Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes

Ahmad H Alghadir, Zaheen A Iqbal, Amir Iqbal, Hashim Ahmed, Swapnil U Ramteke, Ahmad H Alghadir, Zaheen A Iqbal, Amir Iqbal, Hashim Ahmed, Swapnil U Ramteke

Abstract

Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.

Keywords: Y-balance test; ankle joint; balance; musculoskeletal injury; prevention and promotion of the health; rehabilitation; sport performance; sprain.

Conflict of interest statement

The authors declare no conflict of interest. The datasets used in this study are available from the corresponding author on request.

References

    1. Fong D.T.-P., Hong Y., Chan L.-K., Yung P.S.-H., Chan K.-M. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73–94. doi: 10.2165/00007256-200737010-00006.
    1. Fong D.T.-P., Man C.-Y., Yung P.S.-H., Cheung S.-Y., Chan K.-M. Sport-related ankle injuries attending an accident and emergency department. Injury. 2008;39:1222–1227. doi: 10.1016/j.injury.2008.02.032.
    1. Bellows R., Wong C.K. The effect of bracing and balance training on ankle sprain incidence among athletes: A systematic review with meta-analysis. Int. J. Sports Phys. Ther. 2018;13:379. doi: 10.26603/ijspt20180379.
    1. Dick R., Agel J., Marshall S.W. National Collegiate Athletic Association injury surveillance system commentaries: Introduction and methods. J. Athl. Train. 2007;42:173.
    1. Hootman J.M., Dick R., Agel J. Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. J. Athl. Train. 2007;42:311.
    1. Mckay G.D., Goldie P., Payne W.R., Oakes B. Ankle injuries in basketball: Injury rate and risk factors. Br. J. Sports Med. 2001;35:103–108. doi: 10.1136/bjsm.35.2.103.
    1. Youdas J.W., McLean T.J., Krause D.A., Hollman J.H. Changes in active ankle dorsiflexion range of motion after acute inversion ankle sprain. J. Sport Rehabil. 2009;18:358–374. doi: 10.1123/jsr.18.3.358.
    1. Safran M.R., Benedetti R.S., Mandelbaum B. Lateral ankle sprains: A comprehensive review: Part 1: Etiology, pathoanatomy, histopathogenesis, and diagnosis. Med. Sci. Sports Exerc. 1999;31(Suppl. 7):S429–S437. doi: 10.1097/00005768-199907001-00004.
    1. Yeung M., Chan K.-M., So C., Yuan W. An epidemiological survey on ankle sprain. Br. J. Sports Med. 1994;28:112–116. doi: 10.1136/bjsm.28.2.112.
    1. Hintermann B., Boss A., Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am. J. Sports Med. 2002;30:402–409. doi: 10.1177/03635465020300031601.
    1. Hupperets M.D., Verhagen E.A., Van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: Randomised controlled trial. BMJ. 2009;339:b2684. doi: 10.1136/bmj.b2684.
    1. Ivins D. Acute ankle sprain: An update. Am. Fam. Physician. 2006;74:1714–1720.
    1. Barker H.B., Beynnon B.D., Renström P.A. Ankle injury risk factors in sports. Sports Med. 1997;23:69–74. doi: 10.2165/00007256-199723020-00001.
    1. Ross S.E., Guskiewicz K.M., Yu B. Single-leg jump-landing stabilization times in subjects with functionally unstable ankles. J. Athl. Train. 2005;40:298.
    1. Brown C., Ross S., Mynark R., Guskiewicz K. Assessing functional ankle instability with joint position sense, time to stabilization, and electromyography. J. Sport Rehabil. 2004;13:122–134. doi: 10.1123/jsr.13.2.122.
    1. Nakagawa L., Hoffman M. Performance in static, dynamic, and clinical tests of postural control in individuals with recurrent ankle sprains. J. Sport Rehabil. 2004;13:255–268. doi: 10.1123/jsr.13.3.255.
