Search Results (127)

(1) Background: Chronic ankle instability (CAI), a common outcome of ankle sprains, involves recurrent sprains, balance deficits, and gait impairments linked to both peripheral and central neuromuscular dysfunction. Dual-task (DT) demands further aggravate postural control, especially during stair descent, a major source of fall-related injuries. Yet the biomechanical mechanisms of stair-to-ground transition in CAI under dual-task conditions remain poorly understood. (2) Methods: Sixty individuals with CAI and age- and sex-matched controls performed stair-to-ground transitions under single- and dual-task conditions. Spatiotemporal gait parameters, center of pressure (COP) metrics, ankle inversion angle, and relative joint work contributions (Ankle%, Knee%, Hip%) were obtained using 3D motion capture, a force plate, and musculoskeletal modeling. Correlation and regression analyses assessed the relationships between ankle contributions, postural stability, and proximal joint compensations. (3) Results: Compared with the controls, the CAI group demonstrated marked control deficits during the single task (ST), characterized by reduced gait speed, increased step width, elevated mediolateral COP root mean square (COP-ml RMS), and abnormal ankle inversion and joint kinematics; these impairments were exacerbated under DT conditions. Individuals with CAI exhibited a significantly reduced ankle plantarflexion moment and energy contribution (Ankle%), accompanied by compensatory increases in knee and hip contributions. Regression analyses indicated that Ankle% significantly predicted COP-ml RMS and gait speed (GS), highlighting the pivotal role of ankle function in maintaining dynamic stability. Furthermore, CAI participants adopted a “posture-first” strategy under DT, with concurrent deterioration in gait and cognitive performance, reflecting strong reliance on attentional resources. (4) Conclusions: CAI involves global control deficits, including distal insufficiency, proximal compensation, and an inefficient energy distribution, which intensify under dual-task conditions. As the ankle is central to lower-limb kinetics, its dysfunction induces widespread instability. Rehabilitation should therefore target coordinated lower-limb training and progressive dual-task integration to improve motor control and dynamic stability. Full article

Background/Objectives: Chronic ankle instability is a common issue after lateral ankle sprain. The DMA Clinical Pilates method hypothesizes impairments in tibialis anterior and fibularis longus muscles. Methods: A total of 14 adults with chronic ankle instability, and 15 recovered and 16 healthy individuals were prospectively recruited and assessed for lower back, hip, knee, and ankle muscle activities during dominant and non-dominant sides single-leg stand on stable and unstable surfaces using wireless surface electromyography. Results: The study found consistent dysfunction in tibialis anterior muscle activity in adults with chronic ankle instability when compared with healthy adults during single-leg stand on stable and unstable surfaces, and against recovered individuals on unstable surface. As compared to healthy controls, chronic ankle instability group showed higher vastus lateralis activation during dominant side single-leg stand across surface conditions and during dominant side single-leg stand, while the higher dominant side longissimus dorsi activity on stable surface changed to higher dominant side medial gastrocnemius activity on unstable surface. As compared to recovered controls, chronic ankle instability group also showed higher gluteus medius and fibularis longus muscle activities on unstable surface. Conclusions: Tibialis anterior muscle is the main dysfunction among individuals with chronic ankle instability side. Full article

Background: Functional performance interlimb asymmetry may increase the risk of ankle sprains during basic military training. We aimed to (1) evaluate interlimb balance, agility, and ankle instability asymmetry in soldiers in infantry training as a risk factor for acute ankle sprains; (2) evaluate the effect of ankle sprains and sprain prevention exercise program on performance asymmetry. Methods: Newly inducted infantry soldiers were recruited from two induction cycles (intervention [INT] n = 365, control [CON] n = 421). Participants were assessed at the beginning of infantry basic training (T0) and after four months (T1) for anthropometrics, balance, agility, and perceived ankle instability, and were monitored for ankle sprains (SPRAIN/NO-SPRAIN). The INT group performed an ankle sprain prevention program 5 days/week × 5 min/day. Results: at T0 there were differences in interlimb asymmetry in Cumberland Ankle Instability Tool (CAIT) in SPRAIN soldiers in both groups (p-value < 0.001), and differences between the groups in Hexagon, Y-Balance Test (YBT) and CAIT (p-values 0.007, 0.002, 0.002, respectively). There was a decrease in interlimb asymmetry in Hexagon and YBT for SPRAIN soldiers in the INT group, and an increase in CAIT asymmetry in SPRAIN soldiers in both groups. Stepwise logistic regression did not find predictors for ankle sprains during training. Conclusions: The intervention program reduced interlimb asymmetry in balance and agility for soldiers who sprained their ankle during training. In these soldiers, CAIT asymmetry increased during training regardless of the intervention. Ankle sprain intervention programs should be implemented to reduce interlimb asymmetries in functional abilities and reduce the risk of injury. Full article

