The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls

Document Type : RESEARCH PAPER

Authors
Somayeh Mohamadi 1
Nahid Rahmani 2
Ismail Ebrahimi 3
Mahyar Salavati 1
Mehdi Dadgoo 3
1 Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2 University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3 Department of Physiotherapy, Iran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2022.65920.3161
Abstract
Background: To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and 
healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between 
the both legs in terms of dominant and non-dominant in all groups.
Methods: A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT 
was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. 
All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was 
used to compare dominant and non-dominant legs in each group. 
Results: In 75 subjects have participated in the data collection, no significant differences were reported among all 
groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI 
was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference 
was determined between the dominant and non-dominant legs in each group (P>0.05). 
Conclusion:It seems that relevant strategies for postural control should be taken into account in the rehabilitation 
setup of individuals with CAI.
Level of evidence: II
Keywords
Ankle
Balance
Dynamic
Postural control
Postural stability
Sprain
Star excursion balance test
Subjects
  1. Mettler A, Chinn L, Saliba SA, McKeon PO, Hertel J. Balance Training and Center-of-Pressure Location in Participants With Chronic Ankle Instability. J Athl Train. 2015; 50(4):343-349. DOI: 10.4085/1062-6050-49.3.94.
  2. Wikstrom EA, Tillman MD, Borsa PA. Detection of Dynamic Stability Deficits in Subjects with Functional Ankle Instability. Med Sci Sports Exerc. 2005; 37(2):169-175. DOI: 10.1249/01.mss.0000149887.84238.6c.
  3. Croy T, Saliba S, Saliba E, Anderson MW, Hertel J. Differences in Lateral Ankle Laxity Measured via Stress Ultrasonography in Individuals With Chronic Ankle Instability, Ankle Sprain Copers, and Healthy Individuals. J Orthop Sports Phys Ther. 2012; 42(7):593-600. DOI: 10.2519/jospt.2012.3923.
  4. McCann RS, Crossett ID, Terada M, Kosik KB, Bolding BA, Gribble PA. Hip strength and star excursion balance test deficits of patients with chronic ankle instability. J Sci Med Sport. 2017; 20:992-996. DOI: 10.1016/j.jsams.2017.05.005.
  5. Simpson JD, Stewart EM, Macias DM, Chander H, Knight AC. Individuals with chronic ankle instability exhibit dynamic postural stability deficits and altered unilateral landing biomechanics: A systematic review. Phys Ther Sport. 2019;37:210-9. doi: 10.1016/j.ptsp.2018.06.003.
  6. Wikstrom EA, Tillman MD, Kline KJ, Borsa PA. Gender and Limb Differences in Dynamic Postural Stability During Landing. Clin J Sport Med. 2006; 16(4):311-315. DOI: 10.1097/00042752-200607000-00005.
  7. Yu P, Mei Q, Xiang L, Fernandez J, Gu Y. Differences in the locomotion biomechanics and dynamic postural control between individuals with chronic ankle instability and copers: a systematic review. Sports Biomech. 2022; 21(4):531-549. DOI: 10.1080/14763141.2021.1954237.
  8. Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury. Knee Surg Sports Traumatol Arthrosc. 2016; 24(4):1086-1095. DOI: 10.1007/s00167-015-3744-z.
  9. Gribble PA, Hertel J, Plisky P. Using the star excursion balance test to assessdynamic postural-control deficits and outcomes in lower extremity injury: aliterature and systematic review. J Athl Train. 2012; 47(3):339-357. DOI: 10.4085/1062-6050-47.3.08.
  10. Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability. J Athl Train. 2002;37(4):501–506.
  11. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2013; 43(8):585-591. doi: 10.4085/1062-6050-49.1.14.
  12. Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA. Discriminating between Copers and people with chronic ankle instability. J Athl Train. 2012; 47(2):136–142. doi: 10.4085/1062-6050-47.2.136.
  13. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012; 47(3):339-357. DOI: 10.4085/1062-6050-47.3.08.
  14. Hoffman M, Schrader J, Applegate T, Koceja D. Unilateral Postural Control of the Functionally Dominant and Nondominant Extremities of Healthy Subjects. J Athl Train. 1998; 33(4):319-322.
  15. Jaber H, Lohman E, Daher N, et al. Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. PLoS One. 2018; 13(8): 0201479. doi: 10.1371 doi: 10.1371.
  16. Schorderet C, Allet L, Hilfiker R. The role of the dominant leg while assessing balance performance. A systematic review and meta-analysis. Gait posture .2021; 84:66-78. doi: 10.1016/j.gaitpost. 2020.11.008.
  17. Wikstrom EA, Brown CN. Minimum Reporting Standards for Copers in Chronic Ankle Instability Research. Sports Med. 2014; 44(2):251-268. doi: 10.1007/s40279-013-0111-4.
  18. Brown C, Ross S, Mynark R, Guskiewicz K. Assessing Functional Ankle Instability With Joint Position Sense, Time to Stabilization, and Electromyography. J sport rehabil .2004; 13(2) 122-34. DOI:10.1123/jsr.13.2.122.
  19. Doherty C, Bleakley CM, Hertel J, Caulfield B, Ryan J, Delahunt E. Laboratory Measures of Postural Control During the Star Excursion Balance Test After Acute First-Time Lateral Ankle Sprain. J Athl Train. 2015; 50(6):651-664. doi: 10.4085/1062-6050-50.1.09.
  20. Chaiyakul S, Chaibal S. Physical Performance and Psychological Status of Professional Football Players with Recurrent Ankle Sprains. Sport Mont. 2022; 20(2).
  21. Gribble PA, Hertel J, Denegar CR, Buckley WE. The Effects of Fatigue and Chronic Ankle Instability on Dynamic Postural Control. J Athl Train. 2004; 39(4):321-329.
  22. Brown CN, Bowser B, Orellana A. Dynamic postural stability in females with chronic ankle instability. Med Sci Sports Exerc. 2010; 42(12):2258-2263. DOI: 10.1249/MSS.0b013e3181e40108.
  23. Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. J Athl Train. 2019; 54(6):572-588. doi: 10.4085/1062-6050-344-18.
  24. Bressel E, Yonker JC, Kras J, Heath EM. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. J Athl Train. 2007; 42(1):42-46. DOI: not available.
The Archives of Bone and Joint Surgery
Volume 11, Issue 3
March 2023
Pages 206-211

  • Receive Date 26 June 2022
  • Revise Date 10 October 2022
  • Accept Date 17 October 2022