Ultrasonography of Gluteal and Fibularis Muscles During Exercises in Individuals With a History of Lateral Ankle Sprain

Abstract

Context Individuals with a history of lateral ankle sprains (LASs) have ankle and hip neuromuscular changes compared with those who do not have a history of LAS. Objective To compare gluteus maximus (GMax), gluteus medius (GMed), and fibularis longus and brevis muscle activation using ultrasound imaging during tabletop exercises and lateral resistance-band walking in individuals with or without a history of LAS or chronic ankle instability (CAI). Design Cross-sectional study. Patients or Other Participants Sixty-seven young adults (27 males, 40 females). Groups were healthy = 16, coper = 17, LAS = 15, CAI = 19. The number of previous sprains was 0 ± 0 in the healthy group, 1.1 ± 0.3 in the coper group, 2.9 ± 2.4 in the LAS group, and 5.3 ± 5.9 in the CAI group. Main Outcome Measure(s) Ultrasound imaging measures of fibularis cross-sectional area (CSA) were collected during nonresisted and resisted ankle eversion. Gluteal muscle thicknesses were imaged during nonresisted and resisted side-lying abduction and during lateral resistance-band walking exercises (lower leg and forefoot band placement). Separate 4 × 2 repeated-measures analyses of variance and post hoc Fisher least significant difference tests were used to assess activation across groups and resistance conditions. Results All groups demonstrated 3.2% to 4.1% increased fibularis CSA during resisted eversion compared with nonresisted. During side-lying abduction, the LAS and CAI groups displayed increased GMax thickness (6.4% and 7.2%, respectively), and all but the CAI group (−0.4%) increased GMed thickness (5.3%–11.8%) with added resistance in hip abduction. During band walking, the healthy and LAS groups showed increased GMax thickness (4.8% and 8.1%, respectively), and all groups had increased GMed thickness (3.0%–5.8%) in forefoot position compared with the lower leg position. Although the values were not different, copers exhibited the greatest amount of GMed thickness during band-walking activities (copers = 23%–26%, healthy = 17%–23%, LAS = 11%–15%, CAI = 15%–19%). Conclusions All groups had increased fibularis CSA with resisted eversion. In side-lying hip abduction, individuals with CAI had greater GMax thickness than GMed thickness. Ultrasound imaging of fibularis CSA and gluteal muscle thickness may be clinically useful in assessing and treating patients with LAS or CAI.

Ultrasound Measures of Intrinsic Foot Muscle Size and Activation Following Lateral Ankle Sprain and Chronic Ankle Instability

“…These findings are similar to the increased activation ratio (AR) measured in the fibularis and gluteal muscle groups in the same participants. 31 In the unadjusted analysis, both Coper and CAI groups demonstrated moderate, significant decreases in nonresisted QP AR compared with controls. Furthermore, the CAI group demonstrated large, significantly decreased resisted ARs in the QP compared with both LAS and control groups.…”

“…Another study employed USI to compare gluteal muscle thickness and activation during side-lying table top abduction and band-walking exercises in the same participants. 31 One of the primary observations was that the gluteus medius AR in CAI group was significantly smaller contrasted to Copers, LAS, and healthy controls as task difficulty increased. 31 In addition, neuromotor compensations were observed, as the CAI group relied more on the gluteus maximus muscle to complete the exercise.…”

Ultrasound measures of intrinsic foot muscle size and motor activation following lateral ankle sprain and chronic ankle instability. A cross-sectional study

“…27 One of the primary observations was that the gluteus medius AR in CAI group was significantly smaller contrasted to Copers, LAS, and healthy controls as task difficulty increased. 27 In addition, neuromotor compensations were observed, as the CAI group relied more on the gluteus maximus muscle to complete the exercise. 27 The authors suggested this may be due to central motor alterations that occur after injury that may affect the motor recruitment in the area.…”

“…These findings are similar to the increased AR measured in the fibularis and gluteal muscle groups in the same participants. 27…”

“…The average measurement of the three images were utilized for analysis in each condition. Measures of active and resisted contraction were normalized to resting measures and reported as an activation ratio, 11,12,27 calculated using the formula:…”