Injury associated with sport and recreation is a leading reason for physical activity cessation, which is linked with significant long-term negative sequelae. Ankle sprains are the most common injuries associated with physical activity and at least 1 out of every 3 individuals who sprain their ankle will go on to develop chronic ankle instability (CAI), defined by life-long residual symptoms including decreased physical activity. Traditional rehabilitation strategies for CAI have focus on motor impairments, but the high incidence of disability, post- traumatic ankle osteoarthritis, and consequent healthcare burdens clearly indicate that this treatment model is ineffective. Thus, a pressing need exists for a paradigm shift in the development of effective evidenced-based interventions to treat CAI. To date, little attention has been paid to the potential to improve function by intervening through sensory pathways. Research, has shown that the sensorimotor system shifts reliance on various sensory inputs depending on the demands placed on the system. Those with CAI place a greater emphasis on cutaneous and musculotendinous receptors due to damage of the lateral ankle joint receptors. However, by using sensory-targeted ankle rehabilitation strategies such as ankle joint mobilizations, plantar massage, and triceps surae stretching, we hypothesize that we can enhance the information available to the sensorimotor system in order to tune effective movement solutions. Indeed, our evidence suggests that sensory-targeted strategies may be essential to most effectively treating those with CAI. Therefore, the purpose of this proposal is to determine the effectiveness of sensory-targeted ankle rehabilitation strategies at causing immediate and prolonged improvements in subjective and objective outcome measures of clinical disablement and sensorimotor dysfunction in those with CAI. This preliminary investigation will be a randomized controlled trial in which 80 subjects with CAI will be randomly assigned to receive one of three experimental interventions (mobilization, massage, stretch) or a control treatment. To evaluate the effects of the experimental treatments, the following baseline measures will be taken: 1) self-assessed disability, 2) ankle dorsiflexion range of motion, and 3) sensorimotor function via measures of postural control and gait initiation. Subjects will then be randomly assigned to receive ankle mobilization (n=20), plantar massage (n=20), triceps surae stretching (n=20), or a control treatment (n=20). Follow up measures will be taken immediately after the first and final treatment of a two-week intervention as well as 1-month after receiving the treatment intervention. For this investigation, separate MANOVAs will assess the effects of treatment (mobilization, massage, stretch, control) and time (baseline, post 1st treatment, post final treatment, 1-month follow-up) on subjective and objective measures of clinical disablement and sensorimotor function in those with CAI. The results of this randomized controlled study will elucidate the effectiveness of sensory-targeted ankle rehabilitation strategies at improving sensorimotor function and disability in those with CAI.

Public Health Relevance

: Ankle sprains are the most common injury experienced by those who are physically active and recurrent disability associated with these injuries is extremely common. In this study, we aim to determine the benefits of sensory-targeted ankle rehabilitation strategies on subjective and objective outcomes of clinical disablement and sensorimotor function in those with chronic ankle instability. By developing new sensory-targeted strategies for this pervasive condition, we hope to optimize treatment efficiency and quality for patients with chronic ankle instability and subsequently reduce their associated long-term negative sequelae and disability.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Small Research Grants (R03)
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Special Emphasis Panel (ZAR1-EHB (M1))
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Panagis, James S
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University of Kentucky
Physical Medicine & Rehab
Schools of Allied Health Profes
United States
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McKeon, Patrick O; Wikstrom, Erik A (2016) Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability. Med Sci Sports Exerc 48:776-84