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