A Study of the Effects of Previous Lower Limb Ligament Injury on Static Balance in Soccer Players

Transcription

1 International Journal of Sport Studies. Vol., 4 (5), , 2014 Available online at http: ISSN ; Science Research Publications A Study of the Effects of Previous Lower Limb Ligament Injury on Static Balance in Soccer Players Mahdi Majlesi 1*, Elahe Azadian 1 1- Department of Physical Education and Sport Sciences, Hamedan Branch, Islamic Azad University, Hamedan, Iran * Corresponding Author, majlesi11@gmail.com Abstract Purpose: Functional ankle instability (FAI), and Anterior cruciate ligament rupture (ACLR) are among the most common injuries seen in the athletes. Recurrent ankle injury occurs in 70% of individuals experiencing a lateral ankle sprain. Injury to the anterior cruciate ligament (ACL) results in mechanical and functional instability. During the acute phase of injury, there appears a balancing skill deficit in the injured limb. The present study aims at comparing the balance ability of soccer players with and without previous lower limb ligament injuries and, about previously injured players, the balance ability of the previously injured limb with the opposite uninjured limb. Materials and Methods: A total of 30 players were selected and tested in this study. The balance task to be tested included maintaining one-legged balance in eyes open and closed conditions. The data obtained through the tests was analyzed using repeated measure, and the statistical significance was assessed at p< 0.05 level. Results: Statistical analysis revealed that there was no significant difference between the balance scores of any of the previously injured players and those with no previous lower limb ligament injury. Also there was no significant difference in balance between injured limbs and the opposite uninjured limb. Conclusion: It appears that a balance deficit does not persist in soccer players with previous lower limb ligament injury. Key words: Functional ankle instability (FAI), Anterior cruciate ligament rupture (ACLR), Standard deviation of velocity, Proprioceptive Introduction Previous research indicates that a history of lower limb ligament injury is a risk factor for another lower limb ligament injury (Azadian et al., 2011; Hrysomallis et al., 2005). Functional ankle instability (FAI) and anterior cruciate ligament rupture (ACLR) are common orthopedic injuries across a wide variety of sports (Negahban et al., 2009; Verhagen et al., 2004; Wikstrom et al., 2010). There is a reported increased risk of ankle ligament injury in athletes with a prior similar injury in such sports as soccer, basketball, military recruits, volleyball, football and hurling. Also there is a reported increased risk of injury to the anterior cruciate ligament of the knee in athletes of skiing and Football with a prior similar injury (Hrysomallis et al., 2005). Athletes who suffer from ankle sprains are more likely to reinjure the same ankle (>70%), and this can result in disability, chronic pain or instability in 20% to 50% of such cases (Verhagen et al., 2004). Chronic ankle instability can show up in both mechanical and functional ankle instability. Mechanical instability refers to laxity of a joint due to loss of mechanical restraint such as ligamentous tissues, while functional ankle instability describes the perception based on which the ankle gives way, is weaker, more painful, or less functional following an injury(munn et al., 2010). Injury to the ACL can compromise performance in sporting and recreational activities which, in turn, may have adverse effects on health and quality of life. Adults with ACLR and FAI are known to have disturbed postural control on the injured leg (Negahban et al., 2009). 609

