A New Dimension in the Study of Human Functional Joint Instability

Abstract:

Functional joint instability is common after joint soft tissue injuries. We present in this report our pilot finding in a study of functional ankle instability. Although past studies have suggested multiple pathological factors for functional ankle instability, none of those factors has been confirmed in the past studies. More importantly, no known factor can provide an explanation for an ankle giving way phenomenon which is a key element in defining a functional ankle instability. In this pilot study, we tested five subjects with functional ankle instability using a dynamic ankle stretching device combined with nociceptive electrical stimulation. Three out of five subjects showed a drastic reaction in which they totally gave up their control of upright standing after their affected ankles were under the combined ankle stretch and nociceptive stimuli. Such drastic reaction was not observed in the same ankles under only the ankle stretch. There was no such drastic reaction in the unaffected ankle under either testing condition. This pilot finding indicates a possibility of a hyper-reactivity to unloading reaction in the ankles with functional ankle instability

• Periodical: Applied Mechanics and Materials (Volumes 249-250)
• Pages: 1271-1276
• DOI: https://doi.org/10.4028/www.scientific.net/AMM.249-250.1271
• Online since: December 2012
• Authors: Wen Liu, Tarang Jain, Clayton Wauneka
• Keywords: Ankle Joint, Central Nervous System, Functional Instability, Hyper-Reactivity, Unloading

References

[1] P. M. Boruta, J. O. Bishop, W. G. Braly, and H. S. Tullos, Acute lateral ankle ligament injuries: a literature review, Foot Ankle, vol. 11, pp.107-13, Oct (1990).

DOI: 10.1177/107110079001100210

[2] J. Ekstrand and H. Tropp, The incidence of ankle sprains in soccer, Foot Ankle, vol. 11, pp.41-4, Aug (1990).

DOI: 10.1177/107110079001100108

[3] P. A. Renstrom and L. Konradsen, Ankle ligament injuries, Br J Sports Med, vol. 31, pp.11-20, Mar (1997).

DOI: 10.1136/bjsm.31.1.11

[4] T. Nakasa, K. Fukuhara, N. Adachi, and M. Ochi, Evaluation of anterior talofibular ligament lesion using 3-dimensional computed tomography, J Comput Assist Tomogr, vol. 30, pp.543-7, May-Jun (2006).

DOI: 10.1097/00004728-200605000-00032

[5] J. Ekstrand, J. Gillquist, and S. O. Liljedahl, Prevention of soccer injuries. Supervision by doctor and physiotherapist, Am J Sports Med, vol. 11, pp.116-20, May-Jun (1983).

DOI: 10.1177/036354658301100302

[6] K. Quinn, P. Parker, R. de Bie, B. Rowe, and H. Handoll, Interventions for preventing ankle ligament injuries, Cochrane Database Syst Rev, p. CD000018, (2000).

DOI: 10.1002/14651858.cd000018

[7] S. Maehlum and O. A. Daljord, Football injuries in Oslo: a one-year study, Br J Sports Med, vol. 18, pp.186-90, Sep (1984).

DOI: 10.1136/bjsm.18.3.186

[8] M. A. Freeman, Instability of the foot after injuries to the lateral ligament of the ankle, J Bone Joint Surg Br, vol. 47, pp.669-77, Nov (1965).

[9] J. Hertel, Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability, J Athl Train, vol. 37, pp.364-375, Dec (2002).

[10] M. A. Freeman, M. R. Dean, and I. W. Hanham, The etiology and prevention of functional instability of the foot, Journal of Bone & Joint Surgery (British Volume), vol. 47, pp.678-85, Nov (1965).

DOI: 10.1302/0301-620x.47b4.678

[11] H. Tropp, P. Odenrick, and J. Gillquist, Stabilometry recordings in functional and mechanical instability of the ankle joint, Int J Sports Med, vol. 6, pp.180-2, Jun (1985).

