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      Shank Muscle Strength Training Changes Foot Behaviour during a Sudden Ankle Supination

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          Abstract

          Background

          The peroneal muscles are the most effective lateral stabilisers whose tension braces the ankle joint complex against excessive supination. The purpose of this study was to identify the morphological and biomechanical effects of two machine-based shank muscle training methods.

          Methods

          Twenty-two healthy male recreationally active sports students performed ten weeks of single-set high resistance strength training with 3 training sessions per week. The subjects conducted subtalar pronator/supinator muscle training (ST) with the right leg by using a custom-made apparatus; the left foot muscles were exercised with machine-based talocrural plantar and dorsiflexor training (TT). Muscle strength (MVIC), muscle volume and foot biomechanics (rearfoot motion, ground reaction forces, muscle reaction times) during a sudden ankle supination were recorded before and after the intervention.

          Results

          Compared to TT, ST resulted in significantly higher pronator (14% vs. 8%, P<0.01) and supinator MVIC (25% vs. 12%, P<0.01). During sudden foot inversions, both ST and TT resulted in reduced supination velocity (-12%; P<0.01). The muscle reaction onset time was faster after the training in peroneus longus (PL) (P<0.01). Muscle volume of PL (P<0.01) and TA (P<0.01) increased significantly after both ST and TT.

          Conclusion

          After both ST and TT, the ankle joint complex is mechanically more stabilised against sudden supinations due to the muscle volume increase of PL and TA. As the reduced supination velocities indicate, the strength training effects are already present during free-fall. According to a sudden ankle supination in standing position, both machine-based dorsiflexor and pronator strength training is recommended for enhancing the mechanical stability of the ankle.

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          Most cited references42

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          The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

          Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.
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            The adaptations to strength training : morphological and neurological contributions to increased strength.

            High-resistance strength training (HRST) is one of the most widely practiced forms of physical activity, which is used to enhance athletic performance, augment musculo-skeletal health and alter body aesthetics. Chronic exposure to this type of activity produces marked increases in muscular strength, which are attributed to a range of neurological and morphological adaptations. This review assesses the evidence for these adaptations, their interplay and contribution to enhanced strength and the methodologies employed. The primary morphological adaptations involve an increase in the cross-sectional area of the whole muscle and individual muscle fibres, which is due to an increase in myofibrillar size and number. Satellite cells are activated in the very early stages of training; their proliferation and later fusion with existing fibres appears to be intimately involved in the hypertrophy response. Other possible morphological adaptations include hyperplasia, changes in fibre type, muscle architecture, myofilament density and the structure of connective tissue and tendons. Indirect evidence for neurological adaptations, which encompasses learning and coordination, comes from the specificity of the training adaptation, transfer of unilateral training to the contralateral limb and imagined contractions. The apparent rise in whole-muscle specific tension has been primarily used as evidence for neurological adaptations; however, morphological factors (e.g. preferential hypertrophy of type 2 fibres, increased angle of fibre pennation, increase in radiological density) are also likely to contribute to this phenomenon. Changes in inter-muscular coordination appear critical. Adaptations in agonist muscle activation, as assessed by electromyography, tetanic stimulation and the twitch interpolation technique, suggest small, but significant increases. Enhanced firing frequency and spinal reflexes most likely explain this improvement, although there is contrary evidence suggesting no change in cortical or corticospinal excitability. The gains in strength with HRST are undoubtedly due to a wide combination of neurological and morphological factors. Whilst the neurological factors may make their greatest contribution during the early stages of a training programme, hypertrophic processes also commence at the onset of training.
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              Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.

              The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle Consortium and other similar organizations have yet to properly define the clinical phenomenon known as chronic ankle instability (CAI) and its related characteristics for consistent patient recruitment and advancement of research in this area. Although research on CAI and awareness of its impact on society and healthcare systems have grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI, with justifications using the best available evidence.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 June 2015
                2015
                : 10
                : 6
                : e0130290
                Affiliations
                [1 ]Biomechanics Laboratory, Institute of Sport and Movement Sciences, University Duisburg Essen, Essen, Germany
                [2 ]Institute of Neuroradiology, University of Frankfurt, Frankfurt, Germany
                [3 ]Department of Orthopaedic Sports Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
                [4 ]Institute for Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Stiftungsklinikum Mittelrhein Koblenz, Koblenz, Germany
                Universidad Europea de Madrid, SPAIN
                Author notes

                Competing Interests: Authors Marco Hagen, Andreas Gerhardt and Ewald M. Hennig (University Duisburg Essen) declare a potential conflict of interest. University Duisburg-Essen was funded for this research by Kieser Training, Switzerland. Marco Hagen and Ewald Hennig are employees of the University Duisburg Essen and were not paid by Kieser Training. Andreas Gerhardt was a student at the University Duisburg-Essen and was not paid by Kieser Training. The results of the project were transferred to a patented strength training machine (European Patents No. EP 1767249B1 and EP2005997A1: “Training machine”), which was invented by Marco Hagen and is marketed by Kieser Training (name of the product: B3/B4, Kieser Training, Zurich, Switzerland). The owner of the patent is Kieser Training, who purchased the patent from the University Duisburg-Essen. According to the German employment law, Marco Hagen benefited from a payment in 2010 which was paid by his employer University Duisburg-Essen. Therefore, Marco Hagen declares a potential conflict of interest as he is inventor of the European patents EP1767249B1 and EP2005997A1. Only the patent claims of EP 1767249B1 are implemented to the product B3/B4. Marco Hagen, Andreas Gerhardt and Ewald Hennig declare that they have no further professional relationships to Kieser Training, like employment, consultancy, other patents, other products in development or other modified products. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. Stephanie Lescher (University Frankfurt), Matthias Lahner (Ruhr University Bochum) and Stephan Felber (Stiftungsklinikum Mittelrhein, Koblenz) do not have a conflict of interest. (See http://www.google.com/patents/EP1767249A1?cl=de http://www.google.is/patents/EP2005997A1?cl=is for the patent.)

                Conceived and designed the experiments: MH ML SF EMH. Performed the experiments: MH SL AG. Analyzed the data: MH SL AG ML. Contributed reagents/materials/analysis tools: MH SL AG ML. Wrote the paper: MH SL SF EMH.

                Article
                PONE-D-14-00850
                10.1371/journal.pone.0130290
                4481534
                26110847
                70b2d556-2a0a-4c6b-aec2-76b58dcbb3b1
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 16 January 2014
                : 19 May 2015
                Page count
                Figures: 5, Tables: 3, Pages: 17
                Funding
                The University of Duisburg Essen received funding for basic research in machine-based strength training from Kieser Training, Switzerland ( www.kieser-training.com). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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