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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Electromyographic | Research

The influence of local pain on balance control in patients with chronic ankle instability

Authors: Yungu Chen, Shengxuan Cao, Lewen Qian, Wenming Chen, Chen Wang, Xin Ma, Xu Wang, Jiazhang Huang

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Local pain around the ankle joint is a common symptom in patients with chronic ankle instability (CAI). However, whether the local pain would impose any influence on the balance control performance of CAI patients is still unknown.

Methods

A total of twenty-six subjects were recruited and divided into the following two groups: pain-free CAI (group A) and pain-present CAI (group B). Subjects in both groups received two independent tests: the star excursion balance test and the single-leg stance test, in order to reflect their balance control ability more accurately.

Results

Compared with group A, the group B showed significantly more episodes of the history of sprains, decreased ankle maximum plantarflexion angle, and lower Cumberland scores (all p < 0.05). In the star excursion balance test, group B demonstrated a significantly reduced anterior reach distance than group A (p < 0.05). During the single leg stance test, group B showed a significant increase in the magnitude of electromyographic signals both in peroneus longus and soleus muscles than group A (each p < 0.05). Additionally, group B had a significantly more anterolaterally positioned plantar center of pressure than group A (p < 0.05).

Conclusion

CAI patients with local pain around the ankle joint had more episodes of sprains and lower functional scores when compared to those without pain. The balance control performance was also worse in the pain-present CAI patients than those without pain.

Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–505. https://doi.org/10.1136/bjsports-2016-096189.CrossRefPubMed

Mailuhu AKE, Oei EHG, van Putte-Katier N, et al. Clinical and radiological predictors for persistent complaints five years after a lateral ankle sprain: a long-term follow-up study in primary care. J Sci Med Sport. 2018;21(3):250–6. https://doi.org/10.1016/j.jsams.2017.07.005.CrossRefPubMed

Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.PubMedPubMedCentral

Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46(2):133–41. https://doi.org/10.4085/1062-6050-46.2.133.CrossRefPubMedPubMedCentral

Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture. 2010;32(1):82–6. https://doi.org/10.1016/j.gaitpost.2010.03.015.CrossRefPubMed

Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501–6.PubMedPubMedCentral

dos Santos MJ, Gorges AL, Rios JL. Individuals with chronic ankle instability exhibit decreased postural sway while kicking in a single-leg stance. Gait Posture. 2014;40(1):231–6. https://doi.org/10.1016/j.gaitpost.2014.04.002.CrossRefPubMed

Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther. 2009;4(2):92–9.PubMedPubMedCentral

Hubbard TJ, Kramer LC, Denegar CR, Hertel J. Contributing factors to chronic ankle instability. Foot Ankle Int. 2007;28(3):343–54. https://doi.org/10.3113/fai.2007.0343.CrossRefPubMed

10.

Ross SE, Guskiewicz KM, Gross MT, Yu B. Balance measures for discriminating between functionally unstable and stable ankles. Med Sci Sports Exerc. 2009;41(2):399–407. https://doi.org/10.1249/MSS.0b013e3181872d89.CrossRefPubMed

11.

Al Adal S, Pourkazemi F, Mackey M, Hiller CE. The prevalence of pain in people with chronic ankle instability: a systematic review. J Athl Train. 2019;54(6):662–70. https://doi.org/10.4085/1062-6050-531-17.CrossRefPubMedPubMedCentral

12.

Adal SA, Mackey M, Pourkazemi F, Hiller CE. The relationship between pain and associated characteristics of chronic ankle instability: a retrospective study. J Sport Health Sci. 2020;9(1):96–101. https://doi.org/10.1016/j.jshs.2019.07.009.CrossRefPubMed

13.

Wikstrom EA, Song K. Generic and psychological patient-reported deficits in those with chronic ankle instability: a cross sectional study. Phys Ther Sport. 2019;40:137–42. https://doi.org/10.1016/j.ptsp.2019.09.004.CrossRefPubMed

14.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–6. https://doi.org/10.4103/0253-7176.116232.CrossRefPubMedPubMedCentral

15.

van Rijn RM, Willemsen SP, Verhagen AP, Koes BW, Bierma-Zeinstra SM. Explanatory variables for adult patients’ self-reported recovery after acute lateral ankle sprain. Phys Ther. 2011;91(1):77–84. https://doi.org/10.2522/ptj.20090420.CrossRefPubMed

16.

Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Athl Train. 2014;49(1):121–7. https://doi.org/10.4085/1062-6050-49.1.14.CrossRefPubMedPubMedCentral

17.

