This article was downloaded by: [Princeton University] On: 28 August 2014, At: 17:25 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Computer Methods in Biomechanics and Biomedical Engineering Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcmb20
Unipodal landing in individuals with unilateral chronic ankle instability ab
b
a
b
R. Pionnier , N. Découfour , F. Barbier , C. Popineau & E. Simoneau-Buessinger
a
a
Laboratoire d'Automatique, de Mécanique, et d'Informatique industrielles et Humaines, UMR CNRS 8201, Université de Valenciennes et du Hainault-Cambrésis, F-59313, Valenciennes, France b
Laboratoire d'analyse du mouvement, Centre Hospitalier de la Région de Saint-Omer, F-62505, Saint-Omer Cedex, France Published online: 30 Jul 2014.
To cite this article: R. Pionnier, N. Découfour, F. Barbier, C. Popineau & E. Simoneau-Buessinger (2014) Unipodal landing in individuals with unilateral chronic ankle instability, Computer Methods in Biomechanics and Biomedical Engineering, 17:sup1, 100-101, DOI: 10.1080/10255842.2014.931334 To link to this article: http://dx.doi.org/10.1080/10255842.2014.931334
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Computer Methods in Biomechanics and Biomedical Engineering, 2014 Vol. 17, No. S1, 100–101, http://dx.doi.org/10.1080/10255842.2014.931334
Unipodal landing in individuals with unilateral chronic ankle instability R. Pionniera,b*, N. De´coufourb, F. Barbiera, C. Popineaub and E. Simoneau-Buessingera a
Laboratoire d’Automatique, de Me´canique, et d’Informatique industrielles et Humaines, UMR CNRS 8201, Universite´ de Valenciennes et du Hainault-Cambre´sis, F-59313 Valenciennes, France; bLaboratoire d’analyse du mouvement, Centre Hospitalier de la Re´gion de Saint-Omer, F-62505 Saint-Omer Cedex, France
Downloaded by [Princeton University] at 17:25 28 August 2014
Keywords: ankle instability; landing; kinematics; inversion traumatism; ankle sprain
1. Introduction Lateral ankle sprain is one of the most common injuries in sports (Caputo et al. 2009). This is characterised by an impairment of one or several bundles of the ankle collateral lateral ligament. It is consecutive to a forced inversion, corresponding to a supination and an adduction of the foot in plantar flexion when tibia is laterally rotated. Following a first sprain, recurrence can reach over 70% in sports and this can correspond to chronic ankle instability (CAI). CAI is defined as the occurrence of repeated lateral ankle instabilities, causing many lateral ankle sprains (Hertel 2002). People suffering from this pathology generally complain of an ankle disrobement during its loading, this was described as ‘giving way’ (GW) (Freeman 1965). A proprioception alteration is put forward as a cause of CAI (Freeman 1965; Hertel 2002). Unipodal jump is a task assessed by several authors to characterise CAI (Caulfield and Garrett 2004; Delahunt et al. 2006; Brown et al. 2012). This movement, and more precisely the landing following a high jump task, is studied in adequacy with specific sport conditions. Authors usually compared CAI participants with asymptomatic people, using ground reaction forces (GRF) and/or joint kinematics. The aim of this study was to assess unipodal landing in CAI participants. It was assumed that their kinematic and kinetic patterns could explain the occurrence of ankle GW and/or ankle sprains. Then, both joint kinematics and GRF in CAI participants have been assessed in an activity of daily living, landing from a step of a sidewalk high. These data have been compared with data of healthy people and with the contralateral limb of the CAI participants in order to give new information about their achieved strategies.
