Dptportfolios.web.unc.edu



The pathomechanics of changes in joint position sense following lateral inversion ankle sprainsBy Christopher RitterThe sprained ankle is one of the most frequently occurring musculoskeletal injuries associated with physical activity with an estimated incidence rate of 2.15 per 1,000 people each year in the United States.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.I.01537", "ISSN" : "1535-1386", "PMID" : "20926721", "abstract" : "BACKGROUND: Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics.\n\nMETHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race.\n\nRESULTS: During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.\n\nCONCLUSIONS: An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.", "author" : [ { "dropping-particle" : "", "family" : "Waterman", "given" : "Brian R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Brett D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davey", "given" : "Shaunette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zacchilli", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belmont", "given" : "Philip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2010", "10", "6" ] ] }, "page" : "2279-84", "title" : "The epidemiology of ankle sprains in the United States.", "type" : "article-journal", "volume" : "92" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 This rate is greatest for persons between 15 to 19 years of age with a respective incidence rate of 7.2 per 1,000.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.I.01537", "ISSN" : "1535-1386", "PMID" : "20926721", "abstract" : "BACKGROUND: Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics.\n\nMETHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race.\n\nRESULTS: During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.\n\nCONCLUSIONS: An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.", "author" : [ { "dropping-particle" : "", "family" : "Waterman", "given" : "Brian R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Brett D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davey", "given" : "Shaunette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zacchilli", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belmont", "given" : "Philip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2010", "10", "6" ] ] }, "page" : "2279-84", "title" : "The epidemiology of ankle sprains in the United States.", "type" : "article-journal", "volume" : "92" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Ankle sprains are estimated to account for 1.6 million office visits and 8,000 hospitalizations each year in the US with sprains resulting in ligamentous damage representing one of the most common musculoskeletal impairments treated by physical therapists.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0195-9131", "PMID" : "10449021", "abstract" : "PURPOSE: The purpose of this study was to identify rates of diagnosis-specific musculoskeletal injuries in U.S. Marine Corps recruits and to examine the association between patterns of physical training and these injuries.\n\nMETHODS: Subjects were 1,296 randomly selected male Marine recruits, ages 17 to 28 yr, who reported to Marine Corps Recruit Depot San Diego for boot camp training between January 12 and September 14, 1993. Recruits were followed prospectively through 12 wk of training for injury outcomes. Injury patterns were examined in relation to weekly volumes and types of vigorous physical training.\n\nRESULTS: The overall injury rate was 39.6% (number of recruits injured/population at risk), with 82% of injuries occurring in the lower extremities. Overuse injuries accounted for 78% of the diagnoses. The most frequent site of injury was the ankle/foot region (34.3% of injuries), followed by the knee (28.1%). Ankle sprains (6.2%, N = 1,143), iliotibial band syndrome (5.3%, N = 1,143), and stress fractures (4.0%, N = 1,296) were the most common diagnoses. Injury rates were highest during the weeks with high total volumes of vigorous physical training and the most hours of running and marching. Weekly injury rates were significantly correlated with hours of vigorous physical training (overuse injuries r = 0.667, P = 0.018; acute injuries r = 0.633, P = 0.027).\n\nCONCLUSIONS: The results of this controlled epidemiological investigation indicate that volume of vigorous physical training may be an etiologic factor for exercise-related injuries. The findings also suggest that type of training, particularly running, and abrupt increases in training volume may further contribute to injury risk.", "author" : [ { "dropping-particle" : "", "family" : "Almeida", "given" : "S A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shaffer", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brodine", "given" : "S K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medicine and science in sports and exercise", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "1999", "8" ] ] }, "page" : "1176-82", "title" : "Epidemiological patterns of musculoskeletal injuries and physical training.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "0112-1642", "PMID" : "17190537", "abstract" : "This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.", "author" : [ { "dropping-particle" : "", "family" : "Fong", "given" : "Daniel Tik-Pui", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hong", "given" : "Youlian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Lap-Ki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yung", "given" : "Patrick Shu-Hang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Kai-Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Sports medicine (Auckland, N.Z.)", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2007", "1" ] ] }, "page" : "73-94", "title" : "A systematic review on ankle injury and ankle sprain in sports.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^2\u20134", "plainTextFormattedCitation" : "2\u20134", "previouslyFormattedCitation" : "^2\u20134" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2–4 Almost half of all ankle injuries occur during athletic activity, most commonly in sports involving frequent change of direction and jumping such as basketball, volleyball, football, and soccer.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.I.01537", "ISSN" : "1535-1386", "PMID" : "20926721", "abstract" : "BACKGROUND: Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics.\n\nMETHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race.\n\nRESULTS: During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.\n\nCONCLUSIONS: An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.", "author" : [ { "dropping-particle" : "", "family" : "Waterman", "given" : "Brian R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Brett D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davey", "given" : "Shaunette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zacchilli", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belmont", "given" : "Philip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2010", "10", "6" ] ] }, "page" : "2279-84", "title" : "The epidemiology of ankle sprains in the United States.", "type" : "article-journal", "volume" : "92" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jsams.2014.04.005", "ISSN" : "14402440", "author" : [ { "dropping-particle" : "", "family" : "Schiftan", "given" : "Gabriella Sophie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ross", "given" : "Lauren Ashleigh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hahne", "given" : "Andrew John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Science and Medicine in Sport", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "238-244", "publisher" : "Sports Medicine Australia", "title" : "The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,5", "plainTextFormattedCitation" : "1,5", "previouslyFormattedCitation" : "^1,5" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,5 A systematic review of sports injuries from 1977 to 2005 found that the ankle was the most commonly injured body part in 24 of 70 different sports reviewed.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0112-1642", "PMID" : "17190537", "abstract" : "This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.", "author" : [ { "dropping-particle" : "", "family" : "Fong", "given" : "Daniel Tik-Pui", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hong", "given" : "Youlian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Lap-Ki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yung", "given" : "Patrick Shu-Hang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Kai-Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Sports medicine (Auckland, N.Z.)", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2007", "1" ] ] }, "page" : "73-94", "title" : "A systematic review on ankle injury and ankle sprain in sports.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 Specifically, the ankle sprain was the major ankle injury in 33 of 43 sports.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0112-1642", "PMID" : "17190537", "abstract" : "This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.", "author" : [ { "dropping-particle" : "", "family" : "Fong", "given" : "Daniel Tik-Pui", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hong", "given" : "Youlian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Lap-Ki", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yung", "given" : "Patrick Shu-Hang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "Kai-Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Sports medicine (Auckland, N.Z.)", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2007", "1" ] ] }, "page" : "73-94", "title" : "A systematic review on ankle injury and ankle sprain in sports.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 An estimated 83% of ankle sprains are lateral inversion sprains in which an external inversion force applies stress to the ligaments of the talocrural, subtalar joints, and inferior tibiofibular joints.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kannus", "given" : "Pekka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bone & Joint Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1991" ] ] }, "title" : "Current Concepts Review Treatment of Acute Tears of the Lateral Ligaments of the Ankle", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.fcl.2006.07.002", "ISSN" : "1083-7515", "PMID" : "16971255", "abstract" : "Lateral ankle sprains account for 85% of all ankle sprains. This common injury is most frequently sustained during sporting activity. The ATFL is the weakest of the lateral ankle ligament complex, and is most frequently injured. Ankle sprains are often undertreated, resulting in chronic pain, muscular weakness, and instability. The consequence of this common injury for professional sports clubs is days lost in training and matches missed due to injury as well as the cost of rehabilitation. In the UK, an estimated 302,000 ankle sprains are seen each year in Accident and Emergency Departments.", "author" : [ { "dropping-particle" : "", "family" : "Ferran", "given" : "Nicholas Antonio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maffulli", "given" : "Nicola", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Foot and ankle clinics", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2006", "9" ] ] }, "page" : "659-62", "title" : "Epidemiology of sprains of the lateral ankle ligament complex.", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "1938-162X (Electronic)\\n1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "12937557", "abstract" : "Objective: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. Data Sources: I searched MEDLINE (1985\u20132001) and CINAHL (1982\u20132001) using the key words ankle sprain and ankle instability. Data Synthesis: Lateral ankle sprains are among the most common injuries incurred during sports participation. The ankle functions as a complex with contributions from the talocrural, subtalar, and inferior tibiofibular joints. Each of these joints must be considered in the pathomechanics and pathophysiology of lateral ankle sprains and chronic ankle instability. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control. Conclusions/Recommendations: Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. Appreciation of the complex anatomy and mechanics of the ankle joint and the pathomechanics and pathophysiology related to acute and chronic ankle instability is integral to the process of effectively evaluating and treating ankle injuries.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "364-375", "title" : "Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^6\u20138", "plainTextFormattedCitation" : "6\u20138", "previouslyFormattedCitation" : "^6\u20138" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6–8 The lateral ligament complex is comprised of three main ligaments including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL), with the ATFL being the most commonly injured with an estimated two-thirds of all injuries isolated to this ligament.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kannus", "given" : "Pekka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bone & Joint Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1991" ] ] }, "title" : "Current Concepts Review Treatment of Acute Tears of the Lateral Ligaments of the Ankle", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6 The CFL is the second most commonly injured and almost always occurs in the presence of injury to the ATFL.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kannus", "given" : "Pekka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bone & Joint Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1991" ] ] }, "title" : "Current Concepts Review Treatment of Acute Tears of the Lateral Ligaments of the Ankle", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6 The ATFL is the weakest of the three ligaments and most compromised when the ankle is in supination with combined plantar flexion, internal rotation, and inversion, coupled with relative external rotation of the lower leg.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kannus", "given" : "Pekka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bone & Joint Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1991" ] ] }, "title" : "Current Concepts Review Treatment of Acute Tears of the Lateral Ligaments of the Ankle", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "1938-162X (Electronic)\\n1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "12937557", "abstract" : "Objective: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. Data Sources: I searched MEDLINE (1985\u20132001) and CINAHL (1982\u20132001) using the key words ankle sprain and ankle instability. Data Synthesis: Lateral ankle sprains are among the most common injuries incurred during sports participation. The ankle functions as a complex with contributions from the talocrural, subtalar, and inferior tibiofibular joints. Each of these joints must be considered in the pathomechanics and pathophysiology of lateral ankle sprains and chronic ankle instability. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control. Conclusions/Recommendations: Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. Appreciation of the complex anatomy and mechanics of the ankle joint and the pathomechanics and pathophysiology related to acute and chronic ankle instability is integral to the process of effectively evaluating and treating ankle injuries.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "364-375", "title" : "Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^6,8", "plainTextFormattedCitation" : "6,8", "previouslyFormattedCitation" : "^6,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6,8 Risk factors for ankle sprain can be separated into extrinsic and intrinsic factors. Extrinsic factors include specific sports or at risk behaviors, level of competition, shoe type, playing surface, and use of external supports such as tape or ankle brace.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.I.01537", "ISSN" : "1535-1386", "PMID" : "20926721", "abstract" : "BACKGROUND: Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics.\n\nMETHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race.\n\nRESULTS: During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.