Joanne Munn

Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis

Functional ankle instability (FAI) has been associated with impaired sensorimotor function; however individual studies have produced conflicting results. In an attempt to reduce this ambiguity, a systematic review with meta-analysis was undertaken to determine which sensorimotor deficits exist with FAI. Fifty-three studies assessing sensorimotor factors in subjects with FAI were included from 465 identified articles. Studies were rated for methodological quality and data were pooled for peroneal reaction time, joint position sense, and postural sway during single-leg stance and time to stabilisation from a single-leg jump. Data on joint movement sense were unable to be pooled. When subjects with unstable ankles were compared to healthy controls, sensorimotor impairments were demonstrated for passive joint position sense (mean difference (MD)=0.7 degrees , 95% confidence interval (CI): 0.2-1.2 degrees , p=0.004), active joint position sense (MD=0.6 degrees , 95% CI: 0.2-1.0 degrees , p=0.002), postural sway in single-leg stance (standardised MD (SMD)=0.6, 95% CI: 0.2-1.0, p=0.002), the star excursion balance test (SMD=0.4, 95% CI: 0.1-0.7, p=0.009), and time to stabilisation from a single-leg jump in a medio-lateral (MD=0.6 ms, 95% CI: 0.4-0.8, p<0.0001) and an antero-posterior direction (MD=0.7 ms, 95% CI: 0.4-1.0, p<0.0001). Peroneal reaction time was not affected. Sensorimotor deficits occur for joint position sense and postural control in subjects with FAI. Deficits in peroneal muscle reaction time following perturbation are not evident.

Eccentric muscle strength in functional ankle instability

PURPOSE To investigate muscle strength in subjects with unilateral functional ankle instability, with the specific aim of determining whether eccentric strength deficits exist. METHODS Isokinetic invertor and evertor torques were assessed eccentrically and concentrically at speeds of 60 and 120 degrees.s(-1) in 16 subjects with unilateral ankle instability. Absolute peak torque values were compared between the injured and noninjured limbs to determine whether strength deficits existed. RESULTS No eccentric or concentric evertor strength deficit was found in the injured limb. Interestingly, for the injured limb, a significant interaction effect was found whereby eccentric inversion strength was reduced. CONCLUSION Functional ankle instability is not associated with deficits in evertor strength. Deficits in eccentric invertor strength were found, and this may contribute to the symptoms of functional ankle instability. Weak invertors may contribute to functional ankle instability because of a reduced ability to assist in controlling lateral displacement of the shank over the weight-bearing foot. Excess lateral postural sway outside of the base of support results in the foots medial border rising from the floor once the limits of closed chain eversion is reached, which may result in the foot being forced into rapid inversion.

The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: A systematic review

A systematic review of randomised controlled trials (RCTs) was conducted to determine the effectiveness of manual therapy (MT) techniques for the management of musculoskeletal disorders of the shoulder. Seven electronic databases were searched up to January 2007, and reference lists of retrieved articles and relevant MT journals were screened. Fourteen RCTs met the inclusion criteria and their methodological qualities were assessed using the PEDro scale. Results were analyzed within diagnostic subgroups (adhesive capsulitis (AC), shoulder impingement syndrome [SIS], non-specific shoulder pain/dysfunction) and a qualitative analysis using levels of evidence to define treatment effectiveness was applied. For SIS, there was no clear evidence to suggest additional benefits of MT to other interventions. MT was not shown to be more effective than other conservative interventions for AC, however, massage and Mobilizations-with-Movement may be useful in comparison to no treatment for short-term outcomes for shoulder dysfunction.

