Journal of Science and Medicine in Sport
Volume 13, Issue 1 , Pages 2-12 , January 2010

Evidence of sensorimotor deficits in functional ankle instability: A systematic review with meta-analysis

  • Joanne Munn

      Affiliations

    • University of Sydney, Australia
    • Centre for Physiotherapy Research, University of Otago, New Zealand
  • ,
  • S. John Sullivan

      Affiliations

    • Centre for Physiotherapy Research, University of Otago, New Zealand
    • Corresponding Author InformationCorresponding author.
  • ,
  • Anthony G. Schneiders

      Affiliations

    • Centre for Physiotherapy Research, University of Otago, New Zealand

Received 8 August 2008 ,Revised 4 March 2009 ,Accepted 9 March 2009.

References 

  1. Yeung MS, Chan KM, So CH, et al. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28(2):112–116
  2. Beynnon BD, Renstrom PA, Alosa DM, et al. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001;19(2):213–220
  3. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–375
  4. Lentell GL, Katzman LL, Walters MR. The relationship between muscle function and ankle stability. J Orthop Sports Phys Ther. 1990;11(12):605–611
  5. Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000;29(5):361–371
  6. Leanderson J, Ekstam S, Salomonsson C. Taping of the ankle—the effect on postural sway during perturbation, before and after a training session. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):53–56
  7. Tropp H, Odenrick P. Postural control in single-limb stance. J Orthop Res. 1988;6(6):833–839
  8. Gauffin H, Tropp H, Odenrick P. Effect of ankle disk training on postural control in patients with functional instability of the ankle joint. Int J Sports Med. 1988;9(2):141–144
  9. Lofvenberg R, Karrholm J, Sundelin G, et al. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995;23(4):414–417
  10. Garn SN, Newton RA. Kinesthetic awareness in subjects with multiple ankle sprains. Phys Ther. 1988;68(11):1667–1671
  11. Refshauge KM, Kilbreath SL, Raymond J. Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains. J Orthop Sports Phys Ther. 2003;33(4):166–173discussion 173–6
  12. Bernier JN, Perrin DH, Rijke A. Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength. J Athl Train. 1997;32(3):226–232
  13. Ebig M, Lephart SM, Burdett RG, et al. 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. 1997;26(2):73–77
  14. Isakov E, Mizrahi J. Is balance impaired by recurrent sprained ankle?. Br J Sports Med. 1997;31(1):65–67
  15. Richie DH. Functional instability of the ankle and the role of neuromuscular control: a comprehensive review. J Foot Ankle Surg. 2001;40(4):240–251
  16. Herbert RD, Jamtvedt G, Mead J, et al. Practical evidence-based physiotherapy. London: Elsevier Butterworth Heinemann; 2005;
  17. Smith GD, Egger M. Going beyond the grand mean: subgroup analysis of randomised trials. In:  Egger M,  Smith GD,  Altman DG editor. Systematic reviews in health care: meta-analysis in content. London: BMJ; 2001;
  18. Downs SH, Black N. The feasibility of creating a check list for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health. 1998;52(6):377–384
  19. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9(1–2):11–22
  20. The Cochrane Collaboration. Review Manager (RevMan) [Computer program] Version 4.2 for Windows. Copenhagen: The Nordic Cochrane Centre; 2003;
  21. Khin Myo H, Ishii T, Sakane M, et al. Effect of anesthesia of the sinus tarsi on peroneal reaction time in patients with functional instability of the ankle. Foot Ankle Int. 1999;20(9):554–559
  22. Shima N, Maeda A, Hirohashi K. Delayed latency of peroneal reflex to sudden inversion with ankle taping or bracing. Int J Sports Med. 2005;26(6):476–480
  23. Vaes P, Van Gheluwe B, Duquet W. Control of acceleration during sudden ankle supination in people with unstable ankles. J Orthop Sports Phys Ther. 2001;31(12):741–752
  24. Konradsen L, Ravn JB. Prolonged peroneal reaction time in ankle instability. Int J Sports Med. 1991;12(3):290–292
  25. Vaes P, Duquet W, Van Gheluwe B. Peroneal reaction times and eversion motor response in healthy and unstable ankles. J Athl Train. 2002;37(4):475–480
  26. Javed A, Walsh HPJ, Lees A. Peroneal reaction time in treated functional instability of the ankle. Foot Ankle Surg. 1999;5(3):159–166
  27. Karlsson J, Andreasson GO. The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study. Am J Sports Med. 1992;20(3):257–261
  28. Rosenbaum D, Becker HP, Gerngroß H, et al. Peroneal reaction times for diagnosis of functional ankle instability. Foot Ankle Surg. 2000;6(1):31–38