All volunteers practised sports at least four hours per week. All participants completed the Foot and Ankle Ability Measure (FAAM) (Carcia et al. 2002) in order to quantify self-reported instability. It includes a daily activity part (FAAM) and a sport activities part (FAAM Sports). Results are reported in Table 1, completed with annual ankle GW scores. To be included in the CAI group, participants had to complain of unilateral CAI at their dominant limb: they had an history of at least one acute lateral ankle sprain older than four months, with at least three episodes of ankle GW in the past year. They were free of any lower extremity surgery during the past four years. To be included in the CTRL group, participants had to report 100% on both parts of FAAM and FAAM Sports questionnaire. Participants in CTRL group were free of any ankle GW, any ankle sprain during the past four years, any history of other lower extremity osteoarticular injury and any history of lower limb surgery. Participants in the CTRL group were matched by sex, age, height, mass and limb dominance. In this study, participants were asked to practice a unipodal falling from a Domyosw Step 500 (Villeneuve d’Ascq, France) (15 cm high) to a force platform. They were asked to keep their hands on their hips and to maintain balance during 20 seconds after the unipodal landing. This exercise was realised in a movement analysis laboratory instrumented with an 8 optoelectronic cameras Viconw system (Oxford, UK), rated at 100 Hz, and an AMTIw force-plate (Watertown, MA, USA), rated at 1000 Hz. The three components of GRF were measured at foot strike (FS). Foot and ankle complex was divided into three parts, thanks to markers placement (Figure 1). It allowed to study
2.
Table 1. Scores for FAAM and FAAM Sports, and number of ankle GW per year.
Methods
Participants were categorised into either the unilateral CAI group (seven men, three women; age ¼ 26.1 ^ 5.7 years; height ¼ 1.75 ^ 0.10 m; mass ¼ 73.9 ^ 14.5 kg) or the control (CTRL) group (seven men, three women; age ¼ 27.3 ^ 10.3 years; height ¼ 1.79 ^ 0.06 m; mass ¼ 71.6 ^ 11.3 kg). *Corresponding author. Email: [email protected] q 2014 Taylor & Francis
Group FAAM ^ std, % FAAM Sports ^ std, % GW ^ std, % CAI
93.7 ^ 3.6
85.9 ^ 7.7
28 ^ 30
CAI, chronic ankle instability; FAAM, Foot and Ankle Ability Measure; GW, giving way; SD, standard deviation.
Computer Methods in Biomechanics and Biomedical Engineering
Downloaded by [Princeton University] at 17:25 28 August 2014
Figure 1. Local three-dimensional co-ordinates used in the study for right shank, rearfoot and forefoot.
rearfoot movements relative to shank and rearfoot movements relative to forefoot (respectively rearfoot angles and midfoot angles), as well as foot movements relative to shank (ankle angles). Joint kinematics was analysed from 0.2 seconds before FS to 0.2 seconds after FS. Student’s t tests were performed between groups and between limbs of CAI participants. The level of significance was set at p , 0.05 for all analyses. 3.
Results and discussion
Regarding kinematics, results between each lower limb of CAI participants did not highlight any difference. However, ankles of CAI participants were significantly less plantarflexed than CTRL ankles at 0.14 seconds before FS, and less adducted from 0.17 to 0.12 seconds before FS. Moreover, CAI midfoot was significantly more abducted than CTRL from 0.20 seconds before FS to 0.05 seconds after it. Thus, this result is also found at FS (Figure 2). Regarding rearfoot, flexion was significantly greater for CAI limbs than CTRL ones from 0.19 seconds before FS to 0.02 seconds after FS and from 0.08 to 0.16 seconds after it. Regarding kinetic data, no significant group or limb effects were noted. There is no consensus regarding joint kinematics between groups. Indeed, as for Delahunt et al. 2006, the results showed
Figure 2. Midfoot abduction. Dashed line highlights the time interval in which the differences are significant. CAI, chronic ankle instability; CTRL, control; FS, foot strike.
