Context: Chronic ankle instability (CAI) individuals experience residual symptoms including pain, swelling, ankle instability, etc. A small majority of CAI individuals report ankle pain during daily or physical activity. Despite the known negative effects of chronic pain on neuromuscular control, there is a paucity of research exploring the specific impact of chronic pain mechanisms on altered neuromuscular control in CAI individuals. Purpose: The purpose of this study was to identify the effects of pain levels on static and dynamic postural control and visual reliance in CAI individuals. Methods: A total of 60 participants were recruited, consisting of 20 CAI individuals with high pain, 20 CAI individuals with low pain, and 20 healthy controls. Participants performed static postural control with eyes open and closed, the star excursion balance test (SEBT), and single-leg hop stabilization. One-way ANOVA assessed differences in Romberg ratios, SEBT, dynamic postural stability index, and self-reported outcomes. Two-way ANOVA (3x2) was used to assess differences in static postural control across the three groups. Results: The high pain group showed decreased mediolateral (ML) direction of static postural stability in eyes closed and a higher Romberg ratio in ML direction compared to the low pain group. The high pain group showed decreased reach distance and increased dynamic postural control in vertical and dynamic postural stability index compared to the healthy control group and low pain group, respectively. Conclusions: The levels of chronic pain can have a significant impact on both static and dynamic postural control and visual reliance in CAI individuals. Therefore, fluctuating chronic pain levels may result in alterations in motor outcomes.

Bakgrund: Tio till tjugo procent av akuta skador på ligamenten kring fotleden resulterar ikronisk fotledsinstabilitet, vilket innebär en instabilitetskänsla, stukningstendens, smärta ochsvullnad i fotleden. Det är värdefullt att som fysioterapeut ha kunskap om vilkenrehabiliteringsmetod som förbättrar balans i syfte att öka stabiliteten i foten. Syfte: Sammanställa litteraturen och bedöma det vetenskapliga underlaget gällande effektenpå balansen hos individer med kronisk fotledsinstabilitet genom träning med balansbräda.Detta ställs upp i två sammanvägningar: balansbräda jämfört med styrketräning, ochbalansbräda jämfört med ingen behandling. Metod: En systematisk litteratursökning efter randomiserade kontrollerade studier utfördes idatabaserna PubMed, Uppsala universitetsbibliotek, samt Cochrane Library. Totaltinkluderades åtta studier med sammanlagt 286 deltagare. Samtliga studier kvalitetsgranskadesenligt PEDro-skalan, och GRADEstud användes för bedömning av det sammanvägdaresultatets tillförlitlighet. Resultat: Signifikant förbättring av balans kopplat till styrketräning samt balansträning medbalansbräda, men liten fördel för en kombination för de båda kopplat till statisk balans. Kvalitetsgranskning enligt PEDro visade på att sex studier hade en måttlig kvalité och tvåstudier hade hög kvalité. Utifrån evidensbedömningen anses det föreligga en lågtillförlitlighet till det vetenskapliga underlaget för styrketräning med motståndsband förfotleden samt balansträning med balansbräda. Konklusion: Både styrketräning för relevant muskulatur och balansträning med balansbrädaförbättrar balansen efter ett ≥4 veckor långt protokoll med ≥3 träningssessioner/vecka.Evidensen talar för att båda rehabiliteringsmetoder ger liknande utfall, men fler studierbehövs för att bekräfta resultatet då de sammanvägda resultaten har låg tillförlitlighet. / Background: Ten to twenty percent of acute ankle injuries result in chronic ankle instability,which results in instability in the foot, distorsion tendency, and pain and swelling around theankle. Thus it´s valuable for physiotherapists to have knowledge regarding whichrehabilitation methods yield the most positive effect on balance in order to increase stabilityin the foot. Purpose: To compile the literature and assess the evidence regarding the effects on balanceof people diagnosed with chronic ankle instability through rehabilitation with awobble-board. This is set up in two comparisons: wobble-board compared tostrength-training, and wobble-board compared to no treatment. Method: A systematic literature search for randomized controlled trials was done inPubMed, Uppsala University Library, and CochraneLibrary. A total of eight studies wereincluded in this review, with a total of 286 participants. Study quality was judged by using the PEDro-scale, and GRADEstud was used to assess the reliability of the combined results. Results: Significant improvement in balance related to resistance training and balancetraining with wobble-board, with a small advantage to training with a combination of the twowhen measuring static balance. Quality according to PEDro showed six studies of moderatequality and two studies of high quality. Grading of the evidence is deemed insufficient whenit comes to training with resistance bands and training with a wobble-board. Conclusion: Both strength-training for the relevant muscles and balance-training using thewobble-board improves the balance after a ≥4 week-long protocol with ≥3 sessions/week.The evidence shows that both methods give similar results, however further research isrequired to confirm the results because the reliability of the combined results was deemedinsufficient.

