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Journal of Electromyography and Kinesiology
Volume 20, Issue 2 , April 2010, Pages 348-353
doi:10.1016/j.jelekin.2009.03.012 | How to Cite or Link Using DOI
Copyright © 2009 Elsevier Ltd All rights reserved.
Cited By in Scopus (0)
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Cryotherapy and ankle bracing effects on peroneus longus response during sudden
inversion
Mitchell L. Cordova a , Lance W. Bernard b , Kira K. Au c , Timothy J. Demchak d , Marcus B.
Stone e and JoEllen M. Sefton f
a Biodynamics Research Laboratory, Department of Kinesiology and Center for Biomedical
Engineering Systems, The University of North Carolina at Charlotte, Charlotte, NC 28223, United
States
b Brewer High School, Fort Worth, TX 76108, United States
c Bishop Amat Memorial High School, La Puente, CA 91744, United States
d Sports Injury Research Laboratory, Athletic Training Department, Indiana State University, Terre
Haute, IN 47809, United States
e Alegius Consulting, LLC, Avon, IN 46123, United States
f Neuromechanics Research Laboratory, Department of Kinesiology, Auburn University, Auburn,
AL 36849, United States
Received 25 October 2008;
revised 18 March 2009;
accepted 31 March 2009.Available online 8 May 2009.
Abstract
Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No
studies have evaluated the combined effect of these treatments on reflex responses during
inversion perturbation. This study examined the combined influence of ankle bracing and joint
cooling on peroneus longus (PL) muscle response during ankle inversion. A 2 × 2 RM factorial
design guided this study; the independent variables were: ankle brace condition (lace-up brace,
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control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex
latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants
completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle
brace and cryotherapy treatment condition. No two-way interaction was observed between ankle
brace and treatment conditions on PL latency ( P = 0.283) and amplitude ( P = 0.884). The ankle
brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint
did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined
with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during
an inversion perturbation in normal subjects.
Keywords: Reflex activation; Ankle joint; Cold
Article Outline
1. Introduction
Ankle sprains are one of the most common injuries in sports and public health in general
(Denegar and Miller, 2002 ). Approximately 85% are acute and involve the lateral structures of
the ankle ( Garrick, 1977 ). The predominant mechanism of injury involving lateral ankle sprains is
forced inversion of the foot while the ankle is plantar flexed ( [Cordova et al., 2002] and [Sitler et
al., 1994] ), causing injury to the anterior talofibular (ATF) ligament in 66% of cases and the
calcaneofibular (CF) ligament in 17% of all ankle sprains ( Sitler et al., 1994 ). The peroneus
longus muscle (PL) is believed to function as the dynamic defense mechanism against this
injurious etiology ( Konradsen et al., 1997 ). Due to the responsibility of the PL to stabilize and
protect the ankle/foot complex during inversion displacement, the response of this muscle and
the effect of prophylactic ankle support has been studied extensively ( [Cordova and Ingersoll,
2003] , [Cordova et al., 2002] , [Isakov et al., 1986] , [Nishikawa and Grabiner, 1999] and [Sefton
et al., 2006] ).
The response time of the PL during inversion may affect its ability to protect the ankle joint. PL
stretch reflex latency represents the time required for the PL response to be initiated after a
perturbation, providing an indication of changes in PL response time ( [Konradsen and Ravn,
1991] and [Konradsen et al., 1997] ). PL stretch reflex amplitude represents the magnitude of the
PL response to the inversion perturbation, indicating the strength of response of the PL during an
inversion perturbation ( Cordova and Ingersoll, 2003 ). Several studies ( [Karlsson and Andreasson,
1992] , [Konradsen and Ravn, 1991] and [Ricard et al., 2000] ) have reported that individuals with
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unstable ankles have a longer PL stretch reflex latency than healthy ankles, while other
researchers have reported finding no differences ( [Isakov et al., 1986] and [Vaes et al., 2002] ).
