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Clinical Scenario: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted. Focused Clinical Question: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI? Summary of Key Findings: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies. Clinical Bottom Line: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone. Strength of Recommendation: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI. [ABSTRACT FROM AUTHOR]

Individuals with anterior cruciate ligament reconstruction (ACLR) often fail to return to their previous level of sport performance. Although multifaceted, this inability to regain preinjury performance may be influenced by impaired plyometric ability attributable to chronic quadriceps dysfunction. Whole-body vibration (WBV) acutely improves quadriceps function and biomechanics after ACLR, but its effects on jumping performance outcomes such as jump height, the reactive strength index (RSI), and knee work and power are unknown. To evaluate the acute effects of WBV on measures of jumping performance in those with ACLR. Crossover study design. Research laboratory. Thirty-six individuals with primary, unilateral ACLR. Participants stood on a WBV platform in a mini-squat position while vibration or no vibration (control) was applied during six 60-second bouts with 2 minutes of rest between bouts. Double-leg jumping tasks were completed preintervention and postintervention (WBV or control) and consisted of jumping off a 30-cm box to 2 force plates half the participant's height away. The jumping task required participants to maximally jump vertically upon striking the force plates. Whole-body vibration did not produce significant improvements in any of the study outcomes (ie, jump height, RSI, and knee work and power) in either limb (P =.053–.839). These results suggest that a single bout of WBV is insufficient for improving jumping performance in individuals with ACLR. As such, using WBV to acutely improve jumping performance post-ACLR is likely not warranted. Future research should evaluate the effects of repeated exposure to WBV in combination with other plyometric interventions on jumping performance. [ABSTRACT FROM AUTHOR]

Context: Ankle sprains are common during sport participation and associated with long-term deficits in self-report of function. However, little is known of short-term changes in self-report of function following injury. The authors aimed to assess statistical and clinically meaningful changes in self-report of function, as measured by the Foot and Ankle Ability Measure (FAAM), during the first 2 weeks after an ankle sprain injury. Design: A retrospective analysis of electronic medical records. Methods: Eighty-eight patients, who were diagnosed with an ankle sprain injury by an athletic trainer, received usual care from an athletic trainer, and completed the FAAM during treatment at weeks 1 and 2 postinjury. The authors calculated the percentage of patients who reported clinically meaningful changes and used Wilcoxon signed-rank tests to compare differences in FAAM scores between time points. Results: Between weeks 1 and 2, significant differences were noted for the FAAM Activities of Daily Living (FAAM-ADL) (P <.001) and FAAM Sport (FAAM-Sport) (P <.001). At the patient level, 86.5% (64/74) and 85.2% (69/81) of patients reported changes that exceeded the minimal clinically important difference value for the FAAM-ADL and FAAM-Sport, respectively, between weeks 1 and 2. At week 2, 31.8% (28/88) and 47.7% (42/88) of patients reported a score below 90% on the FAAM-ADL and below 80% on the FAAM-Sport subscale, respectively. Also, 36.4% (32/88) and 25.0% (22/88) of patients reported a score of 100% on the FAAM-ADL and FAAM-Sport subscales, respectively, at week 2. Conclusions: Patients report statistically significant and meaningful improvements in self-report of function during the first 2 weeks following ankle sprain injury. However, almost half of patients still report deficits in sport function at 2 weeks postinjury. Patient-reported outcome measures such as the FAAM, can help capture the patient's perception of function and inform patient care decisions. Research efforts should explore individual response patterns to treatment. [ABSTRACT FROM AUTHOR]

Objective: Little is known about cognition's effect on jump-landing movement patterns. Design: Participants completed three baseline cognitive tasks. Then, participants performed three jump-landing trials per condition (dual-task trials (DT)): Stroop Color Word test (SCWT), Symbol Digits Modalities test (SDMT), Brooks Visuospatial task (BVT), and no concurrent cognitive task (single-task). Main Outcome Measures: Total Landing Error Scoring System (LESS) scores were used to evaluate movement patterns. Participant's reaction time (RT) for the jump-landing task was recorded. Results: LESS scores were not different between conditions (F[subscript 3], 17 = 1.77, p = 0.16). RT was different between DT-SCWT and single-task (difference = -0.107 sec, SD = 0.095) and DT-SDMT and single-task (difference = -0.164 sec, SD = 0.245). Additionally, correctness on the BVT (t[subscript 19] = 2.57, p = 0.019) and SDMT (t[subscript 19] = 2.93, p = 0.009) decreased significantly during the dual-task condition relative to baseline task scores. Conclusion: Individuals slowed their RT and were less accurate on the cognitive task during a dual-task condition to create an appropriate jump-landing movement.