101
a more inverted position of the foot before strike and at FS, whereas other studies did not show any difference between groups (Caulfield and Garrett 2004; Wu et al. 2010; Brown et al. 2012). In our study, CAI participants presented a more abducted and more dorsi-flexed position of foot and ankle complex at these instants, which could highlight an adapted protection of the ankle against GW and/or sprains. Previous studies showed an increase in GRF components at FS (Delahunt et al. 2006; Wu et al. 2010), and thus in ankle joint stress. Those results could consequently increase the risk of ankle GW. The absence of difference in our study for kinetic data could be explained by the low height of fall. Regarding between limbs results of CAI participants, the lack of difference could highlight a motor control adaptation to protect both ankles against GW and/or sprains. Moreover, we noted that adduction of rearfoot and ankle tended to be even greater for uninvolved limb compared with involved limb. Thus, adduction of CTRL ankles tended to be even greater than uninvolved limb too. Therefore, the adaptation seems to be better for unstable ankles. 4.
Conclusion
Contrary to what was expected, it was not possible to show that CAI participants displayed movement patterns that could have explained the occurrence of ankle GW and/or ankle sprains during a unipodal landing. In this study, CAI people seemed to use a protection strategy by decreasing the risk of inversion traumatism. Nevertheless, inappropriate neuromuscular mechanisms cannot be excluded to explain ankle sprain recurrence. References Brown C, Bowser B, Simpson KJ. 2012. Movement variability during single leg jump landings in individuals with and without chronic ankle instability. Clin Biomech. 27:52– 63. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley II JA, DeFrate LE. 2009. In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Spor Med. 37(11):2241– 2248. Carcia CR, Martin RL, Drouin JM. 2002. Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability. J Athlet Training. 43(2):179 –183. Caulfield B, Garrett M. 2004. Changes in ground reaction force during jump landing in subjects with functional instability of the ankle joint. Clin Biomech. 19:617 – 621. Delahunt E, Monaghan K, Caulfield B. 2006. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res. 24(10):1991 –2000. Freeman MAR. 1965. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg. 47(4):669–677. Hertel J. 2002. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athletic Training. 37(4):364–375. Wu H-W, Chang Y-W, Liu C-W, Wang L-H. 2010. Biomechanical analysis of landing from counter movement jump and vertical jump with run-up in the individuals with functional ankle instability. Int J Sport Exercise Sci. 2 (2):43 – 48.
Computer Methods in Biomechanics and Biomedical Engineering Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcmb20
Unipodal landing in individuals with unilateral chronic ankle instability ab
b
a
b
R. Pionnier , N. Découfour , F. Barbier , C. Popineau & E. Simoneau-Buessinger
a
a
Laboratoire d'Automatique, de Mécanique, et d'Informatique industrielles et Humaines, UMR CNRS 8201, Université de Valenciennes et du Hainault-Cambrésis, F-59313, Valenciennes, France b
Laboratoire d'analyse du mouvement, Centre Hospitalier de la Région de Saint-Omer, F-62505, Saint-Omer Cedex, France Published online: 30 Jul 2014.
To cite this article: R. Pionnier, N. Découfour, F. Barbier, C. Popineau & E. Simoneau-Buessinger (2014) Unipodal landing in individuals with unilateral chronic ankle instability, Computer Methods in Biomechanics and Biomedical Engineering, 17:sup1, 100-101, DOI: 10.1080/10255842.2014.931334 To link to this article: http://dx.doi.org/10.1080/10255842.2014.931334
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Computer Methods in Biomechanics and Biomedical Engineering, 2014 Vol. 17, No. S1, 100–101, http://dx.doi.org/10.1080/10255842.2014.931334
Unipodal landing in individuals with unilateral chronic ankle instability R. Pionniera,b*, N. De´coufourb, F. Barbiera, C. Popineaub and E. Simoneau-Buessingera a
Laboratoire d’Automatique, de Me´canique, et d’Informatique industrielles et Humaines, UMR CNRS 8201, Universite´ de Valenciennes et du Hainault-Cambre´sis, F-59313 Valenciennes, France; bLaboratoire d’analyse du mouvement, Centre Hospitalier de la Re´gion de Saint-Omer, F-62505 Saint-Omer Cedex, France
