Lower extremity function during gait in participants with first time acute lateral ankle sprain compared to controls

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Abstract

Laboratory analyses of chronic ankle instability populations during gait have elucidated a number of anomalous movement patterns. No current research exists analysing these movement patterns in a group in the acute phase of lateral ankle sprain (LAS) injury. It is possible that participants with an acute LAS display movement patterns continuous with their chronically impaired counterparts.

Sixty eight participants with acute LAS and nineteen non-injured participants completed five gait trials. 3D lower extremity temporal kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2).

During period 1, the LAS group displayed increased knee flexion with increased net extensor pattern at the knee joint, increased ankle inversion with a greater inversion moment, and reduced ankle plantar flexion, compared to the non-injured control group.

During period 2, the LAS group displayed decreased hip extension with a decrease in the flexor moment at the hip, and decreased ankle plantar flexion with a decrease in the net plantar flexion moment, compared to the non-injured control group.

These results indicate that participants with acute LAS display coordination strategies which may play a role in the onset of chronicity or recovery.

Introduction

Ankle sprain injury has consistently been reported to be a significant risk for participants of a wide range of activity types (Doherty et al., 2014b). Indeed, ankle sprain accounts for between 11% and 12% of injuries in activities such as soccer, field hockey, basketball, volleyball and orienteering, with a cumulative incidence of between 3.9 and 4.9 ankle sprains per 1000 h of exposure (Doherty et al., 2014b). The consequences of this injury extend beyond acute maladies however, as it has been reported that 32–74% of individuals with a history of ankle sprain report and endure a range of residual and chronic symptoms including episodes of “giving-way” of the ankle joint, perceived instability, as well as recurrent sprain (Anandacoomarasamy and Barnsley, 2005, Konradsen et al., 2002). Chronic ankle instability (CAI) is the encompassing term used to classify these symptoms (Delahunt et al., 2010, Gribble et al., 2013, Gribble et al., 2014a, Gribble et al., 2014b).

Aberrancy of sensorimotor variables of neuromuscular control as determined using biomechanical analysis is a characteristic feature associated with CAI (Hiller et al., 2011). Biomechanical measures of CAI populations are typically laboratory based, and involve active movements such as gait (Delahunt et al., 2006, Monaghan et al., 2006, Spaulding et al., 2003). For example, previous biomechanical analyses have shown that participants with CAI display increased ankle joint inversion (Delahunt et al., 2006, Monaghan et al., 2006) and increased plantar flexion (Spaulding et al., 2003), with a greater concentric evertor moment at the ankle joint, around heel strike (HS) (Monaghan et al., 2006), and reduced plantar flexion (Spaulding et al., 2003) at toe-off (TO). However, research utilising biomechanical measures to evaluate neuromuscular control during gait in populations prior to the development of CAI, specifically those in the acute phase of a first-time lateral ankle sprain (LAS) injury is sparse. It is possible that a sample group of participants with acute LAS may display movement insufficiencies that are continuous with, and therefore contribute to, those observed in their counterparts in the chronic phase of injury. As such, an evaluation of active movement patterns during gait in a group with first-time acute LAS injury may advance current understanding of the potentially anomalous movement patterns that persist and contribute to the onset of the chronic sequelae of CAI.

Therefore, the objective of the current study was to determine if participants with acute LAS display movement patterns continuous with their chronically impaired counterparts when compared to a non-injured control group, using kinetic (joint moment) and kinematic (angular displacement) laboratory measures around the HS and TO components of the gait cycle.

Section snippets

Participants

Sixty eight participants (forty-six males and twenty-two females; age 23.26 ± 4.94 years; body mass 76.43 ± 14.33 kg; height 1.74 ± 0.09 m) were referred from a University-affiliated hospital Emergency Department with acute, first time, LAS injury. Nineteen non-injured participants (fifteen males and four females; age 22.5 ± 1.7 years; body mass 71.55 ± 11.30 kg; height 1.74 ± 0.1 m) were recruited from the hospital catchment area population using posters and flyers to act as a control group. The injured group

Results

Regarding participant characteristics and swelling there was a statistically significant difference between the injured and control groups on the combined dependent variables, F (81,5) = 4.24, p = 0.002; Wilk’s Lambda = 0.79; partial eta squared = 0.21. When the results of the dependent variables were considered separately, swelling (F [1, 85] = 17.34, p = 0.000, partial eta squared = 0.17) was the only variable to reach statistical significance. An inspection of the mean scores indicated that injured

Discussion

The current investigation was designed to determine whether participants with acute first-time LAS display movement patterns similar to their chronically impaired counterparts with established CAI. Our findings demonstrate a number of injury-associated movement patterns consistent between a group with acute LAS injury (who reported significant functional impairment as determined by the CAIT and subscales of the FAAM) and individuals with CAI compared to non-injured controls.