Protective measures such as taping and bracing are thought to decrease ankle sprain incidence
by providing mechanical support ( [Anderson et al., 1995] and [Cordova et al., 2002] ) and
enhanced proprioception ( [Cordova and Ingersoll, 2003] and [Heit et al., 1996] ). It has been
shown that external ankle support decreases PL stretch reflex latency in individuals with
unstable ankles, producing a quicker defense against inversion perturbation ( [Cordova et al.,
2000a] and [McKenzie et al., 2004] ). Interestingly, other studies ( [Alt et al., 1999] and [Cordova
et al., 2000a] ) have shown no such effect on PL stretch reflex latency in subjects with healthy
ankles. Some controversy also exists regarding ankle bracing’s potential effect on PL stretch
reflex amplitude. Some of this work has shown bracing to increase the amplitude of the PL
muscle ( [Cordova and Ingersoll, 2003] and [Nishikawa and Grabiner, 1999] ), while others report
decreases ( Alt et al., 1999 ) or no change ( Brooks et al., 2001 ) in PL amplitude. More recently,
other work indicates ankle bracing does provide sufficient external mechanical support to
normalize the increased reflex response found during sudden ankle inversion ( Sefton et al.,
2006 ). Although ankle taping and bracing do offer similar mechanical effects in limiting frontal
plane motion ( Cordova et al., 2000b ) the indiscrepancies observed in PL muscle reflex response
may be attributed to different ankle support application techniques as well as different
methodologies used in measuring PL muscle response.
Cryotherapy is a common treatment for musculoskeletal injuries such as lateral ankle sprains
([Bleakley et al., 2004] and [Knight, 1995] ). The resulting decreases in internal temperatures
cause decreases on nerve conduction velocity and synaptic transmission ( Knight, 1995 ).
Moreover, decreases in muscle force production ( Hatzel and Kaminski, 2000 ) and decreased
muscle spindle sensitivity ( [Bell and Lehmann, 1987] and [Harlaar et al., 2001] ) have also been
observed. Cryotherapy is frequently utilized treatment to prepare athletes for return to
participation, as well as for physically-active individuals during rehabilitation. Therefore, it is
important to consider the effect of cryotherapy upon motoneuron pool recruitment and the
stretch reflex response as these factors affect musculoskeletal performance during activity.
Changes resulting in a decreased neuromotor response could potentially render the athlete or
physically active individual more susceptible to injury. Human Achilles tendon ( [Bell and
Lehmann, 1987] and [Harlaar et al., 2001] ) and rabbit patellar tendon ( Lee et al., 2002 ) stretch
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reflex latency and amplitude have been shown to decrease following respective cryotherapy
treatment to the soleus and quadriceps musculature itself. Researchers have also shown that
cooling the ankle joint directly results in significant facilitation of the soleus motoneuron pool
([Krause et al., 2000] and [Hopkins and Stencil, 2002] ). Conversely, when specifically
investigating ankle joint cooling’s direct influence on PL stretch reflex latency after sudden
inversion perturbation, no effect was observed ( Berg et al., 2007 ).
The use of external ankle support continues to be the standard of care in trying to prevent acute
ankle sprains, as well as preventing re-injury when athletes or patients are returned to
competition or work. Cryotherapy is commonly used to treat the residual pain and inflammation
associated with ankle injury in athletes or patients prior to practices, games, or work, as well as
to prepare the joint for exercise in a rehabilitation setting. Together, the application of external
ankle bracing and peripheral joint cooling is a mostly widespread practice used by sports
medicine practitioners in preparing athletes for competition. And although these clinical
practices are widely accepted, and each modality has been studied in isolation, no scientific
evidence exists regarding what the combined effects of external ankle bracing and joint cooling
are on PL muscle response during a simulated lateral ankle injury. The purpose of our study was
to investigate the potential effects of ankle joint cooling and ankle bracing on PL muscle
response during a sudden inversion perturbation.
2. Methods
2.1. Subjects
Twenty-four healthy, physically-active individuals participated in this study
(age = 21.9 ± 2.0 years, mass = 73.2 ± 17.1 kg, ht = 170.5 ± 9.7 cm). Subjects were
recreationally active – defined as participating in 30 min of moderate physical activity at least 3
times a week on a regular basis and reported no low back injury or lower extremity joint injury 6
months prior to data collection. Further, subjects self-reported not having allergies to cold,
hypersensitivity to cold, or any circulatory disorders. Additionally, subjects were not on any other
medications than birth control, ibuprofen, or Tylenol ® during the course of this study. Subjects
agreed to refrain from any cryotherapy treatment and significant changes in caffeine
consumption 24 h prior to, and throughout testing. All subjects provided written informed
consent, and the protocol use in this study was approved by the University’s Institutional Review
Board.