    1. McGuine T.A., Keene J.S. Do proprioceptive training programmes reduce the risk of ankle sprains in athletes? Int. Sportmed J. 2003;4:1–8.
    1. Bahr R. Can we prevent ankle sprains. Evid. Based Sports Med. 2007:519–538.
    1. Brown C.N., Mynark R. Balance deficits in recreational athletes with chronic ankle instability. J. Athl. Train. 2007;42:367.
    1. Verhagen E., Van der Beek A., Twisk J., Bouter L., Bahr R., Van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: A prospective controlled trial. Am. J. Sports Med. 2004;32:1385–1393. doi: 10.1177/0363546503262177.
    1. McGovern R.P., Martin R.L. Managing ankle ligament sprains and tears: Current opinion. Open Access J. Sports Med. 2016;7:33.
    1. Hoffman M., Schrader J., Applegate T., Koceja D. Unilateral postural control of the functionally dominant and nondominant extremities of healthy subjects. J. Athl. Train. 1998;33:319.
    1. Plisky P.J., Rauh M.J., Kaminski T.W., Underwood F.B. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J. Orthop. Sports Phys. Ther. 2006;36:911–919. doi: 10.2519/jospt.2006.2244.
    1. Hjermstad M.J., Fayers P.M., Haugen D.F., Caraceni A., Hanks G.W., Loge J.H., Fainsinger R., Aass N., Kaasa S., Collaborative E.P.C.R. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: A systematic literature review. J. Pain Symptom Manag. 2011;41:1073–1093. doi: 10.1016/j.jpainsymman.2010.08.016.
    1. Hallaįeli H., Uruį V., Uysal H.H., Özden R., Hallaįeli Į., Soyuer F., Parpucu T.I., Yengil E., Cavlak U. Normal hip, knee and ankle range of motion in the Turkish population. Acta Orthop. Traumatol. Turc. 2014;48:37–42. doi: 10.3944/AOTT.2014.3113.
    1. Kolber M.J., Hanney W.J. The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: A technical report. Int. J. Sports Phys. Ther. 2012;7:306.
    1. Payne K.A., Berg K., Latin R.W. Ankle injuries and ankle strength, flexibility, and proprioception in college basketball players. J. Athl. Train. 1997;32:221.
    1. Kim C.-Y., Choi J.-D. Comparison between ankle proprioception measurements and postural sway test for evaluating ankle instability in subjects with functional ankle instability. J. Back Musculoskelet. Rehabil. 2016;29:97–107. doi: 10.3233/BMR-150603.
    1. Glencross D. Position sense following joint injury. J. Sports Med. Phys. Fit. 1981;21:23–27.
    1. Springer B.A., Marin R., Cyhan T., Roberts H., Gill N.W. Normative values for the unipedal stance test with eyes open and closed. J. Geriatr. Phys. Ther. 2007;30:8–15. doi: 10.1519/00139143-200704000-00003.
    1. Zafar H., Alghadir A.H., Iqbal Z.A., Iqbal A., Anwer S., Alnahdi A.H. Influence of different jaw positions on dynamic balance using Y-balance test. Brain Behav. 2020;10:e01507. doi: 10.1002/brb3.1507.
    1. Alhusaini A.A., Alnahdi A.H., Melam G., Aldali A.Z., Al-Mutairi M.S., Alenzi A.R. Normative values of Y Balance Test and isometric muscle strength among Saudi school children. Phys. Med. Rehabil. Kurortmed. 2017;27:164–170. doi: 10.1055/s-0043-105503.
    1. Alnahdi A.H., Alderaa A.A., Aldali A.Z., Alsobayel H. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults. J. Phys. Sci. 2015;27:3917–3921. doi: 10.1589/jpts.27.3917.
    1. Plisky P.J., Gorman P.P., Butler R.J., Kiesel K.B., Underwood F.B., Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N. Am. J. Sports Phys. Ther. 2009;4:92–99.
