Chronic Ankle Instability and Fatigue Create Proximal Joint Alterations during Performance of the Star Excursion Balance Test

Abstract

The combined effects of chronic ankle instability (CAI) and lower extremity fatigue on measures of neuromuscular control have not been well established. The purpose of this study was to investigate the influence of CAI on the performance of a dynamic postural control task, the Star Excursion Balance Test (SEBT), after fatiguing activities. Thirty subjects with (n = 14) or without (n = 16) unilateral CAI completed anterior, medial, and posterior reaching directions of the SEBT performed before and after a lunging fatigue protocol and an open chain ankle isokinetic fatigue protocol. Pre-post fatigue change scores were calculated for sagittal plane kinematics of the stance leg and the normalized reach distances (%MAXD). Using a regression model, group and kinematic data were used to explain between subject differences in %MAXD. For each reaching direction, a separate analysis was completed for the two fatigue conditions. When reaching anteriorly after the lunge fatigue condition, CAI and the changes in knee and hip flexion predicted approximately 49 % of the variance in %MAXD (R² = .487; p = .001). When reaching medially under lunge fatigue, CAI predicted approximately 20 % of the variance in %MAXD (R² = .198; p = .014). Isolated ankle fatigue did not cause significantly different responses between groups. For two of the reaching directions, CAI status significantly influenced the variances in %MAXD under the influence of lunge fatigue. Functional fatigue protocols may expose deficits in dynamic postural control caused by neuromuscular control alterations in proximal joints in the presence of CAI.

