Physical Therapy in Sport

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Physical Therapy in Sport 11 (2010) 3–7

Contents lists available at ScienceDirect

Physical Therapy in Sport journal homepage: www.elsevier.com/ptsp

Original research

Bracing does not improve dynamic stability in chronic ankle instability subjects Phillip A. Gribble*, Brittany L. Taylor, Junji Shinohara University of Toledo, 2801 W. Bancroft St, Toledo, OH 43606, United States

a r t i c l e i n f o

a b s t r a c t

Article history: Received 16 October 2009 Received in revised form 16 November 2009 Accepted 18 November 2009

Objectives: To investigate the effects of an ankle brace on dynamic postural stability, measured with Time to Stabilization (TTS), in subjects with chronic ankle instability (CAI). Design: Two-within (Condition, Side) repeated measures. Setting: Research laboratory. Participants: Fifteen subjects with unilateral CAI. Main outcome measures: Subjects participated in two testing sessions during which a single-limb jumplanding task was performed with one of two conditions: lace-up ankle brace or no ankle brace. Ground reaction forces were used to calculate Resultant Vector TTS (RVTTS). Results: For RVTTS, there were no statistically significant main effects for Side (F1,14 ¼ 1.005; p ¼ 0.33) or Condition (F1,14 ¼ 2.48; p ¼ 0.14), as well as no significant interaction effect (F1,14 ¼ 1.67; p ¼ 0.22). Conclusion: While TTS is a useful outcome tool for identifying deficits in subjects with CAI and improvements related to ankle rehabilitation, this measure of dynamic stability does not appear to be sensitive in detecting the influence of the application of an ankle brace in this pathological group. Researchers need to establish what other testing methods will be the best for determining the outcome of the application of an ankle brace in the laboratory setting to coincide with the epidemiology data that support the use of these devices. Ó 2009 Elsevier Ltd. All rights reserved.

Keywords: Time to stabilization Prophylactic ankle support Jump-landing Ground reaction force

1. Introduction Instability and injury to the ankle is responsible for 25% of all time lost from physical and recreational activity (Ashton-Miller, Ottaviani, Hutchinson, & Wojtys, 1996). Recurrent instability at the ankle, at a rate to be reported as high as 80% following initial insult, (Yeung, Chan, & So, 1994) is commonly referred to as chronic ankle instability (CAI) (Hertel, 2002). One successful method for reducing initial and recurrent ankle injury is through the use of external prophylactic ankle support (PAS) (Gross & Liu, 2003; Mickel, Bottoni, Tsuji, Chang, Baum, & Tokushige, 2006; Olmsted, Vela, Denegar, & Hertel, 2004; Pedowitz, Reddy, Parekh, Huffman, & Sennett, 2008; Rovere, Clarke, Yates, & Burley, 1988; Schmidt, Sulsky, & Amoroso, 2005; Sharpe, Knapik, & Jones, 1997; Sitler et al., 1994; Stasinopoulos, 2004; Surve, Schwellnus, Noakes, & Lombard, 1994; Thacker, Stroup, Branche, Gilchrist, Goodman, & Weitman, 1999). Previous research has demonstrated the ability of these devices to provide passive restraint to ankle motion (Cordova, Ingersoll, & LeBlanc, 2000; Eils, Demming, Kollmeier, Thorwesten, Vo¨lker, & Rosenbaum, 2002; Eils, Imberge, Vo¨lker, & Rosenbaum, 2007;

* Corresponding author. Tel.: þ1 419 530 2691; fax: þ1 419 530 2477. E-mail address: phillip.gribble@utoledo.edu (P.A. Gribble). 1466-853X/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.ptsp.2009.11.003

Greene & Hillman, 1990; Gross, Bradshaw, Ventry, & Weller, 1987), but very little examination of the restraint capabilities provided during active movement has been conducted (Delahunt, O’Driscoll, & Moran, 2009; Gribble, Radel, & Armstrong, 2006; Gudibanda & Wang, 2005; Kimura, Nawoczenski, Epler, & Owen, 1987). Surprisingly, of these laboratory studies examining contributions to ankle stability, only two have utilized a pathological group of subjects (Delahunt et al., 2009; Eils et al., 2002). Eils et al. (Eils et al., 2002) examined the passive restraints of ankle bracing in an open chain testing position and Delahunt et al. (Delahunt et al., 2009) utilized ankle taping as the selected PAS. Therefore, information on the ability of ankle bracing to provide ankle restraint during dynamic movement in subjects with injured ankles is lacking. CAI is associated with deficits in dynamic postural control and stability. Specifically, subjects with CAI present with deficits in dynamic postural control as measured with Time to Stabilization (TTS) during a jump-landing task compared with subjects with no history of ankle pathology (Brown & Mynark, 2007; Brown, Ross, Mynark, & Guskiewickz, 2004; Gribble & Robinson, 2009; Ross & Guskiewickz, 2004; Ross, Guskiewickz, & Yu, 2005; Ross, Guskiewickz, Gross, & Yu, 2008; Wikstrom, Tillman, & PA, 2005; Wikstrom, Tillman, Chmielewski, Cauraugh, & PA, 2007). As stated above, PAS can provide mechanical restraint to the ankle both passively and actively in isolated laboratory testing using a fixed


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