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2.2. Instrumentation
A 16-channel biological signal acquisition system (MP100 MSW; BIOPAC Systems Inc., Santa
Barbara, CA, USA) using disposable 10 mm Ag/AgCl surface electrodes (BIOPAC Systems Inc.,
Santa Barbara, CA, USA), arranged in a bipolar configuration was used to record the electrical
activity of the PL muscle during sudden ankle/foot complex inversion. The raw EMG signal was
amplified (gain set at 500, CMRR 110 dB), band-pass filtered online (2nd order, zero lag,
Butterworth filter with frequency set between 10 and 500 Hz), digitally converted at 1000 Hz,
and full-wave rectified using commercially-available software (Acknowledge V. 3.71, BIOPAC
Systems Inc., Santa Barbara, CA, USA). The analog signal arising from an electrical switch on the
trapdoor was simultaneously sampled and time-matched to the collected EMG signal. When the
trapdoor was released, a deflection of the analog signal identified the start of the inversion
perturbation and allowed for subsequent assessment of the PL reflex response.
Skin interface temperature was measured using a superficial thermocouple TX-29 (Columbus
Instruments, Columbus, OH, USA). The thermocouples were interfaced with a portable
temperature-recording device (PHYSITEMP, Clifton, NJ, USA). This device has been shown to be
accurate within ±0.1 °C according to the manufacturer. A manometer (Aircast Inc., Summit, NJ,
USA) was used to monitor the compression of the ice bags between 42 and 48 mmHg).
2.3. Testing procedures
Each subject reported to the laboratory dressed in shorts and cross training shoes for one hour
each day at approximately the same time of day, for a total of 4 consecutive days. During the
first session, each subject was screened, oriented to the testing procedures, gave written
informed consent, and randomly assigned a treatment order for each day. Subjects were then
familiarized with the platform by experiencing 3 trials of the inversion perturbation. This was
done to ease any pre-existing anxieties about the inversion perturbation. Following this, all
subjects were seated for 30 min before they began treatment and testing on the each day to
equilibrate from any recent physical activity (e.g. walking up the stairs to the laboratory).
Subjects then repeated the 30 min equilibration period, treatment and testing on each of the
next 3 days.
During the equilibration period, the area of PL electrode placement was prepared. Skin
preparation included shaving any hair present, abrading the area with fine sand paper, and
wiping the area clean with a 70% isopropyl alcohol solution ( Myers et al., 2003 ). Surface
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electrodes were then placed directly over the muscle belly of the right PL, 4 cm distal to the
fibular head with inter-electrode distance of 2.5 cm ( Cordova et al., 2000a ). To confirm electrode
placement, the examiner palpated for direct muscle contraction and observed PL EMG activity
while resisting foot eversion for each subject. The reference electrode was placed directly over
the ipsilateral tibial tuberosity as previously described ( Myers et al., 2003 ). The circumference of
the electrode was traced using a permanent marker after the first testing session to ensure
consistent electrode placement for the subsequent testing days. A surface thermocouple was
placed on the skin over the position of the calcaneofibular ligament so that skin surface
temperatures could be recorded throughout the study ( Fig. 1 ). A pre-treatment surface
temperature was recorded immediately after the equilibration period was over.
Full-size image (19K)
Fig. 1. Thermocouple placement.View Within Article
Subjects were then randomly assigned to one of the treatments for that day (ice only, ankle
brace only, ice and ankle brace, or control). The 30 min ice treatment consisted of two, 1 kg
crushed ice bags (Cramer Products Inc., Gardner, KS, USA) applied to each side of the ankle/foot
complex with a compressive force between 42 and 48 mmHg ( Fig. 2 ). The lace-up style ankle
brace (ASO, Medical Specialties Inc., Charlotte, NC, USA) was applied according to the
manufacturer’s suggestion to the right ankle following the 30 min equilibration period. This brace
was chosen because of its widespread clinical use, as well as to decrease the inherent variability
of ankle taping in experimental research ( Cordova et al., 2002 ). For the combined cooling and
ankle brace treatment, each subject completed the ice treatment first, and then application of
the ankle brace immediately followed. The control treatment consisted of subjects not receiving
the ice or ankle brace treatments during following the 30 min equilibration period. Skin
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temperature was monitored throughout each test session at the following time points: at the end
of the initial 30 min equilibration period; 30 s following the treatment; and at the completion of
data collection session. The ankle/foot temperature was assessed after the third platform drop
during each of the cooling treatments to ensure that a consistent temperature remained during
testing. Collectively, these time points were chosen to gather baseline temperature data, record
post-treatment temperature levels, and to maintain the post-treatment temperatures
respectively.
Full-size image (20K)
Fig. 2. Ice bag placement.
View Within Article
A custom-made inversion trapdoor platform was used to perturb the ankle/foot complex into 35°
of inversion ( Fig. 3 ). Following the protocol used previously to assess PL muscle response
([Cordova et al., 2000a] , [Cordova and Ingersoll, 2003] and [Sefton et al., 2006] ), each subject
was instructed to stand on the platform with his/her weight evenly distributed on both legs
([Konradsen and Ravn, 1991] , [Konradsen et al., 1997] and [Ebig et al., 1997] ) and toes pointed
straight ahead while wearing a cross training shoe. Each subject stood with their left foot on the
stationary, middle portion of the platform while their right foot was placed on the right trapdoor
of the platform. The participant’s elbows were flexed with their hands resting on ipsilateral iliac
crest. Once the subject was balanced, a blindfold and headphones were applied to the subject to
reduce visual and auditory feedback. When the trapdoor of the platform was unexpectedly
released, the apparatus forced the right ankle/foot complex into 35° of inversion. The trapdoor
was released at random intervals 5 times, tilting the ankle/foot complex into sudden inversion,
with a minimum 30 s between each drop. The trapdoor was dropped in a random fashion to
prevent the subject from anticipating the release and to eliminate PL pre-motor activity. Potential
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pre-motor response was objectively assessed by analyzing PL baseline activity to ensure no
heightened activity existed prior to release of the trapdoor ( [Cordova et al., 2000a] and [Cordova
and Ingersoll, 2003] ). These testing procedures were repeated for each condition so that every
subject performed all 4 conditions.
Full-size image (35K)
Fig. 3. Inversion perturbation platform.
View Within Article
2.4. Data reduction
The PL stretch reflex latency was defined as the time from the onset of the trapdoor release to
the first PL muscle response as recorded by EMG ( [Konradsen and Ravn, 1991] and [Cordova and
Ingersoll, 2003] ). EMG baseline activity was assessed for 150 ms prior to each inversion
perturbation. An increase in the EMG equal to 5 times the standard deviation of this baseline
value was used to determine the initiation of PL muscle response ( Hopper et al., 1998 ). Stretch
reflex latency was then determined by measuring the amount of time (ms) between the initial
drop of the platform and the start of PL muscle response. The PL stretch reflex amplitude (%
max) was first determined by averaging the amplitude observed over the 5 trials. This value was
then divided (normalized) to the maximum amplitude value obtained during the 5 trials. This
technique was performed to reduce inter-subject variability ( [Yang and Winter, 2002] and
[Cordova and Ingersoll, 2003] ).
2.5. Statistical analysis
A 2 × 2 repeated measures analysis of variance was used to assess the effects of ankle bracing
(ASO lace-up ankle brace and control-no ankle brace) and cooling (ice bag and control-no ice
bag) on average PL stretch reflex latency (ms), and average peak stretch reflex amplitude (% of
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max), following a sudden inversion perturbation. The a priori level of significance was set at P
0.05.
3. Results
The means and standard deviations for PL stretch reflex latency and amplitude by brace
condition and treatment are presented in Table 1 . Descriptive statistics for superficial
temperature data for each condition is presented in Table 2 . No significant two-way interaction
was observed between brace and treatment conditions on PL stretch reflex latency
(F (1, 23) = 1.21, P = 0.283) and amplitude ( F (1, 23) = 0.22, P = 0.884).
Table 1.
Peroneus longus stretch reflex latency and amplitude by treatment condition (Mean ± SD).
TreatmentPL latency
(ms)
PL amplitude (%
of max)
Control 30.6 ± 7.5 78.4 ± 10.8
Ice only 30.2 ± 7.2 79.0 ± 9.8
Ankle brace
only29.5 ± 9.9 76.7 ± 11.2
Ice and ankle
brace31.0 ± 9.5 77.9 ± 8.5
View Within Article
Table 2.