Background/Objectives: Although considerable progress has been made in understanding lateral ankle sprains (LAS) and chronic ankle instability (CAI), recurrent injury rates remain high. This highlights the need to explore additional contributors such as comprehensive lower-limb gait analysis, including multisegmented foot models and proximal joint kinematics and strength. This study aimed to assess multisegmented foot and lower-limb kinematics throughout the gait cycle in individuals with CAI compared to healthy controls. Additionally, associations between hip abductor strength and frontal plane ankle kinematics were examined. Methods: Fifty males (25 with CAI and 25 healthy controls) participated in this cross-sectional study. Gait analysis was conducted using a BTS SMART 3D motion capture system to assess multisegmented foot and proximal joint kinematics. Isometric hip strength was measured using a Biodex dynamometer. Statistical Parametric Mapping (SPM) was used to assess group differences, and correlations were calculated between hip abductor strength and ankle kinematics. Results: The CAI group demonstrated significantly greater calcaneus abduction relative to the shank in the transverse plane between 88% and 93% of the gait cycle (MD = −3.50°, 95% CI [−5.60, −1.40], d = −0.95, p = 0.037). No other statistically significant between-group differences in hip, knee, or foot segment kinematics were detected. Furthermore, correlations between hip abductor strength and ankle frontal plane kinematics were not significant. Conclusions: Males with CAI demonstrated altered rearfoot kinematics in the transverse plane during the terminal swing phase. The multisegmented foot model was valuable in detecting subtle deviations and emphasized the importance of including the swing phase. Hip abductor strength was not associated with ankle kinematics, suggesting that its potential role in CAI may involve other mechanisms. These findings may support clinical gait assessment and rehabilitation planning by highlighting the importance of evaluating all foot segments and the entire lower limb, rather than focusing solely on the ankle joint. Segment-specific deviations, particularly those emerging during the swing phase, may help guide targeted interventions aimed at improving foot positioning in males with CAI. Full article

Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion^®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan^® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy. Full article

Acute ankle sprains frequently lead to chronic ankle instability and muscle atrophy by causing immobilization, which necessitates real-time stiffness modulation for ankle–foot orthoses (AFOs). This paper proposes Active Variable Compression Shoes (AVC-Shoes), an ankle support system inspired by the “heel-lock taping” technique, which employs a wire–fabric compression mechanism to selectively stiffen ankle joints at crucial points in the gait cycle. The experimental results confirmed that AVC-Shoes achieve variable ankle stiffness in all directions, demonstrating dorsiflexion and plantarflexion stiffness ranges of up to 8.3 and 5.9 Nm/rad, respectively. Additionally, preliminary human testing involving three healthy participants revealed that the gastrocnemius muscle activity during the push-off phase in the active compression mode was significantly higher (by 19%) than that in the brace mode. By selectively increasing stiffness at heel strikes, AVC-Shoes represent a promising advancement toward next-generation AFOs capable of stabilizing the ankle while preventing muscle atrophy, which is associated with prolonged brace use. Full article

Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness for mitigating the risk of ankle sprains due to excessive subtalar inversion during high-impact activities, such as landing from a free fall. Methods: We employed biomechanical simulations to assess the influence of translational stiffness on subtalar inversion control, given that inversion angles exceeding 25 degrees are strongly correlated with injury risk. Simulations were conducted using a musculoskeletal model with and without a passive AFO; the stiffness varied in three anatomical directions. A Design of Experiments (DoE) approach was utilized to capture nonlinear interactions among stiffness parameters. Results: The results indicated that increased translational stiffness significantly reduced inversion angles to safer levels, though direction–dependent effects were noted. Based on these insights, we developed a 4D visualization tool that integrates simulation data with an interactive color–coded interface to depict ”safe design” zones for various AFO stiffness configurations. This tool supports clinicians in selecting stiffness values that optimize both safety and functional performance. Conclusions: The proposed framework enhances clinical decision-making and engineering processes by enabling more accurate and individualized AFO designs. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