2 Numerous published studies have identified various sensorimotor impairments associated with FAI and ACLR. Specifically these include: impaired balance (Leanderson et al., 1996a; Lephart et al., 1997; Negahban et al., 2009), increased peroneal reaction time (Löfvenberg et al., 1995), and decreased joint movement sense (Refshauge et al., 2003). However, studies investigating the occurrence of sensorimotor impairments associated with FAI and ACLR have produced inconsistent findings (Bernier et al., 1997; Hrysomallis et al., 2005; Leanderson et al., 1996a; Löfvenberg et al., 1995; Negahban et al., 2009). Because of such inconsistencies, sensorimotor factors significantly associated with FAI and ACLR are not clearly identified in the literature limiting the underlying basis for rehabilitation following ACL and ankle injury (Munn et al., 2010). Soccer players who had injured their ankle in the previous year were 4 times more likely to sustain another ankle injury in the following year. Those players who had previously sustained an ACLR were at least 4 times more likely to experience another similar injury. The majority of the evidence indicates that a previous lower limb ligament injury is a risk factor for a future injury of the same type (Orchard et al., 2001). Could it be that incomplete recovery from a previous injury occurs? It has been found that a balance difference exists between the acutely injured and uninjured ankle 6 week after injury (Holme et al., 1999). Does this balance deficit persist in previously injured athletes? The aims of this project were to compare the balance ability of soccer players with and without previous injury and to compare the balance of a previously injured limb with the uninjured limb of the same player. Materials and Methods Participants The study involved 20 soccer players who participated in this study, 10 subjects with grade (II) Lachman test ACL injury and another 10 subjects with grade (II) FAI were selected as experimental groups (I) and (II) respectively, and 10 individuals with no ankle and knee pathology were chosen as control group. All participants provided informed consent and the study was approved by research council of Hamedan Branch, Islamic Azad University. Inclusion criteria for the FAI group were: (1) history of ACL injury and FAI after 6 months; (2) no history of fracture or surgery in their lower limbs; (3) no other serious orthopedic or neurological pathologies that could affect postural control. Individuals in the healthy comparison group had no history of severe ankle, knee, and/or hip injuries, neurological disorder, or any other pathological conditions that could impair motor performance. Data collection A Kistler force plate 9281 EA (Winterthur, Switzerland) was used to record the position of the center of foot pressure (COP) with 200HZ during each test. Subjects stood barefoot on the force plate for 20 seconds in anatomical up-right standing position with their feet 10cm apart from each other and medial border of the foot was oriented externally by 15. The experimental design consisted of two factors: a) two states of vision (open & closed eyes) and b) two levels of standing position (left foot standing, right foot standing). In the eyes open condition the subject was asked to keep looking at a black point marked on a white paper sheet located in a three meters distance from him. While the participants were standing on a single leg, the other leg was held in a 90º flexed knee position. Hands were held akimbo all through the tests. The test was ignored if the subject s foot was displaced, his hands fell off the hips and the knee s 90º flexion changed. Each test was repeated three times and the average value of the three repetitions was used in statistical analysis. Also, COP sway was recorded for anterior-posterior (AP) and medial-lateral (ML) directions. Statistical analysis Descriptive statistics revealed the demographic and other baseline characteristics in groups. T-test was taken to compare the differences among the subjects in height, weight and age. Differences in mean velocity and standard deviation (SD) of velocity were tested by two separated repeated measures (ANOVA). The calculations were done in SPSS (16.0 version) software, the statistical significance was assessed at p< 0.05 level. 610

