• The Journal of Korean Physical Therapy
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• v.31 no.2
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• pp.129-133
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• 2019

Purpose: This study aimed to investigate effect of ankle instability on peripheral muscle activation among female ballet dancers to provide information on the development of prevention programs for ankle injury rehabilitation. Methods: 32 female ballet dancers were randomly divided into two groups: experience ankle sprain group (n=16, age, $20.7{\pm}0.8years$, BMI $18.6{\pm}1.2kg/m2$) and non-experience ankle sprain group (n=16, $age=21.0{\pm}0.8years$, BMI $19.6{\pm}2.0kg/m2$). Activation of the peroneus longus, tibialis anterior muscle, and gastrocnemius during vertical landing, half pointe, and gait between the two groups were measured. Body composition analyzer was used to examine skeletal muscle mass and body fat mass. Results: A total of 32 patients were included. In the experience ankle sprain group (n=16: left sprain 14, right sprain 2), average ankle sprain injury occurred 7.5 months before the study. The average age of the dancers in the experience ankle sprain group and non-experience ankle sprain group was $20.7{\pm}0.8$ and $21.0{\pm}0.8years$, major period was $64.5{\pm}23.8$ and $71.6{\pm}25.8months$, BMI was $18.6{\pm}1.2$ and $19.5{\pm}2.0kg/m2$, respectively. No significant differences were found on body composition between the two groups (p>0.05). The experience ankle sprain group showed significantly lower tibialis anterior and peroneus longus muscle activation (p<0.5), while gastrocnemius muscle activation appeared to be significantly higher (p<0.05) during landing, half pointe, and normal gait. Conclusion: Ankle sprain can cause a decline in peripheral muscle activation and coordination, which increased the risk for repetitive ankle sprain in the future. Moreover, ankle peripheral muscle selective strength training, coordination program development, and application need to be considered to prevent ankle sprain.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.2
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• pp.83-93
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• 2022

PURPOSE: This study examined the comparative effects of an ankle sensorimotor training program combined with hip strengthening exercise (ASTPCHSE) and ankle sensorimotor training program (ASTP) alone on muscle strength, static balance, and dynamic balance in individuals with functional ankle instability. METHODS: Sixteen research participants with functional ankle instability were enrolled in this study. The participants were divided randomly into the ankle sensory motor training program group and the ankle sensory motor training program combined with the hip strengthening exercise group. Each group performed a series of exercise programs two times per week for four weeks. The Cumberland ankle instability tool (CAIT) was used to measure the participants' functional ankle instability. A Balance trainer 4 was applied to assess the static and dynamic balance, and a Primus RS multimodal dynamometer was used to evaluate the muscle strength. RESULTS: No significant differences in static balance, dynamic balance, and muscle strength were found between the ASTP and ASTPCHSE groups (p > .05). On the other hand, the dynamic balance and muscle strength improved in the ASTP and ASTPCHSE groups after the intervention (p < .05). The static balance was not enhanced in both groups after the intervention (p > .05). CONCLUSION: Ankle exercise and an ankle sensorimotor training program combined with hip strengthening exercise are effective in improving muscle strength and dynamic balance in individuals with ankle instability. On the other hand, there are no meaningful differences between ankle exercise and ankle and hip combined exercise.

• Physical Therapy Korea
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• v.31 no.1
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• pp.18-28
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• 2024

Background: Lateral instability of the ankle is one of the most common causes of musculoskeletal ankle injuries. The peroneus longus (PL) and peroneus brevis (PB) contribute to ankle stability. In early rehabilitation, isometric exercises have been selected for improvement of ankle stability. To effectively train the peroneal muscles during eversion, it is important to consider ankle and body posture. Objects: This study aimed to compare activation of the PL, PB, and biceps femoris (BF) muscles during eversion in different ankle postures (neutral [N], plantarflexed [PF]) and body postures (sitting and side-lying). Methods: Thirty healthy individuals with no history of lateral ankle sprains within the last 6 months were included in the study. Maximal isometric strength of eversion and muscle activation were measured simultaneously. Muscle activation at submaximal eversion was divided by the highest value obtained from maximal isometric eversion among the four postures (percent maximal voluntary isometric contraction [%MVIC]). To examine the differences in muscle activation depending on posture, a 2 × 2 repeated measures analysis of variance (ANOVA) was conducted. Results: There were significant interaction effects of ankle and body postures on PL muscle activation and evertor strength (p < 0.05). The PL muscle activation showed a significantly greater difference in the side-lying and PF conditions than in the sitting and N conditions (p < 0.05). Evertor strength was greater in the N compared to the PF condition regardless of body posture (p < 0.05). In the case of PB and BF muscle activation, only the main effects of ankle and body posture were observed (p < 0.05). Conclusion: Among the four postures, the side-lying-PF posture produced the highest muscle activation. The side-lying-PF posture may be preferred for effective peroneal muscle exercises, even when considering the BF muscle.