This study examined the impact of different breath-holding conditions on iliopsoas and other hip flexor muscle activity in individuals with chronic ankle instability (CAI). It has been hypothesised that impaired diaphragmatic function influences iliopsoas activation, potentially contributing to motor control deficits in patients with CAI. Eleven adults with a history of chronic ankle sprain participated in this study. Maximal isometric hip flexion was assessed under three breath-holding conditions: end-expiration, end-inspiration, and the intermediate state. Surface electromyography was used to record the muscle activity of the iliopsoas, rectus femoris, sartorius, and tensor fasciae latae, while the peak hip flexion torque was measured using an isokinetic dynamometer. Under the end-inspiration condition, iliopsoas activity on the affected side was significantly lower than that on the control side (p < 0.05). However, no significant differences were observed between the affected and control sides in the activity of the other hip flexor muscles or the peak hip flexion torque across breath-holding conditions. This study highlights the association between reduced iliopsoas activity during end-inspiration and compromised diaphragmatic function in patients with CAI. Future research should explore dynamic movement tasks and larger sample sizes to elucidate neuromuscular mechanisms further and refine rehabilitation strategies. Full article

Background/Objectives: Adolescent female basketball players are frequently affected by lateral ankle sprains that may progress to chronic ankle instability (CAI) if not adequately managed. This double-blind, prospective, cluster-randomized controlled trial aimed to compare the effects of hop-stabilization training (hop training) and those of traditional balance training on ankle instability and functional performance of this population. Methods: Thirty-two adolescent female basketball players with CAI were cluster-randomized into the hop training group (HG; n = 16) or balance training group (BG; n = 16). Participants completed three 20 min sessions per week for 6 weeks. The hop training protocol comprised multiplanar hopping exercises with progressive increases in the landing volume and an emphasis on controlled landing mechanics. The balance training protocol included single-leg stance and basketball-specific dynamic activities with gradually increasing difficulty. Primary outcomes were self-reported ankle stability (Cumberland ankle instability tool [CAIT] score) and performance test results (t-test, lateral hop test, figure-8 hop test results). Secondary outcomes included static and dynamic balance and isometric ankle strength (dorsiflexion [DF], plantar flexion, inversion, eversion [EV]). Assessments were conducted at baseline and after interventions. Results: The HG and BG exhibited significant improvements in CAIT scores and balance. However, the HG demonstrated significantly greater enhancements in dynamic performance test results and notable improvements in DF and EV strength compared to those of the BG. Conclusions: Hop training comprising the close replication of the multidirectional and dynamic demands of basketball was more effective than traditional balance training for enhancing functional performance and ankle strength. Full article

Background: Lateral ankle sprains can result in adverse outcomes, including reinjuries or chronic ankle instability. The peroneal musculature plays a key role in stabilizing the ankle and preventing sudden ankle inversions that may lead to sprains. Objective: The purpose of the study is to investigate (1) inter-limb differences in peroneal myoelectrical activity in athletes with a history of ankle sprain during the past six months and (2) to investigate peroneal myoelectrical activity differences between athletes with and without a history of ankle sprain. Methods: Sixty-seven athletes (53% females, 46.3% males) were included in this observational cross-sectional study. Self-reported data regarding history of ankle sprain were collected. The peroneal myoelectrical activity was obtained during (1) isometric ankle eversion, (2) dynamic ankle eversions, (3) single leg squat, (4) unilateral and (5) bilateral drop jump test, (6) sprint, and (7) change of direction. Results: No significant differences in peroneal myoelectrical activity were observed between individuals with (n = 46) and without (n = 21) a history of ankle sprain in the past six months (p > 0.05). Additionally, no significant inter-limb differences were found within the previous ankle sprain group (p > 0.05). Conclusions: This study found no significant inter-limb differences in peroneal muscle activity among athletes with a history of ankle sprain during the past six months. Moreover, no differences were observed between athletes with and without a history of ankle sprain. This study has certain limitations, including the lack of data regarding the timing and severity of the ankle sprain, as well as the duration and specific characteristics of the rehabilitation process. Full article

This study aims to identify the prevalence and patterns of sports injuries in recreational sports activities in South Korea. This study utilized data from the “survey of safety accidents” conducted by the Korea Sports Safety Foundation and finally, 3182 recreational sports participants who experienced injuries were selected for the study. For data processing, data related to recreational sports injuries were first collected and organized using Excel 2015, and frequency analysis was conducted using the SPSS 25.0 program. Furthermore, the association rule method was applied via Python 3.13.3 to analyze the patterns of injury sites and types. First, by investigating the prevalence of injuries in recreational sports, it was found that the injury frequency was highest in soccer, followed by cycling, hiking, and badminton. Second, in soccer, it was found that when ankle injuries, which have a high injury frequency, occur, knee, toe, and sprain injuries also occur together (Lift: 1.843). Additionally, in cycling, when knee injuries occur, toe, sprain, and strain (bruise) injuries also occur together (Lift: 2.420). In mountain biking, when ankle injuries, which have a high injury frequency, occur, cuts, sprains, stab wounds (cuts), sprains, and strains (bruises) also occur together (Lift: 1.808). The current survey on recreational sports injuries is expected to be used as basic data to prevent injuries in advance for participants in recreational sports, and it is expected that this will allow them to participate in sports by recognizing common injury sites before participating in sports. Full article