  29. Schmidt R, Benesch S, Hald R, et al. Die inzidenz und wertigkeit des propriozeptiven defizites bei patienten mit chronischer instabilitaet des oberen sprunggelenkes. Incidence and relevance of proprioceptive deficits in patients with chronic ankle instability. Dtsch Z Sportmed. 2005;56(11):378–382
  30. Forkin DM, Koczur C, Battle R, et al. Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther. 1996;23(4):245–250
  31. Hubbard TJ, Kaminski TW. Kinesthesia is not affected by functional ankle instability status. J Athl Train. 2002;37(4):481–486
  32. Refshauge KM, Kilbreath SL, Raymond J. The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc. 2000;32(1):10–15
  33. Lentell G, Baas B, Lopez D, et al. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther. 1995;21(4):206–215
  34. Boyle J, Negus V. Joint position sense in the recurrently sprained ankle. Aust J Physiother. 1998;44(3):159–163
  35. Brown C, Ross S, Mynark R, et al. Assessing functional ankle instability with joint position sense, time to stabilization, and electromyography. J Sport Rehabil. 2004;13(2):122–134
  36. Fu AS, Hui-Chan CW. Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains. Am J Sports Med. 2005;33(8):1174–1182
  37. Gross MT. Effects of recurrent lateral ankle sprains on active and passive judgements of joint position. Phys Ther. 1987;67(10):1505–1509
  38. Liu Y, Jeng S, Lee AJY. The influence of ankle sprains on proprioception. J Exerc Sci Fitness. 2005;3(1):33–38
  39. Willems T, Witvrouw E, Verstuyft J, et al. Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability. J Athl Train. 2002;37(4):487–493
  40. Halasi T, Kynsburg A, Tallay A, et al. Changes in joint position sense after surgically treated chronic lateral ankle instability. Br J Sports Med. 2005;39(11):818–824
  41. Hartsell HD. The effects of external bracing on joint position sense awareness for the chronically unstable ankle. J Sport Rehabil. 2000;9(4):279–289
  42. Jerosch J, Hoffstetter I, Bork H, et al. The influence of orthoses on the proprioception of the ankle joint. Knee Surg Sports Traumatol Arthrosc. 1995;3(1):39–46
  43. Jerosch J, Bischof M. Proprioceptive capabilities of the ankle in stable and unstable joints. Sports Excerc Inj. 1996;2(4):167–171
  44. Konradsen L, Magnusson P. Increased inversion angle replication error in functional ankle instability. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):246–251
  45. You SH, Granata KP, Bunker LK. Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation. J Orthop Sports Phys Ther. 2004;34(8):449–460
  46. Docherty CL, Arnold BL, Hurwitz S. Contralateral force sense deficits are related to the presence of functional ankle instability. J Orthop Res. 2006;24(7):1412–1419
  47. Baier M, Hopf T. Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability. Arch Phys Med Rehabil. 1998;79(8):939–944
  48. Hiller CE, Refshauge KM, Beard DJ. Sensorimotor control is impaired in dancers with functional ankle instability. Am J Sports Med. 2004;32(1):216–223
  49. Nakagawa L, Hoffman M. Performance in static, dynamic, and clinical tests of postural control in individuals with recurrent ankle sprains. J Sport Rehabil. 2004;13(3):255–268
  50. Ross SE, Guskiewicz KM. Examination of static and dynamic postural stability in individuals with functionally stable and unstable ankles. Clin J Sport Med. 2004;14(6):332–338
  51. Rozzi SL, Lephart SM, Sterner R, et al. Balance training for persons with functionally unstable ankles. J Orthop Sports Phys Ther. 1999;29(8):478–486
  52. Tropp H, Odenrick P, Gillquist J. Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med. 1985;6(3):180–182
  53. Tropp H. Pronator muscle weakness in functional instability of the ankle joint. Int J Sports Med. 1986;7(5):291–294
  54. Pintsaar A, Brynhildsen J, Tropp H. Postural corrections after standardised perturbations of single limb stance: effect of training and orthotic devices in patients with ankle instability. Br J Sports Med. 1996;30(2):151–155
  55. Gribble PA, Hertel J, Denegar CR, et al. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39(4):321–329
  56. Hertel J, Braham RA, Hale SA, et al. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther. 2006;36(3):131–137
  57. Olmsted LC, Carcia CR, Hertel J, et al. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501–506
  58. Ross SE, Guskiewicz KM. Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects with functional ankle instability and subjects with stable ankles. Clin J Sport Med. 2006;16(4):323–328
