Abstract
Functional ankle instability (FAI) has been associated with impaired sensorimotor
function; however individual studies have produced conflicting results. In an attempt
to reduce this ambiguity, a systematic review with meta-analysis was undertaken to
determine which sensorimotor deficits exist with FAI. Fifty-three studies assessing
sensorimotor factors in subjects with FAI were included from 465 identified articles.
Studies were rated for methodological quality and data were pooled for peroneal reaction
time, joint position sense, and postural sway during single-leg stance and time to
stabilisation from a single-leg jump. Data on joint movement sense were unable to
be pooled. When subjects with unstable ankles were compared to healthy controls, sensorimotor
impairments were demonstrated for passive joint position sense (mean difference (MD) = 0.7°, 95% confidence interval (CI): 0.2–1.2°, p = 0.004), active joint position sense (MD = 0.6°, 95% CI: 0.2–1.0°, p = 0.002), postural sway in single-leg stance (standardised MD (SMD) = 0.6, 95% CI: 0.2–1.0, p = 0.002), the star excursion balance test (SMD = 0.4, 95% CI: 0.1–0.7, p = 0.009), and time to stabilisation from a single-leg jump in a medio-lateral (MD = 0.6 ms, 95% CI: 0.4–0.8, p < 0.0001) and an antero-posterior direction (MD = 0.7 ms, 95% CI: 0.4–1.0, p < 0.0001). Peroneal reaction time was not affected. Sensorimotor deficits occur for
joint position sense and postural control in subjects with FAI. Deficits in peroneal
muscle reaction time following perturbation are not evident.
Keywords
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References
- An epidemiological survey on ankle sprain.Br J Sports Med. 1994; 28: 112-116
- Ankle ligament injury risk factors: a prospective study of college athletes.J Orthop Res. 2001; 19: 213-220
- Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability.J Athl Train. 2002; 37: 364-375
- The relationship between muscle function and ankle stability.J Orthop Sports Phys Ther. 1990; 11: 605-611
- Functional instability following lateral ankle sprain.Sports Med. 2000; 29: 361-371
- Taping of the ankle—the effect on postural sway during perturbation, before and after a training session.Knee Surg Sports Traumatol Arthrosc. 1996; 4: 53-56
- Postural control in single-limb stance.J Orthop Res. 1988; 6: 833-839
- Effect of ankle disk training on postural control in patients with functional instability of the ankle joint.Int J Sports Med. 1988; 9: 141-144
- Prolonged reaction time in patients with chronic lateral instability of the ankle.Am J Sports Med. 1995; 23: 414-417
- Kinesthetic awareness in subjects with multiple ankle sprains.Phys Ther. 1988; 68: 1667-1671
- Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains.J Orthop Sports Phys Ther. 2003; 33 (discussion 173–6): 166-173
- Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength.J Athl Train. 1997; 32: 226-232
- 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: 73-77
- Is balance impaired by recurrent sprained ankle?.Br J Sports Med. 1997; 31: 65-67
- Functional instability of the ankle and the role of neuromuscular control: a comprehensive review.J Foot Ankle Surg. 2001; 40: 240-251
- Practical evidence-based physiotherapy.Elsevier Butterworth Heinemann, London2005
- Going beyond the grand mean: subgroup analysis of randomised trials.in: Egger M. Smith G.D. Altman D.G. Systematic reviews in health care: meta-analysis in content. BMJ, London2001
- 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: 377-384
- Factors associated with chronic plantar heel pain: a systematic review.J Sci Med Sport. 2006; 9: 11-22
- Review Manager (RevMan) [Computer program] Version 4.2 for Windows.The Nordic Cochrane Centre, Copenhagen2003
- Effect of anesthesia of the sinus tarsi on peroneal reaction time in patients with functional instability of the ankle.Foot Ankle Int. 1999; 20: 554-559
- Delayed latency of peroneal reflex to sudden inversion with ankle taping or bracing.Int J Sports Med. 2005; 26: 476-480
- Control of acceleration during sudden ankle supination in people with unstable ankles.J Orthop Sports Phys Ther. 2001; 31: 741-752
- Prolonged peroneal reaction time in ankle instability.Int J Sports Med. 1991; 12: 290-292
- Peroneal reaction times and eversion motor response in healthy and unstable ankles.J Athl Train. 2002; 37: 475-480
- Peroneal reaction time in treated functional instability of the ankle.Foot Ankle Surg. 1999; 5: 159-166
- The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study.Am J Sports Med. 1992; 20: 257-261
- Peroneal reaction times for diagnosis of functional ankle instability.Foot Ankle Surg. 2000; 6: 31-38
- 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: 378-382
- Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains.J Orthop Sports Phys Ther. 1996; 23: 245-250
- Kinesthesia is not affected by functional ankle instability status.J Athl Train. 2002; 37: 481-486
- The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle.Med Sci Sports Exerc. 2000; 32: 10-15
- The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle.J Orthop Sports Phys Ther. 1995; 21: 206-215
- Joint position sense in the recurrently sprained ankle.Aust J Physiother. 1998; 44: 159-163
- Assessing functional ankle instability with joint position sense, time to stabilization, and electromyography.J Sport Rehabil. 2004; 13: 122-134
- Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains.Am J Sports Med. 2005; 33: 1174-1182
- Effects of recurrent lateral ankle sprains on active and passive judgements of joint position.Phys Ther. 1987; 67: 1505-1509
- The influence of ankle sprains on proprioception.J Exerc Sci Fitness. 2005; 3: 33-38
- Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability.J Athl Train. 2002; 37: 487-493
- Changes in joint position sense after surgically treated chronic lateral ankle instability.Br J Sports Med. 2005; 39: 818-824
- The effects of external bracing on joint position sense awareness for the chronically unstable ankle.J Sport Rehabil. 2000; 9: 279-289
- The influence of orthoses on the proprioception of the ankle joint.Knee Surg Sports Traumatol Arthrosc. 1995; 3: 39-46
- Proprioceptive capabilities of the ankle in stable and unstable joints.Sports Excerc Inj. 1996; 2: 167-171
- Increased inversion angle replication error in functional ankle instability.Knee Surg Sports Traumatol Arthrosc. 2000; 8: 246-251
- Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation.J Orthop Sports Phys Ther. 2004; 34: 449-460
- Contralateral force sense deficits are related to the presence of functional ankle instability.J Orthop Res. 2006; 24: 1412-1419
- Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability.Arch Phys Med Rehabil. 1998; 79: 939-944
- Sensorimotor control is impaired in dancers with functional ankle instability.Am J Sports Med. 2004; 32: 216-223
- Performance in static, dynamic, and clinical tests of postural control in individuals with recurrent ankle sprains.J Sport Rehabil. 2004; 13: 255-268
- Examination of static and dynamic postural stability in individuals with functionally stable and unstable ankles.Clin J Sport Med. 2004; 14: 332-338
- Balance training for persons with functionally unstable ankles.J Orthop Sports Phys Ther. 1999; 29: 478-486
- Stabilometry recordings in functional and mechanical instability of the ankle joint.Int J Sports Med. 1985; 6: 180-182
- Pronator muscle weakness in functional instability of the ankle joint.Int J Sports Med. 1986; 7: 291-294
- 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: 151-155
- The effects of fatigue and chronic ankle instability on dynamic postural control.J Athl Train. 2004; 39: 321-329
- Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability.J Orthop Sports Phys Ther. 2006; 36: 131-137
- Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability.J Athl Train. 2002; 37: 501-506
- 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: 323-328
- Single-leg jump-landing stabilization times in subjects with functionally unstable ankles.J Athl Train. 2005; 40: 298-304
- Detection of dynamic stability deficits in subjects with functional ankle instability.Med Sci Sports Exerc. 2005; 37: 169-175
- Single-leg postural equilibrium test.Scand J Med Sci Sports. 1991; 1: 244-246
- Mechanical stability, muscle strength and proprioception in the functionally unstable ankle.Aust J Physiother. 1994; 40: 41-47
- Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system.Clin J Sport Med. 2006; 16: 203-208
- Examination of a clinical method of assessing postural control during a functional performance task.J Sport Rehabil. 1999; 8: 171-183
- Measurement and evaluation of dynamic joint stability of the knee and ankle after injury.Sports Med. 2006; 36: 393-410
- Statistical power analysis for the behavioral sciences.2nd ed. Earlbaum, Hillsdale, New Jersey1988
- Sensorimotor system measurement techniques.J Athl Train. 2002; 37: 85-98
- Proprioception and joint pathology.in: Gandevia S.C. Proske U. Stuart D.G. Sensorimotor control of movement and posture. Kluwer Academic/Plenum Publishers, London2002
- 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
- Peroneal reflex contribution to the development of functional instability of the ankle joint.Phys Ther Sport. 2007; 8: 98-104
- Ankle inversion injuries: the role of the dynamic defense mechanism.Am J Sports Med. 1997; 25: 54-58
- 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: 800-809
- Basketball shoe height and the maximal muscular resistance to applied ankle inversion and eversion moments.Am J Sports Med. 1995; 23: 418-423
- Statistical notes: correlation, regression and repeated data.Br Med J. 1994; 308: 896
- Two feet or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine.Foot. 2004; 14: 2-5
- How many patients? How many limbs? Analysis of patients or limbs in the orthopaedic literature: a systematic review.J Bone Joint Surg. 2006; 88A: 41-45
- Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: a systematic review.Aust J Physiother. 2006; 52: 27-37
- 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: 1385-1393
- The Cumberland ankle instability tool: a report of validity and reliability testing.Arch Phys Med Rehabil. 2006; 87: 1235-1241
- Second international ankle symposium summary statement.J Orthop Sports Phys Ther. 2005; 35: A-2-A-6
- Deficits in time-to-boundary measures of postural control with chronic ankle instability.Gait Posture. 2007; 25: 33-39
- 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: 303-311
- Possible factors related to functional ankle instability.J Orthop Sports Phys Ther. 2008; 38: 150-157
- Balance and recovery from a perturbation are impaired in people with functional ankle instability.Clin J Sport Med. 2007; 17: 269-275
- The deficit of joint position sense in the chronic unstable ankle as measured by inversion angle replication error.Arch Orthop Trauma Surg. 2008; 128: 445-449
- Loss of proprioception or motor control is not related to functional ankle instability: an observational study.Aust J Physiother. 2007; 53: 193-198
Article info
Publication history
Published online: September 30, 2009
Accepted:
March 9,
2009
Received in revised form:
March 4,
2009
Received:
August 8,
2008
Identification
Copyright
© 2009 Sports Medicine Australia. Published by Elsevier Inc. All rights reserved.