Superficial ankle temperature by treatment condition (°C ± SD).
TreatmentPre-treatment
(baseline)
Post-
treatment T1
Post-
treatment T2
Control 29.6 ± 1.5 29.0 ± 1.5 28.9 ± 1.5
Ice only 29.8 ± 0.9 9.4 ± 1.0 15.6 ± 1.1
Ankle brace
only
29.6 ± 1.2 28.6 ± 1.0 28.8 ± 1.0
Ice and ankle
brace30.0 ± 1.6 9.8 ± 1.7 15.6 ± 1.3
View Within Article
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There were no significant main effects of brace ( F (1, 23) = 0.031, P = 0.862) or treatment
(F (1, 23) = 0.338, P = .567) on PL stretch reflex latency. Additionally, there was no significant
effect of the brace condition ( F (1, 23) = 0.614, P = 0.441) or the treatment condition
(F (1, 23) = 0.319, P = 0.578) on PL stretch reflex amplitude. Consequently, the brace and ice
treatment together did not produce and effect on the PL latency or amplitude during the
inversion perturbation.
4. Discussion
The use of cryotherapy by sports medicine practitioners and physiotherapists in treating acute
and sub-acute lower extremity injuries to athletes on a daily basis is very common. Following a
typical 20–30 min application, athletes are returned to participation where large forces are
placed on the joint during dynamic activities. The intent of our study was to establish the effect
of ankle joint cooling and ankle bracing on the muscle’s ability to respond to external demands
by measuring the PL muscle response during a simulated ankle injury perturbation, without
actual ankle injury and strain. Several investigations ( [Anderson et al., 1995] and [Cordova et al.,
2000a] ; [Cordova and Ingersoll, 2003] , [Hopper et al., 1997] and [Knight, 1995] ) have examined
the effect of cooling or ankle bracing on various aspects of muscle function; however, no known
research has investigated the specific interaction of these factors; particularly, as the results of
such an investigation have wide clinical implications. It should also be understood that lateral
ankle injuries are complex and extremely difficulty to study in real-time and often implicate the
passive structures of the joint (e.g. ligaments and capsular tissue). Our investigation focused on
studying the primary dynamic defense mechanism against the lateral ankle injury using a
common simulation protocol.
In our investigation, we sought to apply ice directly to the ankle joint and not the muscle belly of
the PL for the following reasons: (1) to focus on understanding joint cooling and muscle response
following a joint perturbation; (2) to potentially influence the joint mechanoreceptors and not
influence the EMG recording on the muscle; and most importantly (3) to make our findings more
applicable to the clinical setting. It was hypothesized that cooling the ankle/foot complex would
result in changes in PL muscle response because under cooled conditions, afferent input from the
receptors in the skin, ligaments, and joint capsule are decreased ( Knight, 1995 ). Additionally,
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joint cooling has been shown to increase α motoneuron pool excitability resulting in an increase
in afferent signal to the spinal cord ( [Hopkins and Stencil, 2002] and [Krause et al., 2000] ).
Cooling the sensory receptors of the ankle would then appear to cause a delay in the efferent
motor response with a resulting increase in PL stretch reflex amplitude ( Knight, 1995 ); therefore,
if an athlete were to return to participation while his/her ankle was still cooled, the nervous
system response to a perturbation would be modified creating a deficit in the neuromuscular
response.
A standard 30 min ice bag treatment at the ankle/foot complex was not found to affect the PL
stretch reflex latency or amplitude during sudden inversion of the ankle/foot complex. According
to our findings, cooling the sensory receptors in the skin and those contained within the soft
tissues of the ankle joint complex was not sufficient to have an appreciable effect on the
collective PL muscle response. The observation that cooling did not adversely affect PL muscle
function can be viewed very positively as it suggests that clinicians can continue the common
practice of cooling the ankle joint prior to activity without the fear that deficits in the primary
defense mechanism against the lateral ankle sprain will occur. This outcome is in complete
agreement with recent findings where a 20 min ice bag application to the lateral ankle resulted
in no change in PL reaction time and RMS amplitude of EMG activity ( Berg et al., 2007 ). Although
the cryotherapy treatment did not directly involve cooling the Ia afferent neurons, it was
reasoned that by cooling the ankle joint itself, excitation of the afferent neurons would be
heightened. Increased muscle spindle sensitivity would then produce a greater response in PL
stretch reflex amplitude. In previous research ( [Bell and Lehmann, 1987] , [Harlaar et al., 2001]
and [Knutsson and Mattsson, 1969] ) stretch reflex latency and amplitude, as measured by
tendon reflex response, was shown to increase following cooling. Each of these studies cooled
the muscle belly of the associated tendon as opposed to cooling the joint. As a result, tendon
reflexes were found to be depressed possibly due to the cooling of γ motor neurons ( Knutsson
and Mattsson, 1969 ). Our results indicate that icing the ankle joint does not produce a decreased
PL stretch reflex during of sudden inversion perturbation.
