Immediate Effects of Wearing an Ankle Bandage on Fine Coordination, Proprioception, Balance and Gait in the Subacute Phase of Ankle Sprains.

Ankle sprains are the most frequently occurring musculoskeletal injuries among recreational athletes. Ankle support through bandages following the initial orthotic treatment might be beneficial for rehabilitation purposes. However, the literature is sparse regarding the use of an ankle support directly after the acute phase of an ankle sprain. Therefore, this study investigates the hypothesis that wearing an ankle bandage immediately after an acute ankle sprain improves motor performance, stability and reduces pain. In total, 70 subjects with acute unilateral supination trauma were tested. Subjects were tested five weeks post-injury to assess immediate effects of the ankle bandage. On the testing day, subjects completed rating questionnaires and underwent comprehensive biomechanical assessments. Biomechanical investigations included fine coordination and proprioception tests, single leg stances, the Y-Balance test, and gait analysis. All biomechanical investigations were conducted for the subject's injured leg with and without a bandage (MalleoTrain® Bauerfeind AG, Zeulenroda-Triebes, Germany) and the healthy leg. Results indicated moderate to strong improvements in ankle stability and pain relief while wearing the bandage. Wearing the bandage significantly normalized single leg stance performance (p < 0.001), stance phase duration (p < 0.001), and vertical ground reaction forces during walking (p < 0.05). However, the bandage did not have a clear effect on fine coordination and proprioception. The findings of our study suggest that ankle bandages may play a crucial role in early-stage rehabilitation by enhancing motor performance and reducing pain.

The Effects of Motor Imagery on Static and Dynamic Balance and on the Fear of Re-Injury in Professional Football Players with Grade II Ankle Sprains.

Lateral ankle sprains are one of the most frequent athletic injuries in football, causing deficits in balance. Motor Imagery (MI) has been successively included in sports rehabilitation as a complementary therapeutic intervention. The aim of the present study was to explore the effects of MI on static and dynamic balance and on the fear of re-injury in professional football players with Grade II ankle sprains. Fifty-eight participants were randomly allocated into two groups: First-MI group (n = 29) and second-Placebo group (n = 29), and they each received six intervention sessions. The first MI group received MI guidance in addition to the balance training program, while the second Placebo group received only relaxation guidance. One-way ANOVA showed statistically significant results for all variables, both before and 4 weeks after the interventions for both groups. The t-test showed statistically significant differences between the two groups for static balance for the right lower extremity (t = 3.25, S (two-tailed) = 0.002, p < 0.05) and also for heart rate (final value) in all time phases. Further research is needed in order to establish MI interventions in sports trauma recovery using stronger MI treatments in combination with psychophysiological factors associated with sports rehabilitation.

Validity and reproducibility of the ARL-RSI score to assess psychological readiness before returning to sport after lateral ankle sprain.

Purpose: Although multiple scales exist to evaluate psychological readiness before returning to sport post-lateral ankle sprain (LAS), no score has been validated specifically for LAS or chronic ankle instability. The main aim of the study is to evaluate the validity and reproducibility of the ankle ligament reconstruction-return to sport injury (ALR-RSI) scale in assessing psychological readiness after LAS and its ability to identify patients who can return to their preinjury level. Methods: A total of 64 patients (35 females and 29 males; 33.8 ± 13.2 years) who recently experienced an acute LAS were included in this study. All patients participated in a predictive validation component of the study and were assessed at 2 and 4 months following an LAS. The ALR-RSI was completed twice by 20 patients at a 7-day interval to evaluate the reliability of the score in patients suffering from LAS. Results: The ALR-RSI was significantly (p < 0.001) and positively correlated with the other scores. The correlation was strong with the Foot and Ankle Ability Measure Sports: r = 0.77; 95% confidence interval [CI]: 0.78-0.83) and moderate with the American Orthopaedic Foot and Ankle Society (r = 0.69; 95% CI: 0.60-0.78) and the Foot and Ankle Ability Measure Activities of Daily Living Scores (r = 0.63; 95% CI: 0.51-0.72). Two-month ALR-RSI scores had good ability for predicting nonreturners at 4 months (area under the curve = 0.76; 95% CI: 0.6-0.9; p = 0.005). A Youden index of 0.51 was observed at an ALR-RSI score of 46%, corresponding to a sensitivity of 67% and specificity of 83%. Test-retest reliability of the ALR-RSI was excellent, with an ICC of 0.98 (95% CI: 0.96-0.99), a standard error of measurement of 3.02% and a minimum detectable change of 8.37%. Conclusions: The results of the current study validated the ALR-RSI as an important questionnaire to assess psychological readiness to return to sport after LAS. Level of Evidence: Level II prospective cohort study.

