle Instability

Hertel

Corbett

2019

Journal of Athletic Training

492

386

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Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

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Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews

Abstract: PROSPERO 2016, CRD42016032592.

Cited by 153 publications

References 100 publications

Altered movement strategies during jump landing/cutting in patients with chronic ankle instability

Altered movement strategies during jump landing/cutting in patients with chronic ankle instability

Alterations in Cortical Activation Among Individuals With Chronic Ankle Instability During Single-Limb Postural Control

An Updated Model of Chronic Ankle Instability

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