Ankle Sprain Rehab Made Easy for Athletic Trainers with the use of Biofeedback

By |2022-01-04T09:16:04-05:00January 6th, 2022|Latest Articles|


Athletic trainers have the uncanny ability to navigate flawlessly through high paced, stressful environments. Often managing multiple teams, athletes, and injuries all at the same time, the name of the game is to optimize, organize, and individualize care for each athlete at any given moment. In the height of the season, tasks are often triaged and delegated. Finding time for a simple ankle sprain seems almost impossible.= – after all, it’s just an ankle sprain.

However, ankle sprains can keep athletes sidelined for weeks, even months. With the use of sEMG biofeedback, athletic trainers now have a tool their athletes can use that provides immediate feedback and visual results of their performance. It’s a tool athletes and trainers can use on the sideline for maximum efficiency and optimal engagement. Most importantly, this tool allows athletes to be self-sufficient, receiving real-time data on their performance, as if the trainer was right there with them.

Background 

Although people brush off ankle sprains as seemingly simple injuries, ankle sprains are one of the most common injuries sustained by an athlete.(1) Some individuals have persistent issues lasting 6+ months.(1) This on top of the high recurrence rate of ankle sprains makes a complete and effective rehab program essential for performance and return to play. As an athletic trainer, dealing with ankle sprains is a given. Unfortunately, for both the busy AT and frustrated injured athlete, coming back from an ankle sprain can be monotonous and boring.

In light of needing fast results, full recovery, and a quick return to play, biofeedback is an excellent intervention that can provide their athletes with direct results, visual feedback, and individualized programing.

After an ankle sprain, strength and balance deficits are commonly noted. Biofeedback has been proven effective for altering muscle firing patterns and immediately improving gait mechanics after an ankle sprain.(2) More specifically, a loss of inversion strength, eccentric eversion strength, hip abductor strength, and muscle reaction time in response to perturbations have all been observed.(1,3–5) Using this information and the mTrigger Biofeedback System, rehabbing an ankle sprain as an athletic trainer just got a lot easier…AND a lot more fun.

 

Protocol

Let’s take a look at how these common deficits can be addressed with mTrigger and merged into a comprehensive rehab program easy for both athlete and trainer to follow.

  1. Ankle Inversion
    1. Using a single channel, place the electrodes on the invertor muscles of the affected ankle.
    2. Instruct patient to perform banded ankle inversion slowly and steadily.
    3. As the patient performs the exercise, they are instructed to increase the muscle activation meter and try to maintain that increased activation throughout the exertion of the exercise.



      *Decreased force production and a lack of control of that force were demonstrated in the literature.(1,4) Keeping the meter high and steady is key for this exercise, but as you can see, she really struggles to keep the meter up and sustain muscle activation! Ideally, you would expect the inverters of the ankle seen here (tibialis posterior, flexor digitorum longus, flexor hallucis longus, tibialis anterior) to be stronger than the evertors.(6) However, due to the deeper nature of their muscle bellies it is more difficult to pick up surface EMG activity compared to the more superficial evertors. Additionally, it is common to see greater deficits in ankle inversion strength and control following an ankle sprain.(6) As this athlete has sustained several ankle sprains, we can clearly see how visual biofeedback gives her a clear picture of this deficit. In this setup, you can also lower the MVC goal to accommodate the deficit and keep up the patient’s confidence – just remember to increase it as they improve!

  2. Ankle Eversion (specifically eccentric)
    1. Using a single channel, place the electrodes on the evertor muscles of the affected ankle.
    2. Instruct patient to perform banded ankle eversion slowly and steadily.
    3. As the patient performs the exercise, they are instructed to increase the muscle activation meter and try to maintain that increased activation throughout the exertion of the exercise.



  3. Hip Abduction
    1.  Using a single channel, place the electrodes on the gluteus medius muscle of the affected side.
    2. With the mTrigger set up and electrodes in place, the patient is now instructed to start performing simple hip abduction exercises
      1. Examples: sidelying hip abduction, band walks, running man
      2. As the patient makes improvements in their quality of movement and activation MVC, you can progress to more complex exercises.
    3. As the patient performs the exercises, they are instructed to increase the muscle activation of the gluteus medius muscle showing good activation and control of that muscle throughout the duration of the exercise.

      *Hip abductor activation strength and control were common deficits after an ankle sprain. Regardless of the exercise chosen, the focus is on smooth, quality, and high activation of the gluteus medius muscle.(4)

  4.  Single Leg Stance (SLS)
    1. Using a dual channel, place one set of electrodes on the invertors and one set of electrodes on the evertors of the affected side.
    2. The patient begins by performing a single leg balance exercise on firm ground then progressing to foam / unstable surfaces for more of a challenge.
    3. During the exercise, the patient is instructed to keep the muscle activation meters low and balanced. The goal here is to not only improve the muscle activation, but to also improve muscle response time in reaction to being off balance. The goal for the patient is twofold: 1, to be able to quiet and steady the meter; and 2, to activate the correct muscle (invertor or evertor depending on which side they are falling to) as quickly and as smoothly as possible in response to internal or external perturbations.

      *Decreased response time in the ankle muscles as a result of perturbation was typical after an ankle sprain.(1) Therefore, achieving quick, smooth, and high MVC contraction of ankle stabilizers is important for this exercise in response to internal perturbation.


Summary

The athletic training room is busy and chaotic. Athletic trainers don’t have extra time to devote to treating commonly occurring ankle sprains. However, ankle sprains can keep athletes sidelined for weeks, even months. With the use of sEMG biofeedback, athletic trainers now have a tool their athletes can use that provides immediate feedback and visual results of their performance. Most importantly, this tool allows athletes to be self-sufficient, receiving real-time data on their performance, as if the trainer was right there with them.

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References

  1. Holmes A, Delahunt E. Treatment of Common Deficits Associated with Chronic Ankle Instability. Sport Med 2009 393. 2012;39(3):207-224. doi:10.2165/00007256-200939030-00003
  2. Migel KG, Wikstrom EA. Immediate effects of vibration biofeedback on ankle kinematics in people with chronic ankle instability. Clin Biomech (Bristol, Avon). 2021;90. doi:10.1016/J.CLINBIOMECH.2021.105495
  3. Witchalls J, Blanch P, Waddington G, Adams R. Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis. Br J Sports Med. 2012;46(7):515-523. doi:10.1136/BJSPORTS-2011-090137
  4. Lee H, Jun Son S, Kim H, Han S, Seeley M, Ty Hopkins J. Submaximal Force Steadiness and Accuracy in Patients With Chronic Ankle Instability. J Athl Train. 2021;56(5):454-460. doi:10.4085/15-20
  5. Sekir U, Yildiz Y, Hazneci B, Ors F, Aydin T. Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability. Knee Surgery, Sport Traumatol Arthrosc 2006 155. 2006;15(5):654-664. doi:10.1007/S00167-006-0108-8
  6. Wilkerson GB, Pinerola JJ, Caturano RW. Invertor vs. evertor peak torque and power deficiencies associated with lateral ankle ligament injury. J Orthop Sports Phys Ther. 1997;26(2):78-86. doi:10.2519/JOSPT.1997.26.2.78

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