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Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI).   To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI.   Randomized controlled clinical trial.   Athletic training research laboratory.   Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg).   Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout.   Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05.   We observed time-by-group interactions in concentric ( P = .02) and eccentric ( P = .01) inversion, eccentric eversion ( P = .01), concentric ( P = .001) and eccentric ( P = .03) plantar flexion, BESS ( P = .01), SEBT ( P = .02), and side hop ( P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable.   Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.

To determine the concurrent validity of standard clinical outcome measures compared to laboratory outcome measure while performing the weight-bearing lunge test (WBLT). Cross-sectional study. Fifty participants performed the WBLT to determine dorsiflexion ROM using four different measurement techniques: dorsiflexion angle with digital inclinometer at 15cm distal to the tibial tuberosity (°), dorsiflexion angle with inclinometer at tibial tuberosity (°), maximum lunge distance (cm), and dorsiflexion angle using a 2D motion capture system (°). Outcome measures were recorded concurrently during each trial. To establish concurrent validity, Pearson product–moment correlation coefficients (r) were conducted, comparing each dependent variable to the 2D motion capture analysis (identified as the reference standard). A higher correlation indicates strong concurrent validity. There was a high correlation between each measurement technique and the reference standard. Specifically the correlation between the inclinometer placement at 15cm below the tibial tuberosity (44.9°±5.5°) and the motion capture angle (27.0°±6.0°) was r=0.76 (p=0.001), between the inclinometer placement at the tibial tuberosity angle (39.0°±4.6°) and the motion capture angle was r=0.71 (p=0.001), and between the distance from the wall clinical measure (10.3±3.0cm) to the motion capture angle was r=0.74 (p=0.001). This study determined that the clinical measures used during the WBLT have a high correlation with the reference standard for assessing dorsiflexion range of motion. Therefore, obtaining maximum lunge distance and inclinometer angles are both valid assessments during the weight-bearing lunge test.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity.

To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. Cross-sectional study. Research laboratory. In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.

Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. To determine if taping techniques effectively support the arch during exercise. Crossover study. Athletic training research laboratory. Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no-tape condition (P > .05). Both taping techniques effectively changed plantar pressures in the lateral midfoot, and these changes were sustained throughout the 15 minutes of exercise.

Approximately 72% of patients with an ankle sprain report residual symptoms 6 to 18 months later. Although 44% of patients return to activity in less than 24 hours after experiencing a sprain, residual symptoms should be evaluated in the long term to determine if deficits exist. These residual symptoms may be due to the quality of ligament tissue and motion after injury. To compare mechanical laxity of the talocrural joint and dorsiflexion range of motion (DFROM) over time (24 to 72 hours, 2 to 4 weeks, and 6 months) after an acute lateral ankle sprain (LAS). Cross-sectional study. Athletic training research laboratory. A total of 108 volunteers were recruited. Fifty-five participants had an acute LAS and 53 participants were control individuals without a history of LAS. Mechanical laxity (talofibular interval and anterior talofibular ligament length) was measured in inversion (INV) and via the anterior drawer test. The weight-bearing lunge test was conducted and DFROM was measured. The data were analyzed using repeated-measures analysis of variance, independent-samples t tests, and 1-way analysis of variance. Of the 55 LASs, 21 (38%) were grade I, 27 (49%) were grade II, and 7 (13%) were grade III. Increases were noted in DFROM over time, between 24 and 72 hours, at 2 to 4 weeks, and at 6 months (P < .05). The DFROM was less in participants with grade III than grade I LASs (P = .004) at 24 to 72 hours; INV length was greater at 24 to 72 hours than at 2 to 4 weeks (P = .023) and at 6 months (P = .035) than at 24 to 72 hours. The anterior drawer length (P = .001) and INV talofibular interval (P = .004) were greater in the LAS group than in the control group at 6 months. Differences in range of motion and laxity were evident among grades at various time points and may indicate different clinical responses after an LAS.

Kinesio Tex tape is a therapeutic tape that is applied with the Kinesio-taping (KT) method and is theorized to increase circulation and subsequently improve muscle function. However, little research has been conducted to determine how KT affects performance. To determine the effect of KT on muscular endurance ratio, blood flow, circumference, and volume of the gastrocnemius muscle. Randomized controlled clinical trial. Research laboratory. Patients or Other Participants: Sixty-one healthy, active people (23 men, 38 women; age = 19.99 ± 8.01 years, height = 169.42 ± 23.62 cm, mass = 71.53 ± 36.77 kg) volunteered to participate. They were assigned randomly to 1 of 3 groups: treatment KT, sham KT, and control. Tape was applied based on group assignment. The treatment KT group received the ankle-tape technique as described in the KT manual. The sham KT group received 1 strip of Kinesio Tex tape around the circumference of the proximal gastrocnemius muscle. The control group did not receive tape application. The dependent variables were blood flow in blood perfusion units, volume of water displacement in milliliters, circumference of the gastrocnemius muscle in centimeters, and endurance ratio in joules measured before, 24 hours after, and 72 hours after the intervention. Separate repeated-measures analyses of variance were conducted for each dependent variable. We found no group-by-test day interaction for endurance ratios (F(4,116) = 1.99, P = .10). Blood flow, circumference, and volume measurements also yielded no differences among groups (F(2,58) range, 0.02-0.51; P > .05) or test days (F(2,116) range, 0.05-2.33; P > .05). We found KT does not enhance anaerobic muscle function measured by endurance ratio. The KT also did not affect circulation or volume of the gastrocnemius muscle in a healthy population.

Background/objectives: Lower limb cutaneous reflex amplitudes can modulate across gait, which helps humans adjust rhythmic motor outputs to maintain balance in an ever-changing environment. Preliminary evidence suggests people who suffer from repetitive ankle sprains and residual feelings of giving way demonstrate altered cutaneous reflex patterns in the gastrocnemius. However, before cutaneous reflex assessment can be implemented as a clinical outcome measure, there is a need to substantiate these early findings by measuring reflex amplitudes across longer latency periods and exploring the variability of reflexes within each subject. Methods: Forty-eight subjects with and without chronic ankle instability (CAI) walked on a treadmill at 4 km/h while activity of the lateral gastrocnemius (LG) was measured via surface electromyography. Non-noxious stimulations were elicited randomly to the ipsilateral sural nerve at the mid-stance phase of gait, and reflex amplitudes were calculated offline by comparing muscle activity during unstimulated and stimulated gait cycles. Two primary outcome measures were compared between groups at the middle latency (MLR: 80–120 ms) and late latency (LLR: 120–150 ms) time windows: (1) average reflex amplitudes and (2) standard deviation of reflex amplitudes for each subject across 10 trials. Results: Both groups demonstrated an equal amount of LG inhibition at the MLR and LG facilitation at the LLR. However, subjects with CAI showed significantly higher variability in LLR amplitude across trials than healthy controls. Conclusions: Increased variability of cutaneous reflex amplitudes may relate to symptoms associated with CAI. These findings suggest that reflex variability following sural nerve stimulation could serve as an objective measure to track treatment progress in patients with CAI, offering clinicians a new tool for conducting rehabilitation assessments in a controlled environment.