3 Results The participants' characteristics are depicted in table 1. Descriptive analysis and t-test revealed the groups were similar in age, weight and height. Table 1: Characteristics of the participants mean (SD) ACLR FAI Control Sig. (F) n Gender Male Male Male Range of age (y) Age (y) 23.9 (4.5) 24.4 (4.5) 22.4 (3.33) 0.54 (0.62) Height (m) 1.78 (0.06) 1.79 (0.08) 1.78 (0.07) 0.73 (0.31) Weight (kg) 81.6 (12.95) (11.48) (11.69) 0.10 (2.48) BMI 25.89(3.24) 23.0(2.47) (3.24) Table 2: Mean and standard error of COP parameters for ACL, ankle injury and control groups Group Mean velocity SD of velocity ACLR 0.43 (0.04) 0.25 (0.02) FAI 0.41 (0.04) 0.23 (0.02) Control 0.40 (0.04) 0.23 (0.02) Unit of mean velocity and SD of velocity is cm/s. Table 3: Mean and standard error of COP parameters of interaction between eye*foot*group Tests condition ACLR FAI Control Uninjured limb-eyes open Mean velocity 0.61± ± ±0.14 SD of velocity 0.35± ± ± 0.08 Uninjured limb- eyes closed Mean velocity 0.33± ± ± 0.06 SD of velocity 0.20± ± ± 0.03 Injured limb- eyes open Mean velocity 0.34± ± ± 0.02 SD of velocity 0.19± ± ± 0.01 Injured limb- eyes closed Mean velocity 0.61± ± ± 0.25 SD of velocity 0.35± ± ± 0.14 Unit of mean velocity and SD of velocity is cm/s. The results showed that, generally, mean velocity and SD of velocity were not significantly different in groups (F=0.08, p=0.91, F=0.114, p=0.89 respectively). The results showed that lower limb injury no significant effect in postural control after 6 months (table 2). No significant differences were found between left and right feet in all groups. In other words, mean velocity and SD of velocity was nearly the same in both injured and uninjured feet of the subjects (F= 0.49, p=0.73, F= 0.60, p=0.66, respectively). The two way ANOVA (eye*group) showed no significant interaction in these factors in mean velocity and SD of velocity (F= 0.61, p= 0.48, F= 0.44, p= 0.64 respectively). This result showed that the factor of visual has the same effect on the mean and SD of velocity in all groups. The result of interaction between eye*foot*group are depicted in Table 3. The results showed no significant interaction in these factors. In addition, mean velocity in subjects was greater for AP direction (M= 0.57 cm, 611

4 SE=0.01) than the ML direction (M= 0.26 cm, SE=0.05), p< 0.001, F= in all conditions. Also, the same result was observed for SD of velocity in AP direction (M= 0.32 cm, SE=0.008) and the ML (M= 0.15 cm, SE=0.03), p< 0.001, F= Discussion and Conclusion In our study, results showed that mean velocity and SD of velocity are relatively less in healthy people than in those who have injured ACLR or FAI, although this difference was not statistically significant. So, it is certified that any injury to knee s ACL or ankle sprain would lead to increased postural in stability. The present results are consistent with those of Negahban et al (2009).They explained that individuals with ACLR, in all conditions, experienced greater posture sway compared to healthy people (Negahban et al., 2009). The only significantly difference in COP sway was detected in anterior-posterior direction with closed eyes. In their respective studies, Lysholm et al (1998) and O Connell et al (1998), concluded that there was no significant difference between the COP sway in person with ACL damage and healthy people (Lysholm et al., 1998; O'Connell et al., 1998). But Zatterstrom et al (2000) and Gauffin et al (1990) showed that there appeared significant difference between injured and uninjured limb standing (Gauffin et al., 1990; Zatterstrom et al., 2000). The balance test is designed to be more specific and challenging than a purely static test. It has been purported that simple static tests may not provide enough challenge to generate balance deficiencies in athletes (Hrysomallis et al., 2005), and because standing quiet is a well-learned skill, it may require little attention for ACLR, FAI and healthy participants (Negahban et al., 2009). A deficit in balance ability was not detected in lower limbs of soccer players with prior ligament injury. This finding is in agreement with previous research which reported that soccer players with a history of ankle joint injury did not display increased postural sway (Hrysomallis et al., 2005; Tropp et al., 1984). Balance ability impaired by a prior ligament injury may be dependent on the severity, time elapsed since the injury and adherence to and effectiveness of the rehabilitation program. In the short term, postural stability is impaired. This has been found several weeks after an ankle sprain (Goldie et al 1994; Leanderson et al., 1996b). Medium term follow- up has revealed that there is no difference in balance ability between the injured and noninjured limbs in patients recovered 10 to 18 months following the surgery (Harrison et al. 1994). Evidence suggests that low balance ability is a risk factor for injuries in a number of sports. The balance