Sports Medicine Research: In the Lab & In the Field: The Role of “Roll-Off” During Gait in Patients Recovering from a Lateral Ankle Sprain (Sports Med Res)
Monday, October 24, 2016

The Role of “Roll-Off” During Gait in Patients Recovering from a Lateral Ankle Sprain

Center of pressure during stance and gait in subjects with or without persistent complaints after a lateral ankle sprain.

Kros W, Keijsers NL, van Ochten JM, Bierma-Zeinstra SM, van Middelkoop M. Gait Posture. 2016 Jul;48:24-9. doi: 10.1016/j.gaitpost.2016.04.022. Epub 2016 Apr 29.

Take Home Message: People with persistent complaints 6 to 12 months after an ankle sprain walk differently than those without persistent complaints.

Following a lateral ankle sprain, many patients may suffer deficits acutely that linger long after an initial injury. We can identify people with chronic ankle instability – one aspect of persistent symptoms – by measuring center of pressure (COP) during certain tasks. Unfortunately, it is unclear if this is true for a larger group of patients with persistent symptoms after a lateral ankle sprain. The authors of this study explored if COP measures during single-leg stance and gait differ between people with and without persistent complaints 6 to 12 months after a lateral ankle sprain. The authors defined persistent complaints based on how participants rated their recovery with a 7-point scale (no complaints = fully recovered or strongly improved).  Fourteen out of 44 participants had persistent complaints. After being put into groups the participants also completed a Visual Analog Scale for pain, and the Ankle Function Score to measure their pain and function. Participants performed barefoot walking, and single leg stance with and without vision on the RSscan footscan. Patients with persistent complaints exhibited a more laterally located COP during the early mid stance and push-off phase of their gait compared with people without persistent symptoms.

While many researchers focus on chronic ankle instability at 12 months after an ankle sprain these authors looked at patients with persistent complaints at 6 to 12 month post lateral ankle sprain. Hence, the authors examined people recovering from a lateral ankle sprain in a different manner from the norm for chronic ankle instability. Despite these differences, the authors’ findings agree with those found among people with chronic ankle instability. Participants with persistent complaints exhibited a laterally located COP. The authors hypothesized this may be the result of a more cautious roll off during gait. Hence, some individuals adopt coping mechanisms to decrease the load and subsequent pain at the ankle. This is important because while these alterations are done as a protective measure these loading changes can also put someone at risk of re-injury. Since these changes in gait may start as early as 6 months post injury we need to recognize them early. Furthermore, these findings should remind clinicians to focus on gait retraining to prevent the development of poor foot biomechanics.

Questions for Discussion: What can be done to address the laterally located COP that can develop following a lateral ankle sprain? How does this article change the way you view treating a lateral ankle sprain, knowing that persistent complaints can be seen at least six months post injury?

Written by: Revay O. Corbett, MS, ATC, PES
Reviewed by: Jeffrey Driban

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Kros, W., Keijsers, N., van Ochten, J., Bierma-Zeinstra, S., & van Middelkoop, M. (2016). Center of pressure during stance and gait in subjects with or without persistent complaints after a lateral ankle sprain Gait & Posture, 48, 24-29 DOI: 10.1016/j.gaitpost.2016.04.022

3 comments:

Christopher Gregory said...

This is one of a few articles that I have seen recently that has tried to push the envelope with chronic ankle instability where they include those who are 6 months out in comparison to the traditional 12 months out. These findings coincide with Koldenhoven et al. and Hopkins et al. who found similar lateral deviation of COP and trajectory in those who have CAI. I think we need to tread lightly when it comes to diagnosing individuals with CAI at 6 months rather than 12 months. To your question of how do we address lateral COP in those who have had a LAS I wonder, should we? I think we first need to know, and the information may be available, do those who are characterized as copers also have COP deviations. If they do, would changing someone's gait who has CAI and lateral COP deviation be the best course of action of those who are a coper also have lateral COP deviation? If that is the course of action you want to take then their is evidence to support that gait can be retrained. Feger et al. found that their novel gait retraining can decrease lateral pressures while also increasing the activation of the peroneus longus muscle. I think like any lower extremity injury you shoud assess the impact the injury has on gait and if it is altered you need to address it. If you look at the gait of an indivudal with LAS and assess that they are rolling more on the outside of their foot and that is predisposing them to another injury then you should take the steps to address and alter that gait abnormality. But I think we should be careful with correcting gait because if that is the manner they have ambulated for their whole lives then a correction to their gait pattern might predispose them to another injury higher up the kinetic chain which would not be used to the forces being transmitted through it due to that new gait pattern.

Jeffrey Driban said...

Hi Christopher: I think you raise some great points. I think we should always be cautious when modifying someone's biomechanics b/c it could be a beneficial adaptation they developed. I agree it would be helpful to know if copers exhibit the same changes and I think it would be interesting to look prospectively to see if they had these biomechanical differences prior to the initial injury.

Revay O.Corbett said...

Hi Christopher! Your comments speak to the need to individualize rehab plans and that is very important to take into consideration. Current literature has shown copers to exhibit some deficits and not necessarily look similar to a healthy cohort, so COP and biomechanical changes are present within that population. Evaluating each patient's deficits would address their particular needs and allow clinicians to determine if a lateral COP is present and if it needs to be addressed.

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