Review
The peroneus reaction time during sudden inversion test: Systematic review

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Abstract

The purpose of the study was to determine whether peroneal reaction time is influenced by ankle’s impairment in subjects with ankle injury assessed by surface electromyography. The studies were identified by electronic research by two independent reviewers at the following databases: MEDLINE (1966–2009), EMBASE (1980–2009), LILACS (1982–2009), CINAHL (1982–2009) and, SPORTDiscus (1975–2009). Studies were divided into following groups: I – subjects with injury (paired by the opposite limb); II – subjects with or without injury (paired by limbs from different subjects) and III – subjects with or without injury (other situations). Studies that used the sudden ankle inversion test were selected. As result, 25 articles were included. The comparison of the reaction time paired by the opposite limb, showed a statistically significant difference in favor of the injured ankles (standardized mean difference – SMD = 0.40; IC 95% [0.01; 0.79], P = 0.05). The comparison paired by limbs from different subjects presented a statistically significant difference, in favor of the injured ankles (SMD = 3.49; IC 95% [1.26; 5.71], P = 0.002). The effect size measured was 0.54 and 1.61, respectively. The greater reaction time delay showed in the subjects with ankle injury compared to that of asymptomatic subjects should be taken into consideration.

Introduction

Ankle sprain is one of the most common injuries found in sports that require jumping and shuffling (Linford et al., 2006). The protection mechanisms are produced by active muscular contraction guided by central reflexes and mediated by spinal and cortical centers. The longus and brevis peroneus muscles are primary evertors of the foot–ankle complex, having an important role in injury protection. Independently, ligaments and capsules too are responsible for static and dynamic protection mechanisms. (Konradsen et al., 1997).

Although the consequences of a sprain do not lead to significant incapacity, residual problems might become chronic, such as pain, swelling, giving way of the ankle and repetitive injuries (Osborne et al., 2001). Functional instability is characterized by recurrent sprains and by the ankle giving way. Mechanical instability, peroneal weakness and proprioceptive deficit have been reported as causes of functional instability (Freeman et al., 1965, Lentell et al., 1995, Matsutaka et al., 2001). Freeman et al. (1965) suggest that ankle ligament injuries often cause proprioceptive deficit in the uninjured ankle and its reflex, leading to an impaired postural control, and possibly causing a disposition to ankle instability. Ligament function damage due to a rupture or injury not only affects joint stability but also kinesthesia perception, muscle reflex activation and related forces (Solomonow, 2004).

Many studies analyzing the presence of mechanoreceptors on the ankle lateral complex have been performed (Lentell et al., 1995). This type of joint receptor has a role in kinesthesia, muscle tonus, joint reflex and probably mediates joint proprioception. At the extremes of the range of motion, mechanoreceptors also send protective reflexes to prevent joint injury (Michelson and Hutchins, 1995). Freeman and Wyke (1967) suggested that mechanoreceptors are highly involved in normal reflexes of muscle tonus coordination, posture and movement; and probably become disorganized in joint injuries.

There are many types of methods to measure ankle sensorimotor control. The sudden ankle inversion test analyses peroneal muscle reaction time, which is defined as the time from the beginning of the inversion movement to the first muscular motor response, determined using surface electromyography. The subject is placed on a platform with two independent trap-doors that simulate an ankle spraining by inversion, with specific speed and angulation. The delayed response of the peroneus muscle has been described as a cause of functional instability after lateral ankle sprain (Karlsson and Andreasson, 1992, Konradsen et al., 1997, Löfvenberg et al., 1995). Some studies support this hypothesis (Brunt et al., 1992, Freeman et al., 1965, Karlsson and Andreasson, 1992, Konradsen et al., 1997, Löfvenberg et al., 1995), though others reject it (Beckman and Buchanan, 1995, Isakov et al., 1986, Johnson and Johnson, 1993, Nawoczenski et al., 1985). Methodological differences could well have contributed to these conflicting results (Hertel, 2000, Lephart and Fu, 2000, Osborne et al., 2001). The aim of this study was to review and summarize studies dealing with the evaluation of peroneus longus reaction time by surface electromyography in subjects both with and without ankle injury, and to verify the limb pairing influence on the determination of reaction time.