\n\nCONCLUSIONS: An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.", "author" : [ { "dropping-particle" : "", "family" : "Waterman", "given" : "Brian R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Brett D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davey", "given" : "Shaunette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zacchilli", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belmont", "given" : "Philip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2010", "10", "6" ] ] }, "page" : "2279-84", "title" : "The epidemiology of ankle sprains in the United States.", "type" : "article-journal", "volume" : "92" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1136/bjsm.37.1.13", "ISBN" : "0306-3674", "ISSN" : "0306-3674", "PMID" : "12547739", "abstract" : "Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine additional risk factors for lower extremity injury.", "author" : [ { "dropping-particle" : "", "family" : "Murphy", "given" : "D F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Connolly", "given" : "D A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beynnon", "given" : "B D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British journal of sports medicine", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "13-29", "title" : "Risk factors for lower extremity injury: a review of the literature.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "1938-162X (Electronic)\\r1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "12937558", "abstract" : "Objective: To review the prospective studies of ankle-ligament-injury risk factors. Data Sources: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. Data Synthesis: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. Conclusions/Recommendations: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury.", "author" : [ { "dropping-particle" : "", "family" : "Beynnon", "given" : "Bruce D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "Darlene F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alosa", "given" : "Denise M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "376-380", "title" : "Predictive factors for lateral ankle sprains: A literature review", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.5312/wjo.v6.i2.161", "ISSN" : "2218-5836", "author" : [ { "dropping-particle" : "", "family" : "McCriskin", "given" : "Brendan J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World Journal of Orthopedics", "id" : "ITEM-4", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "161", "title" : "Management and prevention of acute and chronic lateral ankle instability in athletic patient populations", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,9\u201311", "plainTextFormattedCitation" : "1,9\u201311", "previouslyFormattedCitation" : "^1,9\u201311" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,9–11 Intrinsic risk factors include age, weight, body mass index (BMI), gender, height, flexibility, limb dominance, aerobic fitness level, limb girth, muscle strength, reaction time, postural stability, anatomical alignment, foot type, flexibility, previous injury and inadequate rehabilitation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.I.01537", "ISSN" : "1535-1386", "PMID" : "20926721", "abstract" : "BACKGROUND: Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics.\n\nMETHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race.\n\nRESULTS: During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.\n\nCONCLUSIONS: An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.", "author" : [ { "dropping-particle" : "", "family" : "Waterman", "given" : "Brian R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Brett D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davey", "given" : "Shaunette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zacchilli", "given" : "Michael A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belmont", "given" : "Philip J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "13", "issued" : { "date-parts" : [ [ "2010", "10", "6" ] ] }, "page" : "2279-84", "title" : "The epidemiology of ankle sprains in the United States.", "type" : "article-journal", "volume" : "92" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1136/bjsm.37.1.13", "ISBN" : "0306-3674", "ISSN" : "0306-3674", "PMID" : "12547739", "abstract" : "Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine additional risk factors for lower extremity injury.", "author" : [ { "dropping-particle" : "", "family" : "Murphy", "given" : "D F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Connolly", "given" : "D A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beynnon", "given" : "B D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British journal of sports medicine", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "13-29", "title" : "Risk factors for lower extremity injury: a review of the literature.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "1938-162X (Electronic)\\r1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "12937558", "abstract" : "Objective: To review the prospective studies of ankle-ligament-injury risk factors. Data Sources: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. Data Synthesis: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. Conclusions/Recommendations: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury.", "author" : [ { "dropping-particle" : "", "family" : "Beynnon", "given" : "Bruce D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "Darlene F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alosa", "given" : "Denise M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "376-380", "title" : "Predictive factors for lateral ankle sprains: A literature review", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.5312/wjo.v6.i2.161", "ISSN" : "2218-5836", "author" : [ { "dropping-particle" : "", "family" : "McCriskin", "given" : "Brendan J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World Journal of Orthopedics", "id" : "ITEM-4", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "161", "title" : "Management and prevention of acute and chronic lateral ankle instability in athletic patient populations", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,9\u201311", "plainTextFormattedCitation" : "1,9\u201311", "previouslyFormattedCitation" : "^1,9\u201311" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,9–11 The greatest predictive factor for lateral inversion ankle sprains is the presence of a previous ankle sprain with rates of re-injury estimated to be between 50-78%.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kannus", "given" : "Pekka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bone & Joint Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1991" ] ] }, "title" : "Current Concepts Review Treatment of Acute Tears of the Lateral Ligaments of the Ankle", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "0306-3674", "PMID" : "7921910", "abstract" : "Ankle sprain is a common sports injury and is often regarded as trivial by athletes and coaches. This epidemiological study was conducted among three categories of Hong Kong Chinese athletes: national teams, competitive athletes and recreational athletes. This study shows that as much as 73% of all athletes had recurrent ankle sprain and 59% of these athletes had significant disability and residual symptoms which led to impairment of their athletic performance. This study indicates that a proper approach towards injury prevention and a comprehensive rehabilitation programme are required.", "author" : [ { "dropping-particle" : "", "family" : "Yeung", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "So", "given" : "C H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yuan", "given" : "W Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British journal of sports medicine", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "1994", "6", "1" ] ] }, "language" : "en", "page" : "112-6", "publisher" : "BMJ Group", "title" : "An epidemiological survey on ankle sprain.", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "1062-6050 (Print)\\r1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "16558453", "abstract" : "OBJECTIVE: To determine if ankle muscular strength, flexibility and proprioception can predict ankle injury in college basketball players and to compare ankle injury rates in female and male players. DESIGN AND SETTING: In this prospective, correlational study, subjects were tested at the start of the competitive season for ankle joint muscle strength, flexibility, and proprioception. The first ankle injury for each subject was recorded on an injury report form, and the data were analyzed to determine if any of these preseason measurements predicted future injury. The setting was a competitive 9-week season for four women's and four men's college basketball teams. SUBJECTS: A convenience sample of 31 female and 11 male college basketball players. MEASUREMENTS: Subjects were tested for ankle dorsiflexion range of motion, various measures of ankle proprioception, and isokinetic peak torque of ankle dorsiflexion-plantar flexion and eversion-inversion at 30 degrees /sec and 180 degrees /sec before the start of the conference basketball seasons. Data were analyzed using a series of multiple regression equations to determine the variance in ankle injury attributed to each variable. RESULTS: Various measures of proprioception predicted left ankle injury in all subjects (p < .05), while ankle strength and flexibility measures failed to account for additional variance. There was no statistically significant difference in ankle injury rate between women and men. CONCLUSIONS: Ankle joint proprioceptive deficits can be used to predict ankle injury, but further research is needed to identify other sources of variance. In our study, ankle injury rate was similar in female and male college basketball players.", "author" : [ { "dropping-particle" : "", "family" : "Payne", "given" : "Kristen A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Kris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Latin", "given" : "Richard W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "1997" ] ] }, "page" : "221-225", "title" : "Ankle injuries and ankle strength, flexibility, and proprioception in college basketball players", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1111/j.1600-0838.2004.00428.x", "ISSN" : "0905-7188", "author" : [ { "dropping-particle" : "", "family" : "Willems", "given" : "T. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Witvrouw", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbaere", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philippaerts", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bourdeaudhuij", "given" : "I.", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clercq", "given" : "D.", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian Journal of Medicine and Science in Sports", "id" : "ITEM-4", "issue" : "5", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "336-345", "title" : "Intrinsic risk factors for inversion ankle sprains in females - a prospective study", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1136/bjsm.2006.029645", "ISSN" : "0306-3674", "author" : [ { "dropping-particle" : "", "family" : "Noronha", "given" : "M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Refshauge", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herbert", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kilbreath", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hertel", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Journal of Sports Medicine", "id" : "ITEM-5", "issue" : "10", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "824-828", "title" : "Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain? * COMMENTARY", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^6,12\u201315", "plainTextFormattedCitation" : "6,12\u201315", "previouslyFormattedCitation" : "^6,12\u201315" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6,12–15 An estimated 30-59% of persons who experience recurrent ankle sprains will go on to report residual symptoms, disability, diminished physical activity, and, or functional impairment.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0306-3674", "PMID" : "7921910", "abstract" : "Ankle sprain is a common sports injury and is often regarded as trivial by athletes and coaches. This epidemiological study was conducted among three categories of Hong Kong Chinese athletes: national teams, competitive athletes and recreational athletes. This study shows that as much as 73% of all athletes had recurrent ankle sprain and 59% of these athletes had significant disability and residual symptoms which led to impairment of their athletic performance. This study indicates that a proper approach towards injury prevention and a comprehensive rehabilitation programme are required.", "author" : [ { "dropping-particle" : "", "family" : "Yeung", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chan", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "So", "given" : "C H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yuan", "given" : "W Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British journal of sports medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1994", "6", "1" ] ] }, "language" : "en", "page" : "112-6", "publisher" : "BMJ Group", "title" : "An epidemiological survey on ankle sprain.", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹²", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "¹²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12 Continued symptoms, “giving way”, and recurrent injuries have been termed chronic ankle instability (CAI).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jbmt.2007.03.002", "ISBN" : "13608592", "ISSN" : "13608592", "abstract" : "Sprain of the lateral ankle ligaments are one of the most common injuries encountered during athletic participation. Following initial injury there is an alarmingly high risk of re-injury and the development of residual symptoms such as pain, swelling and \"giving way\" of the ankle joint. These symptoms have been given the generic term chronic ankle instability (CAI). Two causes of CAI reported in the literature are mechanical instability (MI) and functional instability (FI). FI is a distinct phenomenon to MI with many neuromuscular contributing factors being reported. The purpose of this literature review is to describe those neuromuscular factors associated with FI. ?? 2007 Elsevier Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Delahunt", "given" : "Eamonn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Bodywork and Movement Therapies", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "203-213", "title" : "Neuromuscular contributions to functional instability of the ankle joint", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁶", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "¹⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16 CAI has been attributed to two components of instability including mechanical instability and functional instability.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 Mechanical instability includes ankle joint motion which is greater than normal physiological limits resulting from ligamentous laxity or damage following sprain.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 Recent definitions of mechanical instability include pathological laxity, arthrokinematic impairments, degenerative joint disease, and synovial changes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1938-162X (Electronic)\\n1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "12937557", "abstract" : "Objective: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. Data Sources: I searched MEDLINE (1985\u20132001) and CINAHL (1982\u20132001) using the key words ankle sprain and ankle instability. Data Synthesis: Lateral ankle sprains are among the most common injuries incurred during sports participation. The ankle functions as a complex with contributions from the talocrural, subtalar, and inferior tibiofibular joints. Each of these joints must be considered in the pathomechanics and pathophysiology of lateral ankle sprains and chronic ankle instability. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control. Conclusions/Recommendations: Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. Appreciation of the complex anatomy and mechanics of the ankle joint and the pathomechanics and pathophysiology related to acute and chronic ankle instability is integral to the process of effectively evaluating and treating ankle injuries.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "364-375", "title" : "Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁸", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8 Functional instability is a more complex concept involving joint motion within normal physiological limits but beyond voluntary or involuntary control due to changes in the sensorimotor system following injury.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 Freeman and Wyke demonstrated that different mechanoreceptors in ankle ligaments and joint capsules of cats relay information about joint position and movement.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0007-1323 (Print)", "ISSN" : "00071323", "PMID" : "6066324", "abstract" : "Ziel: Methode:", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wyke", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The British journal of surgery", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "1967" ] ] }, "page" : "990-1001", "title" : "Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁸", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "¹⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18 Recent histological studies of human collateral ankle ligaments have confirmed the presence of the four typical types of mechanoreceptors described by Freeman and Wyke.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0007-1323 (Print)", "ISSN" : "00071323", "PMID" : "6066324", "abstract" : "Ziel: Methode:", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wyke", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The British journal of surgery", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "1967" ] ] }, "page" : "990-1001", "title" : "Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1186/s13018-015-0215-7", "ISSN" : "1749-799X", "author" : [ { "dropping-particle" : "", "family" : "Wu", "given" : "Xiaochuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Song", "given" : "Weidong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zheng", "given" : "Cuihuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhou", "given" : "Shixiong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bai", "given" : "Shengbin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic Surgery and Research", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "92", "publisher" : "Journal of Orthopaedic Surgery and Research", "title" : "Morphological study of mechanoreceptors in collateral ligaments of the ankle joint", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^18,19", "plainTextFormattedCitation" : "18,19", "previouslyFormattedCitation" : "^18,19" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18,19 These four include Ruffini corpuscles (type I, low threshold, slowly adapted), Pacinian corpuscles (type II, low threshold, rapidly adapted), Golgi tendon organs (type III, low threshold, slowly adapted), and free nerve endings (type IV, nociceptive).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1159/000143037", "ISBN" : "0021-8782", "ISSN" : "0021-8782", "PMID" : "6051731", "abstract" : "Images: Fig. 1: Fig. 2: Fig. 3: Fig. 4: Fig. 5: Fig. 6: Fig. 7: Fig. 8: Fig. 9: Fig. 10: Fig. 11:", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wyke", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of anatomy", "id" : "ITEM-1", "issue" : "Pt 3", "issued" : { "date-parts" : [ [ "1967" ] ] }, "page" : "505-532", "title" : "The innervation of the knee joint. An anatomical and histological study in the cat.", "type" : "article-journal", "volume" : "101" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1186/s13018-015-0215-7", "ISSN" : "1749-799X", "author" : [ { "dropping-particle" : "", "family" : "Wu", "given" : "Xiaochuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Song", "given" : "Weidong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zheng", "given" : "Cuihuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhou", "given" : "Shixiong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bai", "given" : "Shengbin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic Surgery and Research", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "92", "publisher" : "Journal of Orthopaedic Surgery and Research", "title" : "Morphological study of mechanoreceptors in collateral ligaments of the ankle joint", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^19,20", "plainTextFormattedCitation" : "19,20", "previouslyFormattedCitation" : "^19,20" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }19,20 Interestingly, both the distribution and morphology of these receptors in human collateral ankle ligaments were different than previous reports of animal tissue.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s13018-015-0215-7", "ISSN" : "1749-799X", "author" : [ { "dropping-particle" : "", "family" : "Wu", "given" : "Xiaochuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Song", "given" : "Weidong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zheng", "given" : "Cuihuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhou", "given" : "Shixiong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bai", "given" : "Shengbin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic Surgery and Research", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "92", "publisher" : "Journal of Orthopaedic Surgery and Research", "title" : "Morphological study of mechanoreceptors in collateral ligaments of the ankle joint", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁹", "plainTextFormattedCitation" : "19", "previouslyFormattedCitation" : "¹⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }19 These differences in morphology may indicate a more complicated role of proprioceptive functioning in humans and the increased relative number of Pacinian corpuscles may indicate preferential high velocity motion sense.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s13018-015-0215-7", "ISSN" : "1749-799X", "author" : [ { "dropping-particle" : "", "family" : "Wu", "given" : "Xiaochuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Song", "given" : "Weidong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zheng", "given" : "Cuihuan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhou", "given" : "Shixiong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bai", "given" : "Shengbin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic Surgery and Research", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "92", "publisher" : "Journal of Orthopaedic Surgery and Research", "title" : "Morphological study of mechanoreceptors in collateral ligaments of the ankle joint", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁹", "plainTextFormattedCitation" : "19", "previouslyFormattedCitation" : "¹⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }19 Freeman introduced the concept of functional instability in 1965 along with the underlying theory of de-afferentiation following ankle sprain.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 De-afferentiation refers to the interruption of afferent signals from ligament and joint capsule mechanoreceptors following injurious tensile stress to these tissues and resulting in proprioceptive deficits responsible for functional instability.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 According to Freeman’s theory or articular de-afferentiation, damage to these joint receptors leads to lack of afferent proprioceptive signals communicating the joint position in space which leads to supination without reflexive or volitional corrective response of the peroneals to evert the ankle back into a neutral position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 Other mechanoreceptors located in skin, fascia, synovial tissue, and muscle tissue also contribute to proprioception in the form of position sense, sense of movement, and sense of force.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1916-257X", "PMID" : "21589740", "abstract" : "The architecture of the connective tissue, including structures such as fasciae, sheaths, and membranes, is more important for understanding functional meaning than is more traditional anatomy, whose anatomical dissection method neglects and denies the continuity of the connective tissue as integrating matrix of the body.The connective tissue anatomy and architecture exhibits two functional tendencies that are present in all areas of the body in different ways and relationships. In body cavities, the \"disconnecting\" quality of shaping space enables mobility; between organs and body parts, the \"connecting\" dimension enables functional mechanical interactions. In the musculoskeletal system, those two features of the connective tissue are also present. They cannot be found by the usual analytic dissection procedures. An architectural description is necessary.This article uses such a methodologic approach and gives such a description for the lateral elbow region. The result is an alternative architectural view of the anatomic substrate involved in the transmission and conveyance of forces over synovial joints. An architectural description of the muscular and connective tissue organized in series with each other to enable the transmission of forces over these dynamic entities is more appropriate than is the classical concept of \"passive\" force-guiding structures such as ligaments organized in parallel to actively force-transmitting structures such as muscles with tendons.The discrimination between so-called joint receptors and muscle receptors is an artificial distinction when function is considered. Mechanoreceptors, also the so-called muscle receptors, are arranged in the context of force circumstances-that is, of the architecture of muscle and connective tissue rather than of the classical anatomic structures such as muscle, capsules, and ligaments. In the lateral cubital region of the rat, a spectrum of mechanosensitive substrate occurs at the transitional areas between regular dense connective tissue layers and the muscle fascicles organized in series with them. This substrate exhibits features of type and location of the mechanosensitive nerve terminals that usually are considered characteristic for \"joint receptors\" as well as for \"muscle receptors.\"The receptors for proprioception are concentrated in those areas where tensile stresses are conveyed over the elbow joint. Structures cannot be divided into either joint receptors or muscle receptors when \u2026", "author" : [ { "dropping-particle" : "", "family" : "Wal", "given" : "Jaap", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" } ], "container-title" : "International journal of therapeutic massage & bodywork", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "9-23", "title" : "The architecture of the connective tissue in the musculoskeletal system-an often overlooked functional parameter as to proprioception in the locomotor apparatus.", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^21,22", "plainTextFormattedCitation" : "21,22", "previouslyFormattedCitation" : "^21,22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21,22Proprioception is a term which can have many connotations, being both used to strictly refer to afferent signals used to relay information of body position and orientation in space and more generally to represent a complex multi-level interaction between the conscious and unconscious sense of and ability to control one’s body in space.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1007/s001670100208", "ISBN" : "0942-2056", "ISSN" : "09422056", "PMID" : "11420785", "abstract" : "There is little question that ankle disc training can improve ankle muscle motor performance in a unipedal balance task, most likely through improved strength and coordination [62] and possibly endurance. How much of the observed improvement in motor performance is due to improved ankle proprioception remains unknown. We have reviewed a number of theoretical ways in which training might improve proprioception for moderately challenging weight-bearing situations such as balancing on one leg. Although the relevant experiments have yet to be performed to test this hypothesis, any improvement would theoretically help to reduce injuries at these moderate levels of challenge. We question, however, whether these exercises can ever improve the reactive response required to prevent injury under the most challenging time-critical situations. If confirmed, this limitation needs to be acknowledged by authors and practitioners alike. Alternative protective strategies for the most challenging time-critical situations should be sought. We conclude that, despite their widespread acceptance, current exercises aimed at \"improving proprioception\" have not been demonstrated to achieve that goal. We have outlined theoretical scenarios by which proprioception might be improved, but these are speculative. The relevant experiments remain to be conducted. We argue that even if they were proven to improve proprioception, under the best circumstances such exercises could only prevent injury under slow to intermediate rate provocations to the joint musculoligamentous complex in question.", "author" : [ { "dropping-particle" : "", "family" : "Ashton-Miller", "given" : "James a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wojtys", "given" : "Edward M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huston", "given" : "Laura J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fry-Welch", "given" : "Donna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Knee Surgery, Sports Traumatology, Arthroscopy", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "128-136", "title" : "Can proprioception really be improved by exercises?", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^17,21,23", "plainTextFormattedCitation" : "17,21,23", "previouslyFormattedCitation" : "^17,21,23" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17,21,23 The study of proprioceptive changes is also complex and confounded by the lack of ability to control and account for many variables in a system with redundant yet differentiated contributions.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²¹", "plainTextFormattedCitation" : "21", "previouslyFormattedCitation" : "²¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21 Within the more strictly afferent definition, proprioception is thought to consist of joint position sense, sense of movement, and sense of force. Of these, joint position sense is the most commonly tested in research related to ankle injury. Joint position sense represents a more discretely measurable component of proprioception, and has been researched extensively in relation to lateral inversion ankle injury and reinjury.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Investigators have used three major approaches to measure joint position sense including: threshold of perceptible movement, ability to replicate contralateral joint position, and ability to replicate joint position through return to previous position with the same ankle (ipsilateral). Of these, ipsilateral joint position replication is the most frequently utilized measure in research related to ankle injury. Contralateral methods are used less frequently in part due to the confounding influence of proprioception within both left and right limbs needed to complete this measure.One of the earliest studies to examine this question was conducted by Glencross and Thornton and published in 1981.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0022-4707", "PMID" : "7278217", "author" : [ { "dropping-particle" : "", "family" : "Glencross", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thornton", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of sports medicine and physical fitness", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1981", "3" ] ] }, "note" : "Need to find full text.", "page" : "23-7", "title" : "Position sense following joint injury.", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁴", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "²⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24 In this design, the experimenters measured the subjects’ abilities to actively reproduce a passively determined ankle position along the spectrum of dorsiflexion (DF) and plantar flexion (PF).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0022-4707", "PMID" : "7278217", "author" : [ { "dropping-particle" : "", "family" : "Glencross", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thornton", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of sports medicine and physical fitness", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1981", "3" ] ] }, "note" : "Need to find full text.", "page" : "23-7", "title" : "Position sense following joint injury.", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁴", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "²⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24 The study found that previously injured ankles were less accurate at this task with statistically significant increased error in active reproduction of the position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0022-4707", "PMID" : "7278217", "author" : [ { "dropping-particle" : "", "family" : "Glencross", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thornton", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of sports medicine and physical fitness", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1981", "3" ] ] }, "note" : "Need to find full text.", "page" : "23-7", "title" : "Position sense following joint injury.", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁴", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "²⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24 It is important to note that the positional measurements were garnered using manual goniometry without account for the validity of this method.