Context Over the past decade, the United States military has taken an interest in addressing soldiers’ spiritual fitness and readiness to help improve their mental health and resiliency. Similar efforts have not been applied within the Reserve Officers’ Training Corps (ROTC) population despite the mental health challenges these college students experience. Objective To examine spiritual readiness, spiritual fitness, and depressive symptoms in ROTC cadets. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants We recruited ROTC cadets from 1 large southeastern university (n = 91 of 315, 28.9% response rate). The ROTC cadets (age = 21 ± 3 years; men = 68, 74.7%; women = 22, 24.2%; missing = 1, 1.1%) were mainly classified as juniors (n = 30, 33.0%) and in Army ROTC (ROTC branch: Army = 69, Air Force = 20, Navy = 2). Main Outcome Measure(s) The survey contained 3 validated instruments used to assess spiritual fitness (the Spiritual Fitness Inventory [SFI]), spiritual readiness (Spiritual Wellbeing Scale [SWBS]), and mental health via depressive symptoms (Patient Health Questionnaire [PHQ-9]). Results were analyzed using descriptive statistics and nonparametric Mann-Whitney U tests to compare belief in God or gods with the dependent measures. A Pearson correlation was calculated to assess the relationship between the SWBS score and PHQ-9 data. Results In total, 85.7% (n = 78/91) of ROTC cadets stated that they believed in God or gods. Overall, the cadets were considered to have average spiritual fitness (mean = 75.04 ± 14.89) and moderate spiritual well-being (mean = 90.46 ± 18.09). The average PHQ-9 score was 4.22 ± 5.25. Individuals who believed in God or gods had higher spiritual readiness (believer = 94.44 ± 16.10, nonbeliever = 67.00 ± 9.35; P ≤ .01). No statistically significant differences were noted for symptoms of depression (believer = 3.38 ± 4.90, nonbeliever = 6.60 ± 6.90; P = .143) or spiritual fitness (believer = 76.12 ± 14.78, nonbeliever = 64.40 ± 12.68; P = .054) in ROTC cadets based on belief status. Conclusions Overall, the ROTC cadets had moderate to average spiritual fitness and readiness, with typical depressive symptoms scores. Spiritual readiness was different for those who believed in God or gods, and existential well-being was significantly correlated with depressive symptoms.

CONTEXT:Student-run health clinics (SRHC) are commonly utilized to provide clinical experiences to students in healthcare education programs as well as healthcare services to a target community. Recent reports on athletic training SRHCs (AT-SRHCs) with a client population of university students, employees and/or community members have reported positive patient outcomes and high patient satisfaction, however there is limited data about the treated conditions, services and value provided by AT-SRHC. OBJECTIVE:To track utilization of athletic training services at a free AT-SRHC. DESIGN:Retrospective chart review from September 2022-May 2024. SETTING:University-based AT-SRHC. PATIENTS:97 patients (52 males, 44 females, 1 not documented; age 32.6±13.7 years, range: 18-65 years old; 50 employees, 47 students). MAIN OUTCOME MEASURES:Data were extracted from an electronic medical record and scheduling software. Variables extracted included patient demographics, appointment numbers, mechanism of injury, injured body part, days since injury, injury diagnosis, injury severity, and common procedural terminology (CPT) codes. Data were analyzed descriptively. RESULTS:Sixty-four percent (226/352) of available appointment sessions were reserved. The 3 most commonly injured body areas were the knee (n=26, 23.9%), shoulder (n=23, 21.1%), and thigh (n=13, 11.9%). The 3 most common diagnoses were sprains/strains (n=51, 46.8%), overuse conditions (e.g. epicondylitis, impingement, tendonitis; n=18, 16.5%), and nonspecific joint pain (n=22, 20.2%). The 3 most common CPT codes were for therapeutic exercise (n=136), athletic training evaluation (n=98), and manual therapy (n=78). Estimates for the total value of services range from $6,901 to $13,498 ($39.89-78.03 per session). CONCLUSIONS:Services at an AT-SRHC were utilized by a small portion of the campus population during its first 2 years of operation. Data provides preliminary insight into AT-SRHC service utilization and value. Additional organizations may benefit from developing an AT-SRHC to provide access to affordable care and student clinical experiences.