• Physical Therapy Korea
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• v.29 no.3
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• pp.194-199
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• 2022

Background: Older adults use different ankle muscle activation patterns during difficult static balance conditions. It has been suggested that this is related to a decline in proprioception with age, resulting in reduced postural balance. However, the association between proprioception and ankle muscle activity during quiet standing has not been directly assessed. Objects: This study aimed to investigate the effects of age and sensory condition on ankle muscle activity and the association between ankle proprioception and ankle muscle activity. Methods: We recruited 10 young women and 9 older women. Ankle proprioception was evaluated using joint position sense (JPS) and force sense (FS) divided by dorsiflexion and plantarflexion. The electromyographic activity of the tibialis anterior (TA) and gastrocnemius (GCM) muscles was collected during quiet standing. Results: Older women activated GCM muscle more than young during quiet standing and when performing difficult tasks. Older women had more errors in JPS dorsiflexion and FS plantarflexion than did young. The GCM muscle activity is related to JPS dorsiflexion and FS plantarflexion. Conclusion: Lower proprioception of the GCM with age leads to increased muscle activity, resulting in reduced postural balance. There was no difference in TA proprioception or muscle activity among older women with frequent physical activity.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.4
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• pp.2212-2220
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• 2020

Background: Repetitive damage to the ankle joint causes chronic ankle instability, and studies comparing the effects of exercise in open and closed chains as a treatment method are very rare. Objectives: To investigate the effects of open and closed kinetic exercises on muscle activity and dynamic balance of ankle joint in adults with chronic ankle instability. Design: Single-blind randomized controlled trial. Methods: The selected 30 subjects are randomly divided into open kinetic chain exercise experimental group (EGI, n=10), closed kinetic chain exercise experimental group (EGII, n=10), and stretching control group (CG, n=10). Open and closed kinetic exercises lasted 30 minutes three times a week for six weeks and stretching exercises performed four actions for 20 seconds and five sets. The measurement tools using surface electromyography to measure muscle activity in the ankle joint. The dynamic balance of the ankle was evaluated using the Y-Balance test. Results: Following the intervention, closed and open kinetic chain exercise group showed significant difference in tibialis anterior and gastrocnemius muscle activity and dynamic balance (P<.05). However, no significant difference in tibialis anterior and gastrocnemius muscle activity and dynamic balance between closed and open kinetic chain exercise group (P<.05). Conclusion: This study provides evidence that closed and open kinetic chain exercise can be presented as an effective exercise for the muscle activity of ankle muscle and dynamic balance of the subject with chronic ankle instability.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.4
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• pp.57-69
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• 2022

Purpose : The purpose of this study was to investigate the effect of ankle strengthening exercise combined with sling-assisted gluteus medius strengthening on ankle instability score, and static and dynamic balance ability, muscle strength in adults in their 20s with chronic ankle instability. Methods : Twenty-eight adults in their 20s with chronic ankle instability were recruited. After screening test, they were randomized through R studio program as an experimental group (n=14) to apply an ankle strengthening exercise combined with sling-assisted gluteus medius strengthening and a control group (n=14) to apply ankle strengthening exercise. The intervention lasted two times a week for 6 weeks. To compare the intervention effects, the Cumberland ankle instability tool (CAIT) score, static and dynamic balance ability, and muscle strength of lower extremities were measured. Results : The experimental group showed a significant increase in pre and post-intervention Cumberland ankle instability tool (CAIT) score, static and dynamic balance ability, and muscle strengt (p<.05). The control group showed a significant increase in pre and post-intervention CAIT score, dynamic balance ability, and muscle strength (p<.05). The experimental group showed a significant increase in CAIT score, dynamic balance ability, and muscle strength compared to the control group (p<.05), and showed a high effect size. Conclusions : The results of this study confirmed that ankle strengthening exercise combined with sling-assisted gluteus medius strengthening on people with chronic ankle instability the possibility that it could be effective in improving ankle instability and improving dynamic balance ability, and strength by movement. Although additional research is needed to increase the number of participants due to the small sample size, it is hoped that this study will be an optimistic clinical protocol for people with chronic ankle instability.

• Physical Therapy Rehabilitation Science
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• v.12 no.2
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• pp.149-154
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• 2023

Objective: This study is designed to investigate the effect of ankle joint position on hip extensor muscle activity when bridging exercise in sagittal plane. Design: Cross-sectional study Methods: The subjects were recruited from 20 healthy adult men. The subjects performed three types of bridging exercises (normal bridging, ankle dorsiflexion bridging, ankle plantar flexion bridging) three times for five seconds with a rest of 15 seconds between measurements and two minutes of rest between each motion. The target muscles were the gluteus maximus, biceps femoris, soleus, and tibialis anterior. A surface electromyography was used to measure the muscle activity of these muscles. Results: The results show there was no statistically significant difference between the three types of exercise in the gluteus maximus muscle activity. However, the biceps femoris showed a significant difference between the three types of exercises (p<0.05). Conclusions: In conclusion, when the three different bridging exercises were performed by adding ankle motion to normal bridging exercise, there was a significant difference in the muscle activity of the gluteus maximus relative to the biceps femoris muscle activity in the order of the ankle dorsiflexion bridging, normal bridging, and ankle plantar flexion bridging exercise. Therefore, this could be an effective option for a bridging exercise if applied to patients with a weak gluteal muscle and shortening of the hamstring muscle in further studies.

