Lateral ankle sprain: isokinetic test reliability and comparison between invertors and evertors

doi:10.1016/j.clinbiomech.2004.05.011

Clinical Biomechanics

Volume 19, Issue 8, October 2004, Pages 868-871

https://doi.org/10.1016/j.clinbiomech.2004.05.011 Get rights and content

Abstract

Objective. Evaluate reliability of isokinetic tests for inversion and eversion in individuals with recurrent lateral ankle sprain and compare inversion to eversion muscle performance in the same ankles.

Design. Reliability was evaluated by comparing the results of two ankle inversion/eversion isokinetic tests. Inversion and eversion were compared with the results presented by the tests.

Background. Previous studies showed reliable isokinetic tests for ankles with no sprain history. It is unknown if such tests can also be performed in lateral sprained ankles. It is unclear whether there is difference between invertors and evertors in these ankles.

Methods. Eleven men with recurrent ankle lateral sprain in one limb were tested using an isokinetic dynamometer. The tests consisted of 5 cycles of maximal contraction in 30°/s and 120°/s. Both injured and noninjured ankles were tested. Peak torque was recorded for analysis.

Results. The tests are reliable and intraclass coefficient correlation varied from 0.71 to 0.95. Invertors generated higher peak torques than evertors (P=0.03) when injured ankles were tested at 120°/s.

Conclusions. Isokinetic inversion/eversion tests showed to be reliable. A decrease in peak torques can be seen during higher velocity tests. The only difference between invertors and evertors was seen when injured ankles were tested at 120°/s. In this case invertors showed higher peak torques.
Relevance

Inversion and eversion isokinetic tests can be used to evaluate strength properties in population with recurrent lateral ankle sprain and detect specific muscle performance deficits. Therefore specific treatment can be provided for those individuals.

Introduction

There are many diseases related to the ankle and they vary from congenital disorders to traumas. The traumas are frequently caused by work, car, and sports related accidents.

One of the most common injuries associated with physical activity is the inversion sprain of the ankle (Birmingham et al., 1997), and despite its high occurrence, it is difficult to find reliable muscle measurement procedures within lateral ankle sprain rehabilitation practices (Eggart et al., 1993).

The highest incidence of lateral ankle sprain occurs in plantar flexion, internal rotation and inversion (Garrick, 1977).

Many evaluations used by health professionals in clinics and hospitals, are often considered inefficient, at times because it is difficult to reproduce the tests, other times because of the low level of specificity achieved by the tests (Eggart et al., 1993).

Researchers such as Leslie et al. (1990), Wong et al. (1984), Simoneau (1990) and others have standardized procedures for isokinetic evaluation of the ankle, through acquisition of muscular peak torque produced in isokinetic movement of ankle inversion and eversion. So far, no studies have presented results of reliability tests with the same protocols conducted in individuals with recurrent lateral ankle sprain. It can be a mistake to assume that reliable tests for healthy subjects will be just as reliable when testing pathologic conditions. Therefore, the objectives of this study were to evaluate the reliability of the isokinetic test for ankle inversion and eversion in individuals with recurrent lateral ankle sprain and to compare inversion peak torque to eversion peak torque in all ankles, injured and noninjured.

Section snippets

Subjects

The tests were administered to 11 volunteer men between the ages of 18 and 25. The subjects presented recurrent lateral ankle sprain in only one foot. The last episode of sprain had happened at least 4 months prior to the tests and at the most 12 months prior to the tests. To be eligible for the study the injury had to have caused cessation of sporting activities for at least 2 months. Lateral ankle sprain is defined as a sudden inversion injury resulting in pain, swelling and abnormal gait (

Results

All ICC values for peak torque in inversion and eversion movements for injured and noninjured ankles can be seen in Table 1 and the comparison between invertors and evertors for each ankle is shown in Table 2.

The ICC for inversion and eversion tests in injured ankles varied from 0.71 to 0.92 while the noninjured ankles developed a variation between 0.90 and 0.95. The values found in this study show that the procedures adopted for the tests are reliable.

When invertors were compared to evertors,

Discussion

Comparing previous reliability studies (Karnofel et al., 1989; Leslie et al., 1990; Simoneau, 1984) to the latter, it seems that all found similar reliability levels. The values for ICC found in this present study varied from 0.71 to 0.95, showing that ankle inversion and eversion tests, even in subjects with ankle sprain history, are reliable.

It is important to emphasize that, differently from the previous studies (Karnofel et al., 1989; Leslie et al., 1990; Simoneau, 1984); in this study all

Conclusion

It can be concluded that the isokinetic tests for ankle inversion and eversion, following the procedures used in this study were reliable. The tests showed high reliability for noninjured ankles as well as for injured ankles.

At a higher velocity such as 120°/s, there will be a decrease in the values for peak torque during ankle inversion and eversion.

