Sports Medicine Research: In the Lab & In the Field: Identifying Athletes at Risk for Chronic Ankle Instability (Sports Med Res)
Wednesday, December 14, 2016

Identifying Athletes at Risk for Chronic Ankle Instability

A new jump-landing protocol identifies differences in healthy, coper, and unstable ankles in collegiate athletes

Liu K, Dierkes C, Blair L. Sports Biomechanics. 2016, 15(3):245-254. dx.doi.org/10.1080/14763141.2016.1158859

Take Home Message: The jump-landing protocol was able to distinguish between healthy, ‘coper’, and unstable ankles. This protocol may be useful for identifying athletes at increased risk for injury, and as a return to play indicator following rehabilitation.

Ankle sprains are one of the most common athletic injuries, and suffering a single sprain increases the risk for future sprains, which may lead to chronic ankle issues. A functional deficit identified in individuals with chronic ankle problems is reduced postural stability. Time to stabilize (the time it takes to regain stability after a dynamic movement) is one way to identify ankle instability; however, many time to stabilize protocols are not challenging enough for an athletic population. Therefore the authors wanted to develop a sport-specific jump-landing protocol that involves a large vertical displacement and multi-directional components that could identify differences in healthy, ‘coper’, and unstable groups. The authors placed 61 Division I college athletes (29 males, 32 females) into 1 of 3 groups (healthy, coper, unstable) based on their ankle injury history and score on the Cumberland Ankle Instability Tool. A forward and lateral jump landing protocol was completed for the jump-landing test. In the forward test, participants were instructed to take two preparatory steps, take off from a single leg, jump to an indicator, and land single-legged onto a force plate with the opposite limb. For the lateral test, participants took two side shuffle steps, took off from a single leg, jumped to an indicator, and landed single-legged onto a force plate on the opposite limb. The indicator was positioned at 50% of the athlete’s maximum vertical jump for both jumping tasks. All participants were instructed to land in the middle of the force plate, stabilize as quickly as possible on the single test leg, and remain motionless for 5 seconds. The results showed that the unstable group required more time to stabilize compared to other healthy and coper groups for both forward and lateral hops.

The jump-landing protocol was able to identify differences in time to stabilize among college athletes. It involved three different components: (1) preparatory steps into the jump, (2) both forward and lateral propulsions of the body and (3) a vertical displacement of the body. Other jump-landing protocols incorporate at most two of these components and previous studies were unable to identify differences between groups. Therefore, the researchers suggest that all 3 components are necessary in a time to stabilize protocol to identify athletes at risk for chronic ankle instability. However, the limitations of the study should be noted such as the small, homogenous sample size, which may not be generalizable to other populations, such as high school or recreational athletes. Identifying athletes at high risk for chronic ankle instability is important for medical professional to ascertain since it can help reduce the number of games/practices the athletes lose, and lessen the long-term burden of injury. If the jump-landing protocol is effective at identifying athletes at increased risk for injury then coaches and clinicians can use this information when developing strength training and/or rehabilitation procedures.

Questions for Discussion: What are the best exercises to improve dynamic stability in athletes with chronic ankle instability? Would it be possible to replace the force plate with some form of wearable motion tracking device that could make the test more available to athletes that do not have access to force plates?

Written by: Matt Prebble, MPH, CSCS
Reviewed by: Jane McDevitt

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Liu, K., Dierkes, C., & Blair, L. (2016). A new jump-landing protocol identifies differences in healthy, coper, and unstable ankles in collegiate athletes Sports Biomechanics, 15 (3), 245-254 DOI: 10.1080/14763141.2016.1158859

2 comments:

Kelly Martin said...

I think that the results of this article do a good job at exhibiting the need for prevention when it comes to CAI in the athletic population. The fact that both the coper and healthy groups performed similarly, with the CAI group demonstrating clear differences may raise the suspicion of the role of kinesiophobia or some other factor - as opposed to just mechanical differences between copers and CAI populations when it comes to performance on the jump tasks. Going along with that, I think that this brings up the importance of patient reported outcomes and subjective measures when it comes to athletic injuries and their management. Oftentimes the athlete’s outlook on their injury provides an excellent perspective that could even serve as a bit of a screening tool as to whether the athlete is ready to return to play or not. As far as the best exercises to improve dynamic stability, I think that the STAR excursion balance task is able to both identify those at risk, while also serving as a good objective measure and task that can improve function when incorporated into rehabilitation. This study utilized force plates and did an excellent job of identifying those with CAI. However, this is not always feasible and I think that the use of a wearable tracking device or even a video analysis would be beneficial in moving forward with actually using the jumping task presented in the article clinically. Cost efficiency is crucial, and it may even be possible to go a step further and “eyeball” this jumping task and time to stabilization, similar to a BESS error scoring system. It may not be as accurate, but perhaps it would be more clinically applicable. Overall, it is important to identify athletes that are at risk in order to decrease costs and potential risks, and the 3 tiered jumping task presented in this article may have potential as a screening tool in a high level athletic population.

Jane McDevitt said...

Kelly,
You bring up a lot of great points. I think researchers need to be aware and include patient reported outcomes before they conclude that one test or one rehab actually increases patient care. I think the SEBT has a lot of evidence backing that it can discriminate between healthy and at risk athletes but having a wearable tracking device to more conclusively look at sway and imbalance between legs would be more cost effective and provide more objective outcomes. I do believe we will be seeing more research in this area shortly!

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