Sports Medicine Research: In the Lab & In the Field: It’s All in the Hips – Landing Compensations with Chronic Ankle Instability (Sports Med Res)


Monday, April 2, 2018

It’s All in the Hips – Landing Compensations with Chronic Ankle Instability

Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping

Kim H, Jun Son S, Seely MK, Hopkins JT. Medicine & Science in Sports & Exercise. 2018; 50(2): 308-317. doi: 10.1249/MSS.0000000000001442

Take Home Message: Those with chronic ankle instability employ a hip-dominant strategy during jumping and landing tasks compared with healthy individuals. The strategy may contribute to injury risk and altered performance.

There is increasing information that people with chronic ankle instability (CAI) have altered movement patterns during dynamic tasks; however, less is known about how joints throughout the kinetic chain may contribute to recurrent problems seen in this population. Thus, the authors conducted a large-scale study looking at hip, knee, and ankle biomechanics in 100 individuals with CAI compared to matched healthy counterparts during a jumping and landing task. Participants were set up in a motion capture system and provided 5 minutes to walk on a treadmill to warm up. They were then given up to 10 practice trials followed by 10 collected trials of a jumping and landing protocol. This task consisted of a double leg maximum vertical forward jump, single leg landing with the involved (and matched for healthy subjects) limb onto a designated “x” on a force plate, immediately followed by a 90 degrees side-cutting jump to the opposite side. The investigators specifically examined data from when the foot was in contact with the ground with landing and jumping sub-phases (see table below). The researchers compared groups based on joint power, sagittal plane jointstiffness, and joints moments. Compared to the healthy group, the CAI group demonstrated decreased ankle and knee 1) plantarflexion and knee extension moments during landing, 2) joint stiffness, and 3) eccentric and concentric power during landing and early jumping phases. Conversely, those with CAI had increased hip 1) extension moments during landing and jumping, 2) eccentric power during early landing, 3) concentric power during jumping, and 4) joint stiffness.

These findings are important because they reflect that individuals with CAI are compensating at the hip during loaded, dynamic tasks potentially due to limitations at the ankle. This redistribution of force may be a detrimental strategy because it could lead to decrements in performance and heightened injury risk. These findings highlight the need for clinicians to consider the full lower extremity when treating individuals with CAI. The authors also recommend that these patients may benefit from movement-related functional rehabilitation that challenge proprioception and motor control systems. The authors acknowledged that these findings are limited to those with CAI and cannot be extrapolated to individuals with acute ankle sprains nor to those that are considered “copers”. However, these findings remind clinicians to target movement patterns among those with CAI to improve performance and mitigate the risk of injury.

Questions for Discussion: What rehabilitation protocols have others implemented to target full lower extremity movement patterns? What are other functional movements that would be important to assess as they pertain to injury risk and performance?

Written by: Alexandra F. DeJong
Reviewed by: Jeffrey Driban

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