    1. Smith C.A., Chimera N.J., Warren M. Association of y balance test reach asymmetry and injury in division I athletes. Med. Sci. Sports Exerc. 2015;47:136–141. doi: 10.1249/MSS.0000000000000380.
    1. Gribble P.A., Hertel J. Considerations for normalizing measures of the Star Excursion Balance Test. Meas. Phys. Educ. Exerc. Sci. 2003;7:89–100. doi: 10.1207/S15327841MPEE0702_3.
    1. Rose A., Lee R.J., Williams R.M., Thomson L.C., Forsyth A. Functional instability in non-contact ankle ligament injuries. Br. J. Sports Med. 2000;34:352–358. doi: 10.1136/bjsm.34.5.352.
    1. Huebscher M., Zech A., Pfeifer K., Haensel F., Vogt L., Banzer W. Neuromuscular training for sports injury prevention: A systematic review. Med. Sci. Sports Exerc. 2010;42:413–421. doi: 10.1249/MSS.0b013e3181b88d37.
    1. Hubbard-Turner T., Turner M.J. Physical activity levels in college students with chronic ankle instability. J. Athl. Train. 2015;50:742–747. doi: 10.4085/1062-6050-50.3.05.
    1. McKay G., Goldie P., Payne W., Oakes B., Watson L. A prospective study of injuries in basketball: A total profile and comparison by gender and standard of competition. J. Sci. Med. Sport. 2001;4:196–211. doi: 10.1016/S1440-2440(01)80030-X.
    1. O’Loughlin P.F., Hodgkins C.W., Kennedy J.G. Ankle sprains and instability in dancers. Clin. Sports Med. 2008;27:247–262. doi: 10.1016/j.csm.2007.12.006.
    1. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J. Athl. Train. 2002;37:364.
    1. Hiller C.E., Kilbreath S.L., Refshauge K.M. Chronic ankle instability: Evolution of the model. J. Athl. Train. 2011;46:133–141. doi: 10.4085/1062-6050-46.2.133.
    1. Hubbard T.J., Hertel J. Mechanical contributions to chronic lateral ankle instability. Sports Med. 2006;36:263–277. doi: 10.2165/00007256-200636030-00006.
    1. Freeman M., Dean M., Hanham I. The etiology and prevention of functional instability of the foot. J. Bone Jt. Surg. Br. Vol. 1965;47:678–685. doi: 10.1302/0301-620X.47B4.678.
    1. Freeman M. Instability of the foot affer injuries to the lateral ligament of the ankle. J. Bone Jt. Surg. Br. Vol. 1965;47:669–677. doi: 10.1302/0301-620X.47B4.669.
    1. Lohrer H., Nauck T., Gehring D., Wissler S., Braag B., Gollhofer A. Differences between mechanically stable and unstable chronic ankle instability subgroups when examined by arthrometer and FAAM-G. J. Orthop. Surg. Res. 2015;10:32. doi: 10.1186/s13018-015-0171-2.
    1. Gabriner M.L., Houston M.N., Kirby J.L., Hoch M.C. Contributing factors to star excursion balance test performance in individuals with chronic ankle instability. Gait Posture. 2015;41:912–916. doi: 10.1016/j.gaitpost.2015.03.013.
    1. Springer S., Gottlieb U., Moran U., Verhovsky G., Yanovich R. The correlation between postural control and upper limb position sense in people with chronic ankle instability. J. Foot Ankle Res. 2015;8:23. doi: 10.1186/s13047-015-0082-9.
    1. De Ridder R., Willems T., Vanrenterghem J., Roosen P. Effect of a home-based balance training protocol on dynamic postural control in subjects with chronic ankle instability. Int. J. Sports Med. 2015;36:596–602. doi: 10.1055/s-0034-1396823.
