Sports rehabilitation of chronic ankle instability: research status and characteristics

doi:10.3969/j.issn.2095-4344.0585

Abstract

Abstract:

BACKGROUND: Sports rehabilitation is a noninvasive and effective treatment method of sport injuries. Chronic ankle instability is one of the most common symptoms of exercise, with high recurrence incidence, so it is difficult to restore.
OBJECTIVE: To describe the latest sports rehabilitation method for chronic ankle instability, and to summarize the research status of related methods.
METHODS: The first author retrieved the articles addressing various sports rehabilitation methods and research progress of chronic ankle instability included in the databases of PubMed, MEDLINE, Cochrane, CINAHL and CNKI from January 2003 to June 2018. The key words were “chronic ankle instability, CAI, ankle instability, exercise rehabilitation, athletic rehabilitation, physical therapy, ankle foot orthoses, manual therapy, functional training” in English and Chinese, respectively.
RESULTS AND CONCLUSION: The commonly used protectors for chronic ankle instability are elastic bandage, muscle effect paste and ankle protector, which mainly prevent the recurrence of injury by fixing the ankle joint by external force. The commonly used free hand therapy includes joint loosening and dynamic joint loosening. The training methods include sensory training, balance training and neuromuscular control training. These three kinds of methods hold good therapeutic effects and deserve further promotion and application.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Joint Instability, Exercise Therapy, Tissue Engineering

CLC Number:

R318

Qin Huasheng1, Pan Weimin2, Li Ran1, Li Xintong1. Sports rehabilitation of chronic ankle instability: research status and characteristics[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(36): 5865-5871.

Figures/Tables 1

2.1 慢性踝关节不稳患者弹性绷带、肌内效贴及足踝护具的使用踝关节常用护具有绷带、肌内效贴等辅助器具。研究显示护具使用能防止慢性踝关节不稳患踝扭伤再次复发，同时起到一定的治疗效果[3]。弹力绷带在踝关节损伤防护中应用已久，具有较好的预防再次损伤的效果[4]，但也研究对此持有不同观点。有学者研究了弹力绷带对慢性踝关节不稳患者姿势控制的影响，结果虽然显示佩戴弹力绷带后患者的主观安全感显著提升，但其姿势控制能力并没有得到增强，且由于主观安全增高可能导致踝关节再次损伤风险的增高[5]。另外有研究发现穿与弹力绷带类似的尼龙袜对慢性踝关节不稳患者足部的触觉感知有一定的负面影响，且导致踝关节不稳定增加[6]。由于不同强度的绷带对踝关节的运动学有不同的影响[7]，因而上述弹力绷带的负面效应可能是这些研究采用的都是单一弹力的绷带。绷带的弹性太大起不到保护的作用，太小可能影响踝关节的正常活动。另外佩戴弹性绷带可能对关节活动有一定影响，Trégouët等[8]的研究发现，弹性绷带不会对肌肉活动产生影响，但其提供的机械力学延迟足以使踝部翻转肌产生保护足踝外侧韧带所需的转矩，从而影响踝关节的活动，因而认为佩戴弹性绷带是保护外侧韧带的有效方式，而非弹性绷带却不会产生这种效应。肌内效贴近几年在运动损伤的治疗中得到了广泛的应用。Jackson等[9]研究了肌内效贴对慢性踝关节不稳患者的平衡能力、神经肌肉控制和本体感觉的影响，采取的贴法是患者踝关节处于屈曲位置，在2个锚段采用无张力状态，固定端贴布的拉力为20%-30%。第1条肌效贴以胫骨后肌止点开始，然后围绕胫骨和腓骨后内边界，延伸至内踝；第2条起始为胫骨前肌为起点，从胫骨外侧面的上2/3延伸至足部第一楔骨和足背部的第一跖骨出；第3条起始于腓骨长肌的起点，从腓骨头开始延伸到外踝，继续包饶踝关节跖面，止于第一跖骨基底；第4条从外踝尖横置于足弓下，如图2所示。"

References

[1] Doherty C, Bleakley C, Hertel J, et al. Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. Am J Sports Med. 2016;44(4):995-1003.

[2] Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48(13):1014-1018.

[3] Donovan L, Hart JM, Saliba SA, et al. Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial. J Athl Train. 2016; 51(3):233-251.

[4] Witjes S, Gresnigt F, van den Bekerom MP, et al. The ANKLE TRIAL (ankle treatment after injuries of the ankle ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain? A randomised controlled trial. BMC Musculoskelet Disord. 2012;13:21.

[5] Alguacil-Diego IM, de-la-Torre-Domingo C, López-Román A, et al. Effect of elastic bandage on postural control in subjects with chronic ankle instability: a randomised clinical trial. Disabil Rehabil. 2018;40(7):806-812.

