Sains Malaysiana 49(6)(2020): 1323-1332

http://dx.doi.org/10.17576/jsm-2020-4906-10

 

Effect of Neuro-Dynamic Technique on Repetitive Inward Ankle Rolls among Young Malaysian Athletes - A Randomized Controlled Trial

(Kesan Teknik Dinamik-Neuro pada Gulungan Dalaman Pergelangan Kaki yang Berulang Kali dalam Kalangan Atlet Muda Warganegara Malaysia - Ujian yang Dikawal Secara Rawak)

 

Vinodhkumar Ramalingam1*, Viswanath Sundar2 & Saju Joseph2

 

1Faculty of Health and Life Sciences, INTI International University, 71800 Nilai, Negeri Sembilan, Malaysia

 

2Department of Biomechanics, National Sports Institute, 53000 Kuala Lumpur, Federal Territory, Malaysia

 

Diserahkan: 14 Julai 2019/ Diterima: 31 Januari 2020

 

ABSTRACT

Inversion ankle sprains (IAS) are the most common injuries in sports and recreational activities. Incomplete rehabilitation among injured athletes may result in repetitive inward ankle rolls. Furthermore, inversion ankle sprain causes damage to the superficial peroneal nerve during repeated ankle inversion and plantar flexion. This results in positive neurodynamic tests in patients with sprained ankles. The purpose of this study was to find the effect of the neuro-dynamic technique on repetitive inward ankle rolls and compare it with standard physiotherapy on dynamic balance, pain score, peroneal longus, and tibialis anterior muscle activation response, knee range of motion (ROM), and functional ankle disability index (FADI) among young Malaysian athletes. Fourteen participants of age ranging from 17 to 35 years with repeated ankle sprains were recruited and randomized into Intervention Group A (Neuro-dynamic technique and Standard Physiotherapy-NDT+SP) and Intervention Group B (Standard Physiotherapy-SP). The participants of group A received NDT (4*30 s with 1-min rest) consisting of peroneal nerve mobilization began the day after the baseline and continued through the week for 3 sessions.  In addition, the participants received standard physiotherapy (pain management and exercise) whereas the group B participants received only standard physiotherapy. The participants with repeated IAS were checked for FADI followed by pain score, dynamic balance (Y-balance), and knee ROM (using electro-goniometer). The peroneal longus and tibialis anterior muscle activity response was tested by Surface Electromyography (sEMG) (Noraxon Myo-Muscle) on the injured leg. The subjects of the two groups were tested on selected variables in baseline, mid, post and follow-up measurements.  Repeated Measures Analysis of Variance (ANOVA) was computed to determine the interaction effects of time and between-subject factors. ANOVA results (NDT + SP) indicated that dependent variables FADI (F (1.148, 36) = 4701.14), pain score (F (1.98, 36) = 132.697), dynamic balance (F (1.409, 36) = 16.42), knee ROM (F (1.498, 36) = 62.232), peroneal longus peak activity (F (3, 36) = 25.727), and tibialis anterior peak activity (F (3, 36) = 17.563) had a significant effect (p<0.05) within the times of intervention among participants. Based on the post hoc test. FADI, pain score and knee ROM showed consistent improvement in intervention over the injured leg. The findings of this study show improvement in dynamic balance, pain score, peroneal longus and tibialis anterior muscle activation response, knee ROM, and FADI in both groups. The neuro-dynamic technique together with standard physiotherapy intervention shows safe and similar effects between variables. As part of the ankle rehabilitation protocol, it also recommends the neurodynamic technique to prevent repetitive IAS.