Generalized Joint Hypermobility and Risk of Lower Limb Joint Injury During Sport A Systematic Review With Meta-Analysis

Background: Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of joint injury in hypermobile sporting participants compared with their nonhypermobile peers. Systematic reviews have not been conclusive and no meta-analysis has been performed. Purpose: This review was undertaken to determine whether individuals with generalized joint hypermobility have an increased risk of lower limb joint injury when undertaking sporting activities. Study Design: Systematic review with meta-analysis. Methods: Studies were identified through a search without language restrictions of PubMed, CINAHL, Embase, and SportDiscus databases from the earliest date through February 2009 with subsequent handsearching of reference lists. Inclusion criteria for studies were determined before searching and all included studies underwent methodological quality assessment by 2 independent reviewers. Meta-analyses for joint injury of the lower limb, knee, and ankle were performed using a random effects model. The difference in injury proportions between hypermobility categories was tested with the z statistic. Results: Of 4841 identified studies, 18 met all inclusion criteria with methodological quality ranging from 1 of 6 to 5 of 6. A variety of tests of hypermobility and varied cutoff points to define the presence of generalized joint hypermobility were used, so the authors determined a standardized cutoff to indicate generalized joint hypermobility. Using this criterion, a significantly increased risk of knee joint injury for hypermobile and extremely hypermobile participants compared with their nonhypermobile peers was demonstrated (P < .001), whereas no increased risk was found for ankle joint injury. For knee joint injury, a combined odds ratio of 4.69 (95% confidence interval, 1.33-16.52; P = .02) was calculated, indicating a significantly increased risk for hypermobile participants playing contact sports. Conclusion: Sport participants with generalized joint hypermobility have an increased risk of knee joint injury during contact activities but have no altered risk of ankle joint injury.

Generalized Joint Hypermobility and Risk of Lower Limb Joint Injury During Sport

Background: Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of joint injury in hypermobile sporting participants compared with their nonhypermobile peers. Systematic reviews have not been conclusive and no meta-analysis has been performed. Purpose: This review was undertaken to determine whether individuals with generalized joint hypermobility have an increased risk of lower limb joint injury when undertaking sporting activities. Study Design: Systematic review with meta-analysis. Methods: Studies were identified through a search without language restrictions of PubMed, CINAHL, Embase, and SportDiscus databases from the earliest date through February 2009 with subsequent handsearching of reference lists. Inclusion criteria for studies were determined before searching and all included studies underwent methodological quality assessment by 2 independent reviewers. Meta-analyses for joint injury of the lower limb, knee, and ankle were performed using a random effects model. The difference in injury proportions between hypermobility categories was tested with the z statistic. Results: Of 4841 identified studies, 18 met all inclusion criteria with methodological quality ranging from 1 of 6 to 5 of 6. A variety of tests of hypermobility and varied cutoff points to define the presence of generalized joint hypermobility were used, so the authors determined a standardized cutoff to indicate generalized joint hypermobility. Using this criterion, a significantly increased risk of knee joint injury for hypermobile and extremely hypermobile participants compared with their nonhypermobile peers was demonstrated (P < .001), whereas no increased risk was found for ankle joint injury. For knee joint injury, a combined odds ratio of 4.69 (95% confidence interval, 1.33-16.52; P = .02) was calculated, indicating a significantly increased risk for hypermobile participants playing contact sports. Conclusion: Sport participants with generalized joint hypermobility have an increased risk of knee joint injury during contact activities but have no altered risk of ankle joint injury.

The effect of age on lumbar range of motion: a systematic review

A systematic review and meta-analysis to determine the effect of age on lumbar range of motion (ROM). Assessment of lumbar ROM is commonly used in spinal clinical examination. Although known to reduce with advancing age, it is unclear how this occurs across different age bands; how this compares between movement planes; and what differences exist between males and females. Ten electronic databases were searched to find studies matching predetermined inclusion criteria. Methodological quality was assessed with a quality assessment tool for quantitative studies. Evidence for effect of age on ROM in all planes was investigated with meta-analyses. Sixteen studies met inclusion criteria with results showing age-related reductions in flexion, extension and lateral flexion particularly from 40 to 50 and after 60 years of age. There was very little age effect on lumbar rotation. There is strong evidence for a non-linear age-related reduction in lumbar sagittal and coronal ROM after 40 years of age that also appears to be asymmetric in the coronal plane. These factors should be considered during the evaluation of spinal ROM in patients who present with lumbar disorders.

