||Effects of Balance Training Combined with Plyometric Exercises on Proprioception,Posture Control, and Tendon Property in Athletes with Functional Ankle Instability
||Department of Physical Therapy
結果：單獨增強式訓練和平衡結合增強式訓練可以改善踝關節蹠屈本體覺[F=12.595, p=.001]，減少壓力中心在閉眼單腳站動作的內外側方向之晃動標準差[F=8.222, p=.001]，增加肌腱剛性[F=7.535, p=.002]。在往內側或外側單腳落地的動作，兩組訓練皆會增加下肢在矢狀面的最大角度、減少額狀面及橫向面的最大角度、減少膝關節屈曲達穩定期時間、增加踝關節蹠屈肌與膝關節伸肌在落地前後的活化，以及增加踝關節共同收縮程度。此外，平衡結合增強式訓練能改善踝關節內翻本體覺[F=3.370, p=.046]，減少在內外側方向的最大晃動範圍[F=6.435, p=.002]，與減少膝關節旋轉達穩定期時間。單獨增強式訓練能額外減少閉眼單腳站動作的壓力中心的晃動面積[F=4.412, p=.015]、降低單腳跳躍落地時前後方向[F=4.012, p=.021] 和垂直地面反作用力[F=8.367, p<.001]和垂直負荷率[F=5.574, p=.005]。
Background: Ankle sprains are the most prevalent musculoskeletal injuries that occur in athletes, and the ankle instability is a rather common consequence.
Hypothesis: An isolated plyometric training and a balance combined with plyometric program can positively improve the proprioception, postural control ability, and tendon property in athletes with ankle instability.
Study Design: Randomized controlled clinical trial
Methods: Thirty collegiate recreational athletes with bilateral or unilateral functional ankle instability were randomly assigned to a plyometric group (P group, 8M2F, n=13) or to a balance combined with plyometric group (BP group, 8M2F, n=13) or to a control group (C group, 7M3F, n=12). The outcome measures were the lower limb joint angle, ground reaction force (GRF), loading rate, time to stabilize (TTS), adjusting time and integral electromyography (IEMG) of neronmuscular signal during drop landing, postural sway during one-leg balance, and mechanical property of Achilles tendon.
Results: Isolated plyometric training and balance combined with plyometric training improved the plantar flexion of joint position sense [F=12.595, p=.001], reduced the standard deviation of center of pressure (COP) sway in the medial-lateral (ML) direction [F=8.222, p=.001], increased tendon stiffness [F=7.535, p=.002]. During medial and lateral drop landing tasks, both trainings increased maximum angles of sagittal plane and decreased maximum angle of frontal and transverse plane of lower extremity, and reduced TTS of knee flexion, increased the activations of the ankle plantar flexors and knee extensors in the pre-landing and post-landing, and increased the co-contraction level of dorsiflexors and plantar flexors. Additionally, balance combined with plyometric training improved the inversion of joint position sense [F=3.370, p=.046], reduced maximum sway range in ML direction[F=6.435, p=.002], reduced the TTS of knee rotation. Isolated plyometric training reduced the COP sway area [F=4.412, p=.015], reduced peak anterior-posterior [F=4.012, p=.021] and vertical ground reaction force (GRF) [F=8.367, p<.001] and vertical loading rate [F=5.574, p=.005].
Conclusion: Isolated plyometric exercise and balance combined with plyometric program reduced postural sway in one-leg stance without vision, and improved the ability of regain equilibrium after landing from the one leg hopping. The Achilles tendon became stiffer after these training, but did not strongly improve the dynamic joint stiffness during dynamic movements. One important finding in our study is the plyometric training can modify the neuromuscular control strategies and improve static and dynamic postural control. Therefore, plyometric exercise should be integrated into a common rehabilitation program for functional ankle instability.
中文摘要(Chinese Abstract) iii
英文摘要(English Abstract) v
目錄(Table of Contents) viii
表目錄(List of Tables) xi
圖目錄(List of Figures) xiii
Chapter 1 Literature Review 1
1.1 Background 1
1.2 Epidemiology of Ankle Instability 1
1.3 Risk factors of Ankle Instability 2
1.4 Biomechanical studies of Ankle Instability 4
1.5 Electromyography study of Ankle Instability 5
1.6 Joint Stability and Postural Control Researches of Ankle Joint 6
1.6.1 Proprioception 6
1.6.2 Dynamic joint stiffness (DJS) 7
1.6.3 Tendon Property 8
1.6.4 Posture Sway 9
1.7 Balance Training on Ankle instability 9
1.8 Plyometric Training 11
1.9 Summary 13
1.10 Research Purpose 14
1.11 Hypothesis 14
1.12 Research questions 15
Chapter 2 Method 16
2.1 Subjects 16
2.2 Instrument 17
2.3 Experimental Procedures 21
2.3.1. One Leg Drop Jump 21
2.3.2. One-leg standing 22
2.3.3 Joint Position Sense 22
2.3.4 Tendon Stiffness and Biomechanical Properties 23
2.3.5 Foot and Ankle Disability Index Sports Subscale (FADI-S) 26
2.4 Data Reduction 26
2.4.1 Kinematic and kinetic data 26
2.4.2 EMG data 28
2.4.3 Posture sway data 30
2.4.4 Proprioception data 30
2.4.5 Tendon Property data 31
2.5 Training Program 31
2.6 Statistic Analysis 33
Chapter 3 Result 34
3.1 Demographics 34
3.2 Joint position sense 35
3.3 Tendon Property 37
3.4 Static postural control 39
3.5 Dynamic postural control 42
3.5.1 Kinetics 42
3.5.2 Center of mass (COM) and center of pressure (COP) 44
3.5.3 Kinematics 48
3.5.4 Time to stabilization 56
3.5.5 Electromyography 59
Chapter 4 Discussion 65
4.1 Demographics 65
4.2 Joint position sense 65
4.3 Tendon stiffness and joint stiffness 67
4.4 Static postural control 69
4.5 Dynamic postural control 71
4.5.1 Kinetic data 71
4.5.2 Angles at contact and maximum angles 73
4.5.3 COM and COP 77
4.5.4 Time to stabilization 78
4.5.5 Electromyography 80
4.6 Further researches and limitation 86
Chapter 5 Conclusion 88
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