Context: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. Objective: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. Design: Descriptive observational study. Setting: Laboratory. Patients or Other Participants: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. Intervention: None. Main Outcome Measures: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). Results: For T1ρ relaxation time, intraobserver (ICC = .994–.997, RMSCV = 1.31%–1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975–.980, RMSCV = 3.88%–4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. Conclusions: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable. [ABSTRACT FROM AUTHOR]

Context: Prophylactic and rehabilitative balance training is needed to maximize postural control and develop appropriate sensory organization strategies. Partially occluding vision during functional exercise may promote appropriate sensory organization strategies, but little is known about the influence of partially occluded vision on postural control in those with and without a history of musculoskeletal injury. Objective: To determine the effect of increasing levels of visual occlusion on postural control in a heterogeneous sample of those with and without chronic ankle instability (CAI). The secondary objective was to explore postural control responses to increasing levels of visual occlusion among those with unilateral and bilateral CAI relative to uninjured controls. Design: Cross-sectional. Setting: Sports medicine research laboratory. Patients or Other Participants: Twenty-five participants with unilateral CAI, 10 with bilateral CAI, and 16 participants with no history of lower extremity injury. Main Outcome Measures: All participants completed four 3-minute postural control assessments in double-limb stance under the following 4 visual conditions: (1) eyes open, (2) low occlusion, (3) high occlusion, and (4) eyes closed. Low- and high-occlusion conditions were produced using stroboscopic eyewear. Postural control outcomes included time-to-boundary minima means in the anteroposterior (TTB-AP) and mediolateral directions (TTB-ML). Repeated-measures analysis of variances tested the effects of visual condition on TTB-AP and TTB-ML. Results: Postural control under the eyes-open condition was significantly better (ie, higher) than the limited visual occlusion and eyes-closed conditions (P <.001) for TTB-AP and TTB-ML. For TTB-AP only, partially occluded vision resulted in better postural control than the eyes-closed condition (P ≤.003). Conclusions: Partial and complete visual occlusion impaired postural control during dual-limb stance in a heterogeneous sample of those with and without CAI. Stroboscopic eyewear appears to induce postural control impairments to the same extent as complete visual occlusion in the mediolateral direction. [ABSTRACT FROM AUTHOR]

Context: The modified Star Excursion Balance Test (mSEBT) and Y-Balance Test (YBT) are common dynamic postural stability assessments for individuals with chronic ankle instability (CAI). However, the reach distance measurement technique and movement strategy used during the mSEBT and YBT differ. To date, no studies have compared task performance differences on these tests in CAI patients. Objective: To determine whether individuals with CAI perform the mSEBT and YBT differently. Design: Cross-sectional. Setting: Biomechanics laboratory. Participants: Of 97 consented participants, 86 (43 females, 43 males; age 21.5 [3.3] y, height 169.8 [10.3] cm, mass 69.5 [13.4] kg), who reported ≤25 on the Cumberland Ankle Instability Tool, ≥11 on the Identification of Functional Ankle Instability, and had a history of a moderate to severe ankle sprain(s) participated. Interventions: Participants were instructed to perform the mSEBT and YBT in a predetermined counterbalanced order. Three anterior, posteromedial, and posterolateral trials of each test were completed on the involved limb after 4 practice trials. Test direction order was randomized for each participant. Main Outcome Measures: Normalized (expressed in percentage) reach distance in each direction. Paired sample t tests were performed to compare each of the 3 directions between the mSEBT and YBT. Results: Significantly shorter reach distances in the anterior (58.9% [5.8%] vs 61.4% [5.4%], P =.001) and the posteromedial (98.8% [8.6%] vs 100.8% [8.1%], P =.003) directions were noted on the mSEBT relative to the YBT. No differences in the posterolateral directions were observed. Conclusions: Within those with CAI, mSEBT and YBT normalized reach distances differ in the anterior and posteriomedial directions. As a result, clinicians and researchers should not directly compare the results of these tests. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI. [ABSTRACT FROM AUTHOR]