DOI: 10.1055/s-2008-1025836

[12] W. Liu, S. Siegler, and L. Techner, Quantitative measurement of ankle passive flexibility using an arthrometer on sprained ankles, Clin Biomech (Bristol, Avon), vol. 16, pp.237-44, Mar (2001).

DOI: 10.1016/s0268-0033(00)00088-7

[13] K. M. Refshauge, S. L. Kilbreath, and J. Raymond, Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains, J Orthop Sports Phys Ther, vol. 33, pp.166-73; discussion 173-6, Apr (2003).

DOI: 10.2519/jospt.2003.33.4.166

[14] T. J. Hubbard and T. W. Kaminski, Kinesthesia Is Not Affected by Functional Ankle Instability Status, J Athl Train, vol. 37, pp.481-486, Dec (2002).

[15] S. H. You, K. P. Granata, and L. K. Bunker, Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation, J Orthop Sports Phys Ther, vol. 34, pp.449-60, Aug (2004).

DOI: 10.2519/jospt.2004.34.8.449

[16] H. Tropp, Pronator muscle weakness in functional instability of the ankle joint, Int J Sports Med, vol. 7, pp.291-4, Oct (1986).

DOI: 10.1055/s-2008-1025777

[17] I. Pontaga, Ankle joint evertor-invertor muscle torque ratio decrease due to recurrent lateral ligament sprains, Clin Biomech (Bristol, Avon), vol. 19, pp.760-2, Aug (2004).

DOI: 10.1016/j.clinbiomech.2004.05.003

[18] M. Ebig, S. M. Lephart, R. G. Burdett, M. C. Miller, and D. M. Pincivero, The effect of sudden inversion stress on EMG activity of the peroneal and tibialis anterior muscles in the chronically unstable ankle, J Orthop Sports Phys Ther, vol. 26, pp.73-7, Aug (1997).

DOI: 10.2519/jospt.1997.26.2.73

[19] R. Lofvenberg, J. Karrholm, and G. Sundelin, [Proprioceptive reaction in the healthy and chronically unstable ankle joint], Sportverletz Sportschaden, vol. 10, pp.79-83, Dec (1996).

[20] C. J. Hass, M. D. Bishop, D. Doidge, and E. A. Wikstrom, Chronic ankle instability alters central organization of movement, Am J Sports Med, vol. 38, pp.829-34, Apr (2010).

DOI: 10.1177/0363546509351562

[21] L. K. Drewes, P. O. McKeon, G. Paolini, P. Riley, D. C. Kerrigan, C. D. Ingersoll, and J. Hertel, Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability, J Sport Rehabil, vol. 18, pp.375-88, Aug (2009).

DOI: 10.1123/jsr.18.3.375

[22] P. W. Marshall, A. D. McKee, and B. A. Murphy, Impaired trunk and ankle stability in subjects with functional ankle instability, Med Sci Sports Exerc, vol. 41, pp.1549-57, Aug (2009).

DOI: 10.1249/mss.0b013e31819d82e2

[23] E. G. Spaich, L. Arendt-Nielsen, and O. K. Andersen, Modulation of lower limb withdrawal reflexes during gait: a topographical study, J Neurophysiol, vol. 91, pp.258-66, Jan (2004).

DOI: 10.1152/jn.00360.2003

[24] J. A. Ashton-Miller, R. A. Ottaviani, C. Hutchinson, and E. M. Wojtys, What best protects the inverted weightbearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses, Am J Sports Med, vol. 24, pp.800-9, Nov-Dec (1996).

DOI: 10.1177/036354659602400616

[25] A. L. Dellon, Denervation of the sinus tarsi for chronic post-traumatic lateral ankle pain, Orthopedics, vol. 25, pp.849-51, Aug (2002).

DOI: 10.3928/0147-7447-20020801-22

[26] J. D. Michelson and C. Hutchins, Mechanoreceptors in human ankle ligaments, J Bone Joint Surg Br, vol. 77, pp.219-24, Mar (1995).