Section snippets

Type of studies and inclusion criteria

The studies selected for this research applied the peroneus longus reaction time test to a sudden ankle inversion, which was analyzed by surface electromyography. The studies were divided in three groups, according to their characteristics: group I – subjects with ankle sprain (paired with the opposite limb of the same subject); group II – subjects with ankle sprain (paired with limbs from different uninjured subjects) and group III – subjects with or without injury, comparing the reaction time

Results

The literature search found 39 studies. Of these, 29 manuscripts met the inclusion criteria. Four were excluded due to lack of data (Berg et al., 2007, Fritschy et al., 1988, Pacheco et al., 2005, Sheth et al., 1997). Then, 25 studies were included. Of these, only eight participated in the meta-analysis, and the others were presented descriptively. The reasons for these exclusions included the following: groups were formed according to limbs and not subjects; there was no evidence of group

Discussion

This study reviewed experiments about the main methods used for sensorimotor control deficit evaluation. The focus was the reaction time of the peroneus longus at sudden inversion. There is a constant search for the causes of chronic ankle instability after lateral complex sprain. Three factors are considered the main causes of this impairment: proprioceptive deficit caused by injury to ligament and joint structures; peroneus muscle weakness that can lead to dynamic instability of the joint;

Maryela de Oliveira Menacho graduated in Physical Therapy in 2007 at the Universidade Estadual de Londrina (Brazil). She is currently a M.Sc. student in Physical Education at the same University, with scholarship of CAPES (an organization of the Brazilian federal government under the Ministry of Science of Technology). She is member of the Physical Therapy Assessment and Intervention Research Group and has experience in biomechanics, surface electromyography, spectral analysis, and Pilate’s

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    Maryela de Oliveira Menacho graduated in Physical Therapy in 2007 at the Universidade Estadual de Londrina (Brazil). She is currently a M.Sc. student in Physical Education at the same University, with scholarship of CAPES (an organization of the Brazilian federal government under the Ministry of Science of Technology). She is member of the Physical Therapy Assessment and Intervention Research Group and has experience in biomechanics, surface electromyography, spectral analysis, and Pilate’s method.

    Hugo Maxwell Pereira completed his graduation in Physical Therapy at the Universidade Estadual de Londrina (Brazil) in 2003. He received the Specialist degree in Sports Physical Therapy at the Sport Traumatology Center of the Universidade Federal de Sao Paulo (Brazil) in 2005. He is currently a M.Sc. student in Physical Education at Universidade Estadual de Londrina with scholarship of CAPES. Recently he received a scholarship from Fulbright-CAPES to take his Ph.D. in USA, is member of the Physical Therapy Assessment and Intervention Research Group and the current research interests focus on the neuromuscular aspects of fatigue in relation to sports, aging and rehabilitation.

    Beatriz Ito Ramos de Oliveira graduated in Physical Therapy in 2007 at the Universidade Estadual de Londrina (Brazil). In 2008, she received her Specialist degree in Sports Physical Therapy at the Sport Traumatology Center of the Universidade Federal de Sao Paulo (Brazil). She is currently a M.Sc. student at the Catholic University of Leuven (Belgium) in the Adapted Physical Activity Program. Her current research interest is related to injury prevention programs on athletes with disabilities.

    Laylane Majana Pavão Messias Chagas graduated in Physical Therapy at the Universidade Estadual de Londrina (Brazil) in 2004. In 2008, she completed the Master’s Degree in Osteopathy and Manual Therapy at Universidad Catolica San Anton (UCAM) in Murcia – Spain. She is also specialized in the method Reeducation Posturale Globale (RPG) certified by the Université Internationale Permanente de Thérapie Manuelle of Sain-Mont, France. Her recent project is to work with posture correction in the UK.

    Michelli Toshiko Toyohara graduated in Physical Therapy at the Universidade Estadual de Londrina (Brazil) in 2004. She received her Specialist degree in Orthopedic Physical Therapy at the Medicine School of the Sao Jose do Rio Preto (Brazil) in 2005. She is currently working as a Physical Therapist in a private clinic in Londrina, Brazil.

    Jefferson Rosa Cardoso is a Full Professor at the Department of Physical Therapy of Universidade Estadual de Londrina (UEL), Brazil. He graduated in Physical Therapy in the same University in 1991. His M.Sc. in Health Professionals Education was at Maastricht University, The Netherlands in 1998 and Ph.D. was in Health Sciences at Universidade Federal de Sao Paulo (UNIFESP), Brazil in 2003. He is the coordinator of the Physical Therapy Assessment and Intervention Research Group and his activities are concentrated at the Laboratory of Kinesiologic Electromyography and Kinematic, in the University Hospital of UEL. He has been teaching Epidemiology/Biostatistics and Kinesiologic EMG in two M.Sc. programs at UEL. He is also involved in research activities focusing on EMG, kinematics, fatigue and aquatic physical therapy. He is reviewer of the Cochrane Collaboration and has a productivity scholarship from CNPq.

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