Context: Lateral ankle sprains (LAS) have one of the highest recurrence rates of all musculoskeletal injuries. An emphasis on rapid return to sport (RTS) following LAS likely increases reinjury risk. Unfortunately, no set of objective RTS criteria exist for LAS, forcing practitioners to rely on their own opinion of when a patient is ready to RTS. Purpose: To determine if there was consensus among published expert opinions that could help inform an initial set of RTS criteria for LAS that could be investigated in future research. Evidence Acquisition: PubMed, CINHL, and SPORTDiscus databases were searched from inception until October 2018 using a combination of keywords. Studies were included if they listed specific RTS criteria for LAS. No assessment of methodological quality was conducted because all included papers were expert opinion papers (level 5 evidence). Extracted data included the recommended domains (eg, range of motion, balance, sport-specific movement, etc) to be assessed, specific assessments for each listed domain, and thresholds (eg, 80% of the uninjured limb) to be used to determine RTS. Consensus and partial agreement were defined, a priori, as ≥75% and 50% to 75% agreement, respectively. Evidence Synthesis: Eight domains were identified within 11 included studies. Consensus was reached regarding the need to assess sport-specific movement (n = 9, 90.9%). Partial agreement was reached for the need to assess static balance (n = 7, 63.6%). The domains of pain and swelling, patient reported outcomes, range of motion, and strength were also partially agreed on (n = 6, 54.5%). No agreement was reached on specific assessments of cutoff thresholds. Conclusions: Given consensus and partial agreement results, RTS decisions following LAS should be based on sport-specific movement, static balance, patient reported outcomes, range of motion, and strength. Future research needs to determine assessments and cutoff thresholds within these domains to minimize recurrent LAS risk. [ABSTRACT FROM AUTHOR]

Limited evidence exists regarding the assessment of single-item patient-reported outcomes when patients are medically cleared to return to sport after a lateral ankle sprain (LAS) injury. To evaluate self-reports of improvement in health status, pain, function, and disability at return to sport after an LAS. Descriptive study. Sixty-nine athletic training facilities across 24 states. A total of 637 patients (males = 53.2%) who were diagnosed with an LAS, restricted from sport after injury, and subsequently medically cleared to return to sport within 60 days were included. Descriptive statistics were used to summarize scores for health status (Global Rating of Change), pain (Numeric Pain Rating Scale), function (Global Rating of Function), and disability (Global Rating of Disability). Mann-Whitney U tests were used to compare score differences between sexes. A Kaplan-Meier analysis was performed to provide a visual depiction of sex differences in the time to return to sport. Most patients sustained an LAS injury while participating in basketball, football, or soccer and were cleared to return to sport 8 days after injury. More than two-thirds of patients reported a meaningful improvement in health status between the time of injury and return to sport. However, many noted deficits related to pain (65.1%), function (86.2%), or disability (35.8%) at return to sport. No differences were seen between males and females for pain (P =.90), function (P =.68), change in health status (P =.45), or disability (P =.21) at return to sport, although males returned to sport slightly sooner than females (P =.025). Despite self-perceived improvements in health status since the time of injury, patients typically returned to sport with deficits in pain, function, and disability after an LAS. Patients may be returning to unrestricted sport participation before they feel their bodies have fully recovered from the injury. [ABSTRACT FROM AUTHOR]

Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in alterations of talar cartilage loading behavior. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading. To identify mechanical and sensorimotor outcomes that are linked with the magnitude of talar cartilage deformation after a static loading protocol in patients with and those without CAI. Cross-sectional study. Laboratory setting. Thirty individuals with CAI and 30 healthy individuals. After a 60-minute off-loading period, ultrasonographic images of the talar cartilage were acquired immediately before and after a 2-minute static loading protocol (single-legged stance). Talar cartilage images were obtained and manually segmented to enable calculation of medial, lateral, and overall average talar thickness. The percentage change, relative to the average baseline thickness, was used for further analysis. Mechanical (ankle joint laxity) and sensorimotor (static balance and Star Excursion Balance Test) outcomes were captured. Partial correlations were computed to determine associations between cartilage deformation magnitude and the mechanical and sensorimotor outcomes after accounting for body weight. In the CAI group, greater inversion laxity was associated with greater overall (r = −0.42, P =.03) and medial (r = −0.48, P =.01) talar cartilage deformation after a 2-minute static loading protocol. Similarly, poorer medial-lateral static balance was linked with greater overall (r = 0.47, P =.01) and lateral (r = 0.50, P =.01) talar cartilage deformation. In the control group, shorter posterolateral Star Excursion Balance Test reach distance was associated with greater lateral cartilage deformation (r = 0.42, P =.03). No other significant associations were observed. In those with CAI, inversion laxity and poor static postural control were moderately associated with greater talar cartilage deformation after a 2-minute static loading protocol. These results suggest that targeting mechanical instability and poor balance in those with CAI via intervention strategies may improve how the talar cartilage responds to static loading conditions. [ABSTRACT FROM AUTHOR]