DOI: 10.1302/0301-620x.77b2.7706334

[27] C. J. Woolf, Evidence for a central component of post-injury pain hypersensitivity, Nature, vol. 306, pp.686-8, Dec 15-21 (1983).

DOI: 10.1038/306686a0

[28] T. A. Samad, K. A. Moore, A. Sapirstein, S. Billet, A. Allchorne, S. Poole, J. V. Bonventre, and C. J. Woolf, Interleukin-1beta-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity, Nature, vol. 410, pp.471-5, Mar 22 (2001).

DOI: 10.1038/35068566

[29] J. Scholz, D. C. Broom, D. H. Youn, C. D. Mills, T. Kohno, M. R. Suter, K. A. Moore, I. Decosterd, R. E. Coggeshall, and C. J. Woolf, Blocking caspase activity prevents transsynaptic neuronal apoptosis and the loss of inhibition in lamina II of the dorsal horn after peripheral nerve injury, J Neurosci, vol. 25, pp.7317-23, Aug 10 (2005).

DOI: 10.1523/jneurosci.1526-05.2005

[30] C. J. Woolf and M. W. Salter, Neuronal plasticity: increasing the gain in pain, Science, vol. 288, pp.1765-9, Jun 9 (2000).

DOI: 10.1126/science.288.5472.1765

[31] B. Hintermann, A. Boss, and D. Schafer, Arthroscopic findings in patients with chronic ankle instability, Am J Sports Med, vol. 30, pp.402-9, May-Jun (2002).

DOI: 10.1177/03635465020300031601

[32] G. A. Komenda and R. D. Ferkel, Arthroscopic findings associated with the unstable ankle, Foot Ankle Int, vol. 20, pp.708-13, Nov (1999).

DOI: 10.1177/107110079902001106

[33] M. J. Santos and W. Liu, Unloading reaction to electrical stimulation at neutral and supinated ankle positions, Gait Posture, vol. 26, pp.106-12, Jun (2007).

DOI: 10.1016/j.gaitpost.2006.08.004

[34] M. J. Santos, H. Liu, and W. Liu, Unloading reactions in functional ankle instability, Gait Posture, vol. 27, pp.589-94, May (2008).

DOI: 10.1016/j.gaitpost.2007.08.001

[35] W. Liu, M. J. Santos, K. McIntire, J. Loudon, H. Goist-Foley, and G. Horton, Patterns of inter-joint coordination during a single-limb standing, Gait Posture, vol. 36, pp.614-8, Jul (2012).

DOI: 10.1016/j.gaitpost.2012.06.005

[36] S. L. Rozzi, S. M. Lephart, R. Sterner, and L. Kuligowski, Balance training for persons with functionally unstable ankles, J Orthop Sports Phys Ther, vol. 29, pp.478-86, Aug (1999).

DOI: 10.2519/jospt.1999.29.8.478

[37] S. A. Hale, J. Hertel, and L. C. Olmsted-Kramer, The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability, J Orthop Sports Phys Ther, vol. 37, pp.303-11, Jun (2007).

DOI: 10.2519/jospt.2007.2322

[38] J. N. Bernier and D. H. Perrin, Effect of coordination training on proprioception of the functionally unstable ankle, J Orthop Sports Phys Ther, vol. 27, pp.264-75, Apr (1998).

DOI: 10.2519/jospt.1998.27.4.264

[39] J. C. Kennedy, I. J. Alexander, and K. C. Hayes, Nerve supply of the human knee and its functional importance, Am J Sports Med, vol. 10, pp.329-35, Nov-Dec (1982).

DOI: 10.1177/036354658201000601

[40] M. J. Cross and J. F. Powell, Long-term followup of posterior cruciate ligament rupture: a study of 116 cases, Am J Sports Med, vol. 12, pp.292-7, Jul-Aug (1984).

DOI: 10.1177/036354658401200409