Predicting balance improvements following STARS treatments in chronic ankle instability participants

Erik A Wikstrom, Patrick O McKeon, Erik A Wikstrom, Patrick O McKeon

Abstract

Objectives: Sensory Targeted Ankle Rehabilitation Strategies that stimulate sensory receptors improve postural control in chronic ankle instability participants. However, not all participants have equal responses. Therefore, identifying predictors of treatment success is needed to improve clinician efficiency when treating chronic ankle instability. Therefore, the purpose was to identify predictors of successfully improving postural control in chronic ankle instability participants.

Design: Secondary data analysis.

Methods: Fifty-nine participants with self-reported chronic ankle instability participated. The condition was defined as a history of at least two episodes of "giving way" within the past 6 months; and limitations in self-reported function as measured by the Foot and Ankle Ability Measure. Participants were randomized into three treatment groups (plantar massage, ankle joint mobilization, calf stretching) that received 6, 5-min treatment sessions over a 2-week period. The main outcome measure was treatment success, defined as a participant exceeding the minimal detectable change score for a clinician-oriented single limb balance test.

Results: Participants with ≥3 balance test errors had a 73% probability of treatment success following ankle joint mobilizations. Participants with a self-reported function between limb difference <16.07% and who made >2.5 errors had a 99% probability of treatment success following plantar massage. Those who sustained ≥11 ankle sprains had a 94% treatment success probability following calf stretching.

Conclusions: Self-reported functional deficits, worse single limb balance, and number of previous ankle sprains are important characteristics when determining if chronic ankle instability participants will have an increased probability of treatment success.

Keywords: Joint instability; Joint mobilization; Massage; Musculoskeletal manipulations; Static stretching.

Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

References

    1. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.
    1. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle spranis in the united states. J Bone Joint Surg Am. 2010;92(13):2279–2284.
    1. McKay GD. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103–108.
    1. Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):1–4.
    1. Attenborough AS, Hiller CE, Smith RM, et al. Chronic ankle instability in sporting populations. Sports Med. 2014;44(11):1545–1556.
    1. Mandarakas M, Pourkazemi F, Sman A, et al. Systematic review of chronic ankle instability in children. J Foot Ankle Res. 2014;7(1):21.
    1. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium. J Orthop Sports Phsy Ther. 2013;43(8):585–591.
    1. Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequenes: a constraints-based approach. Sports Med. 2013;43(6):385–393.
    1. Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015;50(10):1019–1033.
    1. Hubbard-Turner T, Turner MJ. Physical activity levels in college students with chronic ankle instability. J Athl Train. 2015;50(7):742–747.
    1. Hintermann B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 2002;30(3):402–409.
    1. Wang HK, Chen CH, Shiang TY, et al. Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility. Arch Phys Med Rehabil. 2006;87(6):821–825.
    1. Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238–244.
    1. McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103–1111.
    1. Ross SE, Arnold BL, Blackburn JT, et al. Enhanced balance associated with coordination training with stochastic resonance stimulation in subjects with functional ankle instability: an experimental trial. J NeuroEngineering and Rehab. 2007;4(47)
    1. Hoch MC, Mullineaux DR, Andreatta RD, et al. Effect of a 2-week joint mobilization intervention on single-limb balance and ankle arthrokinematics in those with chronic ankle instability. J Sport Rehab. 2014;23(1):18–26.
    1. LeClaire JE, Wikstrom EA. Massage for postural control in those with chronic ankle instability. Athl Train Sports Health Care. 2012;4(5):213–219.
    1. McKeon PO, Wikstrom EA. Sensory-targeted ankle rehabilitation strategies for chronic ankle instability. Med Sci Sports Exer. 2015 doi: 10.1249/MSS.0000000000000859.
    1. McGinn TG, Guyatt GH, Wyer PC, et al. Users’ guides to the meduical literatuer: XXII: how to use articles about clinical decision rules. JAMA. 2000;284:79–84.
    1. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. a review and suggested modification of methodological standards. JAMA. 1997;277:488–494.
    1. Brennan GP, Fritz JM, Hunter SJ, et al. Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: results of a randomized clinical trial. Spine. 2006;31:623–631.
    1. Vicenzino B, Collins N, Cleland J, et al. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010;44:862–866.
    1. Whitman JM, Cleland JA, Mintken P, et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Sports Phys Ther. 2009;39(3):188–200.
    1. Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012;40(4):41–51.
    1. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium. J Orthop Sports Phys Ther. 2013;43(8):585–591.
    1. Bennell KL, Talbot RC, Wajswelner H, et al. Intra-rater and inter-rater reliability of a weightbearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44(3):175–180.
    1. Riemann BL, Guskiewicz KM, Shields WW. Relationship between clinical and forceplate measures of postural stability. J Sport Rehab. 1999;8:71–82.
    1. McKeon PO, Wikstrom EA. The responsiveness of multifactorial outcome measures for those with chronic ankle instability. Br J Sport Med. 2015;49(S1):A20.
    1. McKeon PO. First Words: Cultivating functional variability: The dynamical systems approach to rehabilitation. Athl Ther Today. 2009;14(4):1–3.
    1. Wikstrom EA, Naik S, Lodha N, Cauraugh JH. Balance capabilities after lateral ankle trauma and intervention: a meta-analysis. Med Sci Sports Exerc. 2009;41(6):1287–1295.
    1. Burcal CJ, Trier AY, Wikstrom EA. Balance training vs. balance training with STARS in CAI patients: a raondomized controlled trial. J Sport Rehab. 2016 .

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