[6] Burcal CJ, Hoch MC, Wikstrom EA. Effects of a stocking on plantar sensation in individuals with and without ankle instability. Muscle Nerve. 2017;55(4):513-519.

[7] Deschamps K, Dingenen B, Pans F, et al. Effect of taping on foot kinematics in persons with chronic ankle instability. J Sci Med Sport. 2016;19(7):541-546.

[8] Trégouët P, Merland F, Horodyski MB. A comparison of the effects of ankle taping styles on biomechanics during ankle inversion. Ann Phys Rehabil Med. 2013;56(2):113-122.

[9] Jackson K, Simon JE, Docherty CL. Extended use of Kinesiology Tape and Balance in Participants with Chronic Ankle Instability. J Athl Train. 2016;51(1):16-21.

[10] 罗强,胡晨,冯晓琪,等.贴扎对患踝关节不稳的男橄榄球运动员下肢运动素质的影响[J].湖北体育科技,2015,34(5):422-424.

[11] Koyama K, Kato T, Yamauchi J. The effect of ankle taping on the ground reaction force in vertical jump performance. J Strength Cond Res. 2014;28(5):1411-1417.

[12] Mickel TJ, Bottoni CR, Tsuji G, et al. Prophylactic bracing versus taping for the prevention of ankle sprains in high school athletes: a prospective, randomized trial. J Foot Ankle Surg. 2006;45(6):360-365.

[13] Rivera MJ, Winkelmann ZK, Powden CJ, et al. Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review. J Athl Train. 2017;52(11):1065-1067.

[14] Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010;13(3):309-317.

[15] Tenenbaum S, Chechik O, Bariteau J, et al. Gait abnormalities in patients with chronic ankle instability can improve following a non-invasive biomechanical therapy: a retrospective analysis. J Phys Ther Sci. 2017;29(4): 677-684.

[16] Hoch MC, Staton GS, Medina McKeon JM, et al. Dorsiflexion and dynamic postural control deficits are present in those with chronic ankle instability. J Sci Med Sport. 2012;15(6):574-579.

[17] Bonnel F, Toullec E, Mabit C, et al. Chronic ankle instability: biomechanics and pathomechanics of ligaments injury and associated lesions. Orthop Traumatol Surg Res. 2010;96(4): 424-432.

[18] Hoch MC, Andreatta RD, Mullineaux DR, et al. Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. J Orthop Res. 2012;30(11):1798-1804.

[19] Johanson MA, Armstrong M, Hopkins C, et al. Gastrocnemius Stretching Program: More Effective in Increasing Ankle/Rear-Foot Dorsiflexion When Subtalar Joint Positioned in Pronation Than in Supination. J Sport Rehabil. 2015;24(3): 307-314.

[20] 徐建武,李宏图. MULLIGAN手法治疗:脊柱、四肢动态关节松动书 [M].沈阳:辽宁科学技术出版社,2017.

[21] Collins N, Teys P, Vicenzino B. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Man Ther. 2004;9(2):77-82.

[22] Cruz-Díaz D, Lomas Vega R, Osuna-Pérez MC, et al. Effects of joint mobilization on chronic ankle instability: a randomized controlled trial. Disabil Rehabil. 2015;37(7):601-610.

[23] Schaefer JL, Sandrey MA. Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. J Sport Rehabil. 2012;21(4): 313-326.

[24] Marrón-Gómez D, Rodríguez-Fernández ÁL, Martín-Urrialde JA. The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Phys Ther Sport. 2015;16(1):10-15.

[25] Kosik KB, Gribble PA. The Effect of Joint Mobilization on Dynamic Postural Control in Patients With Chronic Ankle Instability: A Critically Appraised Topic. J Sport Rehabil. 2018; 27(1):103-108.

[26] Wikstrom EA, Song K, Lea A, et al. Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability. J Athl Train. 2017;52(7):629-635.

[27] Wikstrom EA, McKeon PO. Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function. J Athl Train. 2017;52(4): 325-331.

[28] 杨珍.功能锻炼对慢性踝关节不稳的临床疗效研究[D].武汉:华中师范大学,2014.

[29] 何伟华,李珂,独建库,等.肌肉功能锻炼对慢性外踝关节不稳的治疗效果[J].实用医学杂志,2014,30(9):1514-1515.

[30] Bagherian S, Rahnama N, Wikstrom EA. Corrective Exercises Improve Movement Efficiency and Sensorimotor Function but Not Fatigue Sensitivity in Chronic Ankle Instability Patients: A Randomized Controlled Trial. Clin J Sport Med. 2017. doi: 10. 1097/JSM. 0000000000000511.