There was no statistical difference between invertors and evertors, except for the test performed at 120°/s in injured ankles. At this velocity,

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Peak passive resistive torque at maximum inversion range of motion in subjects with recurrent ankle sprains
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Effects of recurrent lateral ankle sprains on active and passive judgments of joint position
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Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability
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The knee was extended while testing the plantar flexion and dorsiflexion and in 30–40°/sec flexion while testing the inversion and eversion. The rationale for choosing these speeds was based on previous studies in which comparable speeds were used (De Noronha & Júnior, 2004; Fagher et al., 2016). An injury is defined as any physical complaint sustained by a player that results from a football match or football training, irrespective of the need for medical attention or time loss from football activities.
Validating any screening test to predict and prevent football injuries is in need of identifying related risk factors through prospective designs. In spite of the extensive use of strength testing in football players, there are limited studies investigating the relationship between isokinetic muscle strength and injury risk in young football players. The present study aimed to evaluate the relationship between isokinetic strength and the risk of lower extremity injury among Iranian young football players.
ology: seventy three U-21 football players participated in this study. Isokinetic strength of hip, knee and ankle muscles were measured using the Isokinetic system pro 4. Injuries and exposure in training and matches were registered prospectively by club medical staff for one season.
Significant relationships were revealed between the isokinetic strength of hip abductor and adductor muscles, and isokinetic strength ratio of hip abductor/adductor muscles at an angular speed of 30°/sec, the isokinetic strength of hip abductor muscles at 90°/sec, and isokinetic strength of knee flexor and extensor muscles at 60°/sec and knee flexor/extensor strength ratio at angular velocities of 60°/sec with the injury occurrence among football players.
Conclusion: lower extremity isokinetic strength indices are associated with injuries in young male football players.
Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture
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Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown.
To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture.
Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training.
Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01).
Training on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
Assessment of evertor weakness in patients with chronic ankle instability: Functional versus isokinetic testing
2017, Clinical Biomechanics
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While isokinetic eccentric muscular weakness has been considered as a factor responsible for CAI by some authors (Abdel-Aziem and Draz, 2014; David et al., 2013; Hartsell and Spaulding, 1999; Willems et al., 2002; Yildiz et al., 2003; Tropp, 1986), it is worth noting that there is no clear consensus about the relationships between evertor isokinetic weakness and CAI (Bernier et al., 1997; Kaminski et al., 1999; Kwon et al., 2013; Lentell et al., 1990). In addition, such a deficit has rarely been evaluated in clinical practice (Eggart et al., 1993; De Nohonha and Borges, 2004; Plante and Wikstrom, 2013). Hence, isokinetic evaluation is still considered the gold standard procedure for research purposes, whereas this methodology is not easily transferable to daily practice due to cost, space requirements, portability and time consuming constraints considered as barriers by clinicians.
Ankle sprain is the most common sport-related injury and eccentric weakness of ankle evertors is regarded as a significant muscular deficit related to chronic ankle instability. However, the eccentric performance of the evertors is rarely assessed by clinicians because procedures used for research purposes (i.e. isokinetic tests) are not easily applicable in daily practice.
The present study assessed the ability of two different testing procedures to distinguish between groups of 12 healthy subjects or 12 patients suffering from chronic ankle instability. On the one hand, the strength of evertors was assessed with a gold standard isokinetic procedure. On the other hand, we assessed the ability of the subjects to control ankle inversion during weight bearing (functional standing test).
Data showed no significant difference between groups for isokinetic peak torque values normalized to body weight. Conversely, the functional test revealed a significantly impaired ability to control ankle inversion during weight bearing in subjects with chronic ankle instability.
This suggests that this easy-to-apply functional test is better suited compared to isokinetic testing procedures to assess weakness of evertors in patients suffering from chronic ankle instability. Moreover, this test may also be used to objectively monitor improvements during rehabilitation or progression in prevention protocols.
Assessment of joint position sense deficit, muscular impairment and postural disorder following hemi-Castaing ankle ligamentoplasty
2014, Orthopaedics and Traumatology: Surgery and Research
Hemi-Castaing ligamentoplasty is a treatment for chronic ankle instability, accused of weakening a powerful stabilizing muscle: the peroneus brevis.
To assess proprioceptive and muscular impairment following hemi-Castaing and impact on postural control.
A retrospective series of 21 patients underwent clinical (Karlsson, AOFAS) and proprioceptive assessment with isokinetic assessment (evertors and invertors) on a Con-Trex^® dynamometer and postural assessment on a Win-Posturo^® force platform, at a minimum 6 months postsurgery.
At a mean 18 months’ follow-up, mean Karlsson score was 84 and AOFAS score 88. Ankle joint position sense error was less on the operated than on the healthy side. Evertor strength deficit with respect to the healthy side was 4.7% (ns) at 30°/s and 5.7% (ns) at 120°/s in concentric mode and 6.6% (ns) in excentric mode. After surgery, the evertor/invertor ratio was > 1 (in favor of the evertors). Postural values were significantly higher for the operated ankle.
Hemi-Castaing ligamentoplasty provided excellent clinical and functional results. It did not disturb the agonist/antagonist balance of the ankle muscles, and harvesting a half peroneus brevis did not impair evertor isokinetic force. Joint position sense was not impaired; indeed, deficits with respect to the contralateral side showed improvement.
Retrospective study.
Assessment of joint position sense deficit, muscular impairment and postural disorder following hemi-Castaing ankle ligamentoplasty
2014, Revue de Chirurgie Orthopedique et Traumatologique
La ligamentoplastie selon hémi-Castaing est une technique de traitement de l’instabilité chronique de cheville, auquel on reproche d’affaiblir un puissant stabilisateur de la cheville : le court-fibulaire.
Déterminer les déficits proprioceptifs et musculaires, et leurs conséquences sur le contrôle postural, après ligamentoplastie par hémi-Castaing.
Dans cette étude rétrospective, 21 patients ont bénéficié d’une évaluation clinique (Karlsson, AOFAS), proprioceptive et isocinétique (éverseurs et inverseurs) sur dynamomètre type CON-TREX^®, et posturale sur plateforme de force Win-Posturo^®, à au moins 6 mois de la chirurgie.
À 18 mois de recul moyen, le score de Karlsson post-opératoire était de 84 et l’AOFAS de 88. L’erreur dans l’estimation du positionnement de la cheville était inférieure du côté opéré par rapport au côté controlatéral sain. Le déficit de force des éverseurs par rapport au côté sain était de 4,7 % (ns) à 30°/s et de 5,7 % (ns) à 120°/s en mode concentrique, et de 6,6 % (ns) en mode excentrique. Après la chirurgie, le ratio éverseurs/inverseurs était supérieur à 1, en faveur des éverseurs. Les mesures posturographiques étaient significativement plus élevées sur la cheville opérée.
Cette technique chirurgicale a rapporté d’excellents résultats cliniques et fonctionnels. À la lumière de nos résultats, elle n’a pas perturbé l’équilibre agoniste/antagoniste des muscles de la cheville, et le prélèvement d’un hémi court-fibulaire n’a pas affaibli la force isocinétique des éverseurs. Elle n’a pas non plus altérée la proprioception, et aurait même tendance à améliorer les déficits proprioceptifs par rapport au côté controlatéral.
Étude rétrospective.
Impaired control of weight bearing ankle inversion in subjects with chronic ankle instability
2014, Clinical Biomechanics
Citation Excerpt :
Studies dealing with ankle evertor strength evaluation are classically based on isokinetic tests. Following a standardized procedure proposed 20 years ago (Leslie et al., 1990; Simoneau, 1990), it has been demonstrated that ankle eversion peak torque produced in isokinetic movement gives a reliable measurement of evertor strength for healthy (Aydog et al., 2004) and CAI subjects (De Nohonha and Borges, 2004; Sekir et al., 2008). However, such assessment procedures are not widely used by rehabilitation specialists because the equipment is expensive and the evaluation procedure preparation is time consuming.
Previous studies have proposed that evertor muscle weakness represents an important factor affecting chronic ankle instability. For research purposes, ankle evertor strength is assessed by means of isokinetic evaluations. However, this methodology is constraining for daily clinical use. The present study proposes to assess ankle evertor muscle weakness using a new procedure, one that is easily accessible for rehabilitation specialists. To do so, we compared weight bearing ankle inversion control between patients suffering from chronic ankle instability and healthy subjects.
12 healthy subjects and 11 patients suffering from chronic ankle instability conducted repetitions of one leg weight bearing ankle inversion on a specific ankle destabilization device equipped with a gyroscope. Ankle inversion control was performed by means of an eccentric recruitment of evertor muscles. Instructions were to perform, as slow as possible, the ankle inversion while resisting against full body weight applied on the tested ankle.
Data clearly showed higher angular inversion velocity peaks in patients suffering from chronic ankle instability. This illustrates an impaired control of weight bearing ankle inversion and, by extension, an eccentric weakness of evertor muscles.
The present study supports the hypothesis of a link between the decrease of ankle joint stability and evertor muscle weakness. Moreover, it appears that the new parameter is of use in a clinical setting.

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Brief reportLateral ankle sprain: isokinetic test reliability and comparison between invertors and evertors

Abstract

Introduction

Section snippets

Subjects

Results

Discussion

Conclusion

Peak passive resistive torque at maximum inversion range of motion in subjects with recurrent ankle sprains

Journal of Orthopaedics Sports Physical Therapy

Isokinetic measurement of foot invertor and evertor force in three positions of plantarflexion and dorsiflexion

Journal of Orthopaedics Sports Physical Therapy

Exame fı́sico pré-competição do atlela

The frequency of injury, mechanism of injury, and epidemiology of ankle sprains

American Journal of Sports Medicine

Effects of recurrent lateral ankle sprains on active and passive judgments of joint position

Physical Therapy

Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability

British Journal of Sports Medicine

Brief report
Lateral ankle sprain: isokinetic test reliability and comparison between invertors and evertors