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0022-4707", "PMID" : "7278217", "author" : [ { "dropping-particle" : "", "family" : "Glencross", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thornton", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of sports medicine and physical fitness", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1981", "3" ] ] }, "note" : "Need to find full text.", "page" : "23-7", "title" : "Position sense following joint injury.", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-2", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^24,25", "plainTextFormattedCitation" : "24,25", "previouslyFormattedCitation" : "^24,25" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24,25 A well designed study by MT Gross, published in 1988, set out to answer this question with careful consideration of active versus passive assessments of joint position in sprained and non-sprained ankles.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 For active assessment, the subjects were asked to move their ankle to reproduce a position which was previously achieved passively along the inversion-eversion spectrum of ROM.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 For passive assessment, the experimenter moved the subject’s ankle until the subject verbally indicated it was in the previously achieved position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 This design examined previous theories of the different mechanisms of passive joint receptors versus active muscle receptors on joint position sense. The results of the experiment did not demonstrate significant differences in total error (TE) between sprained and non-sprained ankles for either active or passive assessment of joint position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 There was a trend of increased TE for passive joint position assessment in sprained vs. non-sprained ankle.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 Although this trend was not statistically significant, this may have been the result of power limitations from the small sample size.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 Significant interaction between comparison of the passive and active assessments were observed with passive judgements having degreased TE in comparison to active judgements for non-sprained ankles.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 These differences may reflect the different contributions of articular mechanoreceptors to joint angle and muscle receptors to joint motion.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 Furthermore, the unexpected results seen in the contralateral healthy ankle with improved active judgement and impaired passive judgement relative to the control group, offer two possible explanations. This may represent differences present in the injured and contralateral ankle subjects prior to injury or this may indicate the presents of central processing adaptations following unilateral sprain which impact the contralateral ankle.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0031-9023", "author" : [ { "dropping-particle" : "", "family" : "Gross", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "1987" ] ] }, "page" : "1505-1509", "title" : "Effects of recurrent lateral ankle sprains on active and passive judgments of joint position", "type" : "article", "volume" : "67" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁵", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "²⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 In 1988, Garn and Newton published a study which utilized the threshold of perceptible movement method of measuring joint position sense in sprained and non-sprained ankles of persons with a history of multiple unilateral sprains with no current effusion or sprain in the past 30 days.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0031-9023", "ISSN" : "0031-9023", "PMID" : "3186791", "abstract" : "The purposes of this study were 1) to determine whether decreased kinesthetic awareness occurs in individuals with recurrent ankle sprains and 2) to determine whether the one-legged standing balance test can be used to differentiate between ankle instability in injured and uninjured ankles. Thirty athletes between 18 and 24 years of age with multiple sprains of one ankle and no reported sprains of the other ankle were tested to compare their ability to detect passive plantar flexion and standing balance in each ankle. Luce's choice theory was used to analyze subjects' responses. Subjects had significantly greater difficulty detecting passive motion in the ankle with sprains as compared with the uninjured ankle. Subjects also performed a one-legged standing balance test on both the injured and uninjured legs. In 20 subjects, either the subject or observer reported balance deficits on the injured side as compared with the uninjured side. The results of this study demonstrate the need for clinicians to evaluate kinesthetic deficits and to design exercise programs to improve kinesthetic awareness and decrease ankle instability in individuals with multiple ankle sprains.", "author" : [ { "dropping-particle" : "", "family" : "Garn", "given" : "S N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newton", "given" : "R a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "1988" ] ] }, "note" : "Statist Sig. Passive Movement Sensitifity between injured vs. non-injured ankles.\nMethod: Luce's Choice Theory with passive movement or no movement.\nPssive movement at rate of 0.3degrees/sec ustion Kinesthesiometer (hand operated) for 15 seconds for a total change of 5 degrees.\nObserved correct response= Hit Rate (HR) and False Alarm Rate FAR\nCalculated kinesthetic sensitivity with equation got statsitcally significant result when compared with t-test.", "page" : "1667-1671", "title" : "Kinesthetic awareness in subjects with multiple ankle sprains.", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁶", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "²⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26 This study used a kinesthesiometer to move ankles from neutral to 5 degrees of PF at 0.3?/sec over 15 seconds and the subjects were asked to respond yes or no to indicate if they detected the movement.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0031-9023", "ISSN" : "0031-9023", "PMID" : "3186791", "abstract" : "The purposes of this study were 1) to determine whether decreased kinesthetic awareness occurs in individuals with recurrent ankle sprains and 2) to determine whether the one-legged standing balance test can be used to differentiate between ankle instability in injured and uninjured ankles. Thirty athletes between 18 and 24 years of age with multiple sprains of one ankle and no reported sprains of the other ankle were tested to compare their ability to detect passive plantar flexion and standing balance in each ankle. Luce's choice theory was used to analyze subjects' responses. Subjects had significantly greater difficulty detecting passive motion in the ankle with sprains as compared with the uninjured ankle. Subjects also performed a one-legged standing balance test on both the injured and uninjured legs. In 20 subjects, either the subject or observer reported balance deficits on the injured side as compared with the uninjured side. The results of this study demonstrate the need for clinicians to evaluate kinesthetic deficits and to design exercise programs to improve kinesthetic awareness and decrease ankle instability in individuals with multiple ankle sprains.", "author" : [ { "dropping-particle" : "", "family" : "Garn", "given" : "S N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newton", "given" : "R a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "1988" ] ] }, "note" : "Statist Sig. Passive Movement Sensitifity between injured vs. non-injured ankles.\nMethod: Luce's Choice Theory with passive movement or no movement.\nPssive movement at rate of 0.3degrees/sec ustion Kinesthesiometer (hand operated) for 15 seconds for a total change of 5 degrees.\nObserved correct response= Hit Rate (HR) and False Alarm Rate FAR\nCalculated kinesthetic sensitivity with equation got statsitcally significant result when compared with t-test.", "page" : "1667-1671", "title" : "Kinesthetic awareness in subjects with multiple ankle sprains.", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁶", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "²⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26 Trials were also conducted in which the ankle was not moved to test for true and false negatives.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0031-9023", "ISSN" : "0031-9023", "PMID" : "3186791", "abstract" : "The purposes of this study were 1) to determine whether decreased kinesthetic awareness occurs in individuals with recurrent ankle sprains and 2) to determine whether the one-legged standing balance test can be used to differentiate between ankle instability in injured and uninjured ankles. Thirty athletes between 18 and 24 years of age with multiple sprains of one ankle and no reported sprains of the other ankle were tested to compare their ability to detect passive plantar flexion and standing balance in each ankle. Luce's choice theory was used to analyze subjects' responses. Subjects had significantly greater difficulty detecting passive motion in the ankle with sprains as compared with the uninjured ankle. Subjects also performed a one-legged standing balance test on both the injured and uninjured legs. In 20 subjects, either the subject or observer reported balance deficits on the injured side as compared with the uninjured side. The results of this study demonstrate the need for clinicians to evaluate kinesthetic deficits and to design exercise programs to improve kinesthetic awareness and decrease ankle instability in individuals with multiple ankle sprains.", "author" : [ { "dropping-particle" : "", "family" : "Garn", "given" : "S N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newton", "given" : "R a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "1988" ] ] }, "note" : "Statist Sig. Passive Movement Sensitifity between injured vs. non-injured ankles.\nMethod: Luce's Choice Theory with passive movement or no movement.\nPssive movement at rate of 0.3degrees/sec ustion Kinesthesiometer (hand operated) for 15 seconds for a total change of 5 degrees.\nObserved correct response= Hit Rate (HR) and False Alarm Rate FAR\nCalculated kinesthetic sensitivity with equation got statsitcally significant result when compared with t-test.", "page" : "1667-1671", "title" : "Kinesthetic awareness in subjects with multiple ankle sprains.", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁶", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "²⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26 Using Luce’s Choice theory, the sensitivity to detect this movement was calculated and shown to be statistically significantly decreased for sprained ankles.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0031-9023", "ISSN" : "0031-9023", "PMID" : "3186791", "abstract" : "The purposes of this study were 1) to determine whether decreased kinesthetic awareness occurs in individuals with recurrent ankle sprains and 2) to determine whether the one-legged standing balance test can be used to differentiate between ankle instability in injured and uninjured ankles. Thirty athletes between 18 and 24 years of age with multiple sprains of one ankle and no reported sprains of the other ankle were tested to compare their ability to detect passive plantar flexion and standing balance in each ankle. Luce's choice theory was used to analyze subjects' responses. Subjects had significantly greater difficulty detecting passive motion in the ankle with sprains as compared with the uninjured ankle. Subjects also performed a one-legged standing balance test on both the injured and uninjured legs. In 20 subjects, either the subject or observer reported balance deficits on the injured side as compared with the uninjured side. The results of this study demonstrate the need for clinicians to evaluate kinesthetic deficits and to design exercise programs to improve kinesthetic awareness and decrease ankle instability in individuals with multiple ankle sprains.", "author" : [ { "dropping-particle" : "", "family" : "Garn", "given" : "S N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newton", "given" : "R a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physical therapy", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "1988" ] ] }, "note" : "Statist Sig. Passive Movement Sensitifity between injured vs. non-injured ankles.\nMethod: Luce's Choice Theory with passive movement or no movement.\nPssive movement at rate of 0.3degrees/sec ustion Kinesthesiometer (hand operated) for 15 seconds for a total change of 5 degrees.\nObserved correct response= Hit Rate (HR) and False Alarm Rate FAR\nCalculated kinesthetic sensitivity with equation got statsitcally significant result when compared with t-test.", "page" : "1667-1671", "title" : "Kinesthetic awareness in subjects with multiple ankle sprains.", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁶", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "²⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26In a 1998 article, Konradsen et al. investigated changes in joint position sense in acute grade II and III ankle sprains at 1, 3, 6, and 12 weeks.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0363-5465", "ISSN" : "0363-5465", "PMID" : "9474405", "abstract" : "We performed this study to monitor changes in ankle eversion strength and sensorimotor control functions after acute ankle inversion injury. Forty-four patients with clinical grade II to III first-time ankle inversion sprains were tested for 1) pathologic talar tilt and anterior talar translation at 1 and 12 weeks after injury; 2) isometric eccentric ankle eversion strength and 3) peroneal reaction time to sudden ankle inversion at 3, 6, and 12 weeks after injury; and 4) accuracy of inversion position assessment 1, 3, 6, and 12 weeks after injury. Not all patients could perform all tests at the early follow-up visits. There was mechanical instability in 19 of 40 tested patients at 1 week and in 4 patients at 12 weeks after injury. Eversion strength was 88% of the contralateral side 3 weeks after injury, rising to 96% after 12 weeks. The magnitude of error of inversion position sense was 190% of the contralateral side 1 week after injury; this was still affected after 12 weeks, but fell to 133%. Patients with pathologic talar tilt or anterior talar translation, or both, at 1 week after injury did not show significantly greater error in position assessment or reduction in eversion strength when compared with patients with ankles that remained stable after injury.", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olesen", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hansen", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72-77", "title" : "Ankle sensorimotor control and eversion strength after acute ankle inversion injuries.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 This experiment utilized passive ipsilateral inversion replication of 10?, 15?, and 20? inversion with a movement rate of 2?/sec.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0363-5465", "ISSN" : "0363-5465", "PMID" : "9474405", "abstract" : "We performed this study to monitor changes in ankle eversion strength and sensorimotor control functions after acute ankle inversion injury. Forty-four patients with clinical grade II to III first-time ankle inversion sprains were tested for 1) pathologic talar tilt and anterior talar translation at 1 and 12 weeks after injury; 2) isometric eccentric ankle eversion strength and 3) peroneal reaction time to sudden ankle inversion at 3, 6, and 12 weeks after injury; and 4) accuracy of inversion position assessment 1, 3, 6, and 12 weeks after injury. Not all patients could perform all tests at the early follow-up visits. There was mechanical instability in 19 of 40 tested patients at 1 week and in 4 patients at 12 weeks after injury. Eversion strength was 88% of the contralateral side 3 weeks after injury, rising to 96% after 12 weeks. The magnitude of error of inversion position sense was 190% of the contralateral side 1 week after injury; this was still affected after 12 weeks, but fell to 133%. Patients with pathologic talar tilt or anterior talar translation, or both, at 1 week after injury did not show significantly greater error in position assessment or reduction in eversion strength when compared with patients with ankles that remained stable after injury.", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olesen", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hansen", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72-77", "title" : "Ankle sensorimotor control and eversion strength after acute ankle inversion injuries.