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Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

No / Objective To assess the learning effect, test–retest reliability and measurement error associated with the SEBT. Design Repeated-measures study. Setting Controlled university laboratory environment. Participants Twenty-two healthy recreational athletes (11 male age 22.3 ± 3.7 years, 11 female age 22.8 ± 3.1 years). Main Outcome Measures Repeated-measures ANOVA assessed learning affects. Intraclass correlations coefficients, standard error of measurement and smallest detectable difference values were calculated to assess reliability and measurement error. Results Results showed that excursion distances stabilised after four trials, therefore trials five to seven were analysed for reliability. Test–retest reliability for all reach directions was high, with intraclass correlation coefficients ranging from 0.84 to 0.92. 95% confidence intervals, standard error of measurement and smallest detectable difference ranged from 77.84 to 94.00, 2.21–2.94% and 6.13–8.15%, respectively. Conclusion These statistics will allow clinicians to evaluate whether changes in SEBT scores are due to change in an individual’s performance or random error. The findings of this study show that the SEBT is a reliable measure of lower limb function in healthy recreational athletes. Changes in normalised scores of at least 6–8% are needed to feel confident that a real change in SEBT performance has occurred.

Title: The effect of flat feet on the stability of the ankle joint of floorball players. Objectives: The main aim of this thesis is to determine whether a flat feet has any effects on the floorball players' ankle joint stability. Furthermore, the thesis focuses on the chronic ankle instability, other leg pathologies and on the options of therapeutic interventions. Eventually, the thesis provides summary and output data for physiotherapist, sport couches and the examined players. Methods: First a literature study was conducted to establish a theoretical framework. Based on the feature/aspect examination of longitudinal foot arching and an initial questionnaire 10 particular subjects aged 22 to 29 were selected, all of them form the TJ Tatran Střešovice team. The subjects were divided in 2 groups - with longitudinal flat feet and without longitudinal flat feet pathology. The examined subjects were scored with negative points according to occurrence of any pathologies. Both groups were also benchmarked in the Star Excursion Balance Test that determined feet dynamic stability index. Results: The examination proved that flat feet affects the stability of the ankle joint as the subjects of the group without longitudinal flat feet scored results that were 31% better than results of the subjects with...

L’instabilité chronique de la cheville (CAI) est un fardeau socioéconomique important qui entraine des répercussions néfastes chez la population atteinte, comme des récidives d’entorses de la cheville (ELC), qui peuvent notamment s’expliquer par des déficits biomécaniques aux membres inférieurs. Ces déficits sont notamment observés lors d’activités quotidiennes comme la marche, mais aussi lors de tâches plus difficiles comme l’atterrissage d’un saut. Par contre, les impacts biomécaniques réels d’une CAI lors de la locomotion ne sont pas encore clairement décrits. Les orthèses plantaires sont couramment utilisées dans le traitement de pathologies musculosquelettiques pour modifier les variables biomécaniques des membres inférieurs (cinématique, cinétique et électromyographie) responsables de ces pathologies. Bien que leurs effets sur la biomécanique du membre inférieur d’individus atteints d’une CAI soient encore méconnus, les orthèses plantaires pourraient permettre de les traiter plus efficacement. Les objectifs principaux de cette thèse étaient de déterminer les déficits biomécaniques associés à la CAI lors de la locomotion et lesquels de ces déficits peuvent être atténués avec le port d’orthèses plantaires. L’Étude 1 consistait à réaliser une revue systématique de la littérature sur les impacts biomécaniques d’une CAI lors d’une tâche de marche et de course. L’Étude 2 consistait à identifier les différences biomécaniques entre des individus avec et sans CAI à la marche. L’Étude 3 consistait à déterminer les différences biomécaniques entre des individus avec et sans CAI lors de l’atterrissage d’un saut unipodal sur une surface plane (DROP), inclinée (WEDGE) et instable (FOAM) ainsi qu’à l’atterrissage d’un saut latéral maximal unipodal (SIDE). Finalement, l’Étude 4 consistait à déterminer les effets des orthèses plantaires sur la biomécanique du membre inférieur d’individus atteints d’une CAI lors des tâches de marche et d’atterrissage d’un saut unipodal. À la marche, les individus atteints d’une CAI présentent de nombreux déficits biomécaniques qui pourraient les prédisposer à subir d’autres ELC, notamment une augmentation de l’inversion et de la flexion plantaire de la cheville. Ces augmentations de mouvement à la cheville contribuent à augmenter les forces verticales latérales au pied, à modifier la cinématique et la cinétique du genou ainsi que l’activité des muscles moyen fessier et long fibulaire. Lors de l’atterrissage d’un saut unipodal, les individus atteints d’une CAI présentent une augmentation de la dorsiflexion de la cheville afin de stabiliser l’articulation. Lors de la tâche WEDGE, la diminution de la préactivation musculaire du long fibulaire pourrait mettre ces individus plus à risque de subir d’autres ELC. De plus, le port d’orthèses plantaires diminue l’activité musculaire du tibial antérieur lors de la tâche DROP et du biceps fémoral à la marche chez des individus atteints d’une CAI. Elles semblent n’avoir aucun effet significatif sur la cinématique et cinétique du membre inférieur lors de la marche et l’atterrissage d’un saut unipodal. Finalement, cette thèse permet de mieux identifier les déficits biomécaniques à adresser lors de l’élaboration de plan de traitement pour les individus atteints d’une CAI et de mieux comprendre les effets des orthèses plantaires pour atténuer ces déficits. / Chronic ankle instability (CAI) is a major socioeconomic burden and has adverse repercussions for the affected population, such as recurrence of lateral ankle sprains (LAS), which could be explained by lower limb biomechanical deficits. These deficits are observed during daily activities such as walking but also during more difficult tasks such as jump landing. However, the real impact of CAI during locomotion has not yet been clearly described. Foot orthoses are commonly used to treat musculoskeletal pathologies because they modify lower limb biomechanics (kinematics, kinetics and electromyography). However, their effects on lower limb’s biomechanics of individuals with CAI are still unknown. Foot orthoses may help to treat the individuals with CAI more effectively. The main objectives of this thesis were to determine the biomechanical deficits associated with CAI during locomotion and which of these deficits can be attenuated with foot orthoses. Study 1 consisted of systematically reviewing the literature on the biomechanical deficits associated with CAI during walking and running. Study 2 consisted of identifying the biomechanical differences between individuals with and without CAI during walking. Study 3 consisted of determining the biomechanical differences between individuals with and without CAI during unilateral jump landing on even (DROP), inclined (WEDGE) and unstable (FOAM) surfaces and during a unilateral maximal side jump landing (SIDE). Study 4 consisted of determining the effects of foot orthoses on lower limb’s biomechanics of individuals with CAI during walking and unilateral jump landing. During walking, individuals with CAI present many biomechanical deficits that may predispose them to sustain recurrent LAS, including increased ankle inversion and plantarflexion. These contribute to increase the lateral vertical forces under the foot, to modify knee kinematics and kinetics as well as the activity of the gluteus medius and peroneus longus muscles. During unilateral jump landing, individuals with CAI present increased ankle dorsiflexion in order to stabilize the joint. During the WEDGE task, the decreased peroneus longus muscle preactivation could put these individuals at greater risk of sustaining recurrent LAS. In addition, wearing foot orthoses decreases the muscular activity of the tibialis anterior during the DROP task and the biceps femoris during walking in individuals with CAI. FOs have no significant effect on the kinematics and kinetics of the lower limb during walking and unilateral jump landing. Finally, the results of this thesis will help to better identify the biomechanical deficits to be addressed during rehabilitation for individuals with CAI and to better understand the effects of foot orthoses to attenuate these deficits.