• Korean Journal of Applied Biomechanics
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• v.32 no.1
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• pp.9-16
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• 2022

Objective: The purpose of this study was to investigate how the chronic ankle instability affects postural control during forward jump landing. Method: 20 women with chronic ankle instability (age: 21.7 ± 1.6 yrs, height: 162.1 ± 3.7 cm, weight: 52.2 ± 5.8 kg) and 20 healthy adult women (age: 21.8 ± 1.6 yrs, height: 161.9 ± 4.4 cm, weight: 52.9 ± 7.2 kg) participated in this study. For the forward jump participants were instructed to stand on two legs at a distance of 40% of their body height from the center of force plate. Participants were jump forward over a 15 cm hurdle to the force plate and land on their non-dominant or affected leg. Kinetic and kinematic data were obtained using 8 motion capture cameras and 1 force plates and joint angle, vertical ground reaction force and center of pressure. All statistical analyses were using SPSS 25.0 program. The differences in variables between the two groups were compared through an independent sample t-test, and the significance level was to p < .05. Results: In the hip and knee joint angle, the CAI group showed a smaller flexion angle than the control group, and the knee joint valgus angle was significantly larger. In the case of ankle joint, the CAI group showed a large inversion angle at all events. In the kinetic variables, the vGRF was significantly greater in the CAI group than control group at IC and mGRF. In COP Y, the CAI group showed a lateral shifted center of pressure. Conclusion: Our results indicated that chronic ankle instability decreases the flexion angle of the hip and knee joint, increases the valgus angle of the knee joint, and increases the inversion angle of the ankle joint during landing. In addition, an increase in the maximum vertical ground reaction force and a lateral shifted center of pressure were observed. This suggests that chronic ankle instability increases the risk of non-contact knee injury as well as the risk of lateral ankle sprain during forward jump landing.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.3
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• pp.69-77
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• 2022

Background: Ankle sprains, and the resulting ankle instability worsen to chronic due to recurrent ankle injuries or sprains, 78% of which are accompanied by posture instability and damage due to changes in the position of the talus of the ankle. The purpose of this study is to investigate the immediate effect of applying MWM taping on the patient's muscle strength and balance ability in patients with chronic ankle instability. Methods: 15 people with MWM taping and 15 people with Kinesio taping were applied, and after applying the taping of the ankle, 10 minutes of walking treadmill and 10 times of forward lunge operation, the change in ankle muscle strength and balance ability was confirmed. The strength test of the ankle was performed using a test device called Biodex system 4 (USA) for the movement of the dorsi-flexion and plantar flexion of the foot, and the balance of the two groups was measured using Biodex balance system (USA) to test balance ability. Results: The comparison of muscle strength changes in the ankle does not show a significant increase in the group applying MWM compared to the group applying kinesio taping (p<.05). In the comparison of equilibrium capabilities, the MWM taping group also showed a significant increase in the MWM taping group compared to the kinesio taping group (p<.05). Conclusion: When applying MWM taping and kinesio taping to patients with chronic ankle instability, there was no significant difference in comparison of muscle strength changes, but there was a significant difference in comparison of balance ability.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.1
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• pp.121-130
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• 2023

Purpose : This study aimed to investigate the effect of blood flow restriction exercise on ankle muscle strength and balance ability to achieve maximum efficiency with the same exercise intensity and time. Methods : Twenty-six adults are randomly assigned to experimental group (n=13) and comparison group (n=13). The experimental group performed ankle joint strength exercises with blood flow restriction applied while the comparison group performed ankle joint strength exercises without blood flow restriction applied three times a week for four weeks. The digital muscle measurement, Y-balance test, and Cumberland ankle instability tool were used to evaluate the subject's muscle strength, dynamic balance, and ankle instability index before and after the intervention. Results : In within-group comparison muscle strength, all the two groups showed significant improvements post intervention (p<.05). In between-group comparison, there was significant difference in the change of dorsiflexion, eversion strength pre and post intervention (p<.05). but plantarflexion was no significant difference between pre and post intervention in the group comparison (p>.05). In within-group comparison dynamic balance, all the two groups showed significant improvements post intervention (p<.05). In between-group comparison, there was no significant difference in the change of Y-balance score pre and post intervention (p>.05). In within-group comparison ankle instability index, all the two groups showed significant improvements post intervention (p<.05). In between-group comparison, there was no significant difference in the change of CAIT score pre and post intervention (p>.05). Conclusion : The results of this study show that ankle joint strength exercise improved the strength and balance ability of those complaining of chronic ankle instability, and ankle joint strength exercise applied with blood flow restriction was more effective in dorsiflexion and eversion strength exercise than ankle joint strength exercise without blood flow restriction.

• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.171-176
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• 2022

Purpose: This study reports on a series of patients with chronic lateral ankle instability that underwent the Brostrom procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace. Materials and Methods: This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Brostrom procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months). Results: Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months. Conclusion: Early unrestricted weight-bearing in a stirrup brace following the Brostrom procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.1
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• pp.19-27
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• 2022

Background: This study investigated the effects of a single-leg hopping test and Q-angle when applying Mulligan taping, flossing bands, and a combination of Mulligan taping and flossing bands to chronic ankle instability (CAI) patients. Methods: The subjects of the study were 68 patients with chronic ankle instability, randomly divided into three groups receiving the following treatments: Mulligan taping (n=22), flossing bands (n=23), and a combination of Mulligan taping and flossing bands (n=23). The immediate effects of the treatments were evaluated using the single-leg hopping test and Q-angle measurement for functional movement before and after the intervention. Results: All three groups showed significant improvements in the single-leg hopping test after the intervention, and there was a significant difference between the performance of the simultaneous application group and the Mulligan taping group (p<.01). As a result of the post-hoc test, there was a significant difference in the simultaneous application group than in the mulligan taping group (p<.01). When measuring the Q-angle change during the activity of descending stairs, there was also a significant effect in all three groups, with no significant differences when comparing the changes between groups (p>.05). Conclusions: In conclusion, Mulligan taping and flossing bands were confirmed as effective interventions for the functional movement of the lower extremities in patients with CAI. This study can provide basic data on the effectiveness of interventions in patients with CAI.

• Journal of the Korean Society of Physical Medicine
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• v.18 no.2
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• pp.49-59
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• 2023

PURPOSE: This study examined the relationship between lumbar instability and shortening of the iliopsoas muscles in patients with chronic low back pain. METHODS: Forty-nine patients with chronic low back pain participated in this study. The modified Thomas test was used to examine the shortening state of the iliopsoas muscle. The length of the iliopsoas muscle was measured using the hip flexion angle, and those with a flexion angle of 10° or more were classified as positive. Five subtests were used for the lumbar instability test: testing for prone lumbar instability, passive lumbar extension, anterior-posterior mobility, passive straight leg raise, and age. Those who tested positive for at least three of these tests were classified as positive for the lumbar segment instability test. RESULTS: There was a significant association between the results of the lumbar instability test and the shortening of the iliopsoas test (p < .05). After analyzing the association between the iliopsoas length test and the five lumbar instability subtests, the results of the prone lumbar instability test (p < .001) and the anterior-posterior mobility test (p < .05) showed a significant association with the iliopsoas length test. CONCLUSION: The association between lumbar instability and shortening of the iliopsoas muscles was examined in 49 patients with chronic low back pain. Patients with shortened iliopsoas muscles tested positive in the lumbar instability tests more often. Hence, the length test of the iliopsoas muscle can be used to determine lumbar instability in patients with chronic low back pain.

• Journal of the Korean Society of Physical Medicine
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• v.18 no.2
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• pp.83-92
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• 2023

PURPOSE: This study examined the effect of using a smartphone according to the direction of wearing a bag on muscle characteristics and balance ability in adults in their 20s with chronic ankle instability. METHODS: Twelve people with chronic ankle instability were examined for three weeks. The types of carrying a bag were classified into three conditions: to the right, to the left, and on both sides. The muscle characteristics and balance ability were measured and analyzed. The one-way ANOVA was used to obtain a difference between conditions. RESULTS: A significant difference in the muscle tone of medial gastrocnemius was observed between the dominant group and the non-dominant group. The muscle tone and stiffness of the peroneus longus decreased significantly after walking with a smartphone and carrying a bag. The maximum slope of the forward and reverse directions increased and decreased significantly, respectively, after walking with a smartphone and carrying a bag on both sides. CONCLUSION: In this study, muscle fatigue causes a decrease in muscle tone and stiffness with chronic ankle instability when carrying a heavy back while walking, and there were asymmetric changes in the balance ability. Therefore, adults with chronic ankle instability should carefully avoid carrying a heavy bag for extended times, irrespective of the style or type of the bag.

• Korean Journal of Applied Biomechanics
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• v.34 no.2
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• pp.93-103
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• 2024

Objective: The purpose of this study was to investigate whether dancers with chronic ankle instability (CAI) exhibit different characteristics in dynamic postural control ability and ankle joint laxity compared to dancers without CAI and non-dancers with CAI. Method: Twelve dancers with CAI, 14 dancers without CAI, and 12 non-dancers with CAI participated in the study. Dynamic balance was evaluated using the Star Excursion Balance Test (SEBT) and the single-leg hop balance. The laxity of the ankle joint was evaluated through the anterior drawer test and the talar tilt test. SEBT measured maximum reach distances in anterior, posteromedial, and posterolateral directions. Single-leg hop assessed center of pressure (COP) and time-to-boundary (TTB) outcomes. One-way ANOVA and Chi-square tests were performed to compare the outcome variables among the three groups. Results: Dancers with CAI demonstrated greater reach distance in the posterolateral direction compared to non-dancers with CAI during SEBT (p=.014). Secondly, dancers without CAI showed greater reach distance in the posterolateral (p<.001) and posteromedial (p=.001) directions during SEBT compared to non-dancers with CAI. Additionally, dancers without CAI exhibited better postural control with higher TTB AP mean of minima (p=.003) and TTB AP standard deviation of minima (p=.012) during single-leg hop compared to nondancers with CAI. Thirdly, dancers with CAI showed a lower positive rate during the anterior drawer test compared to non-dancers with CAI (p=.019). Conclusion: Dancers with CAI demonstrated better ankle function and reduced mechanical instability compared to non-dancers with CAI. Therefore, to elucidate the underlying mechanisms of lateral ankle sprain and CAI development exacerbation in dancers, additional factors that can affect ankle sprain, such as visual dependence during postural control and evaluation in dance movements, should be explored.

• Journal of the Korean Society of Physical Medicine
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• v.19 no.2
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• pp.29-45
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• 2024

PURPOSE: This study aimed to compare the effects of pain level, lower back pain dysfunction level, psychosocial level, hip abductor strength (HAS), number of positive lumbar instability tests, and dynamic balance (DB) by applying lumbar stabilization exercises according to the presence or absence of gluteus medius muscle weakness in chronic lower back pain (CLBP) patients with lumbar instability. METHODS: Thirty-five CLBP patients with lumbar instability were divided into the gluteus medius weakness (n = 18) and gluteus medius non-weakened (n = 17) groups using the gluteus medius manual muscle test. Intervention applied conservative physical therapy and lumbar stabilization exercises to both groups that lasted three times a week for four weeks. To compare the intervention effects, the quadruple visual analog scale (QVAS), the Korean version of the Oswestry disability index (K-ODI), fear-avoidance beliefs questionnaire (FABQ), HAS, lumbar instability tests positive response counter (LIC), and DB were measured. RESULTS: Significant differences were shown for QVAS, K-ODI, FABQ, HAS, LIC, and DB for both groups pre- and post-intervention (p < .05). Compared to the gluteus medius weakness group, the gluteus medius non-weakened group showed a significant difference (p < .05) in the changes in QVAS, K-ODI, FABQ-W, FABQ-total, and HAS. CONCLUSION: In CLBP patients with lumbar instability, having gluteus medius weakness was less effective in improving lumbar stabilization exercise than gluteus medius non-weakness regarding pain level, lower back pain dysfunction level, psychosocial level excluding physical activity, and hip abductor strength. Therefore, additional gluteus medius strengthening exercises are necessary for patients with lumbar instability and gluteus medius muscle weakness.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.37-42
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• 2002

Purpose : The purpose of this study was to evaluate the results of arthroscopic meniscal repair according to joint stability. Materials and Methods : Twenty cases were reviewed, which had underwent arthroscopic meniscal repair. The mean age was 32.3 years old. The mean follow-up period was 59.7 months. Menisci that had underwent complete repair of associated ligament injuries (8cases, Sa) and menisci that had no associated ligament injury (9 cases, Sb) were classified as stable group (S), and the others (3 cases) as unstable group (U). Also stable group was divided into acute and chronic group. The result was evaluated with Lysholm score and IKDC method. The statistical analysis was done using Wilcoxon rank sum test and Fisher's exact test (p<0.05). Results : Group Sa had $87.5\%$ satisfactory and Lysholm score was 90.9. Group U had $66.7\%$ satisfactory, and Lysholm score was 77.7. Group Sb had $89.9\%$, satisfactory and Lysholm store was 91.4. In acute group $91.7\%$ was satisfactory, Lysholm score 92.5, in chronic group $80\%$ was satisfactory, Lysholm score 88.6. Conclusion : Joint stability was important factor for the outcome of meniscal repairs. So, it is desirable to repair meniscus injury early and the repair of associated ligament injuries should be performed together.