OBJECTIVE: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. DATA SOURCES: I searched MEDLINE (1985-2001) and CINAHL (1982-2001) using the key words ankle sprain and ankle instability. DATA SYNTHESIS: Lateral ankle sprains are among the most common injuries incurred during sports participation. The ankle functions as a complex with contributions from the talocrural, subtalar, and inferior tibiofibular joints. Each of these joints must be considered in the pathomechanics and pathophysiology of lateral ankle sprains and chronic ankle instability. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control. CONCLUSIONS/RECOMMENDATIONS: Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. Appreciation of the complex anatomy and mechanics of the ankle joint and the pathomechanics and pathophysiology related to acute and chronic ankle instability is integral to the process of effectively evaluating and treating ankle injuries.

Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability.

At present, no agreement on a precise definition of agility within the sports science community exists. The term is applied to a broad range of sport contexts, but with such great inconsistency, it further complicates our understanding of what trainable components may enhance agility. A new definition of agility is proposed: "a rapid whole-body movement with change of velocity or direction in response to a stimulus". Agility has relationships with trainable physical qualities such as strength, power and technique, as well as cognitive components such as visual-scanning techniques, visual-scanning speed and anticipation. Agility testing is generally confined to tests of physical components such as change of direction speed, or cognitive components such as anticipation and pattern recognition. New tests of agility that combine physical and cognitive measures are encouraged.

/pdf/agility-literature-review-classifications-training-and-21h3p91kzr.pdf

Agility literature review: Classifications, training and testing

Study Design Prospective cohort. Objective To determine if Star Excursion Balance Test (SEBT) reach distance was associated with risk of lower extremity injury among high school basketball players. Background Although balance has been proposed as a risk factor for sports-related injury, few researchers have used a dynamic balance test to examine this relationship. Methods and Measures Prior to the 2004 basketball season, the anterior, posteromedial, and posteralateral SEBT reach distances and limb lengths of 235 high school basketball players were measured bilaterally. The Athletic Health Care System Daily Injury Report was used to document time loss injuries. After normalizing for lower limb length, each reach distance, right/left reach distance difference, and composite reach distance were examined using odds ratio and logistic regression analyses. Results The reliability of the SEBT components ranged from 0.82 to 0.87 (ICC3,1) and was 0.99 for the measurement of limb length. Logistic regression models ...

https://www.jospt.org/doi/pdf/10.2519/jospt.2006.2244

Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players

Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1–2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.

Delayed onset muscle soreness : treatment strategies and performance factors.

Context: A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. Objective: To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Data Sources: Databases used to locate peer-reviewed a...

/pdf/using-the-star-excursion-balance-test-to-assess-dynamic-504v3a7uet.pdf

Using the Star Excursion Balance Test to Assess Dynamic Postural-Control Deficits and Outcomes in Lower Extremity Injury: A Literature and Systematic Review

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.

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

0bjective: To estimate intratester and intertester reliability and learning effects during the Star Excursion Balance Tests (SEBTs). Setting: A university athletic training research laboratory. Subjects: Sixteen healthy volunteers with no history of balance disorders or significant lower extremity joint pathology. Measurements: Length of excursion was measured manually for each trial. Results: ICCs for intratester reliability were .78–.96 on day 1 and 32–.96 on day 2. ICCs for intertester reliability were .35–.84 on day 1 and .81–.93 on day 2. Significant learning effects were identified for 4 of the 8 tests. Conclusions: Estimates of intratester and intertester reliability were high, but adequate practice trials should be performed before taking baseline measures.

Intratester and Intertester Reliability during the Star Excursion Balance Tests

Study Design Retrospective study. Objective Assess range of motion, posterior talar glide, and residual joint laxity following ankle sprain in a population of athletes who have returned to unrestricted activity. Background Lateral ankle sprains occur frequently in athletic populations and the reinjury rate may be as high as 80%. In an effort to better understand risk factors for reinjury, the sequelae to injury in a sample of college athletes were assessed. Methods and Measures Twelve athletes with a history of lateral ankle sprain within the last 6 months and who had returned to sport participation were tested. Only athletes who reported never injuring the contralateral ankle were included. The injured and uninjured ankles of subjects were compared for measures of joint laxity, ankle dorsiflexion range of motion, and posterior talar glide. Friedman's test of rank order was used to analyze the laxity measures and a MANOVA was used to assess the dorsiflexion and posterior talar glide measures. Results Laxi...

https://www.jospt.org/doi/pdfplus/10.2519/jospt.2002.32.4.166

The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity

Background: The development of repetitive ankle sprains and persistent symptoms after initial ankle sprain has been termed chronic ankle instability (CAI). There is no clear indication of which mea...

https://etda.libraries.psu.edu/files/final_submissions/6180

Contributing factors to chronic ankle instability.

Study Design A between groups design was used to compare recovery following eccentric muscle damage under 2 experimental conditions. Objective To determine if a compression sleeve donned immediately after maximal eccentric exercise would enhance recovery of physical function and decrease symptoms of soreness. Background Prior investigations using ice, intermittent compression, or exercise have not shown efficacy in relieving symptoms of delayed onset muscle soreness (DOMS). To date, no study has shown the effect of continuous compression on DOMS, yet this would offer a low cost intervention for patients suffering with the symptoms of DOMS. Methods and Measures Twenty nonimpaired non-strength-trained women participated in the study. Subjects were matched for age, anthropometric data, and one repetition maximum concentric arm curl strength and then randomly placed into a control group (n = 10) or an experimental compression sleeve group (n = 10). Subjects were instructed to avoid pain-relieving modalities (...

https://www.jospt.org/doi/pdf/10.2519/jospt.2001.31.6.282

Craig R. Denegar

Papers

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

Intratester and Intertester Reliability during the Star Excursion Balance Tests

The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity

Contributing factors to chronic ankle instability.

Influence of Compression Therapy on Symptoms Following Soft Tissue Injury from Maximal Eccentric Exercise