Downloaded by [Princeton University] at 17:25 28 August 2014
Keywords: ankle instability; landing; kinematics; inversion traumatism; ankle sprain
1. Introduction Lateral ankle sprain is one of the most common injuries in sports (Caputo et al. 2009). This is characterised by an impairment of one or several bundles of the ankle collateral lateral ligament. It is consecutive to a forced inversion, corresponding to a supination and an adduction of the foot in plantar flexion when tibia is laterally rotated. Following a first sprain, recurrence can reach over 70% in sports and this can correspond to chronic ankle instability (CAI). CAI is defined as the occurrence of repeated lateral ankle instabilities, causing many lateral ankle sprains (Hertel 2002). People suffering from this pathology generally complain of an ankle disrobement during its loading, this was described as ‘giving way’ (GW) (Freeman 1965). A proprioception alteration is put forward as a cause of CAI (Freeman 1965; Hertel 2002). Unipodal jump is a task assessed by several authors to characterise CAI (Caulfield and Garrett 2004; Delahunt et al. 2006; Brown et al. 2012). This movement, and more precisely the landing following a high jump task, is studied in adequacy with specific sport conditions. Authors usually compared CAI participants with asymptomatic people, using ground reaction forces (GRF) and/or joint kinematics. The aim of this study was to assess unipodal landing in CAI participants. It was assumed that their kinematic and kinetic patterns could explain the occurrence of ankle GW and/or ankle sprains. Then, both joint kinematics and GRF in CAI participants have been assessed in an activity of daily living, landing from a step of a sidewalk high. These data have been compared with data of healthy people and with the contralateral limb of the CAI participants in order to give new information about their achieved strategies.
All volunteers practised sports at least four hours per week. All participants completed the Foot and Ankle Ability Measure (FAAM) (Carcia et al. 2002) in order to quantify self-reported instability. It includes a daily activity part (FAAM) and a sport activities part (FAAM Sports). Results are reported in Table 1, completed with annual ankle GW scores. To be included in the CAI group, participants had to complain of unilateral CAI at their dominant limb: they had an history of at least one acute lateral ankle sprain older than four months, with at least three episodes of ankle GW in the past year. They were free of any lower extremity surgery during the past four years. To be included in the CTRL group, participants had to report 100% on both parts of FAAM and FAAM Sports questionnaire. Participants in CTRL group were free of any ankle GW, any ankle sprain during the past four years, any history of other lower extremity osteoarticular injury and any history of lower limb surgery. Participants in the CTRL group were matched by sex, age, height, mass and limb dominance. In this study, participants were asked to practice a unipodal falling from a Domyosw Step 500 (Villeneuve d’Ascq, France) (15 cm high) to a force platform. They were asked to keep their hands on their hips and to maintain balance during 20 seconds after the unipodal landing. This exercise was realised in a movement analysis laboratory instrumented with an 8 optoelectronic cameras Viconw system (Oxford, UK), rated at 100 Hz, and an AMTIw force-plate (Watertown, MA, USA), rated at 1000 Hz. The three components of GRF were measured at foot strike (FS). Foot and ankle complex was divided into three parts, thanks to markers placement (Figure 1). It allowed to study
2.
Table 1. Scores for FAAM and FAAM Sports, and number of ankle GW per year.
Methods
Participants were categorised into either the unilateral CAI group (seven men, three women; age ¼ 26.1 ^ 5.7 years; height ¼ 1.75 ^ 0.10 m; mass ¼ 73.9 ^ 14.5 kg) or the control (CTRL) group (seven men, three women; age ¼ 27.3 ^ 10.3 years; height ¼ 1.79 ^ 0.06 m; mass ¼ 71.6 ^ 11.3 kg). *Corresponding author. Email: [email protected] q 2014 Taylor & Francis
Group FAAM ^ std, % FAAM Sports ^ std, % GW ^ std, % CAI
93.7 ^ 3.6
85.9 ^ 7.7
28 ^ 30
CAI, chronic ankle instability; FAAM, Foot and Ankle Ability Measure; GW, giving way; SD, standard deviation.
Computer Methods in Biomechanics and Biomedical Engineering
Downloaded by [Princeton University] at 17:25 28 August 2014
Figure 1. Local three-dimensional co-ordinates used in the study for right shank, rearfoot and forefoot.
rearfoot movements relative to shank and rearfoot movements relative to forefoot (respectively rearfoot angles and midfoot angles), as well as foot movements relative to shank (ankle angles). Joint kinematics was analysed from 0.2 seconds before FS to 0.2 seconds after FS. Student’s t tests were performed between groups and between limbs of CAI participants. The level of significance was set at p , 0.05 for all analyses. 3.
Results and discussion
Regarding kinematics, results between each lower limb of CAI participants did not highlight any difference. However, ankles of CAI participants were significantly less plantarflexed than CTRL ankles at 0.14 seconds before FS, and less adducted from 0.17 to 0.12 seconds before FS. Moreover, CAI midfoot was significantly more abducted than CTRL from 0.20 seconds before FS to 0.05 seconds after it. Thus, this result is also found at FS (Figure 2). Regarding rearfoot, flexion was significantly greater for CAI limbs than CTRL ones from 0.19 seconds before FS to 0.02 seconds after FS and from 0.08 to 0.16 seconds after it. Regarding kinetic data, no significant group or limb effects were noted. There is no consensus regarding joint kinematics between groups. Indeed, as for Delahunt et al. 2006, the results showed
Figure 2. Midfoot abduction. Dashed line highlights the time interval in which the differences are significant. CAI, chronic ankle instability; CTRL, control; FS, foot strike.
101
a more inverted position of the foot before strike and at FS, whereas other studies did not show any difference between groups (Caulfield and Garrett 2004; Wu et al. 2010; Brown et al. 2012). In our study, CAI participants presented a more abducted and more dorsi-flexed position of foot and ankle complex at these instants, which could highlight an adapted protection of the ankle against GW and/or sprains. Previous studies showed an increase in GRF components at FS (Delahunt et al. 2006; Wu et al. 2010), and thus in ankle joint stress. Those results could consequently increase the risk of ankle GW. The absence of difference in our study for kinetic data could be explained by the low height of fall. Regarding between limbs results of CAI participants, the lack of difference could highlight a motor control adaptation to protect both ankles against GW and/or sprains. Moreover, we noted that adduction of rearfoot and ankle tended to be even greater for uninvolved limb compared with involved limb. Thus, adduction of CTRL ankles tended to be even greater than uninvolved limb too. Therefore, the adaptation seems to be better for unstable ankles. 4.
Conclusion
Contrary to what was expected, it was not possible to show that CAI participants displayed movement patterns that could have explained the occurrence of ankle GW and/or ankle sprains during a unipodal landing. In this study, CAI people seemed to use a protection strategy by decreasing the risk of inversion traumatism. Nevertheless, inappropriate neuromuscular mechanisms cannot be excluded to explain ankle sprain recurrence. References Brown C, Bowser B, Simpson KJ. 2012. Movement variability during single leg jump landings in individuals with and without chronic ankle instability. Clin Biomech. 27:52– 63. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley II JA, DeFrate LE. 2009. In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Spor Med. 37(11):2241– 2248. Carcia CR, Martin RL, Drouin JM. 2002. Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability. J Athlet Training. 43(2):179 –183. Caulfield B, Garrett M. 2004. Changes in ground reaction force during jump landing in subjects with functional instability of the ankle joint. Clin Biomech. 19:617 – 621. Delahunt E, Monaghan K, Caulfield B. 2006. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res. 24(10):1991 –2000. Freeman MAR. 1965. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg. 47(4):669–677. Hertel J. 2002. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athletic Training. 37(4):364–375. Wu H-W, Chang Y-W, Liu C-W, Wang L-H. 2010. Biomechanical analysis of landing from counter movement jump and vertical jump with run-up in the individuals with functional ankle instability. Int J Sport Exercise Sci. 2 (2):43 – 48.
