Patrick O. McKeon

Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability.

The purpose of this study was to examine the effects of a single joint mobilization treatment on dorsiflexion range of motion (DF ROM), posterior talar glide, and dynamic and static postural control in individuals with self‐reported chronic ankle instability (CAI). In this randomized cross‐over study, subjects received a Maitland Grade III anterior‐to‐posterior joint mobilization treatment and a control treatment of rest for 5u2009min. Weight‐bearing DF ROM, instrumented posterior talar displacement and posterior stiffness, the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test (SEBT), and time‐to‐boundary (TTB) single‐limb stance static postural control were assessed on both treatment days in 9 males and 11 females with CAI. The results indicated that the joint mobilization treatment was associated with significantly greater DF ROM (pu2009=u20090.01) and TTB in the anterior–posterior direction with eyes‐open (pu2009<u20090.05). Although not significant, trends were identified in posterior talar displacement (pu2009=u20090.08) and the mean of TTB in the medial‐lateral (ML) direction (pu2009=u20090.07). No significant differences were observed in the standard deviation of TTB in the ML direction, the SEBT, or posterior stiffness (pu2009>u20090.05). This indicates that a single joint mobilization treatment has mechanical and functional benefits for addressing impairments in sensorimotor function and arthrokinematic restrictions commonly experienced by individuals with CAI.

Dorsiflexion range of motion significantly influences dynamic balance

The purpose of this study was to examine the relationships between dorsiflexion range of motion on the weight-bearing lunge test (WBLT) and normalized reach distance in three directions on the Star Excursion Balance Test (SEBT). Thirty-five healthy adults (14 males, 21 females, age: 25.9±6.7 years, height: 166.7±22.9 cm, weight: 76.7±22.8 kg) participated. All subjects performed three trials of maximum lower extremity reach in the anterior, posteromedial, and posterolateral directions of the SEBT on each limb to assess dynamic balance. Subjects performed three trials of the WBLT to measure maximum dorsiflexion range of motion. Dependent variables included the means of the SEBT normalized reach distances in the anterior, posteromedial, and posterolateral directions and the mean of the WBLT. Only the anterior direction (mean: 79.0±5.8%) of the SEBT was significantly related to the WBLT (mean: 11.9±2.7 cm), r=0.53 (p=0.001). The r² for this simple linear regression was 0.28, indicating that the WBLT explained 28% of the variance in the anterior normalized reach distance. The WBLT explained a significant proportion of the variance within the anterior reach distance signifying this direction of the SEBT may be a good clinical test to assess the effects of dorsiflexion range of motion restrictions on dynamic balance.

Dorsiflexion and Dynamic Postural Control Deficits are Present in Those with Chronic Ankle Instability

OBJECTIVESnTo determine if differences in weight-bearing ankle dorsiflexion range of motion (DFROM) and Star Excursion Balance Test (SEBT) reach distances were present between participants with chronic ankle instability (CAI) and healthy individuals. A secondary objective was to re-examine the relationship between these measures in participants with and without CAI.nnnDESIGNnCase-control.nnnMETHODSnThirty participants with CAI were matched to 30 healthy participants. All participants performed maximum reach in the anterior, posteromedial and posterolateral directions of the SEBT; as well as, the Weight-Bearing Lunge Test (WBLT) to measure DFROM. Dependent variables included maximal DFROM (cm) and normalized SEBT reach distances (%). Independent t-tests were used for group comparisons (a priori p ≤ 0.05). Simple-linear regression examined the relationship between the WBLT and each SEBT direction.nnnRESULTSnSignificant differences were detected between groups for the WBLT (CAI: 10.73 ± 3.44 cm, healthy: 12.47 ± 2.51 cm; p=0.03) and anterior reach distance (CAI: 76.05 ± 6.25%, healthy: 80.12 ± 5.88%; p=0.01). No differences were identified in posteromedial or posterolateral (ps>0.70) reach. The WBLT had a significant moderate correlation to anterior reach in both groups (ps<0.05) but was not significantly correlated to posteromedial or posterolateral reach distance (ps>0.70).nnnCONCLUSIONSnThe results indicate that participants with CAI demonstrated less DFROM and anterior SEBT reach distance compared to health controls. Additionally, both groups demonstrated similar correlations between WBLT and SEBT performance. These findings suggest that participants with CAI have alterations in ankle motion which may negatively influence dynamic postural control; however, the relationship between WBLT and SEBT performance is consistent in those with and without CAI.

Interventions for the prevention of first time and recurrent ankle sprains.

The uses of external support and balance/coordination training have demonstrated to be effective interventions for the prevention of ankle sprains, especially in those who have a history of ankle sprain. The purpose of this article is to identify areas where evidence has been established to support the use of these interventions for the prevention and enhancement of outcomes of lateral ankle sprain. In addition, areas of deficiency in the evidence are discussed related to these interventions. Finally, future directions for clinicians and researchers as per the use of these interventions are discussed.

Normative range of weight-bearing lunge test performance asymmetry in healthy adults.

Reduced dorsiflexion is a clinical consideration during the management and rehabilitation of several lower extremity injuries (Landrum et al., 2008;Youdas et al., 2009). Decreases in dorsiflexion are often the result of triceps surae muscle tightness (You et al., 2009) or local arthrokinematic restrictions in posterior talar glide in reference to the ankle mortise (Denegar et al., 2002). Additionally, reduced dorsiflexion has been and identified as a risk factor for sustaining lower extremity injury in military recruits (Pope et al., 1998), male physical education students (Willems et al., 2005), and adult volleyball players (Hadzic et al., 2009). Reduced dorsiflexionmay bemodifiable risk factor for lower extremity injury that can be easily identified during clinical examination. The weight-bearing lunge test (WBLT) is a functional and reliable method to indirectly assess dorsiflexion by measuring the maximal advancement of the tibia over the rearfoot in a weightbearing position (Bennell et al., 1998). Previous investigators (Bennell et al., 1998;Jones et al., 2005;Vicenzino et al., 2006) have reported robust inter-tester and intersession reliability associated with the assessment of WBLT performance in healthy adults along with a robust correlation(r 1⁄4 0.95) between degrees of dorsiflexion range of motion and maximal lunge distance. Furthermore, there is a significant positive correlation between WBLT performance and peak ankle sagittal plane kinematics during walking and running (Barrett & Caulfield, 2009); as well as, reach distance on the Star Excursion Balance Test (Hoch et al., 2010b). Lunge distance asymmetries on the WBLT have been used to identifyweight-bearingdorsiflexion impairments in individualswith