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

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 spra...

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Bibliographic Details
Published in:	PloS one Vol. 13; no. 8; p. e0201479
Main Authors:	Jaber, Hatem, Lohman, Everett, Daher, Noha, Bains, Gurinder, Nagaraj, Abhay, Mayekar, Prajakta, Shanbhag, Manali, Alameri, Mansoor
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 13-08-2018 Public Library of Science (PLoS)
Subjects:	Ankle Ankle injuries Balance Biology and Life Sciences Center of pressure Control stability Electromyography EMG Hip Injuries Instability Lateral stability Medicine and Health Sciences Muscle function Muscles Neuromuscular system Physical therapy Posture R&D Rehabilitation Research & development Research and Analysis Methods United States > US Loma Linda California California
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Summary:	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. 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. 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0201479