Skip to main content
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2003 Oct;37(5):410–415. doi: 10.1136/bjsm.37.5.410

Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability

T Kaminski 1, B Buckley 1, M Powers 1, T Hubbard 1, C Ortiz 1, C Mattacola 1
PMCID: PMC1751367  PMID: 14514531

Abstract

Objectives: To examine the effect of six weeks of strength and proprioception training on eversion to inversion isokinetic strength ratios (E/I ratios) in subjects with unilateral functional ankle instability.

Methods: Thirty eight subjects were randomly assigned to one of four treatment groups: strength training (S); proprioception training (P); strength + proprioception training (B); control (C). Isokinetic strength was tested before and after training using a Kin Com 125 automatic positioning isokinetic dynamometer. Subtalar joint eversion and inversion motions were tested both concentrically and eccentrically through a range of motion involving 40°. All peak torque and average torque values were normalised for body mass. E/I ratios were calculated from average torque and peak torque measures by taking the concentric eversion value and combining it with the eccentric inversion value. Data were analysed using a mixed model analysis of variance with repeated measures on the test factor. Average torque and peak torque E/I ratios at 30 and 120°/s were analysed separately.

Results: There were no significant differences in average torque and peak torque E/I ratios of the functionally unstable ankle for any of the groups after training compared with before.

Conclusions: Six weeks of strength and proprioception training (either alone or combined) had no effect on isokinetic measures of strength in subjects with self reported unilateral functional instability. Further studies examining this agonist (concentric) to antagonist (eccentric) muscle group strength ratio are needed.

