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Sains Malaysiana 49(6)(2020): 1323-1332
http://dx.doi.org/10.17576/jsm-2020-4906-10
Effect of
Neuro-Dynamic Technique on Repetitive Inward Ankle Rolls among Young Malaysian
Athletes - A
Randomized Controlled Trial
(Kesan Teknik Dinamik-Neuro pada Gulungan Dalaman Pergelangan Kaki yang Berulang Kali dalam Kalangan Atlet Muda Warganegara Malaysia - Ujian yang Dikawal Secara Rawak)
Vinodhkumar Ramalingam1*, Viswanath Sundar2 & Saju Joseph2
1Faculty of Health and Life Sciences, INTI International University,
71800 Nilai, Negeri Sembilan, Malaysia
2Department of Biomechanics, National Sports Institute, 53000 Kuala Lumpur, Federal Territory, Malaysia
Received: 14 July 2019/Accepted: 31
January 2020
ABSTRACT
Inversion ankle
sprains (IAS) are the most common injuries in sports and recreational
activities. Incomplete rehabilitation among injured athletes may result in
repetitive inward ankle rolls. Furthermore,
inversion ankle sprain causes damage to the superficial peroneal nerve during
repeated ankle inversion and plantar flexion. This results in positive neurodynamic tests in patients with sprained ankles. The purpose of this study
was to find the effect of the neuro-dynamic technique on repetitive inward ankle
rolls and compare it with standard physiotherapy on dynamic balance, pain
score, peroneal longus, and tibialis anterior muscle
activation response, knee range of motion (ROM), and functional ankle
disability index (FADI) among young Malaysian athletes. Fourteen participants
of age ranging from 17 to 35 years with repeated ankle sprains were recruited
and randomized into Intervention Group A (Neuro-dynamic technique and Standard
Physiotherapy-NDT+SP) and Intervention Group B (Standard Physiotherapy-SP). The
participants of group A received NDT (4*30 s with 1-min rest) consisting of
peroneal nerve mobilization began the day after the baseline and continued
through the week for 3 sessions. In
addition, the participants received standard physiotherapy (pain management and
exercise) whereas the group B participants received only standard
physiotherapy. The participants with repeated IAS were
checked for FADI followed by pain score, dynamic balance (Y-balance),
and knee ROM (using electro-goniometer). The peroneal longus
and tibialis anterior muscle activity response was
tested by Surface Electromyography (sEMG) (Noraxon Myo-Muscle) on the
injured leg. The subjects of the two groups were
tested on selected variables in baseline, mid, post and follow-up
measurements. Repeated Measures Analysis of
Variance (ANOVA) was computed to determine the
interaction effects of time and between-subject factors. ANOVA
results (NDT + SP) indicated that dependent variables FADI (F (1.148, 36) =
4701.14), pain score (F (1.98, 36) = 132.697), dynamic balance (F (1.409, 36) =
16.42), knee ROM (F (1.498, 36) = 62.232), peroneal longus peak activity (F (3,
36) = 25.727), and tibialis anterior peak activity (F
(3, 36) = 17.563) had a significant effect (p<0.05) within the times of
intervention among participants. Based on the post hoc test. FADI, pain
score and knee ROM showed consistent improvement in intervention over the
injured leg. The
findings of this study show improvement in dynamic balance, pain score,
peroneal longus and tibialis anterior muscle
activation response, knee ROM, and FADI in both groups. The neuro-dynamic
technique together with standard physiotherapy intervention shows safe and
similar effects between variables. As part of the ankle rehabilitation
protocol, it also recommends the neurodynamic technique to prevent repetitive IAS.
Keywords: Ankle injury; physiotherapy (techniques); range of motion; surface electromyography; visual analogue pain scale
ABSTRAK
Kecederaan terseliuh songsang pada pergelangan kaki (IAS) adalah kecederaan yang paling biasa dalam aktiviti sukan dan rekreasi. Pemulihan yang tidak menyeluruh dalam kalangan atlet yang tercedera boleh mengakibatkan gulungan dalaman pergelangan kaki yang berulang kali. Tambahan lagi, terseliuh songsang pada pergelangan kaki menyebabkan kerosakan pada saraf peroneal semasa gulungan dalaman pergelangan kaki yang berulang kali dan fleksi kaki. Ini menyebabkan ujian neurodinamik yang positif pada pesakit yang terseliuh pergelangan kaki. Tujuan kajian ini adalah untuk mengetahui kesan teknik neuro-dinamik pada gulungan dalaman pergelangan kaki yang berulang kali dan membandingkannya dengan fisioterapi yang standard pada keseimbangan dinamik, skor nyeri,
peroneal longus dan respon pengaktifan otot tibialis anterior, julat pergerakan lutut (ROM) dan indeks kecacatan pergelangan kaki yang berfungsi (FADI) dalam kalangan atlet muda warganegara Malaysia. Empat belas peserta berumur antara 17 hingga 35 tahun dengan pergelangan kaki terseliuh yang kerap dipilih dan dirawakkan kepada Pengantaraan Kumpulan A (teknik neuro-dinamik dan fisioterapi standard-NDT + SPT) dan Pengantaraan Kumpulan B (fisioterapi standard-SP). Peserta Kumpulan A mendapat NDT
(4*30 s dengan 1-min rehat)
yang terdiri daripada mobilisasi saraf peroneal bermula sehari selepas garis dasar dan berterusan sepanjang minggu selama 3 sesi. Di samping itu, peserta mendapat fisioterapi standard (pengurusan kesakitan dan senaman), manakala peserta Kumpulan B hanya menerima fisioterapi standard. Para peserta dengan IAS yang berulang kali diperiksa diikuti dengan skor nyeri, keseimbangan dinamik (keseimbangan-Y) dan lutut ROM (menggunakan elektro-goniometer). Respons peroneal longus dan pengaktifan otot tibialis anterior diuji dengan menggunakan Permukaan Elektromiografi (sEMG) (Noraxon Myo-Muscle) pada kaki yang cedera. Subjek daripada kedua-dua kumpulan diuji pada pemboleh ubah yang terpilih dalam pengukuran garis dasar, pertengahan, pasca dan susulan. Ukuran Analisis Varians yang Berulang Kali
(ANOVA) telah dikira untuk menentukan kesan interaksi masa dan faktor antara subjek. Keputusan ANOVA (NDT + SP) menunjukkan bahawa pemboleh ubah bersandar FADI (F (1.148,
36) = 4701.14), skor nyeri (F (1.98, 36) = 132.697), keseimbangan dinamik (F (1.409, 36) = 16.42), lutut ROM (F (1.498, 36) = 62.232), aktiviti puncak peroneal longus (F (3, 36) = 25.727) dan aktiviti puncak tibialis anterior (F (3, 36) = 17.563) mempunyai kesan yang signifikan (p<0.05) dalam masa intervensi dalam kalangan peserta. Berdasarkan ujian pasca hoc. FADI, skor nyeri dan ROM lutut menunjukkan peningkatan yang berterusan dalam pengantaraan pada kaki yang cedera. Hasil kajian ini menunjukkan peningkatan keseimbangan dinamik, skor nyeri, respons pengaktifan peroneal longus dan otot tibialis anterior, ROM lutut, dan FADI pada kedua-dua kumpulan. Teknik neuro-dinamik bersama dengan pengantaraan fisioterapi standard menunjukkan kesan yang selamat dan serupa antara pemboleh ubah. Sebagai sebahagian daripada protokol pemulihan pergelangan kaki, teknik neurodinamik juga disyorkan untuk mencegah IAS yang berulang.
Kata kunci: Analog skala sakit boleh nampak; fisioterapi (teknik); julat pergerakan; kecederaan pergelangan kaki; permukaan elektromiografi
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*Corresponding
author; email: vinodh.ramalingam@newinti.edu.my
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