RELATIONSHIP BETWEEN DYNAMIC BALANCE ABILITY AND QUADRATUS FEMORIS IN PEOPLE WITH CHRONIC ANKLE INSTABILITY

H. Kitagawa¹, T. Jiroumaru², K. Yoshikawa¹, T. Hirakawa¹, M. Ikeya³, Y. Hyodo¹, Y. Oka¹

¹Kanazawa Orthopedic & Sports Medicine Clinic, Shiga, Japan, ²Bukkyo University, Kyoto, Japan, ³Biwako Professional University of Rehabilitation, Shiga, Japan

Background: Chronic ankle instability (CAI) causes decreased dynamic balance (Plante et al. 2013). The muscle strength of the hip external rotators (HER) and the Star Excursion Balance Test (SEBT) are associated with dynamic balance in people with CAI (McCann et al. 2017).
Previous study examined the relationship between the thickness of gluteus maximus (as a HER) and SEBT in participants with and without CAI. Participants with CAI showed a shorter distance and thicker gluteus maximus in the forward reach portion of the SEBT than those without CAI (Alexandra et al. 2020). It seems that the gluteus maximus may be activated to compensate for the reduced function of the HER due to CAI.
The hip deep external rotators are the major active hip stabilizers (Retchford 2013). In particular, the quadratus femoris has the longest external moment arm at hip flexion 0-90 degree (Neumann 2010). CAI may cause atrophy of the quadratus, resulting in dysfunction of dynamic balance. The relationship between the thickness of the quadratus femoris and dynamic balance remains unknown.

Purpose: This study was performed to clarify the relationship between the maximum muscle strength of the HER and the muscle thickness of the quadratus femoris and altered muscle thickness during the SEBT in people with CAI.

Methods: Thirteen men (mean age, 29.7 ± 5.6 years) with CAI in a single leg provided informed consent. They performed the SEBT as a dynamic balance assessment of both the affected and unaffected legs in three directions: forward, posterolateral, and posteromedial. These reach distances were normalized by their spina malleolar distance. The isometric maximum muscle strength of the HER was measured using a handheld dynamometer. The participants lay on a plinth in the prone position, and the muscle thickness of the quadratus femoris at relaxation and during maximum contraction were measured using ultrasound imaging. The rate of altered muscle thickness was calculated as follows: relaxation / maximum contraction × 100. Both the muscle strength and thickness were normalized by weight. To compare the difference between CAI-affected side and asymptomatic side, all data were analyzed using the paired t-test. Pearson’s correlation coefficient was used to assess the correlation between the SEBT and the quadratus femoris thickness in both legs. This study was approved by the ethics committee of Kanazawa Orthopedic & Sports Medicine Clinic (Kanazawa-OSMC-2022-005).

Results: Although there was no correlation between the SEBT and the strength of the quadratus femoris between the two sides, the muscle strength of the HER was significantly lower on the CAI-affected side than on the healthy side. No correlation was found between the muscle strength of the HER and the SEBT. There was a positive correlation between the posterolateral reach distance in the SEBT and the change rate of the quadratus femoris (r = 0.56, p < 0.05).

Conclusions: Patients with CAI who have sufficient function of the quadratus femoris may be able to improve their dynamic balance.

Implications: Our findings may contribute to establishing assessment and therapeutic training to improve the dynamic balance of patients with CAI. This may prevent recurrent ankle sprain.

Funding acknowledgements: The authors have no conflicts of interest to declare.

Keywords:
Chronic Ankle Instability
Quadratus femoris
Star Excursion Balance Test

Topics:
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Kanazawa Orthopedic & Sports Medicine Clinic

Committee: The Ethics Review Board of Kanazawa Orthopedic & Sports Medicine Clinic

Ethics number: Kanazawa-OSMC-2022-005