Full Text

The Full Text of this article is available as a PDF (313.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aagaard P., Simonsen E. B., Magnusson S. P., Larsson B., Dyhre-Poulsen P. A new concept for isokinetic hamstring: quadriceps muscle strength ratio. Am J Sports Med. 1998 Mar-Apr;26(2):231–237. doi: 10.1177/03635465980260021201. [DOI] [PubMed] [Google Scholar]
  2. BOSIEN W. R., STAPLES O. S., RUSSELL S. W. Residual disability following acute ankle sprains. J Bone Joint Surg Am. 1955 Dec;37-A(6):1237–1243. [PubMed] [Google Scholar]
  3. Baratta R., Solomonow M., Zhou B. H., Letson D., Chuinard R., D'Ambrosia R. Muscular coactivation. The role of the antagonist musculature in maintaining knee stability. Am J Sports Med. 1988 Mar-Apr;16(2):113–122. doi: 10.1177/036354658801600205. [DOI] [PubMed] [Google Scholar]
  4. Barker H. B., Beynnon B. D., Renström P. A. Ankle injury risk factors in sports. Sports Med. 1997 Feb;23(2):69–74. doi: 10.2165/00007256-199723020-00001. [DOI] [PubMed] [Google Scholar]
  5. Docherty C. L., Moore J. H., Arnold B. L. Effects of strength training on strength development and joint position sense in functionally unstable ankles. J Athl Train. 1998 Oct;33(4):310–314. [PMC free article] [PubMed] [Google Scholar]
  6. Draganich L. F., Jaeger R. J., Kralj A. R. Coactivation of the hamstrings and quadriceps during extension of the knee. J Bone Joint Surg Am. 1989 Aug;71(7):1075–1081. [PubMed] [Google Scholar]
  7. Freeman M. A., Dean M. R., Hanham I. W. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965 Nov;47(4):678–685. [PubMed] [Google Scholar]
  8. Garrick J. G., Requa R. K. The epidemiology of foot and ankle injuries in sports. Clin Podiatr Med Surg. 1989 Jul;6(3):629–637. [PubMed] [Google Scholar]
  9. Gauffin H., Tropp H., Odenrick P. Effect of ankle disk training on postural control in patients with functional instability of the ankle joint. Int J Sports Med. 1988 Apr;9(2):141–144. doi: 10.1055/s-2007-1024996. [DOI] [PubMed] [Google Scholar]
  10. Hartsell H. D., Spaulding S. J. Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle. Br J Sports Med. 1999 Aug;33(4):255–258. doi: 10.1136/bjsm.33.4.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000 May;29(5):361–371. doi: 10.2165/00007256-200029050-00005. [DOI] [PubMed] [Google Scholar]
  12. Highgenboten C. L., Jackson A. W., Meske N. B. Concentric and eccentric torque comparisons for knee extension and flexion in young adult males and females using the Kinetic Communicator. Am J Sports Med. 1988 May-Jun;16(3):234–237. doi: 10.1177/036354658801600306. [DOI] [PubMed] [Google Scholar]
  13. Hoffman M., Payne V. G. The effects of proprioceptive ankle disk training on healthy subjects. J Orthop Sports Phys Ther. 1995 Feb;21(2):90–93. doi: 10.2519/jospt.1995.21.2.90. [DOI] [PubMed] [Google Scholar]
  14. Hole C. D., Smit G. H., Hammond J., Kumar A., Saxton J., Cochrane T. Dynamic control and conventional strength ratios of the quadriceps and hamstrings in subjects with anterior cruciate ligament deficiency. Ergonomics. 2000 Oct;43(10):1603–1609. doi: 10.1080/001401300750004023. [DOI] [PubMed] [Google Scholar]
  15. Holme E., Magnusson S. P., 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. Scand J Med Sci Sports. 1999 Apr;9(2):104–109. doi: 10.1111/j.1600-0838.1999.tb00217.x. [DOI] [PubMed] [Google Scholar]
  16. Kaminski T. W., Perrin D. H., Gansneder B. M. Eversion strength analysis of uninjured and functionally unstable ankles. J Athl Train. 1999 Jul;34(3):239–245. [PMC free article] [PubMed] [Google Scholar]
  17. Kannus P., Renström P. Treatment for acute tears of the lateral ligaments of the ankle. Operation, cast, or early controlled mobilization. J Bone Joint Surg Am. 1991 Feb;73(2):305–312. [PubMed] [Google Scholar]
  18. Konradsen L., Magnusson P. Increased inversion angle replication error in functional ankle instability. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):246–251. doi: 10.1007/s001670000124. [DOI] [PubMed] [Google Scholar]
  19. Lentell G., Baas B., Lopez D., McGuire L., Sarrels M., Snyder P. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther. 1995 Apr;21(4):206–215. doi: 10.2519/jospt.1995.21.4.206. [DOI] [PubMed] [Google Scholar]
  20. Matsusaka N., Yokoyama S., Tsurusaki T., Inokuchi S., Okita M. Effect of ankle disk training combined with tactile stimulation to the leg and foot on functional instability of the ankle. Am J Sports Med. 2001 Jan-Feb;29(1):25–30. doi: 10.1177/03635465010290010901. [DOI] [PubMed] [Google Scholar]
  21. McDonagh M. J., Davies C. T. Adaptive response of mammalian skeletal muscle to exercise with high loads. Eur J Appl Physiol Occup Physiol. 1984;52(2):139–155. doi: 10.1007/BF00433384. [DOI] [PubMed] [Google Scholar]
  22. Patterson R. M., Stegink Jansen C. W., Hogan H. A., Nassif M. D. Material properties of Thera-Band Tubing. Phys Ther. 2001 Aug;81(8):1437–1445. doi: 10.1093/ptj/81.8.1437. [DOI] [PubMed] [Google Scholar]
  23. Pintsaar A., Brynhildsen J., Tropp H. Postural corrections after standardised perturbations of single limb stance: effect of training and orthotic devices in patients with ankle instability. Br J Sports Med. 1996 Jun;30(2):151–155. doi: 10.1136/bjsm.30.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Seger J. Y., Arvidsson B., Thorstensson A. Specific effects of eccentric and concentric training on muscle strength and morphology in humans. Eur J Appl Physiol Occup Physiol. 1998 Dec;79(1):49–57. doi: 10.1007/s004210050472. [DOI] [PubMed] [Google Scholar]
  25. Sheth P., Yu B., Laskowski E. R., An K. N. Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain. Am J Sports Med. 1997 Jul-Aug;25(4):538–543. doi: 10.1177/036354659702500418. [DOI] [PubMed] [Google Scholar]
  26. Smith R. W., Reischl S. F. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986 Nov-Dec;14(6):465–471. doi: 10.1177/036354658601400606. [DOI] [PubMed] [Google Scholar]
  27. Staples O. S. Result study of ruptures of lateral ligaments of the ankle. Clin Orthop Relat Res. 1972;85:50–58. doi: 10.1097/00003086-197206000-00011. [DOI] [PubMed] [Google Scholar]
  28. Tropp H. Pronator muscle weakness in functional instability of the ankle joint. Int J Sports Med. 1986 Oct;7(5):291–294. doi: 10.1055/s-2008-1025777. [DOI] [PubMed] [Google Scholar]
  29. Uh B. S., Beynnon B. D., Helie B. V., Alosa D. M., Renstrom P. A. The benefit of a single-leg strength training program for the muscles around the untrained ankle. Am J Sports Med. 2000 Jul-Aug;28(4):568–573. doi: 10.1177/03635465000280042101. [DOI] [PubMed] [Google Scholar]
  30. Wilkerson G. B., Pinerola J. J., Caturano R. W. Invertor vs. evertor peak torque and power deficiencies associated with lateral ankle ligament injury. J Orthop Sports Phys Ther. 1997 Aug;26(2):78–86. doi: 10.2519/jospt.1997.26.2.78. [DOI] [PubMed] [Google Scholar]
  31. Yeung M. S., Chan K. M., So C. H., Yuan W. Y. An epidemiological survey on ankle sprain. Br J Sports Med. 1994 Jun;28(2):112–116. doi: 10.1136/bjsm.28.2.112. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES