Characterization of Multiple Movement Strategies in Participants With Chronic Ankle Instability

Abstract

Context: Chronic ankle instability (CAI) is characterized by multiple sensorimotor deficits, affecting strength, postural control, motion, and movement. Identifying specific deficits is the key to developing appropriate interventions for this patient population; however, multiple movement strategies within this population may limit the ability to identify specific movement deficits. Objective: To identify specific movement strategies in a large sample of participants with CAI and to characterize each strategy relative to a sample of uninjured control participants. Design: Descriptive laboratory study. Setting: Biomechanics laboratory. Patients or Other Participants: A total of 200 individuals with CAI (104 men, 96 women; age = 22.3 +/- 2.2 years, height = 174.2 +/- 9.5 cm, mass = 72.0 +/- 14.0 kg) were selected according to the inclusion criteria established by the International Ankle Consortium and were fit into clusters based on movement strategy. A total of 100 healthy individuals serving as controls (54 men, 46 women; age = 22.2 +/- 3.0 years, height = 173.2 +/- 9.2 cm, mass = 70.7 +/- 13.4 kg) were compared with each cluster. Main Outcome Measure(s): Lower extremity joint biomechanics and ground reaction forces were collected during a maximal vertical jump landing, followed immediately by a side cut. Data were reduced to functional output or curves, kinematic data from the frontal and sagittal planes were reduced to a single representative curve for each plane, and representative curves were clustered using a Bayesian clustering technique. Estimated functions for each dependent variable were compared with estimated functions from the control group to describe each cluster. Results: Six distinct clusters were identified from the frontal-plane and sagittal-plane data. Differences in joint angles, joint moments, and ground reaction forces between clusters and the control group were also identified. Conclusions: The participants with CAI demonstrated 6 distinct movement strategies, indicating that CAI could be characterized by multiple distinct movement alterations. Clinicians should carefully evaluate patients with CAI for sensorimotor deficits and quality of movement to determine the appropriate interventions for treatment.