Passive moment about the hip in straight leg raising

OBJECTIVE The purpose of this examine is to study the load-deformation characteristics of the hip in straight leg raising. DESIGN An experimental study in which passive moment about the hip was determined as a function of hip angle. BACKGROUND Straight leg raising is widely employed in clinical examination, and there is little information on its mechanical characteristics. METHODS Fourteen healthy volunteers were recruited for this study. Three trials of straight leg raise tests were performed while subjects lay supine on a plinth that was fitted with load cells. An electrogoniometer was employed to measure hip flexion during the test. Resistive moment at the hip was determined using a dynamic biomechanical model. RESULTS The present experimental method was shown to be highly reliable. The moment-angle curves of all subjects were shown to follow an exponential function. CONCLUSION Stiffness and strain energy of posterior hip tissues could be derived from the moment-angle curves. Evaluation of such elastic properties is clinically important as they may be altered with injuries of the tissues. RELEVANCE Clinically, contracture of hamstring muscles and other posterior hip tissues is evaluated by measuring the available range of hip flexion in straight leg raising. However, this does not provide any information on the elastic properties of the tissues. The present study reports a reliable method of evaluating such properties.

Manual testing for ankle instability

AIM To assess inter-rater reliability of ankle manual tests. We also correlated the manual tests with the Cumberland Ankle Instability Tool (CAIT). METHOD One ankle from each of 60 participants was assessed using four different manual tests (anterior drawer in supine and crook lying, talar tilt, inversion tilt). Three different raters, varying in experience, tested each participant. The CAIT questionnaire was also administered. The study received ethics approval from the University of Sydney Human Research Ethics Committee. Intraclass correlation coefficients (ICC), standard error of the mean (SEM) and percent close agreement (PCA) were used to determine reliability of the four tests. Pearsons correlation coefficients were used to determine relationships between the manual tests and CAIT scores. RESULTS Inter-rater reliability for the four manual tests was poor regardless of therapists experience (ICC([1,1]) -0.12 to 0.33; SEM 0.93-1.69). Correlations between the CAIT and manual tests were also low varying between r = -0.12 and -0.42. CONCLUSIONS Inter-rater reliability was poor for manual tests of ankle stability. Reliability may be improved by using a grading scale with fewer intervals. The CAIT scores and manual tests correlated poorly, potentially reflecting the variety of conditions leading to ankle instability.

Response: to Comment - Resistance training for strength: effect of number of sets and contraction speed

PURPOSE To compare effects on strength in the early phase of resistance training with one or three sets and fast or slow speeds. METHODS A total of 115 healthy, untrained subjects were randomized to a control group or one of four training groups: one set fast (approximately 140 degrees.s(-1)), three sets fast, one set slow (approximately 50 degrees.s(-1)), or three sets slow. All subjects attended training 3 x wk(-1) for 6 wk. Subjects in the training groups performed unilateral elbow flexion contractions with a target six- to eight-repetition maximum load. Control subjects sat at the training bench but did not train. One repetition maximum strength, arm circumference, and biceps skinfold thickness were measured before and after training. RESULTS One slow set increased strength by 25% (95% CI 13-36%, P < 0.001). Three sets of training produced greater increases in strength than one set (difference = 23% of initial strength, 95% CI 12-34%, P < 0.001) and fast training resulted in a greater increase in strength than slow training (difference = 11%, 95% CI 0.2-23%, P = 0.046). The interaction between sets and speed was negative (-15%) and of borderline significance (P = 0.052), suggesting there is a benefit of training with three sets or fast speeds, but there is not an additive benefit of training with both. CONCLUSIONS Three sets of exercise produce twice the strength increase of one set in the early phase of resistance training. Training fast produces greater strength increases than training slow; however, there does not appear to be any additional benefit of training with both three sets and fast contractions.