Background: Soccer is associated with substantial injury risk, with reported between 13 to 35 injuries per 1000 player-hours of competitive play. Notably, approximately 77% of soccer-related ankle injuries are attributed to ankle sprain injuries (ASIs). ASI can lead to chronic ankle instability, obesity, and post-traumatic osteoarthritis. This study focuses on identifying factors such as gender, age, body mass index (BMI), and a history of ASIs, which contribute to the development of ASI in soccer players. Methods: A systematic literature search was conducted in October 2023 across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and ProQuest, without applying any filters. Keywords included ankle, ankle joint, sprain, risk factors, etc. Data extraction was performed on the included studies, with findings standardized and analyzed using Stata Statistical Software: Release 17 to determine a weighted treatment effect. Results: Our systematic review included 26 studies. The meta-analysis revealed that a history of ankle sprain is the most significant risk factor for future ASIs. BMI emerged as a risk factor in three out of seven studies, while age and height were significant in one out of six studies each. Gender and weight were not found to significantly affect ASI occurrence. Other factors identified but not subjected to a meta-analysis due to methodological heterogeneity or insufficient studies included playing surface, joint laxity, muscle weakness, match congestion, strength asymmetries, ground reaction forces, balance maintenance, skill level, and playing position. Conclusions: This research contributes valuable insights into the prevention of ASIs in soccer, highlighting the importance of previous ankle sprains and playing surface quality. These findings assist sports professionals in developing optimal conditions and strategies for effective ankle sprain prevention. Full article

Aim: The aim of this study was to analyze service-related musculoskeletal injuries of professional firefighters in 2021–2023. Material and methods: Analysis was completed on the basis of annual reports on the injury status of the State Fire Service (SFS) obtained from the Office of Occupational Safety and Health (OOSH) at General Headquarters. The report databases were searched using keywords typical of bone injuries and including anatomical names: “sprain”, “fracture”, “dislocation”, “bone injury”, “bone”, “joint”, “spine”, “skull and “musculoskeletal injury”. Results: Events matching the analysis target of N = 1944 (2021—n = 707; 2022—n = 589; 2023—n = 648) accounted for 49.4% from all accidents in the State Fire Service in Poland in the analyzed period. A significant increase in the analyzed period 2021–2023 was observed in events where the cause of injury was sports activities (45% vs. 49% vs. 63%, p < 0.001). A significant decrease was observed in events where the cause of injury was interventions (26% vs. 27% vs. 17%, p < 0.001), technical and maintenance (TM) work (8% vs. 6% vs. 5%, p = 0.008) and category “other” (15% vs. 14% vs. 11%, p = 0.034). Statistically significant differences were found between cause and the type of injury (p = 0.002), season (p < 0.001) and the location of injury (p < 0.001). Conclusions: A large number of musculoskeletal injuries are associated with sports activities, which is inherent in the risks of the activities. The lower extremities are most affected by injuries during sports activities The spring period dominates in the season category, which may be related to the difficulty of the terrain and return to increased sports activity after the winter period. Full article

Background/Objectives: Ankle sprain is one of the most common sports injuries globally. Despite its prevalence, the adequacy of knowledge in managing ankle sprain among physiotherapists in Saudi Arabia has not been assessed. This study aimed to assess the knowledge and degree of adherence to clinical practice guidelines (CPG) for the management of ankle sprains among physiotherapists. Methods: This study was a cross-sectional with national online questionnaire administered to participants through an online platform. It comprised three sections. The first section collected demographic data. The second section presented two clinical cases as the basis for the participants’ management decisions (the first with negative Ottawa Ankle Rules (OAR) and the second with positive OAR); participants were classified as “following”, “partially following”, “not following”, and “partially not following” the CPGs. In the third section, on a Likert scale (1–5), participants indicated how much they agreed with various CPGs statements. Results: A total of 381 physiotherapists (mean age: 28 ± 5; male: 57.1%) completed the questionnaire. In the case of acute ankle sprain with negative OAR, 0.2% of the participants were considered as “following” CPGs, 31.4% as “partially following”, 19.6% as “partially not following”, and 48.5% as “not-following”. In the case of acute ankle sprain with positive OAR, 5.2% were considered as “following” CPGs, 55.9% as “partially not following”, and 38.8% as “not following”. The knowledge assessment section elicited a 50% agreement among the participants on the 11 provided statements. Conclusions: Most physiotherapists have suboptimal adherence to CPG for managing ankle sprains, thus highlighting an evidence-to-practice gap. Full article