Definition of Chronic Ankle Instability (CAI)[edit | edit source]Chronic ankle instability (CAI) has been defined as “repetitive bouts of lateral ankle instability resulting in numerous ankle sprains.”[1] Chronic instability refers to a feeling of apprehension in the ankle, “giving way” and recurrent ankle sprains, persisting for a minimum of six months after the initial sprain.[2] Symptoms include:[2] Show
Based on the International Classification of Function, Health and Disability (ICF) model, the effects of CAI on function and health include:
Long-term Outcomes[edit | edit source]Patients with CAI experience a reduction in their physical quality of life. Treatments may improve stability, but they take a long time and may require specialised equipment.[2] Konradsen et al.[4] conducted a study that followed-up with patients seven years post-ankle inversion trauma. They found the following:[4]
According to Hertel,[5] one sprain guarantees another.[2] And Struijs and Kerkhoffs[6] found that there was a 30% recurrence of sprains within a year of injury.[2] Additional reported long-term outcomes include:
Mechanical and Functional Instability[edit | edit source]There are two commonly accepted subgroups of CAI: mechanical instability and functional instability.[2][3] In Hertel's[8] model of ankle stability, mechanical and functional instability are part of a continuum. Recurrent sprains occur when both conditions are present.[8] Mechanical Instability[edit | edit source]Mechanical instability is referred to as pathological ligamentous laxity about the ankle-joint complex.[9] Mechanical instability may be caused by various anatomic changes that are present in isolation or in combination. They can lead to pathologies that are responsible for ankle instability.[3] Functional Instability[edit | edit source]There is no universally approved definition of functional ankle instability.[10] Based on the definition established by Evans et al.,[11] functional instability is a subjective complaint of weakness. Lentell et al.[12] describe functional instability as ankle pain and the perception that the injured ankle is less functional than the other ankle or it is less functional than it was pre-injury.[12] Tropp et al.[13] concluded functional instability can be defined as a joint motion which does not exceed normal physiologic limits, but which is no longer controlled voluntarily.[13] Impaired proprioceptive and neuromuscular control can be responsible for functional instability.[8] Table 1 summarises the causes and results of mechanical and functional ankle instability:[2] Diagnostic Procedures[edit | edit source]Diagnostic procedures can help clinicians confirm the presence of various ankle deficiencies, including reduced range of motion and perceived disability. This can help to define / diagnose a specific condition. Clinicians should consider if research findings suggest "consistent positive utility" before deciding which diagnostic tool to use:[14]
[20]
Physiotherapy Management[edit | edit source]Conservative management is the treatment of choice for acute lateral ankle injuries - a surgical approach for these injuries is reserved for special cases.[22] Currently available conservative modalities include:[2]
Neuromuscular Training[edit | edit source]
Guide to Neuromuscular Training[edit | edit source]Neuromuscular training is an "unconscious activation of dynamic restraints in preparation and in response to joint motion and loads to maintain and restore functional joint stability".[2] Goals of neuromuscular training:
Exercises[edit | edit source]Exercises are performed in closed chain and functional positions:
Balance Training[edit | edit source]
Guide to Balance Training[edit | edit source]The literature indicates that the following balance measures should guide clinical practice. However, De Vries et al.[23] did not find a correlation with function:
Proprioception[edit | edit source]Kinesthesia and joint position sense (JPS) are usually impaired in patients with chronic ankle instability.[33] The testing methodology for proprioception includes:
Therapeutic Interventions[edit | edit source]
Mobilisation[edit | edit source]
Therapeutic Interventions[edit | edit source]Mulligan’s mobilisation with movement (MWM) technique should include the following:
Helene Simpson also recommends using an MWM technique that includes midfoot mobility at the navicular.[2] Braces and Taping[edit | edit source]Taping[edit | edit source]
Therapeutic Intervention[edit | edit source]The following taping techniques were clinically assessed:[2]
[40]
[42]
Braces[edit | edit source]No significant effect was found on function and balance when braces were applied.[2] The following findings are of interest:
Therapeutic intervention[edit | edit source]
Flexibility and Strength Training[edit | edit source]Flexibility: Traditional concepts of flexibility exercises in chronic ankle instability include stretches of the soleus and gastrocnemius, performed 3 times for 30 seconds.[2] A new protocol suggests including plantar fascia stretches and walking backwards.[49] Helene Simpson recommends neural roll-down and toe extension stretches (flexor hallucis longus and big toe extension).[2] Strength: A meta-analysis by Arnold et al.[50] on concentric evertor strength deficits found:
During strengthening exercises, muscle co-contraction is essential. Treatment protocols should include:
Strength is important and should be included in rehabilitation. Example Treatment Protocol[edit | edit source]Helene Simpson provides an example of her treatment protocol for the management of chronic ankle instability.[2] General Principles[edit | edit source]
Retraining medial ankle ligament Phase 1[edit | edit source]Cardio-vascular fitness to include:
Postural Control/ Balance exercises to include:
Strengthening exercises to include:
Balance and proximal control Phase 2[edit | edit source]Cardio-vascular fitness
Functional strength
Balance training
Shoe assessment Phase 3[edit | edit source]Cardio-vascular
Balance/ function/ agility
Integration of sport specific activities, but without compromising the quality of movement. Pain monitoring References[edit | edit source]
How should the foot be positioned when taping an ankle for stability?The ankle should be setup in the exact position that it should be in after taping. This is usually neutral dorsiflexion (90 degrees relative to the lower leg) with the hindfoot everted (positioned so that the structures on the outside of the ankle are tight).
What is the proper patient positioning for taping the Achilles tendon quizlet?Do not apply tape if the skin is cold or hot from a therapeutic treatment. When one is taping to support an Achilles tendon, place the athlete in a seated position with the foot at a 90° angle. When one is taping a contused hand, the fingers are held side by side so the anchor can be securely fastened.
Which of the following taping techniques should never use Underwrap?Knee Taping
1. Underwrap should not be used because adequate traction to support the joint can be achieved only by taping directly to the skin.
What conditions can arch taping be used to support?Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity.
|