    1. Hoch M.C., Farwell K.E., Gaven S.L., Weinhandl J.T. Weight-bearing dorsiflexion range of motion and landing biomechanics in individuals with chronic ankle instability. J. Athl. Train. 2015;50:833–839. doi: 10.4085/1062-6050-50.5.07.
    1. Hubbard T.J., Cordova M. Mechanical instability after an acute lateral ankle sprain. Arch. Phys. Med. Rehabil. 2009;90:1142–1146. doi: 10.1016/j.apmr.2009.01.020.
    1. Holme E., Magnusson S., Becher K., Bieler T., Aagaard P., Kjaer M. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand. J. Med. Sci. Sports. 1999;9:104–109. doi: 10.1111/j.1600-0838.1999.tb00217.x.
    1. Verhagen E.A., van Mechelen W., de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin. J. Sport Med. 2000;10:291–296. doi: 10.1097/00042752-200010000-00012.
    1. Wester J.U., Jespersen S.M., Nielsen K.D., Neumann L. Wobble board training after partial sprains of the lateral ligaments of the ankle: A prospective randomized study. J. Orthop. Sport Phys. 1996;23:332–336. doi: 10.2519/jospt.1996.23.5.332.
    1. Doherty C., Bleakley C.M., Hertel J., Caulfield B., Ryan J., Delahunt E. Laboratory measures of postural control during the star excursion balance test after acute first-time lateral ankle sprain. J. Athl. Train. 2015;50:651–664. doi: 10.4085/1062-6050-50.1.09.
    1. Doherty C., Bleakley C., Hertel J., Caulfield B., Ryan J., Delahunt E. Dynamic balance deficits 6 months following first-time acute lateral ankle sprain: A laboratory analysis. J. Orthop. Sport Phys. 2015;45:626–633. doi: 10.2519/jospt.2015.5653.
    1. Guskiewicz K.M., Perrin D.H. Research and clinical applications of assessing balance. J. Sport Rehabil. 1996;5:45–63. doi: 10.1123/jsr.5.1.45.
    1. Hoffman M.A., Koceja D.M. Dynamic balance testing with electrically evoked perturbation: A test of reliability. Arch. Phys. Med. Rehabil. 1997;78:290–293. doi: 10.1016/S0003-9993(97)90036-8.
    1. Rozzi S.L., Lephart S.M., Sterner R., Kuligowski L. Balance training for persons with functionally unstable ankles. J. Orthop. Sport Phys. 1999;29:478–486. doi: 10.2519/jospt.1999.29.8.478.
    1. Caulfield B., Garrett M. Functional instability of the ankle: Differences in patterns of ankle and knee movement prior to and post landing in a single leg jump. Int. J. Sports Med. 2002;23:64–68. doi: 10.1055/s-2002-19272.
    1. Kurz M., Stergiou N. Applied dynamic systems theory for the analysis of movement. Innov. Anal. Hum. Mov. 2004:93–117.
    1. Michelson J.D., Hutchins C. Mechanoreceptors in human ankle ligaments. J. Bone Jt. Surg. Br. Vol. 1995;77:219–224. doi: 10.1302/0301-620X.77B2.7706334.
    1. Nashner L. Practical Biomechanics and Physiology of Balance. In: Jacobson G.P., Newman C.W., Kartush J.M., editors. Handbook of Balance Function Testing. Mosby Year-Book; St. Louis, MO, USA: 1993. pp. 261–279.
    1. Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000;29:361–371. doi: 10.2165/00007256-200029050-00005.
    1. Olmsted L.C., Carcia C.R., Hertel J., Shultz S.J. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J. Athl. Train. 2002;37:501.
    1. Konradsen L., Magnusson P. Increased inversion angle replication error in functional ankle instability. Knee Surg. Sports Traumatol. Arthrosc. 2000;8:246–251. doi: 10.1007/s001670000124.
    1. Sekir U., Yildiz Y., Hazneci B., Ors F., Aydin T. Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability. Knee Surg. Sports Traumatol. Arthrosc. 2007;15:654–664. doi: 10.1007/s00167-006-0108-8.