Background:Manuscripts discussing return to play (RTP) following ankle surgery are common. However, the definition for RTP and the method by which it is determined remains unclear. The purpose of this scoping review was to clarify how RTP is defined following ankle surgery in physically active patients, to identify key factors informing RTP decision making (such as objective clinical measures), and make recommendations for future research. Methods:A scoping literature review was performed in April 2021 using PubMed, EMBASE, and Nursing and Allied Health databases. Thirty studies met inclusion criteria: original research following ankle surgery reporting at least 1 objective clinical test and documentation of RTP. Data were extracted for study methods and outcomes (RTP definition, RTP outcomes, and objective clinical tests). Results:The scoping review found studies on 5 ankle pathologies: Achilles tendon rupture, chronic lateral ankle instability, anterior ankle impingement, peroneal tendon dislocation, and ankle fracture. RTP criteria were not provided in the majority of studies (18/30 studies). In the studies that provided them, the RTP criteria were primarily based on time postsurgery (8/12) rather than validated criteria. Objective clinical outcome measures and patient-reported outcome measures (PROMs) were documented for each surgery when available. Both clinical outcomes and PROMs were typically measured >1 year postsurgery. Conclusion:In physically active patients who have had ankle surgery, RTP remains largely undefined and is not consistently based on prospective objective criteria nor PROMS. We recommend standardization of RTP terminology, adoption of prospective criteria for both clinical measures and PROMs to guide RTP decision making, and enhanced reporting of patient data at the time of RTP to develop normative values and determine when the decision to RTP is not safe. Level of Evidence:Level IV, scoping review.

Talocrural mobilization with movement (MWM) and fibular MWM are ankle joint mobilization techniques which may treat deficits in ankle dorsiflexion range of motion (DFROM) and balance in individuals with chronic ankle instability (CAI). The purpose of this study was to compare the acute effect of fibular MWM versus talocrural MWM in individuals with CAI. Thirty-nine individuals with CAI were enrolled and randomized to intervention (fibular MWM, talocrural MWM, or control). Baseline DFROM, inversion range of motion, and balance were assessed pre- and postintervention. Only the talocrural MWM group significantly increased DFROM postintervention. There were no significant group differences in inversion range of motion or balance. The results support the use of talocrural MWM, but not fibular MWM, to acutely improve DFROM in individuals with CAI.

Context As part of clinical practice, athletic trainers (ATs) provide immediate management of patients with acute joint dislocations. Management techniques may include on-site closed joint reduction of the dislocated joint. Although joint reduction is part of the 2020 educational standards, currently practicing ATs may have various levels of exposure, knowledge, and skills. Objective To capture AT self-reported knowledge and practice patterns concerning closed joint reductions. Design Cohort study. Setting Online survey (Qualtrics). Patients or Other Participants The survey link was emailed to 5000 certified ATs. A total of 772 responses were completed by certified ATs with clinical practice experience (15.4% response rate). Main Outcome Measure(s) Participants were asked to complete a survey about their practice patterns concerning patients with closed joint reductions, which included questions about the types of closed reductions ATs performed most commonly, the frequency of on-site reduction by ATs, and participants' demographic information. Additionally, the survey addressed the ATs' training and comfort level in performing closed reductions and knowledge of standing orders and the state practice act. Results Ninety percent (n = 694) of ATs reported ever performing a closed reduction (either with or without a physician present), with 10% (n = 78) stating they had never performed a joint reduction. The interphalangeal joint of the finger (73.2% of ATs), shoulder (63.3%), and patella (48.2%) were cited as the 3 most common reductions performed without a physician present. Only 46.5% (n = 359) of ATs indicated receiving training in joint-reduction techniques as part of their precertification athletic training curriculum or program; a greater percentage (64%) said they learned directly from a physician. Fewer than 60% of ATs reported having standing orders related to joint reductions. Conclusions Considering the high percentage of ATs who reported performing closed joint reductions and the low percentage with formal training, further development of joint-reduction training and standing orders is warranted.