In the current study, PL stretch reflex latency and amplitude during sudden ankle inversion was
not affected by the application of a lace-up style ankle brace. The lack of change in latency
supports previous studies ( Cordova et al., 2000a ), while other work found a decrease in latency
(Kernozek et al., 2008 ). Further, the lack of change observed in the PL amplitude is not in
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agreement with previous data studying the effects of semi-rigid and lace-up style ankle braces in
healthy subjects ( Cordova and Ingersoll, 2003 ). Similar to our finding with respect to the PL
stretch reflex latency response, the lack of change observed with PL reflex amplitude may have
occurred due to the apparent normal proprioceptive function offered by the joint
mechanoreceptors and dynamic defense mechanism.
During the platform perturbation, inversion of the ankle/foot complex occurs at angular velocities
approaching 500° sec −1 . At the initiation of platform movement, a stretch reflex is elicited within
the PL muscle from the excitation of extrafusal muscle spindle fibers as a result of a high rate of
muscle length change ( Cordova et al., 2000a ; Isakov et al., 1986 ). It is believed that application
of an external ankle support stimulates cutaneous nerve receptors and joint mechanoreceptors
in the ankle/foot complex ( [Feuerbach et al., 1994] and [Heit et al., 1996] ). This may result in an
earlier onset of muscle activity with a stronger amplitude response, potentially decreasing the
amount of strain placed on the joint structures. However, in our study this increased cutaneous
input from ankle bracing did not facilitate the amplitude of the PL stretch reflex enough to
significantly change the latency or amplitude of our measures.
Previous investigations ( [Brooks et al., 2001] and [Sefton et al., 2006] ) studying the influence of
external ankle bracing on PL muscle response utilizing the Hoffmann reflex (rather than the
stretch reflex) do support the current findings of this study. Use of the Hoffmann reflex involves
electrically stimulating the Ia afferent nerve innervating PL muscle group as opposed to the
deformation of joint mechanoreceptors and muscle spindles using a trapdoor apparatus. Despite
differences in methods, the reflex mechanics are similar allowing comparison of the two
methods. Other researchers ( Alt et al., 1999 ) found external ankle support to decrease the
stretch reflex amplitude of the PL. They attributed the decrease in PL stretch reflex amplitude to
the decrease in inversion velocity found with the application of adhesive ankle tape. By
decreasing the inversion velocity of the ankle/foot complex during perturbation, the associated
response of the PL would be diminished. Others have found that application of adhesive tape
(Ricard et al., 2000 ) and lace-up style ankle bracing ( Cordova et al., 2007 ) has significantly
reduced inversion velocity 40% and 46%, respectively compared to no support condition during a
sudden inversion perturbation model as well. However, our results are in disagreement with
previous research utilizing similar functional conditions where ankle bracing was found to
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increase PL amplitude ( Cordova and Ingersoll, 2003 ). It is possible that varying results may be
due to differences in data collection and analysis procedures.
The application of ankle bracing and cooling is typically done in individuals with acute or
chronically injured ankles, and the response may be quite different in those populations. When
considering ankles that suffer from chronic ankle instability, studies show that the application of
external ankle support does enhance PL stretch reflex latency response during a sudden
inversion perturbation ( [Karlsson and Andreasson, 1992] and [McKenzie et al., 2004] ).
Collectively, these data above revealed that the greatest improvements in PL stretch reflex
latency were found in the ankles that suffered from the most instability. Thus, it appears that the
application of external ankle support in the form of tape positively influences the PL stretch
reflex latency in ankles that suffer from functional instability, while this may not be the case in
normal healthy ankles.
