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The Star Excursion Balance Test (SEBT) is a reliable, responsive, and clinically relevant functional assessment of lower limbs’ dynamic postural control. However, great disparity exists regarding its methodology and the reported outcomes. Large and specific databases from various population (sport, age, and gender) are needed to help clinicians when interpreting SEBT performances in daily practice. Several contributors to SEBT performances in each direction were recently highlighted. The purpose of this clinical commentary is to (a) provide an updated review of the design, implementation, and interpretation of the SEBT and (b) propose guidelines to standardize SEBT procedures for better comparisons across studies.

Athletic preinjury function is typically determined via subjective recall; however, obtaining preinjury function before injury occurs should be attempted in order to establish an individual baseline for postinjury comparison. The purpose of this study was to obtain preinjury baseline values for the Foot and Ankle Disability Index (FADI) and Foot and Ankle Disability Index sport version (FADISP), single-leg hop for distance, and Star Excursion Balance Test anterior reach and determine if athletes returned to those values following ankle injury. Out of 41 qualifying injuries, FADI/FADISP scores were significantly reduced at initial injury compared with baseline and all other time points (p p ≥ .98). Subjective and objective preinjury function can be reestablished by discharge from supervised treatment following low-grade ankle injury and maintained for at least 6 months following the cessation of treatment. However, testing metrics should be reviewed on an individual athlete basis, because group data may mask individual patient needs.

Athletic preinjury function is typically determined via patient recall, however obtaining preinjury function before injury occurs should be attempted. The purpose of this study was to obtain preinjury physical function baseline values using the Knee Injury and Osteoarthritis Outcome Score (KOOS), single-leg hop for distance (SLH), and Star Excursion Balance Test (SEBT) anterior reach to determine if athletes return to those baseline values following knee injury. Out of 27 qualifying injuries, KOOS scores were significantly reduced at initial injury compared to baseline and all follow-up points (p ≤ .02). In most instances, baseline KOOS scores were not met at the discharge time point. SLH and SEBT recovered to baseline values by discharge. Injury severity and previous injury created variations in KOOS scores across multiple time points. Subjective and objective preinjury function can be re-established following knee injury but recovery may not occur at discharge from rehabilitation.

Context Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. Objective To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. Design Randomized controlled clinical trial. Setting Laboratory. Patients or Other Participants A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. Intervention(s) The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. Main Outcome Measure(s) All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. Results In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. Conclusions Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population.

Focused Clinical Question: In patients who have sustained a concussion, does vestibular rehabilitation therapy improve clinical symptoms of dizziness and self-reported balance deficits and/or influ...

Balance training typically features as a central component of exercise-based rehabilitation programs for patients with lateral ankle sprain and chronic ankle instability (CAI). The purpose of this study was to conduct a responder/non-responder analysis using existing data to identify factors associated with improvements in dynamic balance performance in CAI patients.Secondary data analysis.Data was used from 73 CAI patients who participated in 6 previous investigations that used the same balance training program. We defined treatment success as a patient exceeding the minimal detectable change score (8.15%) for the posteriomedial direction of the Star Excursion Balance Test (SEBT-PM). Baseline measures of participant and injury demographics, patient-reported function, and dynamic balance were entered into a step-wise logistic regression model to determine the best set of predictors of treatment success.Only 28 out of 73 patients (38.4%) demonstrated a successful improvement in SEBT-PM reach after balance training. Of the variables assessed, SEBT-PM reach distance ≤85.18% and self-reported function activities of daily living score ≤92.55% were significant predictors of treatment success (p0.001). If a patient met both these criteria there was a 70% probability of a successful treatment, indicating a 31.6% increase in the probability of a meaningful balance improvement after completing balance training.Without screening, less than 40% of CAI patients experience a meaningful improvement in SEBT-PM following balance training. Completing a brief pre-treatment assessment of a patient- and clinician-oriented outcome can significantly improve the probability of determining patients with CAI who may improve dynamic balance after balance training.

