Relationship Between Ankle Invertor H-Reflexes and Acute Swelling Induced by Inversion Ankle Sprain

Abstract

Study Design: Single group, post-test design using the uninvolved lower extremity as the experimental control. Objectives: To determine relationships between ankle swelling and flexor digitorum longus and peroneus longus H-reflex amplitude and latency.Backgnnmd: Primary capsuloligamentous injury, neural injury, and joint effusion and swelling may contribute to H-reflex changes following inversion ankle sprain. The relationship between ankle swelling and invertor or evertor H-reflexes has not been reported. Methods and Measures: Fifteen subjects with acute grade I or II inversion ankle sprains (mean + SD) 6.5 + 3 days after onset participated in this study. Swelling was estimated using a tape measure and the figure-of-eight girth assessment method. H-reflexes were determined using standard techniques. Paired t-tests were used to compare mean differences in ankle girth (swelling) and ankle invertor or evertor H-reflex amplitude and latency between the involved and uninvolved limbs. Pearson product moment correlations were used to assess relationships between swelling and H-reflex variables.Results: Involved limb ankle girth was increased with respect to the uninvolved limb (1.5 + 0.9 cm) and the involved ankle flexor digitorum longus latency was delayed (0.72 2 0.7 ms). There was a moderate positive association (r = 0.73) between the latency delay in the involved ankle flexor digitorum longus and swelling. There were no significant differences in H-reflex amplitude and peroneus longus latency between ankles. Conclusions: Grade I or II inversion sprains and the related swelling appear to delay involved ankle flexor digitorum longus latency to a greater extent than peroneus longus latency. Clinicians need to direct greater attention to the ankle invertors when designing and implementing ankle rehabilitation programs, particularly during the swelling management phase of treatment. ) Olthop Sports Phys Ther l999;29:33%344.

Chronic Ankle Instability and Neural Excitability of the Lower Extremity

“…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. Investigators 45,46 evaluating acute lateral ankle sprains have reported observations that were similar to ours, with no difference in spinal reflex excitability of the fibularis longus between groups or limbs. 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.…”

“…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.…”

Short-Term Natural Recovery of Ankle Sprains Following Discharge From Emergency Departments

“…In the laboratory, all measures were obtained dynamically at a fixed speed; therefore, if pain was a factor, then both joint excursion 27 and maximal muscle activation may have been reduced. 15 Indeed, both active and passive ROM were restricted compared to the uninjured side, and the extent of the asymmetry was associated with total ankle function. Furthermore, passive ROM was associated with the FAOS pain subscale score, indicating that excursion was most limited in those who reported more pain.…”

“…The stronger association between swelling and function observed at day 30 is in agreement with these previous observations and may reflect neuromuscular deficits that have been reported in the presence of prolonged effusion. 15,20 Although not evident from clinical ratings of muscle strength, isokinetic dynamometry established significant plantar flexor weakness 1 month postinjury.…”

Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain

“…14 Although evidence supports the presence of increased reflex MNPE in the leg muscles after ankle-effusion models 12 and inhibited MNPE in participants with functionally unstable ankles/ limited evidence is available to confirm the motor-neuron pool response of the soleus, fibularis longus, or tibialis anterior muscle after acute ankle sprains. 16 It is important to determine if acutely sprained ankles exhibit differences in lower extremity MNPE when compared with uninjured contralateral ankles. If differences in MNPE are detected, this information might aid in the immediate treatment provided by athletic trainers.…”