[31] Sekir U, Yildiz Y, Hazneci B, et al. Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):654-664.

[32] 徐国红,葛春林,尹洪满.沙滩排球训练对运动员膝,踝关节肌群肌力影响的比较研究[J].体育学刊,2000,(6):42-45.

[33] Smith BI, Docherty CL, Simon J, et al. Ankle strength and force sense after a progressive, 6-week strength-training program in people with functional ankle instability. J Athl Train. 2012;47(3):282-288.

[34] Kim K, Jeon K. Development of an efficient rehabilitation exercise program for functional recovery in chronic ankle instability. J Phys Ther Sci. 2016;28(5):1443-1447.

[35] 闫亚新,陈亮,杨建全.不同训练方法对大学生运动损伤(慢性踝关节不稳)康复效果的影响[J].体育世界(学术版), 2016,757(7): 132-133.

[36] 邱卓钢.本体感觉与软组织损伤的康复[J].中国康复理论与实践, 2004,10(5):295-296.

[37] Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, et al. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. Evid Based Complement Alternat Med. 2015; 2015:790209.

[38] Lee AJ, Lin WH. Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin Biomech (Bristol, Avon). 2008;23(8):1065-1072. d

[39] 高娜,亓建洪.功能性踝关节不稳的发生机制及其康复治疗的研究进展[C]//亚洲运动医学联合会、中华医学会、中华医学会运动医疗分会、中国体育科学学会运动医学分会.第十三届亚洲运动医学大会论文汇编.2014.

[40] Jain TK, Wauneka CN, Liu W. Four Weeks of Balance Training does not Affect Ankle Joint Stiffness in Subjects with Unilateral Chronic Ankle Instability. Int J Sports Exerc Med. 2016;2(1):036.

[41] McKeon PO, Wikstrom EA. Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability. Med Sci Sports Exerc. 2016;48(5):776-784.

[42] Smith BI, Curtis D, Docherty CL. Effects of Hip Strengthening on Neuromuscular Control, Hip Strength, and Self-Reported Functional Deficits in Individuals With Chronic Ankle Instability. J Sport Rehabil. 2018;27(4):364-370.

[43] Kim E, Choi H, Cha JH, et al. Effects of Neuromuscular Training on the Rear-foot Angle Kinematics in Elite Women Field Hockey Players with Chronic Ankle Instability. J Sports Sci Med. 2017;16(1):137-146.

[44] Delahunt E, Monaghan K, Caulfield B. Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med. 2006;34(12):1970-1976.

[45] Lepley LK, McKeon PO, Fitzpatrick SG, et al. Neuromuscular Alterations After Ankle Sprains: An Animal Model to Establish Causal Links After Injury. J Athl Train. 2016;51(10):797-805.

[46] Kim T, Kim E, Choi H. Effects of a 6-Week Neuromuscular Rehabilitation Program on Ankle-Evertor Strength and Postural Stability in Elite Women Field Hockey Players With Chronic Ankle Instability. J Sport Rehabil. 2017;26(4): 269-280.

[47] 钱菁华.功能性踝关节不稳的神经肌肉控制机制及PNF干预效果研究[D].北京:北京体育大学,2011.

[48] Clanton T, Lin SS. Limited evidence supports neuromuscular training for chronic lateral ankle instability. J Bone Joint Surg Am. 2012;94(4):365.

[49] Rendos NK, Jun HP, Pickett NM, et al. Acute effects of whole body vibration on balance in persons with and without chronic ankle instability. Res Sports Med. 2017;25(4):391-407.

[50] Song K, Burcal CJ, Hertel J, et al. Increased Visual Use in Chronic Ankle Instability: A Meta-analysis. Med Sci Sports Exerc. 2016;48(10):2046-2056.

[51] Donovan L, Feger MA, Hart JM, et al. Effects of an auditory biofeedback device on plantar pressure in patients with chronic ankle instability. Gait Posture. 2016;44:29-36.

[52] Calatayud J, Borreani S, Colado JC, et al. Exercise and ankle sprain injuries: a comprehensive review. Phys Sportsmed. 2014;42(1):88-93.

[53] Gribble PA, Bleakley CM, Caulfield BM, et al. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1493-1495.

[54] Brogden CM, Marrin K, Page RM, et al. The efficacy of elastic therapeutic tape variations on measures of ankle function and performance. Phys Ther Sport. 2018;32:74-79.

[55] Edwards K, Borthwick A, McCulloch L, et al. Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review. J Foot Ankle Res. 2017;10:51.

[56] Loudon JK, Reiman MP, Sylvain J. The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review. Br J Sports Med. 2014;48(5): 365-370.