Background People with diabetes mellitus and peripheral neuropathy (DMPN) often have balance and mobility deficits. Time-to-boundary (TTB) is a parameter of postural control that combines position and velocity center of pressure data. While not previously investigated, assessment of TTB may provide new insight regarding postural control in people with DMPN. Research question Is TTB reduced and related to a measure of mobility in people with DMPN? Methods Thirteen people with DMPN without fall history and 13 healthy matched controls participated in this case-control study. Participants stood in double-limb stance on a force plate. The anterior-posterior and medial-lateral center of pressure position and velocity relative to the boundaries of the base of support were used to calculate TTB (s). Lower values indicate less postural control. Time-to-failure during single-limb stance was a secondary measure of postural control. Time to complete the Timed Up and Go (TUG) was our measure of mobility. Longer TUG times correspond to decreased mobility, strength, and balance. Independent t-tests or Mann-Whitney U tests were conducted to assess group differences. Bivariate correlations between task outcomes were conducted. Results Anterior-posterior TTB and single-limb stance times were shorter in people with DMPN (p ≤ 0.04). TUG times were longer in the DMPN group (p = 0.04). In the DMPN group, inverse relationships were observed between TTB and TUG (anterior-posterior R2 = .34; medial-lateral R2 = .49; both p = 0.01), but not between single-limb stance times and TTB or TUG. Significance TTB was a sensitive measure of postural control in people with DMPN. The detected relationship between TTB and TUG newly establishes TTB as a clinically meaningful indicator of balance and function. Study findings may serve to further guide balance screening and rehabilitation efforts in people with DMPN.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

Multiple treatment options have been shown to improve dorsiflexion range of motion (DFROM) group means in patients with chronic ankle instability (CAI). However, not all patients with CAI respond equally to these treatments. The aim of this study was to identify predictors of successfully improving dorsiflexion range of motion (DFROM) in patients with CAI. Patients with 92% posttest probabilities. Simple pretreatment assessments can dramatically improve treatment success probability following STARS in patients with CAI.

The authors reflect on how the athletic training community was affected by the COVID-19 pandemic, including on athletic training research Topics include how the readers, editors, authors, and reviewers were affected by the pandemic, and how athletic trainers conduct research, evaluate research, and disseminate research

PURPOSE Current theoretical models suggest the importance of a bidirectional relationship between sensation and production in the vocal tract to maintain lifelong speech skills. The purpose of this study was to assess age-related changes in orofacial skilled force production and to begin defining the orofacial perception-action relationship in healthy adults. METHOD Low-level orofacial force control measures (reaction time, rise time, peak force, mean hold force (N) and force hold SD) were collected from 60 adults (19-84 years). Non-parametric Kruskal Wallis tests were performed to identify statistical differences between force and group demographics. Non-parametric Spearman's rank correlations were completed to compare force measures against previously published sensory data from the same cohort of participants. RESULT Significant group differences in force control were found for age, sex, speech usage and smoking status. Significant correlational relationships were identified between labial vibrotactile thresholds and several low-level force control measures collected during step and ramp-and-hold conditions. CONCLUSION These findings demonstrate age-related alterations in orofacial force production. Furthermore, correlational analysis suggests as vibrotactile detection thresholds increase, the ability to maintain low-level force control accuracy decreases. Possible clinical applications and treatment consequences of these findings for speech disorders in the ageing population are provided.

Objectives Sensory Targeted Ankle Rehabilitation Strategies that stimulate sensory receptors improve postural control in chronic ankle instability participants. However, not all participants have equal responses. Therefore, identifying predictors of treatment success is needed to improve clinician efficiency when treating chronic ankle instability. Therefore, the purpose was to identify predictors of successfully improving postural control in chronic ankle instability participants. Design Secondary data analysis. Methods Fifty-nine participants with self-reported chronic ankle instability participated. The condition was defined as a history of at least two episodes of “giving way” within the past 6 months; and limitations in self-reported function as measured by the Foot and Ankle Ability Measure. Participants were randomized into three treatment groups (plantar massage, ankle joint mobilization, calf stretching) that received 6, 5-min treatment sessions over a 2-week period. The main outcome measure was treatment success, defined as a participant exceeding the minimal detectable change score for a clinician-oriented single limb balance test. Results Participants with ≥3 balance test errors had a 73% probability of treatment success following ankle joint mobilizations. Participants with a self-reported function between limb difference 2.5 errors had a 99% probability of treatment success following plantar massage. Those who sustained ≥11 ankle sprains had a 94% treatment success probability following calf stretching. Conclusions Self-reported functional deficits, worse single limb balance, and number of previous ankle sprains are important characteristics when determining if chronic ankle instability participants will have an increased probability of treatment success.

