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Open AccessReview

Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

1
Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
2
Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
3
Health and Sport Analytics Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, USA
4
Department of Neurosciences and Movement Sciences, University of Fribourg, 1700 Fribourg, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(7), 1037; https://doi.org/10.3390/jcm8071037
Received: 18 June 2019 / Revised: 10 July 2019 / Accepted: 10 July 2019 / Published: 16 July 2019
(This article belongs to the Section Neuroscience)
The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI. View Full-Text
Keywords: Hoffmann reflex; transcranial magnetic stimulation; arthrogenic muscle inhibition; arthrogenic muscle response; neural adaptation; ankle sprain; functional ankle instability Hoffmann reflex; transcranial magnetic stimulation; arthrogenic muscle inhibition; arthrogenic muscle response; neural adaptation; ankle sprain; functional ankle instability
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Kim, K.-M.; Kim, J.-S.; Cruz-Díaz, D.; Ryu, S.; Kang, M.; Taube, W. Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis. J. Clin. Med. 2019, 8, 1037.

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