Effect of aquatic versus conventional physical therapy program on ankle sprain grade III in elite athletes: randomized controlled trial.

INTRODUCTION: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. PURPOSE: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. METHODS: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18-30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. RESULTS: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*). CONCLUSION: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.

Epidemiology of lateral ankle sprain focusing on indirect contact mechanism in male and female soccer players: An 18.5-month cohort study.

BACKGROUND: Epidemiological research highlights the need to understand sports injuries for effective prevention. Yet, detailed knowledge about lateral ankle sprain (LAS) in soccer, especially related to indirect contact mechanisms and specific sports movements, remains scarce. This study aimed to determine the prevalence of LAS by examining injury mechanisms, focusing on indirect contact, and analyzing sports-related movements. STUDY DESIGN: Prospective study. METHODS: In this prospective study, 304 high-school and college soccer players (age: 19.0 ± 2.2 years, height: 168.3 ± 10.6 cm, weight: 64.2 ± 11.1 kg) were monitored for 18.5 months. Attendance and LAS incidents were recorded daily. Injury details, including movement at the time of injury, contact presence, and direction, were collected through interviews conducted on the injury day. LAS were categorized into direct contact, indirect contact, and non-contact mechanisms. Direct contact injuries were due to external forces on the lower leg or foot. Indirect contact injuries resulted from impacts on areas other than the lower leg or foot, and non-contact injuries involved no interaction with the ball or opponent. Incidence rates per 1,000 athlete exposures and 95 % confidence intervals (CIs) were calculated, along with rate ratios (RR) to assess sex differences. RESULTS: The study recorded 59 LAS injuries. Indirect injuries were predominant, accounting for 47.5 % (n = 28) of the cases. Men experienced a higher incidence of indirect injuries, with an RR of 2.29 (95 % CI: 1.06-4.96). Outward contact was the most common (77.8 %; n = 21), while inward contact occurred in 22.2 % of the cases (n = 6). CONCLUSION: High school and college soccer players primarily sustained injuries through indirect contact mechanisms, with a significant number of injuries occurring during lateral contact. Men were more prone to indirect contact injuries. Furthermore, 47.5 % of LAS incidents involved reactive movements, and injuries frequently occurred during specific sports actions, such as ball interception.

Correlations of Postural Stability to Proprioception, Tactile Sensation, and Strength Among People With Chronic Ankle Instability.

OBJECTIVES: The static and dynamic correlations of postural stability to its three potential contributors, namely, proprioception, tactile sensation, and strength remain unclear among people with chronic ankle instability (CAI). This study aimed to compare static and dynamic postural stability, along with proprioception, tactile sensation, and strength between people with and without CAI and explore their correlations. METHODS: Sixty-seven participants with CAI and 67 participants without CAI were enrolled in this study. Ankle proprioception, plantar tactile sensation, and lower limb strength were measured by a proprioception test device, a set of monofilaments, and a strength testing system, respectively. Static and dynamic postural stability were measured during standing and jump landing on a force plate and indicated by the root mean square of center of pressure and time to stability. RESULTS: Compared to people without CAI, people with CAI had poorer postural stability, proprioception, tactile sensation, and strength. Both groups demonstrated correlation between proprioception and static postural stability, but only people without CAI showed correlation between proprioception and dynamic postural stability. Both groups demonstrated a correlation between tactile sensation and static postural stability, but not with dynamic stability. Both groups demonstrated a correlation between strength and both static and dynamic postural stability. CONCLUSIONS: People with CAI had deficits in static and dynamic postural stability, proprioception, tactile sensation, and strength. Among people with CAI, proprioception, tactile sensation, and strength can help maintain static postural stability; strength can help maintain dynamic postural stability, whereas proprioception may not provide sufficient information for dynamic postural stability.

Effect of Sex and Lateral Ankle Sprain History on Dorsiflexion Range Of Motion Asymmetry During the Weight Bearing Lunge Test.

Background: Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited. Hypothesis/Purpose: This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry. Study Design: Cross-Sectional Study. Methods: DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry. Results: The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ2(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb. Conclusion: Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments. Level of Evidence: 2b.