    1. Fu A.S., Hui-Chan C.W. Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains. Am. J. Sports Med. 2005;33:1174–1182. doi: 10.1177/0363546504271976.
    1. Lee A.J., Lin W.-H. Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin. Biomech. 2008;23:1065–1072. doi: 10.1016/j.clinbiomech.2008.04.013.
    1. Witchalls J., Waddington G., Blanch P., Adams R. Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus. J. Athl. Train. 2012;47:627–634. doi: 10.4085/1062-6050-47.6.12.
    1. Khin-Myo-Hla, Ishii T., Sakane M., Hayashi K. Effect of anesthesia of the sinus tarsi on peroneal reaction time in patients with functional instability of the ankle. Foot Ankle Int. 1999;20:554–559. doi: 10.1177/107110079902000903.
    1. Bullock-Saxton J. Sensory changes associated with severe ankle sprain. Scand. J. Rehabil. Med. 1995;27:161–167.
    1. Hertel J., Buckley W.E., Denegar C.R. Serial testing of postural control after acute lateral ankle sprain. J. Athl. Train. 2001;36:363.
    1. Hertel J., Denegar C.R., Buckley W.E., Sharkey N.A., Stokes W.L. Effect of rearfoot orthotics on postural sway after lateral ankle sprain. Arch. Phys. Med. Rehabil. 2001;82:1000–1003. doi: 10.1053/apmr.2001.22349.
    1. Yong M.-S., Lee Y.-S. Effect of ankle proprioceptive exercise on static and dynamic balance in normal adults. J. Phys. Sci. 2017;29:242–244. doi: 10.1589/jpts.29.242.
    1. Lee M.-Y., Lee H.-Y., Yong M.-S. Characteristics of cervical position sense in subjects with forward head posture. J. Phys. Sci. 2014;26:1741–1743. doi: 10.1589/jpts.26.1741.
    1. Bleakley C.M., O’Connor S.R., Tully M.A., Rocke L.G., MacAuley D.C., Bradbury I., Keegan S., McDonough S.M. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ. 2010;340:c1964. doi: 10.1136/bmj.c1964.
    1. Van Rijn R.M., van Heest J.A., van der Wees P., Koes B.W., Bierma-Zeinstra S.M. Some benefit from physiotherapy intervention in the subgroup of patients with severe ankle sprain as determined by the ankle function score: A randomised trial. Aust. J. Physiother. 2009;55:107–113. doi: 10.1016/S0004-9514(09)70040-6.
    1. Martin R.L., Davenport T.E., Paulseth S., Wukich D.K., Godges J.J., Altman R.D., Delitto A., DeWitt J., Ferland A., Fearon H. Ankle stability and movement coordination impairments: Ankle ligament sprains: Clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. J. Orthop. Sport Phys. 2013;43:A1–A40.
    1. Eils E., Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med. Sci. Sports Exerc. 2001;33:1991–1998. doi: 10.1097/00005768-200112000-00003.
    1. Hale S.A., Fergus A., Axmacher R., Kiser K. Bilateral improvements in lower extremity function after unilateral balance training in individuals with chronic ankle instability. J. Athl. Train. 2014;49:181–191. doi: 10.4085/1062-6050-49.2.06.
    1. McHugh M.P., Tyler T.F., Tetro D.T., Mullaney M.J., Nicholas S.J. Risk factors for noncontact ankle sprains in high school athletes: The role of hip strength and balance ability. Am. J. Sports Med. 2006;34:464–470. doi: 10.1177/0363546505280427.
    1. Gribble P.A., Delahunt E., Bleakley C., Caulfield B., Docherty C., Fourchet F., Fong D., Hertel J., Hiller C., Kaminski T. Selection Criteria for Patients with Chronic Ankle Instability in Controlled Research: A Position Statement of the International Ankle Consortium. Inc. JOSPT; Alexandria, VA, USA: 2013.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner