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Peroneal Activation Deficits in Persons With Functional Ankle Instability
Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, refe...
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Published in: | The American journal of sports medicine 2009-05, Vol.37 (5), p.982-988 |
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Main Authors: | , , |
Format: | Article |
Language: | English |
Subjects: | |
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Online Access: | Get full text |
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Summary: | Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered
afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint
musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI.
Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability.
Hypothesis Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic
peroneal muscle activity.
Study Design Cross-sectional study; Level of evidence, 3.
Methods Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated
in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI,
while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used
to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way
analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association
between the H:M ratio and the EMG amplitudes.
Results The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 ± 0.185) than in their pathological
ankle (0.323 ± 0.161) ( P = .036), while no differences were noted between the ankles of the controls (0.442 ± 0.176 and 0.425 ± 0.180). The FAI patients
also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 ± 1.3) than in their uninjured ankle
(EMG, 3.3 ± 3.1) ( P < .001), while no differences between legs were noted for controls ( P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG ( P > .05).
Conclusion Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle
activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes
of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle
stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may co |
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ISSN: | 0363-5465 1552-3365 |
DOI: | 10.1177/0363546508330147 |