Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability

Hatem Jaber, Everett Lohman, Noha Daher, Gurinder Bains, Abhay Nagaraj, Prajakta Mayekar, Manali Shanbhag, Mansoor Alameri, Hatem Jaber, Everett Lohman, Noha Daher, Gurinder Bains, Abhay Nagaraj, Prajakta Mayekar, Manali Shanbhag, Mansoor Alameri

Abstract

Background/purpose: Ankle sprains are common and potentially disabling musculoskeletal injuries that often lead to chronic ankle instability (CAI). CAI has been linked to impairments in postural and neuromuscular control; however, inconsistent findings have been reported. Individuals who experience a lateral ankle sprain, but do not develop instability, termed copers, may adapt different neuromuscular control strategies after injury. This study aimed to compare postural control and electromyographic (EMG) activity of hip and ankle muscles during the performance of the Star Excursion Balance Test (SEBT) in subjects with and without CAI.

Method: 48 participants were classified into three groups (16 control, 16 copers, 16 CAI) based on ankle sprain history and Cumberland Ankle Instability Tool score. Outcome measures included normalized reach distance, center of pressure (COP), and integrated EMG activation of gluteus medius (Gmed), gluteus maximus (Gmax), tibialis anterior (TA), and peroneus longus (PL) during each reach direction of SEBT.

Results: Compared to copers and controls, CAI group demonstrated significantly diminished postural control (reach distance and COP measures, p< 0.05) and less EMG activity of TA during the anterior direction (CAI: 33.1% ± 10.1% versus copers: 44.8% ± 12.7% versus controls: 51.7% ± 8.4%, p<0.01) and Gmax in the posterolateral direction (CAI: 25.6% ± 9.4% versus copers: 37.5% ± 13.8% versus controls: 40.2% ± 17.2%, p = 0.011).

Conclusion: Alteration in proximal and distal muscle activity appears to negatively affect postural control and quality of movement, which may lead to prolonged functional impairments. Hence, implementing hip and ankle muscle exercises in the rehabilitation of ankle instability might benefit these patients.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Star Excursion Balance Test for…
Fig 1. Star Excursion Balance Test for a left test leg.
The box represents the force platform. The lines represent the three directions (Anterior, posteromedial, and posterolateral) used in the analysis.
Fig 2. Mean onset time in seconds…
Fig 2. Mean onset time in seconds of gluteus maximus—Gmax (anterior direction) and gluteus medius—Gmed (posteromedial direction) among study groups.

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