Charlie A. Hicks-Little

Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach

OBJECTIVE To perform a systematic review to determine the healing time of the lateral ankle ligaments after an acute ankle sprain. DATA SOURCES We identified English-language research studies from 1964 to 2007 by searching MEDLINE, Physiotherapy Evidence Database (PEDro), SportDiscus, and CINAHL using the terms ankle sprain, ankle rehabilitation, ankle injury, ligament healing, and immobilization. STUDY SELECTION We selected studies that described randomized, controlled clinical trials measuring ligament laxity either objectively or subjectively immediately after injury and at least 1 more time after injury. DATA EXTRACTION Two reviewers independently scored the 7 studies that met the inclusion criteria. Because of differences in study designs, a meta-analysis could not be performed. Effect sizes and confidence intervals could be calculated only for 1 study. The percentages of subjective and objective instability were calculated for the remaining studies. DATA SYNTHESIS Ankle laxity improved over a period of 6 weeks to 1 year. One author showed stress talar tilt values of 16.10 +/- 8.8 degrees immediately after injury and 3.4 +/- 3.6 degrees at 3 months after injury. In 2 articles, the authors reported that positive anterior drawer tests were still present in 3% to 31% of participants at 6 months after injury. Additionally, feelings of instability affected 7% to 42% of participants up to 1 year after injury. CONCLUSIONS/RECOMMENDATIONS In the studies that we examined, it took at least 6 weeks to 3 months before ligament healing occurred. However, at 6 weeks to 1 year after injury, a large percentage of participants still had objective mechanical laxity and subjective ankle instability. Direct comparison among articles is difficult because of differences in methods. More research focusing on more reliable methods of measuring ankle laxity is needed so that clinicians can know how long ligament healing takes after injury. This knowledge will help clinicians to make better decisions during rehabilitation and for return to play.

Six Weeks of Balance Training Improves Sensorimotor Function in Individuals With Chronic Ankle Instability

STUDY DESIGN Prospective cohort study. OBJECTIVE To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability (CAI). BACKGROUND CAI is the tendency toward repeated ankle sprains and recurring symptoms, occurring in 40% to 70% of individuals who have previously sustained a lateral ankle sprain. Recent studies have found deficits in sensorimotor measures in individuals with CAI. As balance training is a common component of ankle rehabilitation, understanding its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocols to better utilize this rehabilitation method. METHODS Twelve participants with CAI and 9 healthy volunteers participated. Independent variables were group (CAI, control) and time (pretraining, posttraining). Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks. RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted posttraining measures of dynamic balance in the anterior medial (P = .021), medial (P = .048), and posterior medial directions (P = .030); motoneuron pool excitability Hmax/Mmax ratio (P = .044) and single-limb presynaptic inhibition (P = .012); and joint position sense inversion variable error (P = .017). It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks. CONCLUSIONS After 6 weeks of balance training, individuals with CAI demonstrated enhanced dynamic balance, inversion joint position sense, and changes in motoneuron pool excitability compared to healthy controls who did not train. LEVEL OF EVIDENCE Therapy, level 2b.

Mechanical and sensorimotor implications with ankle osteoarthritis.

OBJECTIVE To understand the mechanical and sensorimotor adaptations that may occur with ankle osteoarthritis (OA). DESIGN Case-control. SETTING Biodynamics research laboratory. PARTICIPANTS Subjects with ankle OA (n=8; 4 males, 4 females) were matched to healthy controls (n=8; 4 males, 4 females). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mechanical joint stability was assessed with an instrumented ankle arthrometer. Static balance was measured using a force platform during a double-legged stance. Isometric ankle/foot complex strength in the sagittal and frontal plane was assessed with a handheld dynamometer. Last, subjective level of function was assessed using the foot and ankle disability index. RESULTS There were significant group x side interactions for anterior displacement, inversion rotation, eversion rotation, ankle isometric strength, and the foot and ankle disability index (P<.05). The affected ankle of the OA group demonstrated significantly more mechanical stiffness, more impairments in ankle/foot isometric strength, and less subjective level of function than the matched controls. Additionally, the ankle OA group exhibited significantly more center of pressure displacement, total velocity, and medial-lateral velocity (P<.05). CONCLUSIONS These limitations observed in joint laxity, postural control, muscle strength, and perceived function provide evidence that patients with ankle OA display a number of characteristics that affect joint stability and overall function. These identified impairments necessitate the need for rehabilitation and exercise programs to be developed to help improve joint stability and function in patients with ankle OA.