Single-legged landing behavior of high school basketball players with chronic ankle instability.

OBJECTIVES: Anterior cruciate ligament injury is one of the most serious ligamentous injuries. The purpose is to compare the impact of the ankle joint on the knee during landing between athletes with chronic instability and a control group (coper group) and to verify the effects of the kinetic chain from other joints. DESIGN: Prospective study. SETTING: High school basketball. PARTICIPANTS: Participants were 62 female high school basketball players who had participated in team sports for >6 months. MAIN OUTCOME MEASURES: Player joint angles, movements, and moments. RESULTS: The knee valgus moment was significantly higher in the chronic ankle instability group than in the coper group (20%-60% [p < 0.01]; 80%-100% [p < 0.05]) during landing motion. The knee valgus moment was also significantly higher during the change from the maximum knee joint flexion position to the maximum extension (p < 0.05). In addition, the landing motions of the chronic instability group may have utilized suboptimal compensatory motor strategy on the sagittal plane, depending heavily on the knee joint's abduction moment. CONCLUSIONS: Our findings indicate that the chronic ankle instability group uses a different landing strategy pattern than the coper group by changing the joint moment and joint angle during landing, which may increase the risk of anterior cruciate ligament injury.

Distal Tibiofibular Syndesmosis Injuries in the National Football League (NFL): A Spectrum of Pathology That Correlates With Time to Return to Full Participation.

BACKGROUND: Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. HYPOTHESIS: In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. RESULTS: There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). CONCLUSION: In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.

Platelet-Rich Plasma Injections in Chronic Lateral Ankle Instability: A Case Series.

The platelet-rich plasma (PRP) approach may be an effective treatment for joint and cartilage pathologies. However, the rationale for its effectiveness on joint instability is limited. This study aimed to assess the safety and effectiveness of PRP injections in patients with chronic lateral ankle instability (CLAI). This retrospective study was performed at a single-center outpatient clinic between January 2015 and February 2023 and included pre-intervention assessment and short-term follow-up. Patients were excluded if they had received previous surgical treatment or had constitutional hyperlaxity, systemic diseases, or grade II or III osteoarthritis. The clinical and functional evaluation consisted of the Karlsson score, the Cumberland Ankle Instability Tool (CAIT), Good's grading system, the patient's subjective satisfaction level, and the time required to return to exercise. The entire PRP therapy regime consisted of three PRP administrations at 7-day intervals and follow-up appointments. PRP was administered both intraarticularly and into talofibular ligaments. A total of 47 consecutive patients with CLAI were included, 11 were female (23.4%), with a mean age at intervention of 31.19 ± 9.74 years. A statistically significant improvement was found in the CAIT and Karlsson scores at 3 months (27.74 ± 1.68 and 96.45 ± 4.28, respectively) relative to the pre-intervention status (10.26 ± 4.33 and 42.26 ± 14.9, respectively, p < 0.000). The mean follow-up of patients with CLAI was 17.94 ± 3.25 weeks. This study represents successful short-term functional and clinical outcomes in patients with CLAI after PRP treatment, with no adverse effects. It demonstrates the feasibility of a randomized controlled trial to further assess this therapy.

Ultrasound Imaging in Football Players with Previous Multiple Ankle Sprains: Keeping a Close Eye on Superior Ankle Retinaculum.

The superior extensor ankle retinaculum (SEAR), a transversely fascial thickening positioned above the tibia-talar joint, serves as a crucial anatomical structure in ankle stability. The purpose of this study was to measure and compare by ultrasound (US) imaging the bilateral thickness and echogenicity of SEAR in football players with previous multiple ankle sprains (group 1) and healthy volunteers (group 2). A cross-sectional study was performed using ultrasound imaging to measure longitudinal and transversal axes using a new protocol in a sample of 50 subjects: 25 football players with previous multiple ankle sprains and 25 healthy subjects. The findings for SEAR thickness revealed statistically significant differences for both axes (p = 0.0011 and p = 0.0032) between the healthy side and the previously sprained side, and with the corresponding side of group 2 (p = 0.003 and p = 0.004). Moreover, in group 1, regarding the ROI echogenicity, a statistically significant difference was found between the sides (p = 0.0378). These findings suggest that the football players with previous ankle sprains showed a thicker and inhomogeneous SEAR on the sprain side, unveiling a remodeling of this structure compared to the other side and to the healthy volunteers. In these athletes, during US examination, one needs to keep "a US eye" on side-to-side SEAR comparisons.

Management of High Ankle Sprains Utilizing the Tightrope Surgical Procedure - A Novel Approach for a Rapid Return to Play.

The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. Level of Evidence: V.

Fantasy football points capture performance declines in National Football League offensive skill players following an ankle injury.

Background: The ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance. Methods: An open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance. Results: 303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029). Conclusion: Assessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL.

Anatomic Variations of the Calcaneofibular Ligament.

BACKGROUND: The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology. METHODS: The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed. RESULTS: A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint. CONCLUSION: The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction. CLINICAL RELEVANCE: The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.

Validity and Responsiveness of a Modified Balance Error Scoring System Assessment Using a Mobile Device Application in Patients Recovering from Ankle Sprain.

Background: Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury. Purpose: The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain. Study Design: Case-control study. Methods: Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients. Results: The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets (t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments (t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance (r = -0.59, p \< 0.001). Conclusion: The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain. Level of Evidence: Level 3.

Exploring biomechanical variations in ankle joint injuries among Latin dancers with different stance patterns: utilizing OpenSim musculoskeletal models.

Background: Dancers represent the primary demographic affected by ankle joint injuries. In certain movements, some Latin dancers prefer landing on the Forefoot (FT), while others prefer landing on the Entire foot (ET). Different stance patterns can have varying impacts on dancers' risk of ankle joint injuries. The purpose of this study is to investigate the differences in lower limb biomechanics between Forefoot (FT) dancers and Entire foot (ET) dancers. Method: A group of 21 FT dancers (mean age 23.50 (S.D. 1.12) years) was compared to a group of 21 ET dancers (mean age 23.33 (S.D. 0.94) years), performing the kicking movements of the Jive in response to the corresponding music. We import data collected from Vicon and force plates into OpenSim to establish musculoskeletal models for computing kinematics, dynamics, muscle forces, and muscle co-activation. Result: In the sagittal plane: ankle angle (0%-100%, p < 0.001), In the coronal plane: ankle angle (0%-9.83%, p = 0.001) (44.34%-79.52%, p = 0.003), (88.56%-100%, p = 0.037), ankle velocity (3.73%-11.65%, p = 0.017) (94.72-100%, p = 0.031); SPM analysis revealed that FT dancers exhibited significantly smaller muscle force than ET dancers around the ankle joint during the stance phase. Furthermore, FT dancers displayed reduced co-activation compared to ET dancers around the ankle joint during the descending phase, while demonstrating higher co-activation around the knee joint than ET dancers. Conclusion: This study biomechanically demonstrates that in various stance patterns within Latin dance, a reduction in lower limb stance area leads to weakened muscle strength and reduced co-activation around the ankle joint, and results in increased ankle inversion angles and velocities, thereby heightening the risk of ankle sprains. Nevertheless, the increased co-activation around the knee joint in FT dancers may be a compensatory response for reducing the lower limb stance area in order to maintain stability.

Study on the effect of blood flow restriction training combined with IASTAM on ankle strength and function intervention in athletes with chronic ankle instability in sport dance events.

BACKGROUND: Athletes engaged in sports dance frequently encounter the potential for ankle injuries and instability, factors that may contribute to diminished training efficacy, compromised athletic performance, prolonged recuperation, and heightened susceptibility to recurring injuries. OBJECTIVE: The objective of this study was to investigate the impact of an exercise intervention (comprising blood flow restriction training combined with low-load ankle muscle strength training and balance training) as well as instrument-assisted soft tissue mobilization (IASTM) on the foot and ankle function, strength, and range of motion in sports dance athletes exhibiting ankle instability (CAI). METHODS: Thirty participants exhibiting ankle instability, restriction, or discomfort were recruited and randomly assigned to two groups: the Test group (comprising blood flow restriction training combined with IASTM, n = 15) and the traditional ankle strength training group (n = 15). The intervention spanned 4 weeks, with one session per week. Assessment of the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), and ankle range of motion occurred at three time points: pre-intervention, immediately following the initial intervention, and after 4 weeks of intervention. Ankle strength testing was conducted solely before and after the intervention for comparative analysis. RESULTS: There were no significant variances in baseline characteristics between the two intervention groups. In terms of CAIT scores, both groups exhibited notably higher scores following the initial intervention and after 4 weeks of intervention compared to pre-intervention (P < 0.05). The Test group displayed higher CAIT scores than the control group, signifying a more pronounced enhancement in ankle stability among patients in the Test group. Concerning FAAM scores, both groups significantly enhanced ankle function in CAI patients (P < 0.05), with the Test group demonstrating notably higher FAAM-SPORT scores than the control group (P < 0.05), indicating superior restoration of athletic capability in the Test group. As for improvements in ankle range of motion, both groups demonstrated significant enhancements compared to pre-intervention (P < 0.05). The Test group exhibited significantly superior improvements in dorsiflexion, eversion, and inversion range of motion compared to the control group (P < 0.05), while the control group did not exhibit significant enhancements in plantarflexion and eversion range of motion (P > 0.05). Both groups displayed enhanced ankle strength in CAI patients following the intervention (P < 0.05), with the Test group manifesting notably higher dorsiflexion and inversion strength than the control group (P < 0.05). CONCLUSION: Both blood flow restriction training combined with IASTM and traditional ankle strength and stability training have shown significant improvements in stability, function, strength, and range of motion in CAI patients. Furthermore, the Test group exhibits superior efficacy in ankle stability, daily functional movement, dorsiflexion, and eversion range of motion compared to the control group. CLINICAL TRIAL REGISTRATION: 9 February 2024, ClinicalTrials.gov, ID; NCT06251414.

Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis.

BACKGROUND: Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle. PURPOSE: This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain. METHODS: A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES). RESULTS: Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function. CONCLUSION: PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol. REGISTRATION: PROSPERO registration number (CRD42021292930).

Acute Effects of a Hop-Stabilization Warm-Up Program on Dynamic Balance, Ground Reaction Force, and Muscle Activity During Cutting Movements in Collegiate Athletes with Chronic Ankle Instability.

First-time lateral ankle sprains often lead to chronic ankle instability (CAI), with 47% facing recurrent injuries, emphasizing the need for preventive measures. Side-cutting movements in sports pose a risk for CAI individuals due to potential biomechanical control alterations. While the hop-stabilization warm-up program has proven effective in preventing ankle sprains, its specific acute impact on CAI individuals lacks substantial evidence. This study employed a crossover design with eight CAI participants (23 ± 3.4 years, BMI 23 ± 1.5 kg/m2) and eight healthy participants (25 ± 3.6 years, BMI 23 ± 1.7 kg/m2) to investigate the acute effects of the hop-stabilization warm-up program on dynamic balance, ground reaction force (GRF), and muscle activity during 45- and 90-degree side-cutting movements. Each participant underwent hop-stabilization and control warm-up programs on two experimental days. Assessments, including the Y-balance test, GRF, and muscle activity pre- and post-warm-up, revealed significant improvements in dynamic balance, GRF, and muscle activity during 45-degree side-cutting movements in CAI participants. These findings suggest the potential benefits of incorporating the hop-stabilization warm-up program into the warm-up protocol for individuals with CAI.

Venous thromboembolism (VTE) developing after ankle sprain. Comparison with VTE after knee arthroplasty.

BACKGROUND: Venous thromboembolism (VTE) is a critical complication after non-major trauma or surgery. While the risk and severity of VTE following major orthopedic surgery is well-documented, there is significant knowledge gap regarding, non-major trauma such as ankle sprains. METHODS: We analyzed data from the RIETE registry to assess the clinical characteristics, VTE prophylaxis usage, and outcomes in patients with VTE following ankle sprain versus those post elective knee arthroplasty. We aimed to assess the risk and severity of VTE in a population traditionally considered at lower risk. Risk stratification was performed using the TRiP(cast) score. RESULTS: Among 1,250 patients with VTE, those with ankle sprain (n = 459) were much younger than those post knee arthroplasty (n = 791), less often female, had fewer comorbidities, and received VTE prophylaxis less often (27% vs. 93 %). During anticoagulation, 26 patients developed recurrent VTE, 31 had major bleeding, and 12 died (fatal PE 3, fatal bleeding 2). There were no differences between the two groups in the rates of VTE recurrences (rate ratio (RR): 1.65; 95%CI: 0.69-3.88) or death (RR: 1.12; 95%CI: 0.33-3.46), but patients with VTE after ankle sprain had a lower rate of major bleeding (RR: 0.39; 95%CI: 0.13-0.99). CONCLUSIONS: Ankle sprain patients are often undertreated for VTE prophylaxis and have similar severity of VTE than those undergoing elective knee surgery, indicating the need for a more customized approach to VTE management.