In the current

Conclusion

The findings of this study advance current understanding of how individuals with acute first-time LAS achieve walking locomotion. The results suggest that participants with acute first-time LAS demonstrate bilateral differences in gait movement patterns compared to noninjured controls, which adhere intuitively to the fundamental goals of safe and efficient locomotion, and which may have potential links to the progression of chronic sequelae.

Source of funding

This study was supported by the Health Research Board (HRA_POR/2011/46) as follows: PI – Eamonn Delahunt; Co-investigators – Chris Bleakley and Jay Hertel; PhD student – Cailbhe Doherty).

Conflicts of interest

No conflicts of interest were associated with the authors and the results of this research.

Acknowledgements

This study was supported by the Health Research Board (HRA_POR/2011/46) as follows: PI – Eamonn Delahunt; Co-investigators – Chris Bleakley and Jay Hertel; PhD student – Cailbhe Doherty).

Cailbhe Doherty graduated from the UCD School of Public Health, Physiotherapy and Population Science in 2007. Upon graduation he was the recipient of a HRB post-graduate research scholarship, to undertake a longitudinal investigation into the motor control and movement predictors of chronic ankle instability. This project is currently ongoing and will contribute to his doctorate studies.

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    Cailbhe Doherty graduated from the UCD School of Public Health, Physiotherapy and Population Science in 2007. Upon graduation he was the recipient of a HRB post-graduate research scholarship, to undertake a longitudinal investigation into the motor control and movement predictors of chronic ankle instability. This project is currently ongoing and will contribute to his doctorate studies.

    Chris Bleakley graduated from the University of Ulster in 2000 with BSc (Hons) in Physiotherapy. Between 2000 and 2004, he completed his Doctorate in acute soft tissue injury management. He is currently a member of academic staff at the Ulster Sports Academy and the Course Director for the MSc Sport and Exercise Medicine at the University of Ulster. His research interests include: acute soft tissue injury management; ankle sprain prognosis and rehabilitation; cryotherapy and recovery; and monitoring injury risk factors.

    Jay Hertel is the Joe H. Gieck Professor of Sports Medicine in the Department of Kinesiology at the University of Virginia where he directs the graduate programs in Athletic Training and Sports Medicine and the Exercise & Sport Injury Laboratory. His primary area of research is lateral ankle instability which he studies from a multifactorial perspective using diverse methods ranging from laboratory-based assessments of biomechanics and motor control to evidence-based practice principles inherent to clinical epidemiology. He is a fellow of both the American College of Sports Medicine and the National Athletic Trainers’ Association.

    Brian Caulfield is a Director of the Insight Centre for Data Analytics (www.insight-centre.org), is the Lead Investigator in the Applied Research for Connected Health Centre (www.arch.ie), and is also the Dean of Physiotherapy at University College Dublin. Professor Caulfield’s research interests fall within the areas of motor control and exploitation of technology to advance rehabilitation science in the medical field. His early work focused on the role of disordered motor control in the development of soft tissue injuries (such as ankle and knee sprains) and investigation into the effectiveness of rehabilitation interventions for these injuries. More recently the focus of his work has moved towards the integration of sensor and computer technology to develop novel methods of motion and physiological analysis and therapies for medicine and sports performance enhancement, including the development of novel methodologies for electrical stimulation of muscle. He has co-authored over 200 scientific publications and patent documents.

    John Ryan is an associate clinical professor at St. Vincent’s University Hospital, and has developed several links in the area of research to a number of centres in University College Dublin. He is a consultant in Emergency Medicine, with a particular interest in Sports and Exercise Medicine. He is a board member of the Faculty of Sports and Exercise Medicine in Ireland, and has been team doctor to Leinster Rugby since 2007.

    Eamonn Delahunt graduated with a 1st Class Honours Degree from the UCD School of Physiotherapy in 2003 placing first in his class. Upon graduation he was the recipient of a prestigious IRCSET post-graduate research scholarship, to undertake and investigation into motor control and movement dysfunction in patients with chronic ankle instability. He was awarded his PhD from the UCD School of Physiotherapy and Performance Science in 2006. Eamonn has been the recipient of numerous research bursaries for his research on chronic ankle instability and has published extensively on this topic in all the leading sports medicine/science journals. To date he has published more than 50 peer-reviewed papers. He currently works as a senior lecturer in the UCD School of Public Health, Physiotherapy and Population Science, and acts as the programme coordinator for the BSc Health and Performance Science degree programme. Eamonn also has extensive clinical experience having previously worked as a Chartered Physiotherapist in the area of sports medicine. He was recently awarded the honorary title of “Specialist Member” of the Irish Society of Chartered Physiotherapists. Dr Delahunt is an editorial board member of the Journal of Science and Medicine in Sport.

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