Evidence-based practice (EBP) is now a well-known paradigm for the athletic training (AT) profession. The Commission on Accreditation of Athletic Training Education accredited programs have required EBP as an explicit focus for professional education, and researchers are gradually producing insightful and relevant evidence concerning the education and implementation of clinically based EBP in educational programs. Likewise, many clinicians are attempting to incorporate EBP into their daily practice in order to guide and enhance patient care, and the Board of Certification has mandated regular EBP education in order to maintain national certification status. Although there remains much work to be completed before AT can claim to be a health care profession that is saturated with EBP, there is growing evidence of positive momentum toward that goal. However, the extent of EBP implementation remains limited to clinically based, patient-oriented outcomes. To date, there is little suggestion that the profession of AT has used an evidence-based approach for other related aspects of its professional practice. To that point, a multifactorial and more comprehensive model for evidence-based AT (EBAT) is presented with the intent of better situating and centering the potentiality for a larger evidence-based culture to inform and guide the AT profession's 3 critical subcomponents: practice, regulation, and education. We attempt here to expand upon the paradigm for EBP as a precondition for an overarching, more inclusive EBAT model. To do this, we will introduce and interconnect 2 other critical aspects of professional practice: evidence-based regulation and evidence-based education. Alongside EBP, both evidence-based regulation and education are fundamentally interrelated and vital components of an effective, comprehensive, and progressive evidence-based profession of AT, or EBAT.

Lateral ankle sprains are the most common injuries sustained during physical activity. The epidemiologic trends associated with chronic ankle instability (CAI) suggest that current rehabilitation approaches may be inadequate. We sought to synthesize best-practices evidence for the rehabilitation of patients with acute ankle sprains and CAI through the integration of emerging paradigms in perception, the dynamics of skill acquisition, and the biopsychosocial model of function, disability, and health. From the best available evidence, 4 key factors emerged for effective treatment and rehabilitation strategies: pain reduction, external ankle support for up to 1 year, progressive return to motion, and coordination training. We combined these factors into a meta-theoretical framework that centers on the perceptual interdependence of the cellular, local, and global functioning levels by linking insights from the body-self neuromatrix, the dynamics of skill acquisition, and the biopsychosocial model. Based on the best-practice recommendations from systematic reviews, ankle-sprain rehabilitation represents a multidimensional phenomenon governed by perception. The impairments, activity limitations, and participation restrictions associated with CAI may be linked to perceptual-interdependence alterations. Pain and edema reduction, the use of external ankle support for up to 1 year, progressive return to motion, and coordination training foster enhanced perceptual interdependence from cells to society. Using the perceptual-interdependence framework for ankle-sprain rehabilitation, we offer new insights for charting the course of effective strategies for enhancing function, reducing disability, and preventing the long-term sequelae associated with CAI.

Single joint kinematic alterations have been identified during gait in those with chronic ankle instability (CAI). The purpose of this study was to compare sagittal plane hip, knee, and ankle kinematics during walking in participants with and without CAI. Twelve individuals with CAI and 12 healthy individuals walked on a treadmill at 1.5 m/s. Three-dimensional kinematics were analyzed using mean ensemble curves and independent t tests. Participants with CAI demonstrated less lower extremity flexion during the absorption phase of stance and the limb placement phase of swing, which may have implications for limb placement at initial contact.

Individuals with chronic ankle instability (CAI) have demonstrated deviations in gait initiation (GI) compared to healthy individuals. However, the intersession reliability of GI measures remains unknown in this population. The objective of this study was to determine the reliability and responsiveness of GI measures between two testing days in those with CAI. Twelve individuals with CAI volunteered. Participants performed barefoot GI on a force plate which captured center of pressure (COP). Data was collected on two separate occasions separated by one week. The GI profile was separated into three phases (S1, S2, and S3). S1 began from the deviation of normal balanced standing to the most posterolateral displacement under the stepping limb. S2 began from the end of S1 to the maximum medial position under the stance foot. S3 began at the end of S2 and continued until the vertical ground reaction force dropped below 100N. COP displacement (cm) was calculated as the sum of resultant vectors of the medial-lateral and anterior-posterior excursions for adjacent COP data points within each phase. The averages of 5 trials were used for analyses. Intraclass correlation coefficients (ICC(2,5)), standard error of measurement, and minimum detectable change (MDC) were calculated to determine reliability and responsiveness. S1, S2, and S3 displacement values were highly reliable between days (ICC(2,5) ≥0.76) with the exception of anterior-posterior S1 and medial-lateral S3. MDC values were relatively small (0.6-2.2cm). GI can be reliably assessed in those with CAI which is important for identifying interventions to alter GI profiles in these individuals.

The impact that visual perturbation has on upright postural stability in an athlete with a concussion has not been established. The present study aimed to characterize the influence that visual perturbation stimuli have on upright balance among athletes with acute concussions.A 2X2X2 repeated measure designed was used.The present study examined the influence visual perturbation has on individuals suffering from an acute concussion. Fourteen participants (7 with a concussion and 7 matched controls) underwent various balance assessments with and without visual perturbation.Overall, athletes with acute concussions demonstrated impairments in balance 24-48 hours following a concussion. However, when assessed using a visual perturbation task, athletes with acute concussions demonstrated improved balance, while control subjects did not show any significant changes during the same visual perturbation task.An athlete's ability to disregard visual perturbation stimuli is imperative for successful participation in sports. Due to the observed alterations in balance when given a visual perturbation task, it is suggested that athletes with acute concussions place more attention on the balance task and may disregard other less meaningful tasks.

The intrinsic muscles of the foot play a critical role in the regulation of absorption and propulsion during dynamic activities. Dysfunction of these may lead to an increased demand on the remaining components within the foot core system to maintain dynamic foot control, leading to a more rapid breakdown of these contributors and those proximal to the foot. Training the intrinsic foot muscles through a systematic progression of isolation via the short foot exercise offers the opportunity to reincorporate their contribution into the foot core system. This article discusses the function of the intrinsic foot muscles, their contributions to dynamic foot control, and a progressive training paradigm.

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity.

Objectives To determine the effects of sensory-targeted ankle rehabilitation strategies on laboratory-oriented measures of single-leg balance in those with chronic ankle instability. Design Non-inferiority randomized controlled trial. Methods Seventy-seven participants with self-reported chronic ankle instability were randomized into 4 treatment groups: Ankle joint mobilization, plantar massage, triceps surae stretching, and a control group. All participants performed 3 trials of single-leg balance on a force plate with eyes open and closed at 3 time points (baseline, immediately after the first treatment, and following 6 treatments over 2 weeks). The spatial (standard deviation), temporal (velocity), and spatiotemporal (time-to-boundary) elements of center of pressure excursions in single-leg balance were evaluated with eyes open and eyes closed at each time point. Immediate and final change scores were calculated for each group from the baseline values on these variables. Results Joint mobilization produced immediate improvements in the temporal elements with eyes open and closed that exceeded the minimum detectable changes for these measures. Plantar massage and triceps surae stretching also enhanced the temporal element after a single treatment, but only with eyes closed. No substantial benefit of any of the interventions were found after 2-weeks of treatment, regardless of treatment group. Conclusions Sensory-targeted ankle rehabilitation strategies substantially improve single-leg postural control after one treatment, but these changes are short-lived. Future research is needed to determine whether combinations of sensory-targeted ankle rehabilitation strategies with other therapeutic interventions potentially improve single-leg balance stability in those with CAI compared to use in isolation. Clinical trial registration number NCT01541657.

Context: Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. Objective: To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. Design: Cross-sectional design. Setting: Clinical biomechanics laboratory. Participants: Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. Intervention: Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. Main Outcome Measures: Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges’ g), 95% confidence intervals, and repeated-measures analysis of variance (P Results: Significant reductions in Visual Analog Scale were recorded during squats between tapes (F2.505,12.867 = 3.407, P = .04, Hedges’ g = −0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. Conclusions: A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.