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 The mean error was calculated for all three positions and compared to the healthy non-sprained contralateral ankle.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0363-5465", "ISSN" : "0363-5465", "PMID" : "9474405", "abstract" : "We performed this study to monitor changes in ankle eversion strength and sensorimotor control functions after acute ankle inversion injury. Forty-four patients with clinical grade II to III first-time ankle inversion sprains were tested for 1) pathologic talar tilt and anterior talar translation at 1 and 12 weeks after injury; 2) isometric eccentric ankle eversion strength and 3) peroneal reaction time to sudden ankle inversion at 3, 6, and 12 weeks after injury; and 4) accuracy of inversion position assessment 1, 3, 6, and 12 weeks after injury. Not all patients could perform all tests at the early follow-up visits. There was mechanical instability in 19 of 40 tested patients at 1 week and in 4 patients at 12 weeks after injury. Eversion strength was 88% of the contralateral side 3 weeks after injury, rising to 96% after 12 weeks. The magnitude of error of inversion position sense was 190% of the contralateral side 1 week after injury; this was still affected after 12 weeks, but fell to 133%. Patients with pathologic talar tilt or anterior talar translation, or both, at 1 week after injury did not show significantly greater error in position assessment or reduction in eversion strength when compared with patients with ankles that remained stable after injury.", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olesen", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hansen", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72-77", "title" : "Ankle sensorimotor control and eversion strength after acute ankle inversion injuries.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 The mean differences in error in the sprained ankles compared to the non-sprained ankles were 2.5? at week 1, 1.9? at week 3, 1.1? at week 6, and 1.1? at week 12.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0363-5465", "ISSN" : "0363-5465", "PMID" : "9474405", "abstract" : "We performed this study to monitor changes in ankle eversion strength and sensorimotor control functions after acute ankle inversion injury. Forty-four patients with clinical grade II to III first-time ankle inversion sprains were tested for 1) pathologic talar tilt and anterior talar translation at 1 and 12 weeks after injury; 2) isometric eccentric ankle eversion strength and 3) peroneal reaction time to sudden ankle inversion at 3, 6, and 12 weeks after injury; and 4) accuracy of inversion position assessment 1, 3, 6, and 12 weeks after injury. Not all patients could perform all tests at the early follow-up visits. There was mechanical instability in 19 of 40 tested patients at 1 week and in 4 patients at 12 weeks after injury. Eversion strength was 88% of the contralateral side 3 weeks after injury, rising to 96% after 12 weeks. The magnitude of error of inversion position sense was 190% of the contralateral side 1 week after injury; this was still affected after 12 weeks, but fell to 133%. Patients with pathologic talar tilt or anterior talar translation, or both, at 1 week after injury did not show significantly greater error in position assessment or reduction in eversion strength when compared with patients with ankles that remained stable after injury.", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olesen", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hansen", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72-77", "title" : "Ankle sensorimotor control and eversion strength after acute ankle inversion injuries.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 Additionally, the relative deficit in joint position sense was not correlated to pathological joint laxity, indicating that these changes were not due to mechanical instability.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0363-5465", "ISSN" : "0363-5465", "PMID" : "9474405", "abstract" : "We performed this study to monitor changes in ankle eversion strength and sensorimotor control functions after acute ankle inversion injury. Forty-four patients with clinical grade II to III first-time ankle inversion sprains were tested for 1) pathologic talar tilt and anterior talar translation at 1 and 12 weeks after injury; 2) isometric eccentric ankle eversion strength and 3) peroneal reaction time to sudden ankle inversion at 3, 6, and 12 weeks after injury; and 4) accuracy of inversion position assessment 1, 3, 6, and 12 weeks after injury. Not all patients could perform all tests at the early follow-up visits. There was mechanical instability in 19 of 40 tested patients at 1 week and in 4 patients at 12 weeks after injury. Eversion strength was 88% of the contralateral side 3 weeks after injury, rising to 96% after 12 weeks. The magnitude of error of inversion position sense was 190% of the contralateral side 1 week after injury; this was still affected after 12 weeks, but fell to 133%. Patients with pathologic talar tilt or anterior talar translation, or both, at 1 week after injury did not show significantly greater error in position assessment or reduction in eversion strength when compared with patients with ankles that remained stable after injury.", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olesen", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hansen", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72-77", "title" : "Ankle sensorimotor control and eversion strength after acute ankle inversion injuries.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 In 1999, Holme et al. published a study which examined the effects of rehabilitation on several factors including position sense, strength, postural sway, and re-injury risk following acute ankle sprains.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1600-0838.1999.tb00217.x", "ISBN" : "0905-7188 (Print)\\n0905-7188 (Linking)", "ISSN" : "0905-7188", "PMID" : "10220845", "abstract" : "The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.", "author" : [ { "dropping-particle" : "", "family" : "Holme", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "S P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becher", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bieler", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aagaard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kjaer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian journal of medicine & science in sports", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "104-109", "title" : "The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28 This study utilized an active reproduction assessment method and did not detect a statistically significant difference in position sense for injured versus uninjured ankles at either 6 weeks or 4 months for both the control and training groups.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1600-0838.1999.tb00217.x", "ISBN" : "0905-7188 (Print)\\n0905-7188 (Linking)", "ISSN" : "0905-7188", "PMID" : "10220845", "abstract" : "The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.", "author" : [ { "dropping-particle" : "", "family" : "Holme", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "S P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becher", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bieler", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aagaard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kjaer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian journal of medicine & science in sports", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "104-109", "title" : "The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28 The training group did demonstrate superior joint position sense to the control group at 6 weeks and 4 months for both injured and uninjured ankles.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1600-0838.1999.tb00217.x", "ISBN" : "0905-7188 (Print)\\n0905-7188 (Linking)", "ISSN" : "0905-7188", "PMID" : "10220845", "abstract" : "The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. 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Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.", "author" : [ { "dropping-particle" : "", "family" : "Holme", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "S P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becher", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bieler", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aagaard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kjaer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian journal of medicine & science in sports", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "104-109", "title" : "The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28 Furthermore, during 12 months after the injury, only 7% of the training group suffered re-injury, but 29% of the control group suffered reinjury.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1600-0838.1999.tb00217.x", "ISBN" : "0905-7188 (Print)\\n0905-7188 (Linking)", "ISSN" : "0905-7188", "PMID" : "10220845", "abstract" : "The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.", "author" : [ { "dropping-particle" : "", "family" : "Holme", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "S P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becher", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bieler", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aagaard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kjaer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian journal of medicine & science in sports", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "104-109", "title" : "The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28 This study highlights the importance of supervised rehabilitation with focus on balance recovery in the potential to prevent re-injury, even though the findings on joint position sense were not statistically significant or consistent with previous experiments.A 2010 systematic review with meta-analysis authored by Munn et al. found significant differences in both passively measured (mean difference=0.7?) and actively measured (mean difference=0.6?) joint position sense in persons with CAI. This indicates the potential contribution of joint position sense deficits involved in CAI.Much of the variability in research involving measures of joint position sense following ankle injury or in the presence of CAI may be attributed to methodological differences in the way joint position sense is measured. A 2010 meta-analysis including 10 studies, examined six key methodological variables involved in testing joint position recognition differences observed in persons with CAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 The first key methodological variable examined was the study design group comparison.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Of the 10 studies examined, 1 study compared ankles with CAI to normal contralateral ankles, 5 studies compared CAI ankles to ankles of different persons in a control group, and 4 studies performed both contralateral and control group comparisons. The pooled results of each group comparison design demonstrated moderate effect sizes with confidence intervals (CI’s) which did not cross zero, indicating that both methods were suitable to identify significant deficits in joint position recognition in ankles with CAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 More complex interactions observed in studies which utilized both methods of comparison indicate the presence of central changes within the sensorimotor systems of persons with unilateral CAI which impact health contralateral limbs.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 For this reason between group comparisons offer a higher level of precision and are therefore recommended.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4Starting position was a second methodological variable investigated with most studies starting in the neutral position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Pooled results of starting in the neutral position or moving into midrange to end range plantar flexion resulted in moderate effect size (0.51) with narrow CI’s indicating an optimal method.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Furthermore, plantar flexion is of particular interest given its involvement in the mechanism of injury with lateral inversion ankle sprains. The two possible repositioning methods compared were active and passive repositioning. In active repositioning the subject uses his or her muscles to move the ankle into a previously established position. In passive repositioning, the ankle is moved through the range manually by the experimenter or an external machine such as a kinesiometer until the subject indicates the previously established position has been reached. Both active and passive methods resulted in pooled results to indicate significant differences in ankles with CAI but active methods had larger pooled effect sizes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Active methods may also allow for involvement of motion sense and mechanoreceptors within musculotendinous structures which would not be seen in truly passive methods.Another interesting methodological variable examined was the testing range of motion or directions in which the ankles were moved in. Given their significance in relation to mechanism of injury, plantar flexion and inversion were the most frequently tested ranges with in the 10 studies. The largest effect sizes with the greatest precision were demonstrated throughout these ranges and in both directions.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 End-range dorsiflexion also demonstrated a moderate effect size with narrow CI’s but more studies are needed which test dorsiflexion and eversion to rule out potential type II errors.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4Movement velocity represents the speed at which subjects are passively moved through range of motion or allowed to actively move to reposition. Smaller movement velocities of 2?/sec, 4?/sec, and 5?/sec were best able to identify true differences in ankles with CAI, but as velocity decreases, all errors increase. Methods which use faster movement velocities have demonstrated decreased threshold to movement and increased consistency with the theory that muscle spindles may provide added afferent information.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0363546508324309", "ISBN" : "1552-3365 (Electronic)\\n0363-5465 (Linking)", "ISSN" : "1552-3365", "PMID" : "18927252", "abstract" : "BACKGROUND: Taping is often used to counter the proprioceptive deficit after joint injury such as ankle sprain. However, the effect of taping on proprioceptive acuity at the ankle is unclear, with conflicting findings.\\n\\nHYPOTHESIS: Application of tape improves detection of inversion and eversion movements at the ankle.\\n\\nSTUDY DESIGN: Controlled laboratory study.\\n\\nMETHODS: The 70% threshold for movement detection was measured in 16 participants with recurrent ankle sprain under 2 conditions: with the ankle taped or untaped. The threshold for movement detection was examined at 3 velocities (0.1 deg/s, 0.5 deg/s, and 2.5 deg/s) and in 2 directions (inversion and eversion).\\n\\nRESULTS: Application of tape significantly decreased the ability to detect movements at the ankle (P < .023). For example, at 0.5 deg/s, the 70% detection threshold was 3.40 degrees +/- 1.05 degrees in inversion and 3.49 degrees +/- 1.15 degrees in eversion at the untaped ankle, and 4.02 degrees +/- 0.86 degrees in inversion and 4.04 degrees +/- 0.89 degrees in eversion at the taped ankle.\\n\\nCONCLUSION: Taping the ankle decreased the ability to detect movement in the inversion-eversion plane in participants with recurrent ankle sprain.