  59. Ross SE, Guskiewicz KM, Yu B. Single-leg jump-landing stabilization times in subjects with functionally unstable ankles. J Athl Train. 2005;40(4):298–304
  60. Wikstrom EA, Tillman MD, Borsa PA. Detection of dynamic stability deficits in subjects with functional ankle instability. Med Sci Sports Exerc. 2005;37(2):169–175
  61. Chrintz H, Falster O, Roed J. Single-leg postural equilibrium test. Scand J Med Sci Sports. 1991;1(4):244–246
  62. Ryan L. Mechanical stability, muscle strength and proprioception in the functionally unstable ankle. Aust J Physiother. 1994;40(1):41–47
  63. Docherty CL, Valovich McLeod TC, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system. Clin J Sport Med. 2006;16(3):203–208
  64. Riemann B, Caggiano N, Lephart S. Examination of a clinical method of assessing postural control during a functional performance task. J Sport Rehabil. 1999;8(3):171–183
  65. Wikstrom EA, Tillman MD, Chmielewski TL, et al. Measurement and evaluation of dynamic joint stability of the knee and ankle after injury. Sports Med. 2006;36(5):393–410
  66. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed.. Hillsdale, New Jersey: Earlbaum; 1988;
  67. Riemann B, Myers J, Lephart S. Sensorimotor system measurement techniques. J Athl Train. 2002;37(1):85–98
  68. Refshauge KM. Proprioception and joint pathology. In:  Gandevia SC,  Proske U,  Stuart DG editor. Sensorimotor control of movement and posture. London: Kluwer Academic/Plenum Publishers; 2002;
  69. McCloskey DI. Differences between the senses of movement and position shown by the effects of loading and vibration of muscles in man. Brain Res. 1973;61:119–131
  70. Delahunt E. Peroneal reflex contribution to the development of functional instability of the ankle joint. Phys Ther Sport. 2007;8(2):98–104
  71. Konradsen L, Voigt M, Højsgaard C. Ankle inversion injuries: the role of the dynamic defense mechanism. Am J Sports Med. 1997;25(1):54–58
  72. Ashton-Miller JA, Ottaviani RA, Hutchinson C, et al. What best protects the inverted weight bearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses. Am J Sports Med. 1996;24(6):800–809
  73. Ottaviani R, Ashton-Miller J, Kothari S, et al. Basketball shoe height and the maximal muscular resistance to applied ankle inversion and eversion moments. Am J Sports Med. 1995;23(4):418–423
  74. Bland JM, Altman DG. Statistical notes: correlation, regression and repeated data. Br Med J. 1994;308:896
  75. Menz HB. Two feet or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine. Foot. 2004;14:2–5
  76. Bryant D, Havey TC, Roberts R, et al. How many patients? How many limbs? Analysis of patients or limbs in the orthopaedic literature: a systematic review. J Bone Joint Surg. 2006;88A(1):41–45
  77. van der Wees PJ, Lenssen AF, Hendricks EJM, et al. Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: a systematic review. Aust J Physiother. 2006;52(1):27–37
  78. Verhagen E, van der Beek A, Twisk J, et al. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: A prospective controlled trial. Am J Sports Med. 2004;32(6):1385–1393
  79. Hiller CE, Refshauge KM, Bundy AC, et al. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2006;87(9):1235–1241
  80. Hertel J, Kaminski TW. Second international ankle symposium summary statement. J Orthop Sports Phys Ther. 2005;35(5):A-2–A-6
  81. Hertel J, Olmsted-Kramer LC. Deficits in time-to-boundary measures of postural control with chronic ankle instability. Gait Posture. 2007;25(1):33–39
  82. Hale SA, Hertel J, Olmsted-Kramer LC. 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. 2007;37(6):303–311
  83. Santos MJ, Liu W. Possible factors related to functional ankle instability. J Orthop Sports Phys Ther. 2008;38(3):150–157
  84. Hiller CE, Refshauge KM, Herbert RD, et al. Balance and recovery from a perturbation are impaired in people with functional ankle instability. Clin J Sport Med. 2007;17(4):269–275
  85. Nakasa T, Fukuhara K, Adachi N, et al. The deficit of joint position sense in the chronic unstable ankle as measured by inversion angle replication error. Arch Orthop Trauma Surg. 2008;128(5):445–449
  86. de Noronha M, Refshauge KM, Kilbreath SL, et al. Loss of proprioception or motor control is not related to functional ankle instability: an observational study. Aust J Physiother. 2007;53(3):193–198

PII: S1440-2440(09)00054-1

doi: 10.1016/j.jsams.2009.03.004

Journal of Science and Medicine in Sport
Volume 13, Issue 1 , Pages 2-12 , January 2010