ability of soccer players with previous lower limb ligament injuries did not significantly differ from those with no previous ankle or knee ligament injury. In addition, the balance ability of the previously injured limb did not significantly differ from the uninjured limb of the same player. A balance deficit was not detected in soccer players with a history of lower limb ligament injury. Acknowledgment With grateful appreciation, the authors would like to acknowledge the kind assistance and financial support provided by the Vice Chancellor for Research at the Islamic Azad University of Hamedan. References Azadian E, Majlesi M, Karimi L, Investigating the present procedure in return to play after injury in athletes of football primary league in Iran. Australian Journal of Basic & Applied Sciences, 5(12), Bernier JN, Perrin DH, Rijke A, Effect of unilateral functional instability of the ankle on postural sway and inversion and eversion strength. Journal of Athletic Training, 32(3), Gauffin H, Pettersson G, Tegner Y, Tropp H, Function testing in patients with old rupture of the anterior cruciate ligament. Int J Sports Med, 11, Goldie PA, Evans OM, Bach TM, Postural control following inversion injuries of the ankle. Archives of Physical Medicine And Rehabilitation, 75, Harrison EL, Duenkel N, Dunlop R, Russell G, Evaluation of single-leg standing following anterior cruciate ligament surgery and rehabilitation. Physical Therapy, 74, Holme E, Magnusson S, Becher K, Bieler T, Aagaard P, Kjaer M, The effect of supervised rehabilitation on strength, postural sway, position sense and re injury risk after acute ankle ligament sprain. Scandinavian Journal Of Medicine & Science In Sports, 9, Hrysomallis C, McLaughlin P, Goodman C, Does a balance deficit persist in Australian Football players with previous lower limb ligament injury?. Journal of Science and Medicine in Sport, 8,

5 Leanderson J, Ekstam S, Salomonsson C, 1996a. Taping of the ankle-the effect on postural sway during perturbation, before and after a training session. Knee Surgery, Sports Traumatology, Arthroscopy, 4, Leanderson J, Eriksson E, Nilsson C, Wykman A, 1996b. Proprioception in classical ballet dancers a prospective study of the influence of an ankle sprain on proprioception in the ankle joint. The American Journal Of Sports Medicine, 24, Lephart SM, Pincivero DM, Giraldo JL, Fu FH, The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med, 25, Löfvenberg R, Kärrholm J, Sundelin G, Ahlgren O, Prolonged reaction time in patients with chronic lateral instability of the ankle. The American Journal Of Sports Medicine, 23, Lysholm M, Ledin T, Odkvist LM, Good L, Postural control-a comparison between patients with chronic anterior cruciate ligament insufficiency and healthy individuals. Scand J Med Sci Sports, 8, Munn J, Sullivan SJ, Schneiders AG, Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. Journal of Science and Medicine in Sport, 13, Negahban H, Hadian MR, Salavati M, Mazaheri M, Talebian S, Jafari AH, et al, The effects of dualtasking on postural control in people with unilateral anterior cruciate ligament injury. Gait & Posture, 30, O'Connell M, George K, Stock D, Postural sway and balance testing: a comparison of normal and anterior cruciate ligament deficient knees. Gait & Posture, 8, Orchard J, Seward H, McGivern J, Hood S, Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. The American Journal Of Sports Medicine, 29, Refshauge KM, Kilbreath SL, Raymond J, Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains. Journal of Orthopaedic & Sports Physical Therapy, 33, Tropp H, Ekstrand J, Gillquist J, Stabilometry in functional instability of the ankle and its value in predicting injury. Medicine and Science in Sports and Exercise, 16: Verhagen E, Van Der Beek A, Twisk J, Bouter L, Bahr R, Van Mechelen W, The effect of a proprioceptive balance board training program for the prevention of ankle sprains a prospective controlled trial. The American Journal Of Sports Medicine, 32, Wikstrom EA, Fournier KA, McKeon PO, Postural control differs between those with and without chronic ankle instability. Gait & Posture, 32, Zatterstrom R, Friden T, Lindstrand A, Moritz U, Rehabilitation following acute anterior cruciate ligament injuries-a 12-month follow-up of a randomized clinical trial. Scand J Med Sci Sports, 10,