Copious research exists regarding ankle instability, yet lateral ankle sprains (LAS) persist among the most common recurrent musculoskeletal injuries. Key anatomical structures, necessary to subtalar joint (STJ) stability, have been potentially overlooked. The functional STJ complex is comprised of 2 compartments – the talocalcaneal joint (posteriorly) and the talocalcaneonavicular joint (anteriorly). Stability is provided by extrinsic ligaments (calcaneofibular and deltoid ligaments) and a series of broad intrinsic ligaments situated in the tarsal canal. These intrinsic ligaments, separating the 2 compartments, are a crucial source of mechanical stability and proprioceptive information. The specific stabilising direction of the STJ complex is controversial; there is likely a multiplanar function, similar to the ACL. Damage to the STJ complex occurs in approximately 25%–80% all LAS injuries, especially when the lateral ligaments are also involved. STJ complex disruption allows non-physiologic anterolateral rotary displacement, especially in weight-bearing. Patients with STJ instability present similarly to those with chronic ankle instability (CAI), including a history of acute LAS, recurrent ‘giving way’ episodes, insecurity on unstable surfaces, recurrent swelling, stiffness, and diffuse hindfoot pain that is aggravated by activity or uneven ground. Persistent pain over the sinus tarsi is common. Few special tests for STJ instability exist. Imaging with stress radiograph, diagnostic ultrasound, and MRI all have varying degrees of effectiveness of visualising soft tissue damage within the STJ complex. Laboratory-oriented evidence supports the vital role of ankle intrinsic ligaments for ankle instability, yet clinically-relevant research on evaluating and treating the STJ complex lags. This critical review summarises the literature, providing model to support further investigations into the role of the STJ complex in CAI. Future research should focus on identifying the clinical population overlap of CAI patients and those with concurrent STJ complex instability, and the best practices for clinical action when the intrinsic ankle ligaments are involved.

Study Design Reliability/Responsiveness study. Objectives To determine the responsiveness of single-limb postural control variables in those with chronic ankle instability (CAI) over 2 weeks without intervention. The variables of interest included the spatial (area of a 95% confidence ellipse) and temporal (average velocity of COP excursions) elements of centre of pressure excursions (COP). Background Single limb balance assessment using an instrumented force plate is one of the most common assessments of sensorimotor dysfunction associated with CAI. These measures have been used in numerous investigations, but the responsiveness of these measures remains unclear. Methods and Measures Seventy-seven participants with self-reported CAI participated in this study. CAI was defined in accordance to the International Ankle Consortium guidelines. All participants performed three 10 s trials of single limb balance with eyes open and eyes closed. After a 2 week period, all participants were reassessed. To analyse the spatial and temporal elements of the COP excursions, the area of a 95% confidence ellipse (cm 2 ) and the average resultant velocity (cm/s) were calculated, respectively. The mean of 3 trials in each condition was used for analysis. To analyse the responsiveness, intraclass correlation coefficients (ICC (2,3) ), the standard error of measure (SEM), and the minimum detectable change (SEM*2 1/2 ) were calculated. Results The spatial element of COP excursions displayed strong responsiveness (eyes open ICC=0.78,SEM=1.7 cm 2 ,MDC=1.9 cm 2 ; eyes closed ICC=0.85,SEM=3.9 cm 2 ,MDC=5.6 cm 2 ). Similarly, the temporal element demonstrated excellent responsiveness (eyes open ICC=0.96,SEM=0.4 cm/s,MDC=0.55 cm/s; eyes closed ICC=0.91,SEM=0.8 cm/s,MDC=1.1 cm/s). Conclusion Based on the results of this study, both the spatial and temporal elements of COP excursions display excellent responsiveness over time in those with CAI. By understanding the normally occurring error associated with these single-limb balance measures, it is possible to determine the clinical meaningfulness of changes associated with injury and rehabilitation in the CAI population. Changes/differences beyond the MDCs associated with this study may be potentially meaningful.

