Repeated Ankle Sprains and Delayed Neuromuscular Response: Acceleration Time Parameters

Robert E.H. van Cingel, Gertjan Kleinrensink, Elian J. Uitterlinden, Patrick P.G.M. Rooijens, Paul G.H. Mulder, Geert Aufdemkampe, Rob Stoeckart

DOI: 10.2519/jospt.2006.2160

Study Design: A comparative study.

Objectives: To assess whether in subjects with unilateral chronic ankle instability the dynamic reaction time of the affected ankle differs from the healthy ankle and from ankles of a control group.

Background: Reaction time is an essential element in joint protection against sudden unexpected excessive movement requiring fast and coordinated muscle action. During a sudden ankle inversion movement, a reflex action of the evertor muscles is needed to counteract the movement. Adequate neuromuscular response is crucial and a delayed response could contribute to inversion trauma and subsequently to chronic ankle instability. The isokinetic dynamometer acceleration time (ACC-TIME) provides valuable information on dynamic neuromuscular ability.

Material and Methods: Patients with unilateral chronic ankle instability (n = 11) and healthy individuals in a control group (n = 11) were tested on an isokinetic dynamometer during 3 sets of 3 reciprocal inversion/eversion movements of both ankles at 30°/s and 120°/s. Analysis of variance models were used to compare the ACC-TIME of the affected ankle to the unaffected ankle of the same subjects and a control group.

Results: For the evertor muscles at 30°/s and 120°/s, a significantly prolonged ACC-TIME was found when comparing the affected ankles to the contralateral ankles and both ankles of the control group. For the invertor muscles at 120°/s a significantly prolonged ACC-TIME was found when comparing the affected ankle to the unaffected ankles of patients and those of the control group.

Conclusions: Because the most important evertor muscles are innervated by the fibular nerve, the significantly prolonged ACC-TIME of the affected ankle is consistent with the finding of a lower motor nerve conduction velocity of the fibular nerve after inversion trauma. The results support the concept of a delayed neuromuscular response as an important factor in the etiology of chronic ankle instability.

J Orthop Sports Phys Ther. 2006;36(2):72-79.

Key Words: ankle instability, fibularis muscles, isokinetics, neuromuscular response

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