Context: Following a lateral ankle sprain, ~40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and, therefore, possibly prevent reinjury. Objective: To determine if an acute bout of WBV can improve AMI and proprioception in individuals with CAI. Design and Participants: The authors examined if an acute bout of WBV can improve AMI and proprioception in individuals with CAI with a repeated-measures design. A total of 10 young adults with CAI and 10 age-matched healthy controls underwent a control, sham, and WBV condition in randomized order. Setting: Biomechanics laboratory. Intervention: WBV. Main Outcome Measures: Motoneuron pool recruitment was assessed via Hoffmann reflex (H-reflex) in the soleus. Proprioception was evaluated using ankle joint position sense at 15° and 20° of inversion. Both were assessed prior to, immediately following, and 30 minutes after the intervention (pretest, posttest, and 30mPost, respectively). Results: Soleus maximum H-reflex:M-response (H:M) ratios were 25% lower in the CAI group compared with the control group (P = .03). Joint position sense mean constant error did not differ between groups (P = .45). Error at 15° in the CAI (pretest 0.8 [1.6], posttest 2.0 [2.8], 30mPost 2.0 [1.9]) and control group (pretest 0.8 [2.0], posttest 0.6 [2.9], 30mPost 0.5 [2.1]) did not improve post-WBV. Error at 20° did not change posl-WBV in the CAI (pretest 1.3 [1.7], posttest 1.0 [2.4], 30mPost 1.5 [2.2]) or control group (pretest -0.3 [3.0], posttest 0.8 [2.1 ], 30mPost 0.6 [1.8]). Conclusion: AMI is present in the involved limb of individuals with CAI. The acute response following a single bout of WBV did not ameliorate the presence of AMI nor improve proprioception in those with CAI. [ABSTRACT FROM AUTHOR]

Context: Neuromuscular control deficit has been reported in people with chronic ankle instability (CAI) and hopping exercises have been recommended as a functional training tool to prevent lower limb injury, but its effects on lower-extremity neuromuscular control in those with CAI are unclear. Objective: To investigate the effect of hop stabilization training on neuromuscular control and self-reported function in college basketball players with CAI. Study Design: A randomized controlled trial. Setting: Research Laboratory. Patients (or Other Participants): A total of 28 college basketball players with CAI were randomly assigned to the experimental hop stabilization group (age = 22.78 [3.09] y, weight = 82.59 [9.51] kg, and height = 187.96 [7.93] cm) or the control group (age = 22.57 [2.76] y, weight = 78.35 [7.02] kg, and height = 185.69 [7.28] cm). Intervention: Participants in the experimental group performed supervised hop stabilization exercises 3 times per week for 6 weeks. The control group received no intervention. Main Outcome Measures: Preparatory and reactive muscle activation levels and muscle onset time were assessed from 8 lower-extremity muscles during a jump-landing task before and after the 6-week training program. Results: Significant improvements in preparatory muscle activation, reactive muscle activation, and muscle onset time were noted across the lowerextremity in the experimental group relative to the control group (P < .05). Self-reported function also improved in the experimental group relative to the control group (P< .05). Conclusions: These findings demonstrate that 6 weeks of hop stabilization training is effective in improving neuromuscular control and self-reported function in college basketball players with CAI. Hop stabilization exercises can be incorporated into the rehabilitation program for CAI. [ABSTRACT FROM AUTHOR]

Context: Preparticipation examinations are the standard approach for assessing poor movement quality that would increase musculoskeletal injury risk. However, little is known about how core stability influences functional movement patterns. Objective: The primary purpose of this study was to determine the effect of an 8-week core stability program on functional movement patterns in college athletes. The secondary purpose was to determine if the core stability training program would be more effective in those with worse movement quality (ie, ≤14 baseline functional movement screen [FMS] score). Design: Quasi-experimental design. Setting: Athletic training facility. Participants: One-hundred college athletes. Main Outcome Measures: Functional movement patterns included the FMS, lateral step-down, and Y balance test and were assessed before and after the 8-week program. Intervention: Participants were placed into one of the 2 groups: intervention and control. The intervention group was required to complete a core stability training program that met 3 times per week for 8 weeks. Results: Significant group × time interactions demonstrated improvements in FMS, lateral step-down, and Y balance test scores in the experimental group relative to the control group (P <.001). Independent sample t tests demonstrate that change scores were larger (greater improvement) for the FMS total score and hurdle step (P <.001) in athletes with worse movement quality. Conclusions: An 8-week core stability training program enhances functional movement patterns and dynamic postural control in college athletes. The benefits are more pronounced in college athletes with poor movement quality. [ABSTRACT FROM AUTHOR]