Lower extremity joint kinematics during stair climbing in knee osteoarthritis.

PURPOSE Knee osteoarthritis (OA) is one of the most prevalent chronic lower extremity diseases, causing profound limitation of movement and ability to perform activities of daily living. The purpose of this study was to compare various hip, knee, and ankle joint kinematic variables between knee OA subjects and matched healthy controls during stair ascent and descent. METHODS Eighteen subjects with knee OA (age = 60.2 ± 9.9 yr, mass = 90.3 ± 16.7 kg, height = 168.4 ± 9.9 cm) and 18 healthy matched controls (age = 60.3 ± 10.7 yr, mass = 81.1 ± 21.2 kg, height = 168.3 ± 11.9 cm) participated in the study. Subjects performed five ascending and descending trials on a custom-built staircase while their motion was captured three-dimensionally using an eight-camera optical video motion capture system. RESULTS Significant group × direction interactions were found for average hip flexion angle at foot strike (P = 0.04), for average ankle adduction angle at foot strike (P = 0.01), and for peak ankle dorsiflexion angle during support (P = 0.05) and swing (P = 0.01). Specifically, knee OA and control subjects demonstrated greater hip flexion angle at foot strike and ankle dorsiflexion angle during swing but showed smaller ankle dorsiflexion angle during support during stair ascent compared with descent. Furthermore, compared with controls, knee OA patients demonstrated greater hip abduction at foot strike (-3.1° ± 3.9°) and smaller peak knee flexion during support (60.4° ± 5.0°) and swing (86.7° ± 5.4°). Time of peak hip abduction (34.2% ± 7.1%), hip flexion (7.0% ± 12.3%), knee flexion (69.8% ± 4.6%), dorsiflexion (51.4% ± 2.9%), and ankle adduction (37.3% ± 20.8%) during support occurred later in the gait cycle for knee OA patients. CONCLUSIONS These data demonstrate that knee OA directly influences specific knee joint kinematics and induces kinematic alterations at the hip and ankle perhaps to compensate for the existing knee joint pathology.

Temporal-spatial gait adaptations during stair ascent and descent in patients with knee osteoarthritis.

Knee osteoarthritis (OA) accounts for more functional disability of the lower extremity than any other disease. We recruited 18 patients with knee OA and 18 healthy age-, height-, mass-, and gender-matched control subjects to investigate the effects knee OA has on select spatial and temporal gait variables during a stair climbing task. No group-by-direction interaction was observed; however, significant effects did occur for group and direction. Specifically, patients with knee OA demonstrated less time in single support, greater time in double support, decreased step length, greater step width, less stride length, decreased total gait velocity, greater total time in support, and less total time in swing, compared with controls. Early-stage knee OA directly influences specific temporal and spatial gait characteristics during stair climbing.

Intersession Reliability of Hoffmann Reflex Gain and Presynaptic Inhibition in the Human Soleus Muscle

UNLABELLED Hayes BT, Hicks-Little CA, Harter RA, Widrick JJ, Hoffman MA. Intersession reliability of Hoffmann reflex gain and presynaptic inhibition in the human soleus muscle. OBJECTIVE To determine the day-to-day reliability of Hoffmann reflex (H-reflex) gain and presynaptic inhibition of spinal reflexes in the human soleus muscle. DESIGN Controlled trial. SETTING Research laboratory. PARTICIPANTS Volunteers (N=30; mean +/- SD age, 23.4+/-3.9y; height, 175.64+/-10.87cm; mass, 84.50+/-24.18kg) with no history of lower extremity pathology and/or injury participated. INTERVENTIONS Subjects lay prone with the head, shoulders, arms, and hips supported in a static position by a massage body pillow and the ankle positioned at 90 degrees . Recording electrodes were placed over the soleus and tibialis anterior muscle bellies, and the stimulating electrodes were positioned over the tibial nerve in the popliteal space and the common peroneal nerve near the fibular head. MAIN OUTCOME MEASURES The H-reflex and motor wave recruitment curves were then measured and recorded. Presynaptic inhibition was also assessed in the soleus muscle, and a conditioning stimulation of the common peroneal nerve (1 x motor threshold = motor threshold) was used prior to soleus H-reflex measurement. Two testing sessions took place between 2 and 7 days, and each session occurred at the same time of day. RESULTS Assessments of H-reflex gain and presynaptic inhibition yielded test-retest reliability of R equal to . 95 and .91, respectively. CONCLUSIONS Measures of presynaptic inhibition and H-reflex gain (H slope/M slope) in the human soleus muscle are consistent and reliable day to day.

Changes in Ankle Mechanical Stability in Those With Knee Osteoarthritis

UNLABELLED Hubbard TJ, Hicks-Little C, Cordova M. Changes in ankle mechanical stability in those with knee osteoarthritis. OBJECTIVE To examine ankle joint mechanical stability in patients who had mild to moderate knee osteoarthritis (OA). DESIGN Case control study. SETTING Biodynamics research laboratory. PARTICIPANTS Subjects with knee OA (n=15; 5 men and 10 women; mean age +/- SD, 60.3+/-10.2y; mean mass +/- SD, 93.9+/-18.3kg; mean height +/- SD, 167.23+/-9.5cm) were matched to healthy controls (n=15; 5 men and 10 women; mean age +/- SD, 59.6+/-12.6y; mean mass +/- SD, 83.5+/-19.2kg; mean height +/- SD, 169.7+/-12.6cm). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mechanical ankle-subtalar joint stability was assessed with an instrumented arthrometer where ankle-subtalar joint motion for anterior/posterior displacement and inversion/eversion rotation was measured. Separate 2 x 2 mixed model analyses of variance were performed. RESULTS Significant group x side interactions were observed for anterior and posterior displacement (P<.05) where patients with knee OA had significantly less anterior and posterior ankle displacement compared with the control group, as well as compared with their unaffected extremity. Additionally, patients with knee OA had significantly (P<.05) less inversion/eversion rotation than their respective controls. CONCLUSIONS These data suggest that altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. Compensatory changes in ankle joint mechanics must also be considered when addressing lower extremity functional deficits in patients with knee OA.

Landing Error Scoring System Differences Between Single-Sport and Multi-Sport Female High School–Aged Athletes

CONTEXT Single-sport specialization (SSS) is becoming more prevalent in youth athletes. Deficits in functional movement have been shown to predispose athletes to injury. It is unclear whether a link exists between SSS and the development of functional movement deficits that predispose SSS athletes to an increased risk of knee injury. OBJECTIVE To determine whether functional movement deficits exist in SSS athletes compared with multi-sport (M-S) athletes. DESIGN Cross-sectional study. SETTING Soccer practice fields. PATIENTS OR OTHER PARTICIPANTS A total of 40 (21 SSS [age = 15.05 ± 1.2 years], 19 M-S [age = 15.32 ± 1.2 years]) female high school athlete volunteers were recruited through local soccer clubs. All SSS athletes played soccer. INTERVENTION(S) Participants were grouped into 2 categories: SSS and M-S. All participants completed 3 trials of the standard Landing Error Scoring System (LESS) jump-landing task. They performed a double-legged jump from a 30-cm platform, landing on a rubber mat at a distance of half their body height. Upon landing, participants immediately performed a maximal vertical jump. MAIN OUTCOME MEASURE(S) Values were assigned to each trial using the LESS scoring criteria. We averaged the 3 scored trials and then used a Mann-Whitney U test to test for differences between groups. Participant scores from the jump-landing assessment for each group were also placed into the 4 defined LESS categories for group comparison using a Pearson χ(2) test. The α level was set a priori at .05. RESULTS Mean scores were 6.84 ± 1.81 for the SSS group and 6.07 ± 1.93 for the M-S group. We observed no differences between groups (z = -1.44, P = .15). A Pearson χ(2) analysis revealed that the proportions of athletes classified as having excellent, good, moderate, or poor LESS scores were not different between the SSS and M-S groups ([Formula: see text] = 1.999, P = .57). CONCLUSIONS Participation in soccer alone compared with multiple sports did not affect LESS scores in adolescent female soccer players. However, the LESS scores indicated that most female adolescent athletes may be at an increased risk for knee injury, regardless of the number of sports played.

