The effect of immediate neuromuscular training on ankle biomechanics in individuals with functional ankle instability

  • Jiongxiang Zhao Faculty of Sport Science, Ningbo University, Ningbo 315211, China
  • Enze Shao Faculty of Sport Science, Ningbo University, Ningbo 315211, China
  • Julien S. Baker Faculty of Sport Science, Ningbo University, Ningbo 315211, China
  • Ee-Chon Teo Faculty of Sport Science, Ningbo University, Ningbo 315211, China
  • Yaodong Gu Faculty of Sport Science, Ningbo University, Ningbo 315211, China; Faculty of Engineering, University of Szeged, Szeged 6724, Hungary
Keywords: functional ankle instability; neuromuscular training; foam cushion surface; muscle; ankle biomechanics
Ariticle ID: 162

Abstract

Functional ankle instability arises from recurrent ankle sprains. Neuromuscular training is employed to enhance ankle stability in individuals who experience functional ankle instability. The study involved 24 male university students with functional ankle instability, undergoing ankle neuromuscular training on three surfaces. The OpenSim musculoskeletal model assessed effects on ankle kinematics, kinetics, and muscle activity. Using one-way repeated measures ANOVA and one-dimensional statistical non-parametric mapping to distinguish differences among training surfaces. The study aimed to compare biomechanical characteristics of ankle motion in individuals with functional ankle instability undergoing immediate neuromuscular training on a foam cushion surface versus training on level-ground and artificial turf. Results showed foam cushion training significantly increased tibialis anterior and gastrocnemius medial activation during walking (p < 0.05), with no differences observed in peak ankle plantarflexion, peroneus longus, and gastrocnemius lateral. Foam cushion training further increased activation in four muscles and peak ankle plantarflexion moment during jogging and fast running (p < 0.05). Furthermore, foam cushion training reduced subtalar mobility (p < 0.05) and showed greater dorsiflexion angles during jogging and fast running (p < 0.05). Therefore, immediate ankle neuromuscular training on a foam cushion is more advantageous in enhancing ankle stability among individuals with functional ankle instability, positively impacting functional ankle instability improvement.

References

1. Monteiro PA, Chen KY, Lira FS, et al. Concurrent and aerobic exercise training promote similar benefits in body composition and metabolic profiles in obese adolescents. Lipids in health and disease. 2015; 14(1): 1-9.

2. Paluska SA. An overview of hip injuries in running. Sports medicine. 2005; 35: 991-1014.

3. Chen TL-W, Wong DW-C, Wang Y, et al. Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: a dynamic finite element analysis. Journal of Biomechanics. 2019; 83: 260-72.

4. Tenforde AS, Yin A, Hunt KJJPM, Clinics R. Foot and ankle injuries in runners. 2016; 27(1): 121-137.

5. Hertel JJJoat. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. 2002; 37(4): 364.

6. Kobayashi T, Gamada KJF. Lateral ankle sprain and chronic ankle instability: a critical review. 2014; 7(4): 298-326.

7. Delahunt E, Coughlan GF, Caulfield B, et al. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Medicine & Science in Sports & Exercise. 2010; 42(11): 2106-2121.

8. Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. Journal of Science and Medicine in Sport. 2010;13(1):2-12.

9. Hamacher D, Hollander K, Zech AJCb. Effects of ankle instability on running gait ankle angles and its variability in young adults. 2016; 33: 73-78.

10. Kaminski TW, Needle AR, Delahunt E. Prevention of lateral ankle sprains. Journal of Athletic Training. 2019; 54(6): 650-661.

11. Miller H, Needle AR, Swanik CB, et al. Role of external prophylactic support in restricting accessory ankle motion after exercise. Foot & Ankle International. 2012; 33(10): 862-869.

12. Owoeye OB, Palacios-Derflingher LM, Emery CAJCjosm. Prevention of ankle sprain injuries in youth soccer and basketball: effectiveness of a neuromuscular training program and examining risk factors. 2018; 28(4): 325-331.

