The Effects of Fatigue and Chronic Ankle Instability on Dynamic Postural Control

Abstract

OBJECTIVE: Deficits in static postural control related to chronic ankle instability (CAI) and fatigue have been investigated separately, but little evidence links these factors to performance of dynamic postural control. Our purpose was to investigate the effects of fatigue and CAI on performance measures of a dynamic postural-control task, the Star Excursion Balance Test. DESIGN AND SETTING: For each of the 3 designated reaching directions, 4 separate 5 (condition) x 2 (time) x 2 (side) analyses of variance with a between factor of group (CAI, healthy) were calculated for normalized reach distance and maximal ankle-dorsiflexion, knee-flexion, and hip-flexion angles. All data were collected in the Athletic Training Research Laboratory. SUBJECTS: Thirty subjects (16 healthy, 14 CAI) participated. MEASUREMENTS: All subjects completed 5 testing sessions, during which sagittal-plane kinematics and reaching distances were recorded while they performed 3 reaching directions (anterior, medial, and posterior) of the Star Excursion Balance Test, with the same stance leg before and after different fatiguing conditions. The procedure was repeated for both legs during each session. RESULTS: The involved side of the CAI subjects displayed significantly smaller reach distance values and knee-flexion angles for all 3 reaching directions compared with the uninjured side and the healthy group. The effects of fatigue amplified this trend. CONCLUSIONS: Chronic ankle instability and fatigue disrupted dynamic postural control, most notably by altering control of sagittal-plane joint angles proximal to the ankle.

Figures

Figure 1. Reaching directions for the SEBT

A, Anterior. B, Medial. C, Posterior

Figure 2. Group × side interaction for reach distance as a percentage of leg length (MAXD) in the anterior reaching direction (*P < .05)

Figure 3. Group × time interaction for knee flexion in the anterior reaching direction (*P < .05)

Figure 4. Group × day × side interaction for hip flexion in the anterior reaching direction (*P < .05)

A, Healthy subjects. B, Chronic ankle instability subjects

Figure 5. Group × side interaction for reach distance as a percentage of leg length (MAXD) in the medial reaching direction (*P < .05)

Figure 6. Group × day × time interaction for knee flexion in the medial direction(**P < .01)

A, Healthy subjects. B, Chronic ankle instability subjects

Figure 7. Group × time interaction for knee flexion in the medial reaching direction (*P < .05)

Figure 8. Group × day interaction for knee flexion in the medial direction (*P < .05)

Figure 9. Group × day × side × time interaction for reach distance as a percentage of leg length (MAXD) in the posterior reaching direction

A, Healthy subjects, uninvolved side. B, Healthy subjects, involved side. C, Chronic ankle instability subjects, uninvolved side. D, Chronic ankle instability subjects, involved side

Figure 10. Group × side interaction for reach distance as a percentage of leg length (A) and hip-flexion angle (B) in the posterior reaching direction (side difference, *P < .05; group difference, †P < .05)