 

Keywords: Ankle injury; physiotherapy (techniques); range of motion; surface electromyography; visual analogue pain scale

ABSTRAK

Kecederaan terseliuh songsang pada pergelangan kaki (IAS) adalah kecederaan yang paling biasa dalam aktiviti sukan dan rekreasi. Pemulihan yang tidak menyeluruh dalam kalangan atlet yang tercedera boleh mengakibatkan gulungan dalaman pergelangan kaki yang berulang kali. Tambahan lagi, terseliuh songsang pada pergelangan kaki menyebabkan kerosakan pada saraf peroneal semasa gulungan dalaman pergelangan kaki yang berulang kali dan fleksi kaki. Ini menyebabkan ujian neurodinamik yang positif pada pesakit yang terseliuh pergelangan kaki. Tujuan kajian ini adalah untuk mengetahui kesan teknik neuro-dinamik pada gulungan dalaman pergelangan kaki yang berulang kali dan membandingkannya dengan fisioterapi yang standard pada keseimbangan dinamik, skor nyeri, peroneal longus dan respon pengaktifan otot tibialis anterior, julat pergerakan lutut (ROM) dan indeks kecacatan pergelangan kaki yang berfungsi (FADI) dalam kalangan atlet muda warganegara Malaysia. Empat belas peserta berumur antara 17 hingga 35 tahun dengan pergelangan kaki terseliuh yang kerap dipilih dan dirawakkan kepada Pengantaraan Kumpulan A (teknik neuro-dinamik dan fisioterapi standard-NDT + SPT) dan Pengantaraan Kumpulan B (fisioterapi standard-SP). Peserta Kumpulan A mendapat NDT (4*30 s dengan 1-min rehat) yang terdiri daripada mobilisasi saraf peroneal bermula sehari selepas garis dasar dan berterusan sepanjang minggu selama 3 sesi. Di samping itu, peserta mendapat fisioterapi standard (pengurusan kesakitan dan senaman), manakala peserta Kumpulan B hanya menerima fisioterapi standard. Para peserta dengan IAS yang berulang kali diperiksa diikuti dengan skor nyeri, keseimbangan dinamik (keseimbangan-Y) dan lutut ROM (menggunakan elektro-goniometer). Respons peroneal longus dan pengaktifan otot tibialis anterior diuji dengan menggunakan Permukaan Elektromiografi (sEMG) (Noraxon Myo-Muscle) pada kaki yang cedera. Subjek daripada kedua-dua kumpulan diuji pada pemboleh ubah yang terpilih dalam pengukuran garis dasar, pertengahan, pasca dan susulan. Ukuran Analisis Varians yang Berulang Kali (ANOVA) telah dikira untuk menentukan kesan interaksi masa dan faktor antara subjek. Keputusan ANOVA (NDT + SP) menunjukkan bahawa pemboleh ubah bersandar FADI (F (1.148, 36) = 4701.14), skor nyeri (F (1.98, 36) = 132.697), keseimbangan dinamik (F (1.409, 36) = 16.42), lutut ROM (F (1.498, 36) = 62.232), aktiviti puncak peroneal longus (F (3, 36) = 25.727) dan aktiviti puncak tibialis anterior (F (3, 36) = 17.563) mempunyai kesan yang signifikan (p<0.05) dalam masa intervensi dalam kalangan peserta. Berdasarkan ujian pasca hoc. FADI, skor nyeri dan ROM lutut menunjukkan peningkatan yang berterusan dalam pengantaraan pada kaki yang cedera. Hasil kajian ini menunjukkan peningkatan keseimbangan dinamik, skor nyeri, respons pengaktifan peroneal longus dan otot tibialis anterior, ROM lutut, dan FADI pada kedua-dua kumpulan. Teknik neuro-dinamik bersama dengan pengantaraan fisioterapi standard menunjukkan kesan yang selamat dan serupa antara pemboleh ubah. Sebagai sebahagian daripada protokol pemulihan pergelangan kaki, teknik neurodinamik juga disyorkan untuk mencegah IAS yang berulang.

 

Kata kunci: Analog skala sakit boleh nampak; fisioterapi (teknik); julat pergerakan; kecederaan pergelangan kaki; permukaan elektromiografi

 

RUJUKAN

Bavdek, R., Zdolšek, A., Strojnik, V. & Dolenec, A. 2018. Peroneal muscle activity during different types of walking. Journal of Foot and Ankle Research 11: 50.

Bleakley, C.M., O’Connor, S.R., Tully, M.A., Rocke, L.G., MacAuley, D.C., Bradbury, I., Keegan, S. & McDonough, S.M. 2010. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ  2010: 340.

Buchanan, A.S., Docherty, C.L. & Schrader, J. 2008. Functional performance testing in participants with functional ankle instability and in a Healthy Control Group. Journal of Athletic Training 43(4): 342-346.

Bullock-Saxton, J.E. 1995. Sensory changes associated with severe ankle sprain. Scand. J. Rehabil. Med. 27(3): 161-167.

Butler, S.D. 2005. The Neurodynamic Techniques: A Definitive Guide from the Noigroup Team. Adelaide: Noigroup Publications.

Castellote-Caballero, Y., Valenza, M.C., Puentedura, E.J., Fernández-de-las-Peñas, C. & Alburquerque-Sendín, F. 2014. Immediate effects of neurodynamic sliding versus muscle stretching on hamstring flexibility in subjects with short hamstring syndrome. Journal of Sports Medicine 2014: 127471.

Coppieters, M.W., Stappaerts, K.H., Everaert, D.G. & Staes, F.F. 2001. Addition of test components during neurodynamic testing: Effect on range of motion and sensory responses. Journal of Orthopaedic & Sports Physical Therapy 31(5): 226-237.

Coughlan, G. & Caulfield, B. 2007. A 4-week neuromuscular training program and gait patterns at the ankle joint. Journal of Athletic Training (National Athletic Trainers’ Association) 42(1): 51-59.

Docherty, C.L., Arnold, B.L., Gansneder, B.M., Hurwitz, S. & Gieck, J. 2005. Functional-performance deficits in volunteers with functional ankle instability. Journal of Athletic Training 40(1): 30-34.

Faude, O., Junge, A., Kindermann, W. & Dvorak, J. 2006. Risk factors for injuries in elite female soccer players. British Journal of Sports Medicine 40(9): 785-790.

Garrick, J.G. & Requa, R.K. 1988. The epidemiology of foot and ankle injuries in sports. Clinics in Sports Medicine 7(1): 29-36.

Gutierrez, G.M., Kaminski, T.W. & Douex, A.T. 2009. Neuromuscular control and ankle instability. PM and R. 1(4): 359-365

Hertel, J. 2002. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training 37(4): 364-375.

Hoch, M.C. & McKeon, P.O. 2014. Peroneal reaction time after ankle sprain: A systematic review and meta-analysis. Medicine and Science in Sports and Exercise 46(3): 546-556.

Hopkins, J.T., Coglianese, M., Glasgow, P., Reese, S. & Seeley, M.K. 2012. Alterations in evertor/invertor muscle activation and center of pressure trajectory in participants with functional ankle instability. Journal of Electromyography and Kinesiology 22(2): 280-285.

Kang, A.L. & Ramalingam, V. 2018. Risk factors for lower extremity injuries in young badminton players. Scientia Medica 28(2): 5.

Khalid, R., Millar, T., Khalid, R., Peroneal, T.M. & Internet, T. 2008. Peroneal nerve palsy following an ankle sprain: Case report. European Journal of Orthopaedic Surgery & Traumatology 15(1): 26507641.

Malliaropoulos, N., Ntessalen, M., Papacostas, E., Longo, U.G., Maffulli, N., Malliaropoulos, N. & Papacostas, E. 2009. Reinjury after acute lateral ankle sprains in elite track and field athletes. The American Journal of Sports Medicine 37: 1755-1761.

Mattacola, C.G. & Dwyer, M.K. 2002. Rehabilitation of the ankle after acute sprain or chronic instability. Journal of Athletic Training 37(4): 413-429.

McKay, G.D. 2001. Ankle injuries in basketball: Injury rate and risk factors. British Journal of Sports Medicine 35(2): 103-108.

McKeon, P.O. & Mattacola, C.G. 2008. Interventions for the prevention of first time and recurrent ankle sprains. Clinics in Sports Medicine 27(3): 371-382.

Mitsiokapa, E., Mavrogenis, A.F., Drakopoulos, D., Mauffrey, C. & Scarlat, M. 2016. Peroneal nerve palsy after ankle sprain: An update. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie 27(1): 53-60.

Murphy, D.F., Connolly, D.A.J. & Beynnon, B.D. 2003. Risk factors for lower extremity injury: A review of the literature. British Journal of Sports Medicine 37(1): 13-29.

Nee, R.J. & Butler, D. 2006. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport 7(1): 36-49.

O’Neill, P.J., Parks, B.G., Walsh, R., Simmons, L.M. & Miller, S.D. 2007. Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. Journal of Bone and Joint Surgery - Series A 89(5): 979-986.

Oda, K., Ogaki, R., Murakami, K., Kurosawa, T., Yamaguchi, T., Takahashi, Y. & Miyakawa, S. 2019. Effects of functional ankle instability on collegiate female football players’ performances. Journal of Sports Science 7: 1-5.

Olmsted, L.C., Carciat, C.R., Hertel, J. & Shultz, S.J. 2002. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. Journal of Athletic Training 37(4): 501-506.

Pahor, S. & Toppenberg, R. 1996. An investigation of neural tissue involvement in ankle inversion sprains. Manual Therapy 1(4): 192-197.

Ramalingam, V., Sundar, V. & Joseph, S. 2018. Neurodynamic technique on functional ankle instability: A case report. Journal of Clinical and Diagnostic Research 12(4): YD01-YD04.

Santilli, V. 2005. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability: A surface electromyographic study. American Journal of Sports Medicine 33(8): 1183-1187.

Sefton, J.E.M., Hicks-Little, C.A., Hubbard, T.J., Clemens, M.G., Yengo, C.M., Koceja, D.M. & Cordova, M.L. 2009. Sensorimotor function as a predictor of chronic ankle instability. Clinical Biomechanics 24(5): 451-458.

Shacklock, M. 2005. Clinical Neurodynamics. Netherlands: Elsevier Health Sciences.

Shaffer, S.W., Teyhen, D.S., Lorenson, C.L., Warren, R.L., Koreerat, C.M., Straseske, C.P. & Childs, J.D. 2015. Y-balance test: A reliability study involving multiple raters. Mil. Med. 178(11): 1264-1270.

Shariff, A.H., George, J. & Ramlan, A.A. 2009. Musculoskeletal injuries among Malaysian badminton players. Singapore Medical Journal 50(11): 1095-1097.

Türker, H., Sözen, H., Feger, M.A., Hertel, J., Balakrishnan, R., Ellanchezlian, E. & Clinic, B.O. 2016. Difference in response latency of the peroneus longus between the dominant and nondominant legs. Journal of Athletic Training 37(1): 321-332.

Villafa, J.H., Pillastrini, P. & Borboni, A. 2013. Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: A case report. Journal of Chiropractic Medicine 12(3): 176-181.

Webster, K.A. & Gribble, P.A. 2010. Functional rehabilitation interventions for chronic ankle instability: A systematic review. Journal of Sport Rehabilitation 19(1): 98-114.

Wikstrom, E.A., Hubbard-Turner, T. & McKeon, P.O. 2013. Understanding and treating lateral ankle sprains and their consequences: A constraints-based approach. Sports Medicine 43(6): 385-393.

Wikstrom, E A., Tillman, M.D., Chmielewski, T.L., Cauraugh, J.H., Naugle, K.E. & Borsa, P.A. 2009. Self-assessed disability and functional performance in individuals with and without ankle instability: A case control study. Journal of Orthopaedic & Sports Physical Therapy 39(6): 458-467.

 

*Pengarang untuk surat-menyurat; email: vinodh.ramalingam@newinti.edu.my

 

 

 

 

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