Controlled research has shown that a single-exercise wobble-board intervention is effective at reducing symptoms and increasing function in patients with chronic ankle instability. However, the effectiveness of this protocol has not been documented in a realistic intercollegiate athletics environment. Eight intercollegiate athletes with chronic ankle instability participated in an 8-week (3 sessions/wk) wobble-board intervention. In a realistic environment, this simple intervention was feasible to implement and resulted in meaningful improvements in patient-reported stability for more than half of the patients (5 of 8) but only improved the global rating of function and pain for a minority of the patients (2 of 8 and 3 of 8, respectively). Not all patients experienced equal symptom reduction; however, no new ankle sprains occurred during the intervention.

Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal joints. Athletic trainers are responsible for managing acute joint-dislocation injuries, which may include performing closed-reduction techniques when appropriate. To achieve optimal patient outcomes, the clinician should be formally trained and skilled in performing various techniques and familiar with the evidence supporting the selection of each technique. In this clinical review, we outline general reduction procedures and then summarize and synthesize the existing literature on common closed-reduction techniques for glenohumeral-, patellofemoral-, and interphalangeal-joint dislocations. When appropriate, the content has been adapted to be specific to the athletic trainer's scope of practice.

Context International topics in athletic training are gaining recognition. Particularly interesting are opportunities for athletic training students to gain international experiences and develop cultural competence through study abroad. However, little is known about current international experience opportunities for these students. Objective To identify international experience opportunities for athletic training students, investigate student and faculty participation, and describe characteristics of institutions and programs offering such experiences. Design Survey. Setting Online. Patients or Other Participants All directors of Commission on Accreditation of Athletic Training Education–accredited professional athletic training programs were recruited. The response rate was 41.9% (163/389). Data Collection and Analysis An e-mail soliciting participation was sent in January 2019. The online survey had 4 sections: (1) questions about athletic training–related international experiences, (2) questions about discipline-related international experiences, (3) questions about athletic training faculty or student participation, and (4) demographic questions about the program or institution. Data were analyzed descriptively. The characteristics of programs offering athletic training–related international experiences were compared with programs offering discipline-related international experiences using χ2 tests for degree level, institution type, and athletic division. Results Twenty-nine programs (17.8%) offered athletic training–related international experiences and 68 programs (41.7%) offered discipline-related experiences. Private universities were more likely to offer an athletic training–related experience, and public universities more likely to offer a discipline-related experience (χ2 = 4.197, df = 1, P = .04). There were no other differences between institution types, program degree levels, or athletic divisions (all P > .05). Some programs reported no recent athletic training student (44%) or athletic training faculty (58%) participation in any international experience. Conclusions A minority of programs currently offer either athletic training–related or discipline-related international experiences. Characteristics of available programs vary widely. To keep pace with professional globalization, future work should identify ways to develop international experiences.

Focused Clinical Question: Does an acute bout of foam rolling (FR) help reduce delayed onset muscle soreness (DOMS)-related muscle soreness or pain in the first 0–72 hr? Clinical Bottom Line: There is moderate quality evidence to support the use of FR to reduce DOMS-related muscle soreness or pain at 24, 48, and 72 hr post DOMS. There is no evidence to support FR to reduce DOMS-related muscle soreness immediately after physical activity, or that FR before physical activity can prevent muscle soreness or pain.

ContextInternational experiences (eg, study abroad, international service projects) have many benefits, including increasing cultural sensitivity, that can enhance athletic training student development. However, international experiences directly related to athletic training may be limited or hard to identify.ObjectiveTo outline current and upcoming resources available through the work of the National Athletic Trainers' Association International Committee (IC) related to athletic training international experience opportunities.BackgroundThe IC collaborated with the Commission on Accreditation of Athletic Training Education to ask about international experiences available in accredited programs in the 2016–2017 annual report.SynthesisData were analyzed from all accredited programs (N = 410).ResultsData indicated that athletic training–specific international experiences are available at a lower rate (0%–10.6% of programs) than general university-sponsored international experiences (15.4%–84.4% of programs). Information on athletic training student and faculty involvement is limited; at least 1 student participated in 39.5% to 61.5% of programs, and at least 1 faculty member participated in 15.4% to 23.4% of programs.Recommendation(s)Future research should identify and describe current international experience opportunities, as well as identify strengths, challenges, and priorities for developing and expanding international opportunities for athletic training students.Conclusion(s)With the globalization of athletic training, emphasis on providing culturally competent care, and undergraduate opportunities created by the degree transition, it seems an opportune time to encourage international experiences for athletic training students. Current and future IC resources aim to provide guidance to students and faculty interested in international experiences.