Key words

Dynamic postural control - fatigue - kinematics

References

• 1 Adlerton A K, Moritz U. Does calf-muscle fatigue affect standing balance?.  Scand J Med Sci Sports. 1996;  6 211-215
• 2 Bernier J, Perrin D. Effect of coordination training on proprioception of the functionally unstable ankle.  J Orthop Sports Phys Ther. 1998;  27 264-275
• 3 Beynnon B D, Murphy D F, Alosa D M. Predictive factors for lateral ankle sprain: a literature review.  J Athl Train. 2002;  37 376-380
• 4 Bullock-Saxton J E. Local sensation changes and altered hip muscle function following severe ankle sprain.  Phy Ther. 1994;  74 17-31
• 5 Bullock-Saxton J E, Janda V, Bullock M. The influence of ankle sprain injury on muscle activation during hip extension.  Int J Sports Med. 1994;  15 330-334
• 6 Caulfield B M, Garrett M. Functional instability of the ankle: differences in patterns of ankle and knee movement prior to and post landing in a single leg jump.  Int J Sports Med. 2002;  23 64-68
• 7 Earl J E, Hertel J. Lower-extremity muscle activation during the Star Excursion Balance Tests.  J Sport Rehabil. 2001;  10 93-104
• 8 Evans T E, Hertel J, Sebastianelli W. Bilateral deficits in postural control following lateral ankle sprain.  Foot Ankle Int. 2004;  25 833-839
• 9 Freeman M A, Dean M R. The etiology and prevention of functional instability of the foot.  J Bone Joint Surg. 1965;  47-B 678-685
• 10 Garrick J G, Requa R K. The epidemiology of foot and ankle injuries in sports.  Clin Sports Med. 1988;  7 29-36
• 11 Gauffin H, Tropp H, Odenrick P. Effect of ankle disk training on postural control in patients with functional instability of the ankle joint.  Int J Sports Med. 1988;  9 141-144
• 12 Gray G W. Lower Extremity Functional Profile. Adrian, MI; Wynn Marketing, Inc. 1995
• 13 Gribble P A, Hertel J. Predictors for performance of dynamic postural control using the Star Excursion Balance Test.  Measure Phys Educ Exerc Sci. 2003;  7 89-100
• 14 Gribble P A, Hertel J. Effect of hip and ankle muscle fatigue on unipedal postural control.  J Electromyogr Kines. 2004;  14 641-646
• 15 Gribble P A, Hertel J. Effect of lower extremity muscle fatigue on postural control.  Arch Phys Med Rehabil. 2004;  85 589-592
• 16 Gribble P A, Hertel J, Denegar C R. The reliability and validity of a 2-D video digitizing system during representations of sagittal plane joint positions of the lower extremity during a static and dynamic task.  J Sport Rehabil. 2005;  14 137-149
• 17 Gribble P A, Hertel J, Denegar C R, Buckley W E. The effects of fatigue and chronic ankle instability on dynamic postural control.  J Athl Train. 2004;  39 321-329
• 18 Hale S A, Hertel J. Reliability and sensitivity of the Foot and Ankle Disability Index in subjects with chronic ankle instability.  J Athl Train. 2005;  40 35-40
• 19 Hartsell H D, Spaulding S J. Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle.  Br J Sports Med. 1999;  33 255-258
• 20 Hertel J, Miller S J, Denegar C R. Intratester and intertester reliability during the Star Excursion Balance Test.  J Sport Rehabil. 2000;  9 104-116
• 21 Johnston R B, Howard M E, Cawley P W. Effect of lower extremity muscular fatigue on motor control performance.  Med Sci Sports Exerc. 1998;  30 1703-1707
• 22 Munn J, Beard D J, Refshauge K M, Lee R Y. Eccentric muscle strength in functional ankle instability.  Med Sci Sports Exerc. 2003;  35 245-250
• 23 Ochsendorf D T, Mattacola C G, Arnold B L. Effect of orthotics on postural sway after fatigue of the plantar flexors and dorsiflexors.  J Athl Train. 2000;  35 26-30
• 24 Olmsted L C, Carcia C R, Shultz S J, Gansneder B M. The effects of functional ankle instability on the performance of the Star Excursion Balance Test.  J Athl Train. 2002;  37 35-41
• 25 Pincivero D M, Aldworth C, Dickerson T, Petry C, Shultz T. Quadriceps-hamstring EMG activity during functional, closed kinetic chain exercise to fatigue.  Eur J Appl Physiol. 1999;  81 504-509
• 26 Pinstaar A, Brynhildsen J, Tropp H. Postural corrections after standardized perturbations of single limb stance: effect of training and orthotic devices in patients with ankle instability.  Br J Sports Med. 1996;  30 151-155
• 27 Safran M R, Benedetti R S, Barolozzi A R, Mandelbaum B R. Lateral ankle sprains: a comprehensive review: etiology, pathoanatomy, histopathogenesis, and diagnosis.  Med Sci Sports Exerc. 1999;  31 S429-S437
• 28 Testerman C, Vander Griend R. Evaluation of ankle instability using the Biodex Stability System.  Foot Ankle Int. 1999;  20 317-321
• 29 Tropp H, Ekstrand J, Gillquist J. Factors affecting stabilometry recordings of single limb stance.  Am J Sports Med. 1984;  12 185-188
• 30 Tropp H, Odendrick P, Gillquist J. Stabilometry recordings in functional and mechanical instability of the ankle joint.  Int J Sports Med. 1985;  6 180-182
• 31 Vaes P, Duquet W, van Ghelume B. Peroneal reaction times and eversion motor response in healthy and unstable ankles.  J Athl Train. 2002;  37 475-480
• 32 Willems T, Witvrouw E, Verstuyft J, Vaes P, De Clercq D. Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability.  J Athl Train. 2002;  37 487-493
• 33 Yaggie J A, Mcgregor S J. Effects of isokinetic ankle fatigue on the maintenance of balance and postural limits.  Arch Phys Med Rehabil. 2002;  83 224-228
• 34 Yaggie J A, Mcgregor S J. Effects of lower extremity fatigue on indices of balance.  J Sport Rehabil. 2004;  13 312-322
• 35 Yeung M S, Chan K, So C. An epidemiological survey on ankle sprain.  Br J Sports Med. 1994;  28 112-116