13. O'Driscoll J, Delahunt E. Neuromuscular training to enhance sensorimotor and functional deficits in subjects with chronic ankle instability: A systematic review and best evidence synthesis. Sports Medicine Arthroscopy Rehabilitation Therapy & Technology. 2011; 3: 1-20.

14. Vriend I, Gouttebarge V, Van Mechelen W, Verhagen EJJoI. Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies. 2016; 1(4): 202-213.

15. Herb CC, Hertel J. Current concepts on the pathophysiology and management of recurrent ankle sprains and chronic ankle instability. Current Physical Medicine and Rehabilitation Reports. 2014; 2: 25-34.

16. Lee HM, Oh S, Kwon JW. Effect of plyometric versus ankle stability exercises on lower limb biomechanics in taekwondo demonstration athletes with functional ankle instability. International Journal of Environmental Research and Public Health. 2020; 17(10): 3665.

17. De Ridder R, Willems T, Vanrenterghem J, Roosen P. Influence of balance surface on ankle stabilizing muscle activity in subjects with chronic ankle instability. Journal of rehabilitation medicine. 2015; 47(7): 632-8.

18. Ha S-Y, Han J-H, Sung Y-H. Effects of ankle strengthening exercise program on an unstable supporting surface on proprioception and balance in adults with functional ankle instability. Journal of exercise rehabilitation. 2018; 14(2): 301.

19. Behm DG, Muehlbauer T, Kibele A, Granacher U. Effects of strength training using unstable surfaces on strength, power and balance performance across the lifespan: a systematic review and meta-analysis. Sports Medicine. 2015; 45: 1645-69.

20. Lin C-C, Roche JL, Steed DP, et al. Test-retest reliability of postural stability on two different foam pads. Journal of nature and science. 2015; 1(2): e43.

21. Van Jaarsveld G. The effect of concrete and artificial turf surfaces on lower limb muscle fatigue among UFS netball players: University of the Free State; 2015.

22. Simon J, Donahue M, Docherty C. Development of the identification of functional ankle instability (IdFAI). Foot & Ankle International. 2012; 33(9): 755-63.

23. Baray A-L, Philippot R, Neri T, et al. The Hemi-Castaing ligamentoplasty for chronic lateral ankle instability does not modify proprioceptive, muscular and posturographic parameters. Knee Surgery, Sports Traumatology, Arthroscopy. 2016; 24: 1108-15.

24. Busquets R, Sanchez-Raya J, Sallent A, et al. Proximal medial gastrocnemius release: muscle strength evaluation. Foot and Ankle Surgery. 2020; 26(7): 828-32.

25. Yokoyama H, Sasaki A, Kaneko N, et al. Robust identification of motor unit discharges from high-density surface EMG in dynamic muscle contractions of the tibialis anterior. IEEE Access. 2021; 9: 123901-123911.

26. Burkhard MD, Wirth SH, Andronic O, et al. Clinical and functional outcomes of peroneus longus to brevis tendon transfer. Foot & Ankle International. 2021;42(6):699-705.

27. KK S, Verma R, Kumar L. Ethylene-Vinyl Acetate Foam. Polymeric Foams: Fundamentals and Types of Foams (Volume 1): ACS Publications; 2023. p. 205-21.

28. Hopkins JT, Son SJ, Kim H, et al. Characterization of multiple movement strategies in participants with chronic ankle instability. Journal of Athletic Training. 2019; 54(6): 698-707.

29. Mei Q, Fernandez J, Xiang L, et al. Dataset of lower extremity joint angles, moments and forces in distance running. Heliyon. 2022; 8(11): e11517.

30. Donovan L, Hart JM, Saliba S, et al. Effects of ankle destabilization devices and rehabilitation on gait biomechanics in chronic ankle instability patients: a randomized controlled trial. Physical Therapy in Sport. 2016; 21: 46-56.