• PNF and Movement
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• v.17 no.3
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• pp.463-469
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• 2019

Purpose: This study investigated the effect of plantar-flexor muscle fatigue on the force sense and joint reposition sense of ankle joints in the healthy adults. Methods: Fifteen healthy subjects (male: 9, female: 6) participated in this study. A digital dynamometer was used to measure the force sense error while a wireless motion capture device was used to measure the joint reposition sense error. To induce plantar-flexor muscle fatigue for a dominant lower extremity, the subjects were asked to perform plantar flexion until exhaustion while barefoot. The differences in force sense error and joint reposition sense error for the ankle joint were measured immediately. The Wilcoxon test was used to compare these values before and after inducing plantar-flexor muscle fatigue. Results: The force sense error and joint reposition sense error of ankle joints after inducing plantar-flexor muscle fatigue increased significantly compared to the values before inducing muscle fatigue. Conclusion: This study suggests that plantar-flexor muscle fatigue could degrade the force sense and joint reposition sense in ankle joints. In addition, it could deteriorate ankle proprioception.

• The Journal of Korean Physical Therapy
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• v.34 no.1
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• pp.12-17
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• 2022

Purpose: Ankle dorsiflexion is an essential element of normal functions, including walking, activities of daily living and sport activities. The tibialis anterior (TA) muscle functioned as a dorsiflexor and as a dynamic stabilizer of the ankle joint during walking and jumping. This study aimed to compare TA muscle thickness using ultrasonography according to the four different toe and ankle postures for the selective TA strengthening exercise. Methods: This study were recruited 26 (males: 15, females: 11) aged 20-30 years, with no injury ankle and calf in the medical history, had normal dorsiflexion and inversion range of motion (ROM). The thickness of the TA muscle was measured by ultrasonography in the four different toe and ankle postures: 1. Ankle dorsiflexion with all toe extension and ankle inversion (ITEDF); 2. Ankle dorsiflexion with all toe flexion and ankle inversion (ITFDF); 3. Ankle dorsiflexion with all toe extension and neutral position (NTEDF); 4. Ankle dorsiflexion with all toe flexion and neutral position (NTFDF). One-way repeated analysis of variance (ANOVA) and Bonferroni correction were used to confirm the significant difference among conditions. The level of statistical significance was set at α=0.01. Results: TA muscle thickness with ITFDF was significantly greater than in any other ankle positions, including ITEDF, NTFDF, and NTEDF (p<0.01). Conclusion: Among the four toe and ankle postures, isometric contraction in ITFDF postures showed the greatest increase in thickness of TA rather than ITEDF, NTEDF, and NTFDF postures. Based on these results, ITFDF can be recommended in an efficient way to selectively strengthen TA muscle.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.1
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• pp.21-29
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• 2023

Purpose : Using a smartphone while walking districts attention and increases the risk of losing balance or falling. Ankle instability is caused by decreased muscle strength and decreased neuromuscular ability leading to postural control problems. Dual tasks increases the risk of falls by reducing postural control in adults with ankle instability. This study aimed to investigate the effect of performing a dual task on balance and muscle activity in adults with ankle instability using a smartphone. Methods : Forty-nine individuals with ankle instability participated in this study. A game of finding the wrong picture was performed using a smartphone in the dual task, and only looking at the blank screen of a smartphone was evaluated in the single task. The participants randomly performed single and dual task to evalutate balance and muscle atcitivy. Balance was evaluated using the Biodex balance system (BBS), and muscle activity was evaluated using surface EMG. Muscle activity of the gastrocnemius and tibialis anterior was measured at the same time as balance. Results : The results of this study showed that overall, anteior/posterior, and medial/lateral balance indices all showed significant differences when performing the dual task compared with those during the single task (p<.05). The muscle activity results showed a significant difference compared with that of the gastronemius muscle on the nondominant side during the dual task (p>.05). Conclusion : The results of this study showed that maintaining balance is more difficult when performing the dual task than during the single task, and only the muscle activity of the nondominant gastrocnemius muscle decreased. The dual task causes a decrease in concentration for postural control, which negatively affects postural stability. Individuals with ankle ankle instability should refrain from performing dual tasks, such as using smartphones, to prevent ankle damage.