Cao S, Wang C, Ma X, et al. Stair descent biomechanics reflect perceived instability in people with unilateral ankle sprain history. Clin Biomech (Bristol, Avon). 2020;72:52–7. https://doi.org/10.1016/j.clinbiomech.2019.11.022.CrossRef

18.

Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2006;87(9):1235–41. https://doi.org/10.1016/j.apmr.2006.05.022.CrossRefPubMed

19.

Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3(4):310–6. https://doi.org/10.1111/j.1530-7085.2003.03034.x.CrossRefPubMed

20.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240–52. https://doi.org/10.1002/acr.20543.CrossRef

21.

van Middelkoop M, van Rijn RM, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Re-sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: an observational study. J Physiother. 2012;58(3):181–8. https://doi.org/10.1016/s1836-9553(12)70109-1.CrossRefPubMed

22.

Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653–60. https://doi.org/10.1177/107110079801901002.CrossRefPubMed

23.

Suttmiller AMB, Cavallario JM, Baez SE, Martinez JC, McCann RS. Perceived instability, pain, and psychological factors predict function and disability in individuals with chronic ankle instability. J Athl Train. 2022. https://doi.org/10.4085/1062-6050-0605.21.CrossRefPubMed

24.

Fullam K, Caulfield B, Coughlan GF, Delahunt E. Kinematic analysis of selected reach directions of the star excursion balance test compared with the Y-balance test. J Sport Rehabil. 2014;23(1):27–35. https://doi.org/10.1123/jsr.2012-0114.CrossRefPubMed

25.

Robinson RH, Gribble PA. Support for a reduction in the number of trials needed for the star excursion balance test. Arch Phys Med Rehabil. 2008;89(2):364–70. https://doi.org/10.1016/j.apmr.2007.08.139.CrossRefPubMed

26.

Qian L, Yang X, Ma X, Yu Y, Chen WM. Integration of reginal shear measurements at the foot-ground interface during routine balance assessment of the elderly population. Gait Posture. 2022;96:18–21. https://doi.org/10.1016/j.gaitpost.2022.05.008.CrossRefPubMed

27.

Sousa ASP, Silva A, Santos R, Sousa F, Tavares J. Interlimb coordination during the stance phase of gait in subjects with stroke. Arch Phys Med Rehabil. 2013;94(12):2515–22. https://doi.org/10.1016/j.apmr.2013.06.032.CrossRefPubMed

28.

Chen WM, Li JW, Geng X, Wang C, Chen L, Ma X. The potential influence of stochastic resonance vibrations on neuromuscular strategies and center of pressure sway during single-leg stance. Clin Biomech (Bristol, Avon). 2020;77:105069. https://doi.org/10.1016/j.clinbiomech.2020.105069.CrossRef

29.

Boe SG, Rice CL, Doherty TJ. Estimating contraction level using root mean square amplitude in control subjects and patients with neuromuscular disorders. Arch Phys Med Rehabil. 2008;89(4):711–8. https://doi.org/10.1016/j.apmr.2007.09.047.CrossRefPubMed

30.

Moghadam M, Ashayeri H, Salavati M, et al. Reliability of center of pressure measures of postural stability in healthy older adults: Effects of postural task difficulty and cognitive load. Gait Posture. 2011;33(4):651–5. https://doi.org/10.1016/j.gaitpost.2011.02.016.CrossRefPubMed

31.

Freitas SMSF, Prado JM, Duarte M. The use of a safety harness does not affect body sway during quiet standing. Clin Biomech. 2005;20(3):336–9. https://doi.org/10.1016/j.clinbiomech.2004.12.002.CrossRef

32.

Mettler A, Chinn L, Saliba SA, McKeon PO, Hertel J. Balance training and center-of-pressure location in participants with chronic ankle instability. J Athl Train. 2015;50(4):343–9. https://doi.org/10.4085/1062-6050-49.3.94.CrossRefPubMedPubMedCentral

33.

Pope M, Chinn L, Mullineaux D, McKeon PO, Drewes L, Hertel J. Spatial postural control alterations with chronic ankle instability. Gait Posture. 2011;34(2):154–8. https://doi.org/10.1016/j.gaitpost.2011.04.012.CrossRefPubMed

34.

Boileau P, Zumstein M, Balg F, Penington S, Bicknell RT. The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete. J Shoulder Elbow Surg. 2011;20(1):98–106. https://doi.org/10.1016/j.jse.2010.05.020.CrossRefPubMed

35.

Hass CJ, Bishop MD, Doidge D, Wikstrom EA. Chronic ankle instability alters central organization of movement. Am J Sports Med. 2010;38(4):829–34. https://doi.org/10.1177/0363546509351562.CrossRefPubMed

36.

Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair. 2012;26(6):646–52. https://doi.org/10.1177/1545968311433209.CrossRefPubMed

37.

