Athletic Trainers' Perceptions of Treating and Managing Patients With Ankle Sprains.

CONTEXT: Ankle sprains are common occurrences in athletic and general populations. High volumes of ankle sprains elevate the clinical burden on athletic trainers (ATs). The National Athletic Trainers' Association (NATA) published a position statement regarding the treatment and management of ankle sprains, but certain factors might affect an AT's ability to effectively implement the recommendations. OBJECTIVE: To evaluate ATs' current understanding, perceptions, and difficulties regarding the treatment, management, and long-term effects of ankle sprains. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: A total of 796 ATs (years certified = 12.1 ± 9.2) across all athletic training job settings. MAIN OUTCOME MEASURE(S): Participants completed a 38-question survey that addressed their demographic characteristics, as well as their perceptions and knowledge of the epidemiology, treatment, and management of ankle sprains. The survey was also used to document participants' patient education practices and attitudes toward the NATA position statement regarding ankle sprains, along with the challenges of and pressures against implementation. Descriptive statistics, correlations, and analyses of variance were used to analyze the data and evaluate group differences and relationships. RESULTS: Of the participants, 83% demonstrated a moderate understanding of fundamental ankle sprain epidemiology. Group differences regarding patient education were seen by education levels, years certified, and job setting. Overall, 38.1% of ATs were either unsure or unaware of the NATA position statement, but those who were aware rated its usefulness at 3.89 on a scale of 1 to 5, with 1 being not useful at all; 3, neutral; and 5, very useful. On average, 1.9 ± 0.88 challenges to implementing effective treatment practices were documented, and 2.0 ± 0.95 pressures to return athletes to play after ankle sprain were reported. CONCLUSIONS: Nearly 40% of the ATs were either unaware or unsure of the current recommendations regarding how patients with ankle sprains are treated, which could affect how care is delivered.

Patient-Reported Outcomes and Perceived Confidence Measures in Athletes With a History of Ankle Sprain.

CONTEXT: Patient-reported outcome measures (PROs) and functional performance tests are recommended in the National Athletic Trainers' Association's position statement on the prevention and management of ankle sprains during the return-to-play process. Evaluating perceived confidence may be another valuable method to evaluate an athlete's readiness to return-to-play following an ankle sprain. OBJECTIVE: To evaluate the relationship between PROs and perceived confidence when performing functional performance tasks in high school athletes with a history of ankle sprain. DESIGN: Descriptive study. SETTING: Public high school. PATIENTS OR OTHER PARTICIPANTS: A total of 25 high school student-athletes (6 males and 19 females, age 16.2 [1.1] y, height 169.3 [7.7] cm, mass 63.2 [9.8] kg). INTERVENTION(S): None. MAIN OUTCOME MEASURES: The Cumberland Ankle Instability Tool, visual analog scale (VAS) for pain, Identification of Functional Ankle Instability, and Tampa Scale of Kinesiophobia-11 were completed by all participants. Participants then completed the weight-bearing lunge test; star excursion balance test; lateral, up-down, and triple hop tests; the single-leg vertical jump; and Southeast Missouri agility test and were asked to report their confidence in completing each task using a VAS with anchors of "no confidence" and "complete confidence." Pearson r correlations were calculated between the PROs and the confidence VAS scores of the functional tests. RESULTS: Moderate to strong negative correlations were identified between pain VAS measures and confidence VAS measures for all functional tests except the star excursion balance test and vertical jump. Moderate negative correlations were found between Tampa Scale of Kinesiophobia-11 scores and perceived confidence during the star excursion balance test and vertical jump. Finally, a moderate positive correlation was identified between Cumberland Ankle Instability Tool scores and perceived confidence measures during the Southeast Missouri agility test. CONCLUSIONS: High school athletes with a history of ankle sprain demonstrated significant correlations between several PROs and perceived confidence during various functional performance tests. The value of perceived confidence measures when making return-to-play decisions after ankle sprains warrants further investigation.

An Updated Model of Chronic Ankle Instability.

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.

Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise.

The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.