Friday, August 7, 2009

Ankle Sprains & the Core

Impaired Trunk and Ankle Stability in Subjects with Functional Ankle Instability
PAUL W. M. MARSHALL1, AMANDA D. MCKEE1, and BERNADETTE A. MURPHY2- Medicine & Science in Sport/Exercise; August 09.

My blog readers know ankle injuries are "my bag" as Austin Powers said.
The authors found TTS (time to stabilization) delays in the trunk musculature of athletes with FAI (functional ankle instability). They are cautious of prescribing traditional "core training" to ameliorate this. In other words, they are unsure as to who is zooming who- is the trunk assisting proprioception deficits in the lower extremity, or is the ankle sending erroneous neural drive to the trunk? Either way, you see what a pain in the ass a sprained ankle is? They provide reference to an '08 Clinical Biomechanics article that showed improvements in whole body postural stability as well as localized ankle stability by way of ankle rehab alone.
At GAIN '09 I presented several recent real life cases I had with athletes with chronic back pain that I helped resolve by never even touching the back, or administering traditional back pain exercises. Rather I chose to attack the trouble makers that were directly or indirectly overloading the lumbar spine.
So take your time when you evaluate those ankle sprains. There is no such thing as just an ATF tear, or a just a high ankle sprain. They are all a little different, and a good eval will tell you which way to go first. Stop protocol cookbooking.


JH said...

Great stuff Joe!!

My question is in regards to the core or the unstable ankle, which one is sending the erroneous message...

Could it be that: both send an erroneous message OR both recieve an accurate message erroneously? Does it have to be one or the other? Isn't it a feedback loop so once the loop is disrupted the loop has then become dys-functional?

Garrett said...

Just to add fuel to the fire Joe and JH - two conflicting studies investigating SEBT and core stability in the past two years - Kahle and Gribble (2008 -ATSHC) reported improvement in SEBT reach distances following 6 weeks of core training whereas Sato and Mokha (2009-J Stren Cond Res) report no significant changes in SEBT but improved performance in 5000m runs - improvements in SEBT have previously been noted in CAI populations following dynamic balance interventions (Hale et al, 2007 - JOSPT and Mc Keon et al, 2008 - MSSE) - suppose it boils down to feedback deficits been compensated for along the kinetic chain and the trunk as well as potentially affecting these too

Brian said...

I agree that altered kinematics and muscle firing patterns of the LE's can change how forces in the spine are attenuated and possibly lead to spine pathology. Again this only reinforces how load is carried up through the body towards the head with each step. Someone correct me but I believe the forces around the pelvis and L-Spine can reach 4-6 times body wt. I think that an individual with a history of ankle instability(CAI) will continue to have episodes of instability before you begin to see spine issues thus I think the impaired sensory/motor function of the spine is a result of what's happening in the LE's....I think....