5. Summary
The results of this study found that 30 min of cooling the ankle joint, application of a lace-up
style ankle brace, and the combination of the external ankle bracing and ankle joint cooling
during an simulated inversion perturbation in healthy subjects did not produce changes in PL
stretch reflex latency or amplitude. Clinically, this is an important finding, implying that an ice
treatment at the ankle does not appear to cause any diminished response of the PL and that
cooling the joint is not detrimental to athletes prior to commencing activity. Additionally, the
application of an ankle brace with or without cooling does not interfere with the dynamic defense
mechanism during ankle inversion.
References
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rigid bracing, Clin J Sports Med 5 (1995), pp. 18–24. Full Text via CrossRef | View Record in
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Bell and Lehmann, 1987 K.R. Bell and J.F. Lehmann, Effect of cooling on H- and T-reflexes in
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Berg et al., 2007 C.L. Berg, J.M. Hart, R. Palmieri-Smith, K.M. Cross and C.D. Ingersoll,
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Corresponding author. Tel.: +1 704 687 3176; fax: +1 704 687 3350.
Vitae
Cordova serves as Professor, Director of the Biodynamics Research Laboratoryand Chairperson of the Department of Kinesiology at The University of North
Carolina at Charlotte. Additionally, he is an affiliate researcher within the Center
for Biomedical Engineering Systems at UNC Charlotte. He earned his BS degree
in Athletic Training from East Stroudsburg University, his Masters degree in
Athletic Training from Indiana State University and his Doctor of Philosophy
degree in Biomechanics from The University of Toledo. He is a Fellow of the
American College of Sports Medicine and National Athletic Trainers’ Association.
He is an Associate Editor for the Journal of Athletic Training and serves on the
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Editorial Board for the Journal of Sport Rehabilitation . Further, he serves as a
manuscript reviewer for the British Journal of Sports Medicine , Journal of
Orthopaedic and Sport Physical Therapy , and Acta Physiologica. His research
focus involves investigating the neuromechanical consequences of lower
extremity joint injury and pathology.
Bernard serves as the Head Athletic Trainer at Brewer High School in Fort
Worth Texas. He earned his BS degree in Athletic Training from the University of
Texas - Austin, and his Masters Degree in Athletic Training from Indiana State
University.
Au serves as the Head Athletic Trainer at Bishop Amat Memorial High School in
la Puente, California. She earned her BS degree in Athletic Training from the
University of La Verne, and her Masters Degree in Athletic Training from Indiana
State University.
Demchak is an Associate Professor and Director of the Graduate Athletic
Training Program in the Athletic Training Department at Indiana State
University. He earned his BS degree in Exercise Science from Manchester
College, his Masters degree in Biomechanics from Ball State University, and his
Doctor of Philosophy degree in Exercise Physiology from The Ohio State
University. He serves as a manuscript review for many journals including:
Journal of Athletic Training, Journal of Sport Rehabilitation and Journal of
Orthopaedic & Sport Physical Therapy . His research area includes studying
tissue temperature effects with therapeutic modalities.Stone is the CEO and Founder of Alegius Consulting, LLC in Avon, Indianapolis.
He earned his BS degree in Physical Education / Athletic Training from Brigham
Young University, his Masters degree in Athletic Training from Indiana State
University, and his Doctor of Philosophy degree in Sports Medicine from Indiana
State University. He serves as a manuscript review for the Journal of Athletic
Training and Journal of Sport Rehabilitation . His research area includes studying
the effects exercise associated muscle cramping, and tissue temperature effects
with therapeutic modalities.
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Sefton is an Assistant Professor, Coordinator of the Masters Degree program in
Sports Medicine, and Director of the Neuromechanics Research Laboratory in
the Department of Kinesiology at Auburn University. She received her Bachelor’s
degree in zoology from Ohio University, Masters degrees in Athletic Training and
Exercise Science from Central Connecticut State University, and her Doctor of
Philosophy Degree in Biomedicine from the University of North Carolina at
Charlotte. She also holds a massage therapy degree from Connecticut Center for
Massage Therapy. Sefton is active in the National Athletic Trainers Association,
American College of Sports Medicine and the Society for Neuroscience and
serves as a reviewer for many scientific journals. Her research interests involve
understanding nervous system adaptations to joint injury and rehabilitation.
Journal of Electromyography and
Kinesiology
Volume 20, Issue 2 , April 2010,
Pages 348-353