Context: Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)–associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. Objective: To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. Design: Secondary analysis of a randomized controlled clinical trial. Setting: Sports medicine research laboratories. Patients or Other Participants: Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. Intervention(s): Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. Main Outcome Measure(s): Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure–Sport (FAAM–S). Results: Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM–S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM–S improvements from AJM. Patients Conclusions: Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and

HOCH, M. C., and P. O. MCKEON. Peroneal Reaction Time after Ankle Sprain: A Systematic Review and Meta-analysis. Med. Sci. Sports Exerc., Vol. 46, No. 3, pp. 546–556, 2014. Background: Many studies have examined the temporal response of the peroneal muscles to sudden inversion perturbation in patients with a previous ankle sprain. The purpose of this systematic review with metaanalysis was to synthesize the evidence and determine whether peroneal reaction time (PRT) impairments are present after ankle sprain. Methods: An electronic search was conducted using PubMed Central and EBSCOhost (1965–January 2013). Articles were included if they 1) examined the PRT to sudden inversion perturbation in patients with a history of ankle sprain using a mechanical tilt platform, 2) made comparisons with a control group or contralateral limb with no history of ankle sprain, and 3) provided data for the calculation of effect sizes (ES). In addition to examining the overall effect of sustaining an ankle sprain on PRT, the effects of study design and subject characteristics on PRT were evaluated. Bias-corrected Hedges g ES and 95% confidence intervals (CI) were calculated to make comparisons across studies. Results: A total of 23 studies met the inclusion criteria. The overall ES was 0.67 (95% CI = 0.37–0.95, P G 0.001), indicating that a previous ankle sprain, regardless of study design or subject characteristics, resulted in moderate-to-strong PRT deficits. Further analyses determined studies with patients classified as having chronic ankle instability demonstrated large magnitude PRT deficits in between groups (ES = 0.72, 95% CI = 0.29–1.14, P = 0.001) and side-to-side (ES = 1.24, 95% CI = 0.70–1.79, P G 0.001) comparisons, whereas patients with all other ankle sprain histories demonstrated weak PRT alterations in between groups (ES = j0.21, 95% CI = j1.01 to 0.59, P = 0.61) and side-to-side (ES = 0.21, 95% CI = j0.19 to 0.60, P = 0.31) comparisons. Conclusions: Overall, this meta-analysis determined that individuals with a previous ankle sprain exhibit delayed PRT. Further analyses determined that these deficits are more evident in patients with chronic ankle instability when compared with the contralateral uninvolved limb or a healthy

Objectives Although ankle sprains have the highest recurrence rate of any musculoskeletal injury, objective estimates of when an athlete is likely to return-to-play (RTP) are unknown. The purpose was to compare time to return-to-play probability timelines for new and recurrent ankle sprains in interscholastic athletes. Design Observational. Methods Ankle sprain data were collected at seven high schools during the 2007–2008 and 2008–2009 academic years. Ankle sprains were categorized by time lost from participation (same day return, next-day return, 3-day return, 7-day return, 10-day return, >22-day return, no return [censored data]). Time-to-event analyses were used to determine the influence of ankle injury history on return-to-play after an ankle sprain. Results 204 ankle sprains occurred during 479,668 athlete-exposures, 163 were new (4 censored) and 35 recurrent (1 censored). There was no significant difference ( p =0.89) between the time-to-event curves for new and recurrent ankle sprains. The median (inter-quartile rage) time to return-to-play for new sprains (inter-quartile range)=3 days (same day to 7 day return); recurrent sprains=next day return (next day to 7 day return). Noteworthy probabilities [95% CIs] include: same day return (new=25.2[18.7, 31.9], recurrent=17.1[6.6, 30.3]); next-day return (new=43.6[35.3, 52.7], recurrent=51.4[32.5, 67.5]); and 7-day return (new=85.9[73.8, 94.4], recurrent=94.3[47.8, 99.5]). Conclusions Previous injury history did not affect time until return-to-play probabilities for ankle sprains. Time until return-to-play analyses that describe the likelihood of return-to-play are useful to clinicians by providing prognostic guidelines and can be used for educating athletes, coaches, and parents about the likely timeframe of being withheld from play.

Lateral ankle sprains are one of the most prevalent lower limb musculoskeletal injuries incurred by individuals who participate in recreational physical activities and sports.1 2 ### Propensity for the development of chronic ankle instability The misconception that acute lateral ankle sprains are innocuous injuries that require little treatment is common across patients and healthcare professionals; indeed, up to 50% of individuals who incur an acute lateral ankle sprain do not seek formal healthcare management for their injury.3 All too often colloquial terms such as a ‘rolled’ ankle or ‘twisted’ ankle are used to describe an acute lateral ankle sprain injury. In reality, acute lateral ankle sprains are rarely ever a ‘simple’ injury. …