Kröger S, Watkins B. Muscle spindle function in healthy and diseased muscle. Skelet Muscle. 2021;11(1):3. https://doi.org/10.1186/s13395-020-00258-x.CrossRefPubMedPubMedCentral

38.

Wright CJ, Arnold BL, Ross SE, Ketchum J, Ericksen J, Pidcoe P. Clinical examination results in individuals with functional ankle instability and ankle-sprain copers. J Athl Train. 2013;48(5):581–9. https://doi.org/10.4085/1062-6050-48.3.15.CrossRefPubMedPubMedCentral

39.

Kwon DG, Sung KH, Chung CY, et al. Associations between MRI findings and symptoms in patients with chronic ankle sprain. J Foot Ankle Surg. 2014;53(4):411–4. https://doi.org/10.1053/j.jfas.2014.02.018.CrossRefPubMed

40.

Gribble PA, Hertel J, Denegar CR. Chronic ankle instability and fatigue create proximal joint alterations during performance of the star excursion balance test. Int J Sports Med. 2007;28(3):236–42. https://doi.org/10.1055/s-2006-924289.CrossRefPubMed

41.

Simsek S, Yagci N. Acute effects of distal fibular taping technique on pain, balance and forward lunge activities in chronic ankle instability. J Back Musculoskelet Rehabil. 2019;32(1):15–20. https://doi.org/10.3233/bmr-181132.CrossRefPubMed

42.

Terada M, Harkey MS, Wells AM, Pietrosimone BG, Gribble PA. The influence of ankle dorsiflexion and self-reported patient outcomes on dynamic postural control in participants with chronic ankle instability. Gait Posture. 2014;40(1):193–7. https://doi.org/10.1016/j.gaitpost.2014.03.186.CrossRefPubMed

43.

Schaefer JL, Sandrey MA. Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. J Sport Rehabil. 2012;21(4):313–26. https://doi.org/10.1123/jsr.21.4.313.CrossRefPubMed

44.

Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8–15. https://doi.org/10.1519/00139143-200704000-00003.CrossRefPubMed

45.

Thompson CS, Hiller CE, Schabrun SM. Altered spinal-level sensorimotor control related to pain and perceived instability in people with chronic ankle instability. J Sci Med Sport. 2019;22(4):425–9. https://doi.org/10.1016/j.jsams.2018.10.009.CrossRefPubMed

46.

El-Tallawy SN, Nalamasu R, Salem GI, LeQuang JAK, Pergolizzi JV, Christo PJ. Management of musculoskeletal pain: an update with emphasis on chronic musculoskeletal pain. Pain Ther. 2021;10(1):181–209. https://doi.org/10.1007/s40122-021-00235-2.CrossRefPubMedPubMedCentral

47.

Konradsen L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports. 2002;12(3):129–35. https://doi.org/10.1034/j.1600-0838.2002.02104.x.CrossRefPubMed

48.

Hiller CE, Nightingale EJ, Raymond J, et al. Prevalence and impact of chronic musculoskeletal ankle disorders in the community. Arch Phys Med Rehabil. 2012;93(10):1801–7. https://doi.org/10.1016/j.apmr.2012.04.023.CrossRefPubMed

49.

Braun BL. Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation. Arch Fam Med. 1999;8(2):143–8. https://doi.org/10.1001/archfami.8.2.143.CrossRefPubMed

50.

Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554–9. https://doi.org/10.1136/bjsports-2017-098673.CrossRefPubMed

51.

Suttmiller AMB, McCann RS. Injury-related fear in individuals with and without chronic ankle instability: a systematic review. J Sport Rehabil. 2021;30(8):1203–12. https://doi.org/10.1123/jsr.2021-0015.CrossRefPubMed

52.

Shin HJ, Kim SH, Jeon ET, Lee MG, Lee SJ, Cho HY. Effects of therapeutic exercise on sea sand on pain, fatigue, and balance in patients with chronic ankle instability: a feasibility study. J Sports Med Phys Fitness. 2019;59(7):1200–5. https://doi.org/10.23736/s0022-4707.19.09405-2.CrossRefPubMed

53.

Komenda GA, Ferkel RD. Arthroscopic findings associated with the unstable ankle. Foot Ankle Int. 1999;20(11):708–13. https://doi.org/10.1177/107110079902001106.CrossRefPubMed

Title: The influence of local pain on balance control in patients with chronic ankle instability
Authors: Yungu Chen
Shengxuan Cao
Lewen Qian
Wenming Chen
Chen Wang
Xin Ma
Xu Wang
Jiazhang Huang
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Electromyographic
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05656-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The influence of local pain on balance control in patients with chronic ankle instability

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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