Hop Stabilization Training and Landing Biomechanics in Athletes With Chronic Ankle Instability: A Randomized Controlled Trial
Ardakani MK, Wikstrom EA, Minoonejad H, Rajabi R, Sharifnezhad. J Athl Train. 2019; 5(12). Published online ahead of print October 16 2019. DOI:10.4085/1062-6050-550-17
Take-Home Message
A 6-week hop-stabilization training program improved landing mechanics and self-reported outcomes among male collegiate basketball players with chronic ankle instability.
Summary
Ankle sprains are one of the most common athletic injuries, particularly in a basketball population, and often result in chronic ankle instability (CAI). Plyometric training improves lower extremity biomechanics in healthy participants, and balance training improves postural control in people with CAI. However, the effects of plyometric hop training in people with CAI is unknown. Therefore, these authors conducted a randomized controlled clinical trial with 30 male collegiate basketball players with CAI to determine if jump-landing biomechanics improved after a hop stabilization training program versus no training. All athletes completed ankle specific patient-reported outcomes and had their lower extremity biomechanics analyzed during a drop-landing task before and after the 6-week period. The hop stabilization program consisted of 3 sessions per week that gradually progressed in repetitions and difficulty. Exercises consisted of lateral, horizontal, and multi-directional hopping (see article for full program). One person in each group dropped out of the study.
The athletes that completed the hop training improved more in most of the patient-reported outcomes (e.g., pain, symptoms, quality of life) and lower extremity biomechanics (e.g., peak ground reaction forces, rate of loading) compared with the control athletes. Notably, athletes who completed the hop training had increased knee/hip flexion and less knee valgus, ankle inversion, and ankle plantarflexion.
Viewpoints
Overall, the authors found that hop-stabilization training successfully improved self-reported outcomes and lower extremity landing biomechanics in male basketball athletes with CAI. The hope is that these improvements would reduce the risk of injury and long-term complications. It would be interesting to see how long these improvements last after the program ended and whether their self-reported symptoms were related to any specific biomechanical changes. In looking at the vertical ground reaction forces, it was interesting to see that there was a slight effect on the rate of loading and peak forces, but it remains unknown what effect this may have on the cartilage or long-term joint health. The program involved an increase in contacts per week and a gradual progression in the complexity of exercises. However, it would be interesting to know if there should be certain criteria that each participant should pass before making an exercise progression. For example, if I had difficulty with the zigzag hopping on 2 legs with balance, I might not be ready to progress to a single leg during the prescribed week. The progression of exercises and verbal feedback cues seemed effective in male basketball athletes, and it would be interesting to see if the same results would occur in female basketball athletes or other sports. Hop-stabilization training was successful at improving outcomes and should be considered when treating someone with CAI.
Questions for Discussion
How do you assess whether your patients have chronic ankle instability? What interventions have you utilized for patients with chronic ankle instability?
Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban
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For CAI we typically focus on the patients history (# of sprains, if they have recurrent feelings of it “giving away”) and disability questionnaires (IdFAI,FAAM) along with strength, balance, ROM, and functional activity measures. Interventions usually include exercises focusing on adjusting any deficits in strength, balance, ROM, and functional activity. We also have used blood flow restriction, hot/cold modalities, and joint mobilizations. Wondering what other tools you have used to diagnose CAI as well as what other interventions to treat CAI?
I am currently an athletic training student and at my clinical site we determine if someone has CAI based off their past medical history when it comes to ankle sprains. I currently work with the football team and we just finished our season and are now preparing for a bowl game so there is more time for rehabilitation and treatment for injuries, both chronic and acute. However, mid-season there isn’t much time to pull someone from playing with CAI to put them through a rehab protocol so we would do treatment with those athletes before practice which focused on basic strengthening and proprioceptive exercises and then they would get their ankle(s) taped or braced before practice or a game to try and prevent any further injury to the affected ankle(s). I am sure the football rehab protocol for CAI is different than for the basketball players based off of the intensity of the sport, type of athlete, type of shoe, and even the type of floor they practice and play on. I will have the opportunity to work with the men’s basketball team next semester at the same clinical site under a different preceptor so I am interested to see if there is a difference in protocol for management of athletes with CAI.
I think it is great that a hop training protocol was able to have such a positive outcome on the athletes that were put through it. I would be interested to see how long the effects of the training last after the protocol is finished or would the athletes have to continue something like this throughout their athletic career to be able to maintain the stability in their ankle. I also think that it should be specific to each individual athlete that way it can be known by the clinician that the athlete is making safe and appropriate progress based on their own weaknesses or strengths. Not every athlete is able to progress at the same exact rate. Since ankle sprains are the most common injuries among athletes, I also wonder if this program should be given to every athlete as a part of their strength and conditioning program or warm up and not just athletes with CAI that way ankle stability can be a focus to try and prevent an injury that already has a good chance of happening in the future.
I have always used palpation, laxity, and special tests to assess ankle instability whether it be acute or chronic. Testing the integrity of each of the ligaments within the ankle joint and identifying the deficits from the hip down has usually my method to asses CAI.
The intervention I have used mostly is strengthening the deficits within the lower extremity and lower leg. There should also be pain free full ROM at the ankle joint but lastly attempting to correct those identified postural miscues that could be inhibiting the ankle more.
I would like to try this hop protocol specifically with our football collegiate athletes to see if the study correlates with them as well.