31. Delp SL, Anderson FC, Arnold AS, et al. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE transactions on biomedical engineering. 2007; 54(11): 1940-50.

32. Monaghan K, Delahunt E, Caulfield B. Ankle function during gait in patients with chronic ankle instability compared to controls. Clinical biomechanics. 2006;21(2):168-74.

33. Chinn L, Dicharry J, Hertel J. Ankle kinematics of individuals with chronic ankle instability while walking and jogging on a treadmill in shoes. Physical Therapy in Sport. 2013; 14(4): 232-9.

34. Iwamoto Y, Takahashi M, Shinkoda K. Differences of muscle co-contraction of the ankle joint between young and elderly adults during dynamic postural control at different speeds. Journal of physiological anthropology. 2017; 36(1): 1-9.

35. Hartigan EH, Lawrence M, Bisson BM, et al. Relationship of the functional movement screen in-line lunge to power, speed, and balance measures. Sports health. 2014; 6(3): 197-202.

36. Jang J, Migel KG, Kim H, Wikstrom EA. Acute vibration feedback during gait reduces mechanical ankle joint loading in chronic ankle instability patients. Gait & Posture. 2021; 90: 261-6.

37. Seth A, Hicks JL, Uchida TK, et al. OpenSim: Simulating musculoskeletal dynamics and neuromuscular control to study human and animal movement. PLoS computational biology. 2018; 14(7): e1006223.

38. Lu Y, Mei Q, Peng H-T, et al. A comparative study on loadings of the lower extremity during deep squat in Asian and Caucasian individuals via OpenSim musculoskeletal modelling. BioMed Research International. 2020; 2020.

39. Stefaniak W, Marusiak J, Bączkowicz D. Heightened tone and stiffness with concurrent lowered elasticity of peroneus longus and tibialis anterior muscles in athletes with chronic ankle instability as measured by myotonometry. Journal of Biomechanics. 2022; 144: 111339.

40. Pataky TC, Vanrenterghem J, Robinson MA. Zero- vs. one-dimensional, parametric vs. non-parametric, and confidence interval vs. hypothesis testing procedures in one-dimensional biomechanical trajectory analysis. J Biomech. 2015; 48(7): 1277-85.

41. Steele KM, DeMers MS, Schwartz MH, Delp SL. Compressive tibiofemoral force during crouch gait. Gait & posture. 2012; 35(4): 556-60.

42. Smith BI, Docherty CL, Simon J, et al. Ankle strength and force sense after a progressive, 6-week strength-training program in people with functional ankle instability. Journal of athletic training. 2012; 47(3): 282-8.

43. Cloak R, Nevill A, Day S, Wyon M. Six-week combined vibration and wobble board training on balance and stability in footballers with functional ankle instability. Clinical journal of sport medicine. 2013; 23(5): 384-91.

44. Huang P-Y, Jankaew A, Lin C-F. Effects of plyometric and balance training on neuromuscular control of recreational athletes with functional ankle instability: a randomized controlled laboratory study. International journal of environmental research and public health. 2021; 18(10): 5269.

45. Samadi H, Rajabi R, Karimizadeh Ardakani M. The effect of six weeks of neuromuscular training on joint position sense and lower extremity function in male athletes with functional ankle instability. Journal of Exercise Science and Medicine. 2017; 9(1): 15-33.

46. Samadi H, Rajabi R, Alizadeh MH, Jamshidi A. Effect of six weeks neuromuscular training on dynamic postural control and lower extremity function in male athletes with functional ankle instability. Studies in sport medicine. 2014; 5(14): 73-90.

47. Fujimoto M, Hsu W-L, Woollacott MH, Chou L-S. Ankle dorsiflexor strength relates to the ability to restore balance during a backward support surface translation. Gait & posture. 2013; 38(4): 812-7.