Context Spirituality is an important component of holistic health care. While attitudes of athletic training program directors and clinicians toward spirituality are documented, the attitudes and practices of athletic training students are unknown. Objective To describe the beliefs and behaviors of athletic training students regarding spirituality and spiritual care. Design Repeated measures cohort. Setting Online survey. Patients or Other Participants All athletic training students (n = 33) enrolled in an accredited athletic training program at a private religiously affiliated university were invited to participate. The response rate was 78.8% (males = 7, females = 19, age = 20.3 ± 2.1). Intervention(s) An email invitation to complete the online survey was sent in September and April of the same academic year. The online survey included demographic data, the Spiritual Perspectives Scale (SPS), modified Spiritual Care Perspectives Scale (mSCPS), and modified Spiritual Care Therapeutics Scale (mSCTS). Main Outcome Measure(s) Level of agreement on the mSCPS items and therapeutic action frequency on the mSCTS were recorded and compared between fall and spring using paired t tests. For both scales, all item averages were organized from lowest to highest. SPS summary score was calculated. Results The mSCPS items with the highest and lowest agreement, respectively, were “Relationships with others are important to patient's spiritual health” and “Spiritual care is only for religious persons.” The mSCTS items with the highest and lowest frequencies, respectively, were “After completing a task, remained present just to show caring” and “Offered to pray with a patient.” Only 3 mSCPS items changed significantly over time, whereas 8 mSCTS items changed significantly (all P < .05). The SPS did not change over time (P = .848; fall = 4.74 ± 0.96, spring = 4.73 ± 0.87). Conclusions Athletic training students in this pilot study believe that spirituality is an important part of health care; however, athletic training students preferred items in which patients took the lead in raising spiritual issues. Therapeutic actions that support a patient's spiritual well-being without being openly religious were preferred.

Facemask removal is an emergency skill to gain airway access in football athletes with potential cervical injury. While facemask removal performance has been reported in experienced athletic trainers, initial skill acquisition is undocumented. Therefore, the purpose was to document skill development in novice athletic training students. After instruction, student performance was documented during six consecutive facemask removal trials. From first to last trials, there were significant improvements in time, confidence, and rating of perceived exertion. Induced head motion did not improve. While overall skill performance began to approximate previously reported norms, improvements in success rate, consistency, and motion are needed.