\\n\\nCLINICAL RELEVANCE: The findings suggest that the efficacy of taping is unlikely to be explained by an enhanced ability to detect inversion or eversion movements. However, because it has been found effective in reducing the incidence of ankle sprain, clinicians should continue taping to reduce the likelihood of resprain.", "author" : [ { "dropping-particle" : "", "family" : "Refshauge", "given" : "Kathryn M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raymond", "given" : "Jacqueline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kilbreath", "given" : "Sharon L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pengel", "given" : "Liset", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heijnen", "given" : "Inger", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "371-5", "title" : "The effect of ankle taping on detection of inversion-eversion movements in participants with recurrent ankle sprain.", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^4,29", "plainTextFormattedCitation" : "4,29", "previouslyFormattedCitation" : "^4,29" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4,29The final methodological variable examined was the data-reduction method.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 The data reduction method represents the way in which the experimenters combined the data from multiple tests to create numerical values which could be analyzed statistically. The most common method used by the 10 studies reviewed was mean absolute error, in which the distance or angle of error in either direction from the target position was averaged for all trials in that position or range of motion. The mean absolute error was also found to yield moderated effects and provide the greatest precision, and therefore is recommended by the authors.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4This meta-analysis concluded that persons with CAI consistently demonstrate joint position recognition deficits and that these measures are appropriate tools for identifying kinesthetic deficits associated with CAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Pooled results indicate that between-group comparisons starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5?/second with active repositioning, were the most sensitive and precise methods for detecting joint position recognition in persons with CAI The authors also made other specific recommendations for the measurement methodology which are included in Appendix A.Changes in joint position sense have also been evaluated in terms of the ability to predict future ankle injuries within prospective studies.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bjsm.2006.029645", "ISSN" : "0306-3674", "author" : [ { "dropping-particle" : "", "family" : "Noronha", "given" : "M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Refshauge", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herbert", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kilbreath", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hertel", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Journal of Sports Medicine", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "824-828", "title" : "Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain? * COMMENTARY", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁵", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "¹⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }15 A 1997 study by Payne et al. found changes in inversion and dorsiflexion to be predictive of future ankle injury as measured by active ipsilateral position replication.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1062-6050 (Print)\\r1062-6050 (Linking)", "ISSN" : "10626050", "PMID" : "16558453", "abstract" : "OBJECTIVE: To determine if ankle muscular strength, flexibility and proprioception can predict ankle injury in college basketball players and to compare ankle injury rates in female and male players. DESIGN AND SETTING: In this prospective, correlational study, subjects were tested at the start of the competitive season for ankle joint muscle strength, flexibility, and proprioception. The first ankle injury for each subject was recorded on an injury report form, and the data were analyzed to determine if any of these preseason measurements predicted future injury. The setting was a competitive 9-week season for four women's and four men's college basketball teams. SUBJECTS: A convenience sample of 31 female and 11 male college basketball players. MEASUREMENTS: Subjects were tested for ankle dorsiflexion range of motion, various measures of ankle proprioception, and isokinetic peak torque of ankle dorsiflexion-plantar flexion and eversion-inversion at 30 degrees /sec and 180 degrees /sec before the start of the conference basketball seasons. Data were analyzed using a series of multiple regression equations to determine the variance in ankle injury attributed to each variable. RESULTS: Various measures of proprioception predicted left ankle injury in all subjects (p < .05), while ankle strength and flexibility measures failed to account for additional variance. There was no statistically significant difference in ankle injury rate between women and men. CONCLUSIONS: Ankle joint proprioceptive deficits can be used to predict ankle injury, but further research is needed to identify other sources of variance. In our study, ankle injury rate was similar in female and male college basketball players.", "author" : [ { "dropping-particle" : "", "family" : "Payne", "given" : "Kristen A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "Kris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Latin", "given" : "Richard W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1997" ] ] }, "page" : "221-225", "title" : "Ankle injuries and ankle strength, flexibility, and proprioception in college basketball players", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹³", "plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "¹³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13 A 2005 study by Willems et al. that deficits of 11? error in inversion joint position sense measured through passive ipsilateral replication were predictive of future ankle injuries sustained by 159 female physical education students.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1600-0838.2004.00428.x", "ISSN" : "0905-7188", "author" : [ { "dropping-particle" : "", "family" : "Willems", "given" : "T. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Witvrouw", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbaere", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philippaerts", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bourdeaudhuij", "given" : "I.", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clercq", "given" : "D.", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scandinavian Journal of Medicine and Science in Sports", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "336-345", "title" : "Intrinsic risk factors for inversion ankle sprains in females - a prospective study", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁴", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "¹⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }14 Other factors including reduced dorsiflexion range of motion and increased postural sway have also demonstrated predictive ability for ankle sprains and it is likely that joint position sense deficits are merely one factor among many others.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bjsm.2006.029645", "ISSN" : "0306-3674", "author" : [ { "dropping-particle" : "", "family" : "Noronha", "given" : "M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Refshauge", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herbert", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kilbreath", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hertel", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Journal of Sports Medicine", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "824-828", "title" : "Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain? * COMMENTARY", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁵", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "¹⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }15 Further studies are needed which better control for the influence and interaction of multiple factors to better understand the contribution of joint position sense to injury. One theory involving the contribution of joint position sense deficits to recurrent injury in persons with CAI, is that this lack of awareness leads persons with CAI to allow their ankle to be in a more compromised position during activities, leading to increased risk of injury. This is supported by the findings of an increased ankle inversion positioning during the transitional loading phase of walking observed in persons with CAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0363546506290989", "ISSN" : "0363-5465", "PMID" : "16926342", "abstract" : "BACKGROUND: The ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle.\n\nPURPOSE: To compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group.\n\nSTUDY DESIGN: Controlled laboratory study.\n\nMETHODS: Three-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles, were recorded simultaneously while subjects walked on a treadmill at a velocity of 4 km/h.\n\nRESULTS: Before heel strike, subjects with functional instability exhibited a decrease in vertical foot-floor clearance (12.62 vs 22.84 mm; P < .05), as well as exhibiting a more inverted position of the ankle joint before, at, and immediately after heel strike (1.69 degrees , 2.10 degrees , and -0.09 degrees vs -1.43 degrees , -1.43 degrees , and -2.78 degrees , respectively [minus value = eversion]; P < .05) compared with controls. Subjects with functional instability were also observed to have an increase in peroneus longus integral electromyography during the post-heel strike time period (107.91%.millisecond vs 64.53%.millisecond; P < .01).\n\nCONCLUSION: The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation. It is hypothesized that the observed increase in peroneus longus activity may be the result of a change in preprogrammed feed-forward motor control.", "author" : [ { "dropping-particle" : "", "family" : "Delahunt", "given" : "Eamonn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monaghan", "given" : "Kenneth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caulfield", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of sports medicine", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2006", "12" ] ] }, "page" : "1970-6", "title" : "Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint.", "type" : "article-journal", "volume" : "34" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.clinbiomech.2005.09.004", "ISSN" : "0268-0033", "PMID" : "16269208", "abstract" : "BACKGROUND: Despite much research, the reasons behind the development of chronic ankle instability in individuals post ankle inversion sprain are unknown. Chronic ankle instability has not previously been investigated dynamically using 3D motion analysis during walking. We hypothesised that chronic ankle instability subjects would exhibit a different kinematic and kinetic pattern during normal walking when compared with a control group.\n\nMETHODS: Gait analysis was carried out on fifty subjects (25 chronic ankle instability, and 25 age, gender, activity, and gait velocity matched controls) during walking. Kinematic and kinetic pattern differences using the 3D motion analysis system combined with a force plate were established during 100 ms pre-heel strike and 200 ms post-heel strike, between the chronic ankle instability subjects and controls during normal walking.\n\nFINDINGS: Chronic ankle instability subjects were significantly (P<0.01) more inverted in the frontal plane compared to controls from 100 ms pre-heel strike to 200 ms post-heel strike. The joint angular velocity was significantly (P<0.05) higher at heel strike in the chronic ankle instability group. During the early stance phase of gait chronic ankle instability subjects appear to be controlled by an evertor muscle moment working concentrically compared to an invertor muscle moment working eccentrically in the controls.\n\nINTERPRETATION: These changes in kinematics and kinetics which arise are likely to result in increased stress being applied to ankle joint structures during the heel strike and loading response phases of the gait cycle. This could result in repeated injury and consequent damage to ankle joint structures.", "author" : [ { "dropping-particle" : "", "family" : "Monaghan", "given" : "Kenneth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delahunt", "given" : "Eamonn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caulfield", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical biomechanics (Bristol, Avon)", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2006", "2" ] ] }, "page" : "168-74", "title" : "Ankle function during gait in patients with chronic ankle instability compared to controls.", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^30,31", "plainTextFormattedCitation" : "30,31", "previouslyFormattedCitation" : "^30,31" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }30,31 Other studies evaluating the biomechanics of persons with CAI have found similar inversion positioning changes with jump landing, which is one of the most common mechanisms of lateral inversion ankle sprains, and running.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/jor.20235", "ISSN" : "0736-0266", "PMID" : "16894592", "abstract" : "The purpose of this study was to identify differences in 3D kinematics, kinetics, and ankle joint muscle activity in subjects with functional instability (FI) of the ankle joint during a drop jump. Twenty-four subjects with the subjective complaint of FI of the ankle joint and 24 noninjured control subjects performed 10 single leg drop jumps onto a force-plate. Timing and magnitude of kinetic data, timing of kinematic data, and integrated EMG (IEMG) activity of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles during two 200-ms time periods either side of initial contact (IC) with the ground were analyzed and compared between groups. Subjects with FI demonstrated a significant decrease in pre-IC peroneus longus IEMG activity, which was accompanied by a change in frontal plane movement at the ankle joint during the same time period. Following IC, FI subjects were less efficient than control group subjects in reaching the closed packed position of the ankle joint. Significant differences were seen between the groups' time-averaged and peak vertical and sagittal components of ground reaction force. The altered pre-IC peroneus longus IEMG and increased inversion of the ankle joint observed in FI subjects could help to explain why subjects with FI may suffer from inversion injury to their ankle joint when subjected to an unanticipated ground contact. The kinematic and kinetic differences observed in subjects with FI may lead to repeated injury and damage to the supporting structures of the ankle joint.", "author" : [ { "dropping-particle" : "", "family" : "Delahunt", "given" : "Eamonn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monaghan", "given" : "Kenneth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caulfield", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of orthopaedic research : official publication of the Orthopaedic Research Society", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2006", "10" ] ] }, "page" : "1991-2000", "title" : "Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump.", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1056-6716", "PMID" : "19827501", "abstract" : "CONTEXT: Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).\n\nOBJECTIVE: To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.\n\nDESIGN: Case control.\n\nSETTING: Motion-analysis laboratory.\n\nPARTICIPANTS: 7 participants (3 men, 4 women) suffering from CAI (age 24.6 +/- 4.2 y, height 172.6 +/- 9.4 cm, mass 70.9 +/- 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 +/- 4.5 y, height 168.2 +/- 5.9 cm, mass 66.5 +/- 9.8 kg).\n\nINTERVENTIONS: Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.\n\nMAIN OUTCOME MEASURES: The positions of rear-foot inversion-eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.\n\nRESULTS: The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.