Negative Mood States Correlate with Laterobasal Amygdala in Collegiate Football Players

A number of studies have suggested that sports-related concussion (SRC) may place individuals at increased risk for depression and negative outcomes including suicide. However, the mechanisms underlying a potential relationship between brain integrity and mood remain unclear. The current study is aimed at examining the association between amygdala shape, mood state, and postconcussion symptoms in collegiate football players. Thirty members of 1 football team completed the Profile of Mood States (POMS), the postconcussion symptom scale (PCSS), and an MRI protocol during preseason camp. T1-weighted images were acquired and three-dimensional amygdala and probabilistic maps were created for shape analysis. Correlation analyses between POMS and PCSS and the relationship between POMS and amygdala shape were completed. In the amygdala, the left laterobasal subregion showed a positive relationship with the POMS total score and subscales scores. No significant relationship between PCSS and amygdala shape was found. Significant positive correlations were found between POMS subscales and PCSS. These results indicate that amygdala structure may be more closely associated with negative mood states than postconcussion symptoms. These findings suggest that premorbid individual differences in effect may provide critical insight into the relationship between negative mood and outcomes in collegiate football players with SRC.

Correlation between Ankle Dorsiflexion, Hip Flexion Range of Motion and the Functional Movement Screen Hurdle Step Score.

CONTEXT Functional movement screening (FMS) has been gaining popularity in the fields of sports medicine and performance. Currently, limited research has examined whether FMS screening that identifies low FMS scores is attributed primarily to limits in range of motion (ROM). OBJECTIVE To compare scores from the FMS hurdle-step movement with ROM measurements for ankle dorsiflexion and hip flexion (HF). DESIGN Correlational research design. SETTING Sports medicine research laboratory. PARTICIPANTS 20 healthy active male (age 21.2 ± 2.4 y, weight 77.8 ± 10.2 kg, height 180.8 ± 6.8 cm) and 20 healthy active female (21.3 ± 2.0 y, 67.3 ± 8.9 kg, 167.4 ± 6.6 cm) volunteers. INTERVENTION All 40 participants completed 3 trials of the hurdle-step exercise bilaterally and goniometric ROM measurements for active ankle dorsiflexion and HF. MAIN OUTCOME MEASURES Correlations were determined between ROM and FMS scores for right and left legs. In addition, mean data were compared between FMS scores, gender, and dominant and nondominant limbs. RESULTS There were no significant correlations present when all participants were grouped. However, when separated by gender significant correlations were identified. There was a weak correlation with HF and both hurdle-step (HS) and average hurdle-step (AHS) scores on both left (r = .536, P = .015 and r = .512, P = .012) and right (r = .445, P = .049 and r = .565, P = .009) legs for women. For men, there was a poor negative correlation of HF and both HS and AHS on the left leg (r = -.452, P = .045 and r = .451, P = .046). CONCLUSION Our findings suggest that although hip and ankle ROMs do not have a strong relationship with FMS hurdle-step scores, they are a contributing factor. More research should be conducted to identify other biomechanical factors that contribute to individual FMS test scores.