48. Monteleone BJ, Ronsky JL, Meeuwisse WH, Zernicke RF. Ankle kinematics and muscle activity in functional ankle instability. Clinical Journal of Sport Medicine. 2014; 24(1): 62-8.

49. Feger MA, Donovan L, Hart JM, Hertel J. Lower extremity muscle activation during functional exercises in patients with and without chronic ankle instability. PM&R. 2014; 6(7): 602-11.

50. Ferreira LAB, Pereira WM, Rossi LP, et al. Analysis of electromyographic activity of ankle muscles on stable and unstable surfaces with eyes open and closed. Journal of bodywork and movement therapies. 2011; 15(4): 496-501.

51. Conceição JS, Schaefer de Araújo FG, Santos GM, et al. Changes in postural control after a ball-kicking balance exercise in individuals with chronic ankle instability. Journal of athletic training. 2016; 51(6): 480-90.

52. Williams III DB, Murray NG, Powell DW. Athletes who train on unstable compared to stable surfaces exhibit unique postural control strategies in response to balance perturbations. Journal of sport and health science. 2016; 5(1): 70-6.

53. Dias A, Pezarat-Correia P, Esteves J, Fernandes O. The influence of a balance training program on the electromyographic latency of the ankle musculature in subjects with no history of ankle injury. Physical Therapy in sport. 2011; 12(2): 87-92.

54. Petersen J, Nielsen RO, Rasmussen S, Sørensen H. Comparisons of increases in knee and ankle joint moments following an increase in running speed from 8 to 12 to 16 km· h− 1. Clinical Biomechanics. 2014; 29(9): 959-64.

55. Frigo CA, Merlo A, Brambilla C, Mazzoli D. Balanced Foot Dorsiflexion Requires a Coordinated Activity of the Tibialis Anterior and the Extensor Digitorum Longus: A Musculoskeletal Modelling Study. Applied Sciences. 2023; 13(13): 7984.

56. Weerapong P, Hume PA, Kolt GS. Stretching: mechanisms and benefits for sport performance and injury prevention. Physical Therapy Reviews. 2004; 9(4): 189-206.

57. Hoch MC, McKeon PO. Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. Journal of Orthopaedic Research. 2011; 29(3): 326-32.

58. Hoch MC, Farwell KE, Gaven SL, Weinhandl JT. Weight-bearing dorsiflexion range of motion and landing biomechanics in individuals with chronic ankle instability. Journal of athletic training. 2015; 50(8): 833-9.

59. Michael JM, Golshani A, Gargac S, Goswami T. Biomechanics of the ankle joint and clinical outcomes of total ankle replacement. Journal of the mechanical behavior of biomedical materials. 2008; 1(4): 276-294.

60. Wilkerson GB, Pinerola JJ, Caturano RW. Invertor vs. evertor peak torque and power deficiencies associated with lateral ankle ligament injury. Journal of Orthopaedic & Sports Physical Therapy. 1997; 26(2): 78-86.

61. Rosen A, Swanik C, Thomas S, et al. Differences in lateral drop jumps from an unknown height among individuals with functional ankle instability. Journal of athletic training. 2013;48(6):773-781.

62. DeMers MS, Hicks JL, Delp SL. Preparatory co-activation of the ankle muscles may prevent ankle inversion injuries. Journal of biomechanics. 2017; 52: 17-23.

63. Chen ET, McInnis KC, Borg-Stein J. Ankle sprains: evaluation, rehabilitation, and prevention. Current sports medicine reports. 2019; 18(6): 217-223.

Published
2024-07-08
How to Cite
Zhao, J., Shao, E., Baker, J. S., Teo, E.-C., & Gu, Y. (2024). The effect of immediate neuromuscular training on ankle biomechanics in individuals with functional ankle instability. Molecular & Cellular Biomechanics, 21, 162. https://doi.org/10.62617/mcb.v21.162
Section
Article