\n\nCONCLUSIONS: Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.", "author" : [ { "dropping-particle" : "", "family" : "Drewes", "given" : "Lindsay K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paolini", "given" : "Gabriele", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riley", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kerrigan", "given" : "D Casey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ingersoll", "given" : "Christopher D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of sport rehabilitation", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009", "8" ] ] }, "page" : "375-88", "title" : "Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability.", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^32,33", "plainTextFormattedCitation" : "32,33", "previouslyFormattedCitation" : "^32,33" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }32,33 It should be acknowledged that many studies to date examine differences in persons with functional or chronic ankle instability in comparison to health contralateral limbs or healthy control subjects. While changes in joint position sense have been demonstrated in persons with functional and chronic ankle instability, all differences in persons with CAI are not necessarily attributable to altered joint position sense alone. Given the available research, which supports the role of joint position sense deficits seen in persons with CAI, and as predictive variables of re-injury, there are grounds to focus research on potential interventions aimed at improvement of joint position sense.Most interventions which focus on improvement of proprioception following lateral inversion ankle sprains utilize the more general definition of proprioception with outcome measures that assess sensorimotor function including postural control, reflex reactions, drop landings, and gait analysis. There are fewer experiments which examine the potential for interventions to have impacts on the more strict definition of proprioception pertaining only to measures of joint position sense and joint motion sense. An underlying assumption of experiments with the former operation definition of proprioception is that improvements in these neuromuscular outcome measures can be attributed at least in part to effects on the impaired feed-back system proposed by Freeman.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\r0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "5846767", "abstract" : "1. Eighty-five patients have been studied soon after a ligamentous injury at the foot or ankle. These patients were treated in one of three ways, and in fifty-six patients the results were evaluated six to fifteen months after injury.2. It is concluded: a) that ligamentous injuries at the foot and ankle frequently produce a proprioceptive deficit affecting the muscles of the injured leg; b) that such a deficit is responsible for the symptom of \"giving way\" of the foot; and c) that the incidence of both the proprioceptive deficit and the symptom of \"giving way\" can substantially be reduced by treatment after injury with the coordination exercises described in this study.3. The mechanism of production of the proprioceptive defect is discussed.\\n", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hanham", "given" : "I W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1965" ] ] }, "page" : "678-685", "title" : "The etiology and prevention of functional instability of the foot.", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^17,21", "plainTextFormattedCitation" : "17,21", "previouslyFormattedCitation" : "^17,21" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17,21 A 2015 systematic review including 7 studies which evaluated the effectiveness of proprioceptive training on the prevention of ankle sprains, found interventions involving use of wobble boards, and balance without visual feedback were effective in the reduction of ankle sprain injuries.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsams.2014.04.005", "ISSN" : "14402440", "author" : [ { "dropping-particle" : "", "family" : "Schiftan", "given" : "Gabriella Sophie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ross", "given" : "Lauren Ashleigh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hahne", "given" : "Andrew John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Science and Medicine in Sport", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "238-244", "publisher" : "Sports Medicine Australia", "title" : "The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }5 This preventative effect was demonstrated in both persons with and without previous history of ankle sprain.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsams.2014.04.005", "ISSN" : "14402440", "author" : [ { "dropping-particle" : "", "family" : "Schiftan", "given" : "Gabriella Sophie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ross", "given" : "Lauren Ashleigh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hahne", "given" : "Andrew John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Science and Medicine in Sport", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "238-244", "publisher" : "Sports Medicine Australia", "title" : "The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }5 These studies did not include specific measures of afferent signals of position in space and the term proprioception was used in the more general sense. True measures of afferent signals themselves are difficult, but measurements of changes in joint position sense can provide insight to potential responses to treatment interventions. A 2008 study, which implemented a 12 week biomechanical ankle platform system (BAPS) training demonstrated significant improvement in joint position sense in persons with FAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.clinbiomech.2008.04.013", "ISSN" : "02680033", "author" : [ { "dropping-particle" : "", "family" : "Lee", "given" : "Alex J.Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "Wei-Hsiu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Biomechanics", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1065-1072", "title" : "Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁴", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "³⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34 It should be noted that the methods for measurement of joint position sense with a demonstrated improvement of both active (1.1? ) and passive (1.2 ?) reduction in error for ipsilateral reproduction of position.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.clinbiomech.2008.04.013", "ISSN" : "02680033", "author" : [ { "dropping-particle" : "", "family" : "Lee", "given" : "Alex J.Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "Wei-Hsiu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Biomechanics", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1065-1072", "title" : "Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁴", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "³⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34 While there is no consensus of what constitutes a clinically relevant amount of improvement in joint position sense, previous studies have indicated that an inversion error of 7? would represent a 5 mm drop in the lateral border of the foot, which is enough to create an external inversion moment capable of causing a lateral inversion ankle sprain.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s001670000124", "ISBN" : "0942-2056 (Print)\\r0942-2056 (Linking)", "ISSN" : "0942-2056", "PMID" : "10975268", "abstract" : "The inversion-angle replication error of the ankle joint was measured in subjects with a functionally stable or unstable ankle. Testing was performed as a passive set-active replication design. The absolute replication error on the unstable side of 23 unilaterally, functionally, and mechanically unstable subjects was found to be significantly greater (2.5 degrees) than the error on the healthy contralateral side (2.0 degrees ; P < 0.05) and the error in a group of 40 ankle healthy controls (1.7 degrees; P < 0.01). In 10 ankle-healthy high-level cross-country runners the replication error was reduced by 38% after warming up (P = 0.04).", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "246-251", "title" : "Increased inversion angle replication error in functional ankle instability.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.clinbiomech.2008.04.013", "ISSN" : "02680033", "author" : [ { "dropping-particle" : "", "family" : "Lee", "given" : "Alex J.Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "Wei-Hsiu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Biomechanics", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1065-1072", "title" : "Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^34,35", "plainTextFormattedCitation" : "34,35", "previouslyFormattedCitation" : "^34,35" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34,35 The observed improvements in joint position sense also correlated to improvements in postural stability as measure by center of pressure excursion during both eyes open and eyes closed conditions.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.clinbiomech.2008.04.013", "ISSN" : "02680033", "author" : [ { "dropping-particle" : "", "family" : "Lee", "given" : "Alex J.Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "Wei-Hsiu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Biomechanics", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1065-1072", "title" : "Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁴", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "³⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34 Another intervention aimed at controlling joint position to prevent lateral inversion ankle sprains is the use of external support through bracing or taping.A 2000 study of cross country athletes found that both external ankle bracing and active warmup decreased the inversion angle replication error in athletes with functionally stable ankles.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s001670000124", "ISBN" : "0942-2056 (Print)\\r0942-2056 (Linking)", "ISSN" : "0942-2056", "PMID" : "10975268", "abstract" : "The inversion-angle replication error of the ankle joint was measured in subjects with a functionally stable or unstable ankle. Testing was performed as a passive set-active replication design. The absolute replication error on the unstable side of 23 unilaterally, functionally, and mechanically unstable subjects was found to be significantly greater (2.5 degrees) than the error on the healthy contralateral side (2.0 degrees ; P < 0.05) and the error in a group of 40 ankle healthy controls (1.7 degrees; P < 0.01). In 10 ankle-healthy high-level cross-country runners the replication error was reduced by 38% after warming up (P = 0.04).", "author" : [ { "dropping-particle" : "", "family" : "Konradsen", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "246-251", "title" : "Increased inversion angle replication error in functional ankle instability.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35 A 2008 Cochrane review which included 14 randomized trials found a significant reduction in the number of ankle sprains following use of external ankle supports in the form of semi-rigid orthosis and air-cast braces.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Handoll, H. G. H., Rowe, B. R., Quinn, K. M., de Bie", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Cochrane Library", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "22-50", "title" : "Interventions for preventing ankle ligament injuries (Review", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁷", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "³⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37 These prophylactic benefits were greatest for persons who had previously sustained ankle sprain injuries and those participating in high risk activities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Handoll, H. G. H., Rowe, B. R., Quinn, K. M., de Bie", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Cochrane Library", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "22-50", "title" : "Interventions for preventing ankle ligament injuries (Review", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁷", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "³⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37 A 2012 meta-analysis including 8 studies concluded that ankle taping or bracing do not significantly improve joint position sense or sense of movement threshold.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsams.2012.03.008", "ISBN" : "14402440", "ISSN" : "14402440", "PMID" : "22513304", "abstract" : "Objectives: To determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability. Design: Systematic review and meta-analysis. Methods: Studies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace. Results: Eight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08\u00b0, 95% CI: -0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately. Conclusions: The pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability. \u00a9 2012 Sports Medicine Australia.", "author" : [ { "dropping-particle" : "", "family" : "Raymond", "given" : "Jacqueline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "Leslie L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hiller", "given" : "Claire E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Refshauge", "given" : "Kathryn M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Science and Medicine in Sport", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "386-392", "publisher" : "Sports Medicine Australia", "title" : "The effect of ankle taping or bracing on proprioception in functional ankle instability: A systematic review and meta-analysis", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "³⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38 The authors of the meta-analysis concluded that the mechanism for prophylactic effects of taping and bracing are likely due to restriction of joint range of motion, reduced mechanical instability, and improved confidence with functional tasks.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsams.2012.03.008", "ISBN" : "14402440", "ISSN" : "14402440", "PMID" : "22513304", "abstract" : "Objectives: To determine if wearing an ankle brace or taping the ankle, compared to no brace or tape, improves proprioceptive acuity in people with a history of ankle sprain or functional ankle instability. Design: Systematic review and meta-analysis. Methods: Studies using controlled, cross-over designs whereby participants who had sprained their ankle at least once or had functional ankle instability, underwent some form of proprioceptive sensation testing with and without ankle brace or tape, were included. Proprioceptive acuity was reported for the ankle tape/brace condition and the condition where no tape or brace was worn. Meta-analysis was employed to compare proprioceptive acuity with and without ankle tape/brace. Results: Eight studies were included in the review. Studies measured either sense of movement or sense of joint position. The mean differences in 19 of 32 comparisons were not significant. Of the remaining mean differences, 10 were positive, indicating better proprioceptive acuity in the taped/braced condition and 3 were negative, indicating poorer proprioceptive acuity. Overall, there was no significant effect with ankle tape/brace compared to the no tape/brace condition (mean difference: 0.08\u00b0, 95% CI: -0.39 to 0.55). This finding was consistent when the two aspects of proprioception (sense of movement or joint position) were considered separately. Conclusions: The pooled evidence suggests that using an ankle brace or ankle tape has no effect on proprioceptive acuity in participants with recurrent ankle sprain or who have functional ankle instability. \u00a9 2012 Sports Medicine Australia.", "author" : [ { "dropping-particle" : "", "family" : "Raymond", "given" : "Jacqueline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "Leslie L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hiller", "given" : "Claire E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Refshauge", "given" : "Kathryn M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Science and Medicine in Sport", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "386-392", "publisher" : "Sports Medicine Australia", "title" : "The effect of ankle taping or bracing on proprioception in functional ankle instability: A systematic review and meta-analysis", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "³⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38Based upon the evidence reviewed, the full relationship between ankle injury and joint position sense remains unclear. The methodology used to measure joint position sense seems to capture different aspects of this sense and result in varying degrees of statistical significance. The results of most studies reviewed supports the presence of temporary deficits observed in passive ipsilateral measurements and movement threshold measurements of joint position sense in plantar flexion and inversion ranges during the acute stage following grade II and III sprains. Overtime, these changes in joint position sense appear to fade or become more difficult to detect through the same methodology. In many persons who go on to develop CAI, long term changes in position sense appear to be more easily detected through active position replication starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5?/second.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 There is sufficient evidence to conclude that there is a relationship between changes in joint position sense and lateral inversion ankle sprain injury. It also appears that deficits in joint position sense play a role in CAI and recurrent ankle injuries. The results of the current literature do not allow for a comprehensive explanation based solely upon the altered reflexes within the feedback theory of articular de-afferentiation as presented by Freeman.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0007-1323 (Print)", "ISSN" : "00071323", "PMID" : "6066324", "abstract" : "Ziel: Methode:", "author" : [ { "dropping-particle" : "", "family" : "Freeman", "given" : "M a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wyke", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The British journal of surgery", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "1967" ] ] }, "page" : "990-1001", "title" : "Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1007/s001670100208", "ISBN" : "0942-2056", "ISSN" : "09422056", "PMID" : "11420785", "abstract" : "There is little question that ankle disc training can improve ankle muscle motor performance in a unipedal balance task, most likely through improved strength and coordination [62] and possibly endurance. How much of the observed improvement in motor performance is due to improved ankle proprioception remains unknown. We have reviewed a number of theoretical ways in which training might improve proprioception for moderately challenging weight-bearing situations such as balancing on one leg. Although the relevant experiments have yet to be performed to test this hypothesis, any improvement would theoretically help to reduce injuries at these moderate levels of challenge. We question, however, whether these exercises can ever improve the reactive response required to prevent injury under the most challenging time-critical situations. If confirmed, this limitation needs to be acknowledged by authors and practitioners alike. Alternative protective strategies for the most challenging time-critical situations should be sought. We conclude that, despite their widespread acceptance, current exercises aimed at \"improving proprioception\" have not been demonstrated to achieve that goal. We have outlined theoretical scenarios by which proprioception might be improved, but these are speculative. The relevant experiments remain to be conducted. We argue that even if they were proven to improve proprioception, under the best circumstances such exercises could only prevent injury under slow to intermediate rate provocations to the joint musculoligamentous complex in question.", "author" : [ { "dropping-particle" : "", "family" : "Ashton-Miller", "given" : "James a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wojtys", "given" : "Edward M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huston", "given" : "Laura J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fry-Welch", "given" : "Donna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Knee Surgery, Sports Traumatology, Arthroscopy", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "128-136", "title" : "Can proprioception really be improved by exercises?", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.5312/wjo.v6.i5.434", "ISSN" : "2218-5836", "PMID" : "26085985", "abstract" : "Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. However, there is no consensus on whether the neuromuscular control and proprioception are compromised in unstable ankles. To reduce the prevalence of ankle sprains, the effectiveness of engaging balance training to enhance the neuromuscular control and proprioception of the ankle joint is also questionable.", "author" : [ { "dropping-particle" : "", "family" : "Hung", "given" : "You-Jou", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World journal of orthopedics", "id" : "ITEM-4", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "434-8", "title" : "Neuromuscular control and rehabilitation of the unstable ankle.", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^18,21,23,36", "plainTextFormattedCitation" : "18,21,23,36", "previouslyFormattedCitation" : "^18,21,23,36" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18,21,23,36 There is reason to suspect along with signs of local and central adaptation at the spinal and supraspinal level as demonstrated in changes to contralateral limbs and motor control changes of more proximal joints seen in CAI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.5312/wjo.v6.i5.434", "ISSN" : "2218-5836", "PMID" : "26085985", "abstract" : "Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. However, there is no consensus on whether the neuromuscular control and proprioception are compromised in unstable ankles. To reduce the prevalence of ankle sprains, the effectiveness of engaging balance training to enhance the neuromuscular control and proprioception of the ankle joint is also questionable.", "author" : [ { "dropping-particle" : "", "family" : "Hung", "given" : "You-Jou", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "World journal of orthopedics", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "434-8", "title" : "Neuromuscular control and rehabilitation of the unstable ankle.", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.csm.2008.03.006", "ISBN" : "0278-5919", "ISSN" : "02785919", "PMID" : "18503872", "abstract" : "The presence of sensorimotor deficits in patients who have suffered ankle sprains or who have chronic ankle instability has been recognized for several decades; however, a body of research literature has developed that elucidates potential physiologic explanations for these deficits. Alterations in a spectrum of sensorimotor measures make it apparent that conscious perception of afferent somatosensory information, reflex responses, and efferent motor control deficits are present with ankle instability. The specific origin of these deficits local to the ankle ligaments or at the spinal or supraspinal levels of motor control have yet to be fully elucidated. It is clear, however, that both feedback and feedforward mechanisms of motor control are altered with ankle instability. ?? 2008 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Hertel", "given" : "Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in Sports Medicine", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "353-370", "title" : "Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^21,36", "plainTextFormattedCitation" : "21,36" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21,36 Interventions with proprioceptive training in a more general sense are recommended as part of rehabilitation, given evidence to support the efficacy towards improved function and injury prevention despite the lack of clear understanding of how they work. Modification of other intrinsic and extrinsic factors should also be addressed through rehabilitation with gradual progression towards return to high risk activities and environments. Supportive semi-rigid ankle bracing represents a relatively inexpensive approach which has demonstrated efficacy in the reduction of lateral inversion ankle sprains.References ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279-2284. doi:10.2106/JBJS.I.01537.2. Almeida SA, Williams KM, Shaffer RA, Brodine SK. Epidemiological patterns of musculoskeletal injuries and physical training. Med Sci Sports Exerc. 1999;31(8):1176-1182. . Accessed November 23, 2015.3. Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. . Accessed November 16, 2015.4. McKeon JMM, McKeon PO. 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Br J Sports Med. 2003;37(1):13-29. doi:10.1136/bjsm.37.1.13.10. Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: A literature review. J Athl Train. 2002;37(4):376-380.11. McCriskin BJ. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop. 2015;6(2):161. doi:10.5312/wjo.v6.i2.161.12. Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28(2):112-116. /pmc/articles/PMC1332043/?report=abstract. Accessed November 25, 2015.13. Payne KA, Berg K, Latin RW. Ankle injuries and ankle strength, flexibility, and proprioception in college basketball players. J Athl Train. 1997;32:221-225. . Willems TM, Witvrouw E, Delbaere K, Philippaerts R, De Bourdeaudhuij I, De Clercq D. Intrinsic risk factors for inversion ankle sprains in females - a prospective study. Scand J Med Sci Sport. 2005;15(5):336-345. doi:10.1111/j.1600-0838.2004.00428.x.15. de Noronha M, Refshauge KM, Herbert RD, Kilbreath SL, Hertel J. Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain? * COMMENTARY. Br J Sports Med. 2006;40(10):824-828. doi:10.1136/bjsm.2006.029645.16. Delahunt E. Neuromuscular contributions to functional instability of the ankle joint. J Bodyw Mov Ther. 2007;11(3):203-213. doi:10.1016/j.jbmt.2007.03.002.17. Freeman M a, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965;47(4):678-685.18. Freeman M a, Wyke B. Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles. Br J Surg. 1967;54(12):990-1001.19. Wu X, Song W, Zheng C, Zhou S, Bai S. Morphological study of mechanoreceptors in collateral ligaments of the ankle joint. J Orthop Surg Res. 2015;10:92. doi:10.1186/s13018-015-0215-7.20. Freeman M a, Wyke B. The innervation of the knee joint. An anatomical and histological study in the cat. J Anat. 1967;101(Pt 3):505-532. doi:10.1159/000143037.21. Hertel J. Sensorimotor Deficits with Ankle Sprains and Chronic Ankle Instability. Clin Sports Med. 2008;27(3):353-370. doi:10.1016/j.csm.2008.03.006.22. van der Wal J. The architecture of the connective tissue in the musculoskeletal system-an often overlooked functional parameter as to proprioception in the locomotor apparatus. Int J Ther Massage Bodywork. 2009;2(4):9-23. . Ashton-Miller J a., Wojtys EM, Huston LJ, Fry-Welch D. Can proprioception really be improved by exercises? Knee Surgery, Sport Traumatol Arthrosc. 2001;9(3):128-136. doi:10.1007/s001670100208.24. Glencross D, Thornton E. Position sense following joint injury. J Sports Med Phys Fitness. 1981;21(1):23-27. . Accessed October 9, 2015.25. Gross MT. Effects of recurrent lateral ankle sprains on active and passive judgments of joint position. Phys Ther. 1987;67(10):1505-1509. . Garn SN, Newton R a. Kinesthetic awareness in subjects with multiple ankle sprains. Phys Ther. 1988;68(11):1667-1671.27. Konradsen L, Olesen S, Hansen HM. Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med. 1998;26(1):72-77.28. Holme E, Magnusson SP, Becher K, Bieler T, Aagaard P, Kjaer M. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports. 1999;9(2):104-109. doi:10.1111/j.1600-0838.1999.tb00217.x.29. Refshauge KM, Raymond J, Kilbreath SL, Pengel L, Heijnen I. The effect of ankle taping on detection of inversion-eversion movements in participants with recurrent ankle sprain. Am J Sports Med. 2009;37(2):371-375. doi:10.1177/0363546508324309.30. Delahunt E, Monaghan K, Caulfield B. Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med. 2006;34(12):1970-1976. doi:10.1177/0363546506290989.31. Monaghan K, Delahunt E, Caulfield B. Ankle function during gait in patients with chronic ankle instability compared to controls. Clin Biomech (Bristol, Avon). 2006;21(2):168-174. doi:10.1016/j.clinbiomech.2005.09.004.32. Delahunt E, Monaghan K, Caulfield B. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res. 2006;24(10):1991-2000. doi:10.1002/jor.20235.33. Drewes LK, McKeon PO, Paolini G, et al. Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability. J Sport Rehabil. 2009;18(3):375-388. . Accessed December 3, 2015.34. Lee AJY, Lin W-H. Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin Biomech. 2008;23(8):1065-1072. doi:10.1016/j.clinbiomech.2008.04.013.35. Konradsen L, Magnusson P. Increased inversion angle replication error in functional ankle instability. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):246-251. doi:10.1007/s001670000124.36. Hung Y-J. Neuromuscular control and rehabilitation of the unstable ankle. World J Orthop. 2015;6(5):434-438. doi:10.5312/wjo.v6.i5.434.37. Handoll, H. G. H., Rowe, B. R., Quinn, K. M., de Bie R. Interventions for preventing ankle ligament injuries (Review. Cochrane Libr. 2008;(3):22-50.38. Raymond J, Nicholson LL, Hiller CE, Refshauge KM. The effect of ankle taping or bracing on proprioception in functional ankle instability: A systematic review and meta-analysis. J Sci Med Sport. 2012;15(5):386-392. doi:10.1016/j.jsams.2012.03.008.39. Brown CN, Ross SE, Mynark R, Guskiewicz KM. Assessing Functional Ankle Instability with Joint Position Sense, Time to Stabilization, and Electromyography.pdf. J Sport Rehabil. 2004;13:122-134.Appendix A: Recommendations for Measurement of Joint Position Recognition deficits associated with CAI.“1. Compare JPR measures between groups with and without CAI.2. During testing, the starting position of the foot should be between neutral and 308 of plantar flexion.3. The active repositioning method is the most appropriate to use; however, passive repositioning has its benefits and can be explored further.4. Early to midrange plantar flexion and the full range of inversion are the 2 directions that should be used. A combination of the 2 has not been explored, but we recommend investigating it systematically.5. The repositioning velocity for testing should be less than 5?/s. larger effects become more apparent as testing velocity decreases.6. The most consistent data-reduction method for JPR testing is the calculation of the mean absolute error across at least 2”ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4085/1062-6050-47.4.15", "ISBN" : "1062605047", "ISSN" : "10626050", "PMID" : "22889661", "abstract" : "OBJECTIVE: To identify the most precise and consistent variables using joint repositioning for identifying joint position recognition (JPR) deficits in individuals with chronic ankle instability (CAI).\\n\\nDATA SOURCES: We conducted a computerized search of the relevant scientific literature from January 1, 1965, to July 31, 2010, using PubMed Central, CINAHL, MEDLINE, SPORTDiscus, and Web of Science. We also conducted hand searches of all retrieved studies to identify relevant citations. Included studies were written in English, involved human participants, and were published in peer-reviewed journals.\\n\\nSTUDY SELECTION: Studies were included in the analysis if the authors (1) had examined JPR deficits in patients with CAI using active or passive repositioning techniques, (2) had made comparisons with a group or contralateral limb without CAI, and (3) had provided means and standard deviations for the calculation of effect sizes.\\n\\nDATA EXTRACTION: Studies were selected and coded independently and assessed for quality by the investigators. We evaluated 6 JPR variables: (1) study comparisons, (2) starting foot position, (3) repositioning method, (4) testing range of motion, (5) testing velocity, and (6) data-reduction method. The independent variable was group (CAI, control group or side without CAI). The dependent variable was errors committed during joint repositioning. Means and standard deviations for errors committed were extracted from each included study.\\n\\nDATA SYNTHESIS: Effect sizes and 95% confidence intervals were calculated to make comparisons across studies. Separate meta-analyses were calculated to determine the most precise and consistent method within each variable. Between-groups comparisons that involved active repositioning starting from a neutral position and moving into plantar flexion or inversion at a rate of less than 5\u00b0/s as measured by the mean absolute error committed appeared to be the most sensitive and precise variables for detecting JPR deficits in people with CAI.", "author" : [ { "dropping-particle" : "", "family" : "McKeon", "given" : "Jennifer M Medina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McKeon", "given" : "Patrick O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Athletic Training", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "444-456", "title" : "Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4Taken from McKeon JMM, McKeon PO. Evaluation of joint position recognition measurement variables associated with chronic ankle instability: A meta-analysis. J Athl Train. 2012;47(4):444-456. doi:10.4085/1062-6050-47.4.15. ................
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