Original Research freePreliminary Analysis of the Effects of Noise Stimulation on Joint Reposition Sense in Ankles With and Without Chronic Instability Scott E. Ross, PhD, ATC, , , PhD, ATC Shelley W. Linens, PhD, ATC, , , PhD, ATC Cynthia J. Wright, PhD, ATC, , and , PhD, ATC Brent L. Arnold, PhD, ATC, , PhD, ATC Scott E. Ross, PhD, ATC , Shelley W. Linens, PhD, ATC , Cynthia J. Wright, PhD, ATC , and Brent L. Arnold, PhD, ATC Athletic Training & Sports Health Care, 2017;10(1):20–30Published Online:July 03, 2017https://doi.org/10.3928/19425864-20170703-02PDFAbstract ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreAbstractPurpose:To determine whether stochastic resonance stimulation improved inversion joint reposition sense.Methods:The inversion joint reposition sense protocol required participants with and without chronic ankle instability (the chronic ankle instability and stable ankle groups, respectively) to reproduce a target angle with and without stochastic resonance stimulation using random subsensory mechanical white noise. A secondary analysis placed participants into subgroups to interpret the stochastic resonance stimulation effects.Results:In the primary analysis, stochastic resonance stimulation did not improve reposition sense (P > .05). However, non-statistically significant results may be due to washout effects from combining participants who responded to stochastic resonance stimulation (positive response subgroup) with those who had significant decrements with stochastic resonance stimulation (negative response subgroup). In the secondary analysis, stochastic resonance stimulation produced small to moderate improvements in the positive response subgroup (Cohen's effect size d: 0.18 to 0.64) and caused small to moderate decrements in the negative response subgroup (Cohen's effect size d: −0.33 to −0.76).Conclusions:Ranges in response warrant further investigation prior to implementing stochastic resonance stimulation for correcting joint reposition sense errors.[Athletic Training & Sports Health Care. 2018;10(1):20–30.]IntroductionInversion ankle sprains occur commonly in sport1 and prolonged symptoms are reported frequently in individuals with chronic ankle instability.2–4 Chronic ankle instability is more accurately defined as ankles with repetitive episodes of "giving way" or perceived instability that lead to additional sprains.5–7 Several functional inadequacies have been proposed as causal factors of chronic ankle instability and include impairments in proprioception, kinesthesia, neuromuscular control, strength, and balance.8 Correcting these deficits is paramount to reducing the incidence of sprains, but rehabilitation alone may not improve functional inadequacies to an extent that decreases sprains or enhances joint stability.9 Consequently, a complimentary therapeutic intervention may be required to enhance treatment effects for chronic ankle instability.Joint movement and position (ie, proprioception) are impaired with chronic ankle instability,8,10,11 but the exact source of these deficiencies is still unknown.8 Active joint reposition sense protocols for the foot and ankle have identified these proprioceptive deficits in patients with chronic ankle instability, and this identification leads to the potential to assess the inability of both articular mechanoreceptors and muscle spindles to relay joint position feedback.11–14 However, the clinical significance of miniscule statistical differences of 1 or 2 degrees between unstable and stable ankles that are reported in the literature on this laboratory measure has been questioned.15 To demonstrate the clinical significance, researchers entered these degrees of joint position deficits into a computer model and their results indicated that a 1-degree difference in reproducing joint angles for individuals with and without chronic ankle instability is enough of a disparity to cause individuals with chronic ankle instability to present 8 to 10 degrees of joint positioning error during a functional movement.15 This inadequate position of the foot could generate enough rotational force at ground contact to predispose the ankle to an inversion sprain.15Consequently, correcting proprioceptive impairments may be a critical component for the rehabilitation and prevention of reoccurring sprains. Evidence in the literature does not provide strong support for correcting proprioception (as measured by joint reposition sense) through traditional rehabilitation.16–22 Stochastic resonance stimulation may serve as a complementary therapy for chronic ankle instability because it may facilitate the activation of mechanoreceptors.23–29 Stochastic resonance stimulation introduces subsensory mechanical or electrical noise through the skin to improve the detection and transmission of weak sensory signals.30,31 In conjunction with rehabilitation and when used as a stand-alone modality, stochastic resonance stimulation has been proven to improve balance and force sense (ie, the ability to reproduce a muscle force) in ankles with chronic instability.23–29 To enhance balance and force sense, stochastic resonance stimulation acts on muscle spindles to enhance sensory feedback and contractions necessary for maintaining balance and replicating forces.28,29 Although balance and force sense quantify sensorimotor system functions, these measurements may not isolate proprioception as well as a joint reposition sense assessment does. Additionally, joint reposition errors on this laboratory measure for proprioception may provide insight into the pathological positioning errors that may occur with chronic ankle instability during gait.15 No evidence currently exists to demonstrate that stochastic resonance stimulation can improve proprioception as measured by joint reposition sense.The purpose of the current study was to examine the effects of stochastic resonance stimulation on improving inversion joint reposition sense in patients with and without chronic ankle instability. A case–control study with an embedded crossover design was implemented to examine the effects of stochastic resonance stimulation on joint reposition sense. Our hypothesis was that stochastic resonance stimulation would improve proprioception as measured by joint reposition sense because receptors in the sensorimotor system responsible for position sense have reacted to this stimulation to produce benefits in balance. A secondary purpose was to study the effects of stochastic resonance stimulation on joint reposition sense when participants were divided into two subgroups (positive and negative response) as determined by improvements or decrements, respectively, resulting from stochastic resonance stimulation in the constant error measurement for joint reposition sense.MethodsParticipantsApproval for this investigation was granted by Viriginia Commonwealth University's Institutional Review Board and written informed consent was obtained from the participants. Twelve participants with chronic ankle instability (chronic ankle instability group; 6 men, 6 women; height: 174 ± 8 cm; weight: 69 ± 10 kg; age: 23 ± 3 years) and 12 participants with stable ankles (stable ankle group; 6 men, 6 women; height: 170 ± 7 cm; weight: 64 ± 10 kg; age: 22 ± 2 years) were matched by limb dominance. Dominance was operationally defined as the limb used to kick a ball. Participants also took part in other published research investigations.28,29 An inclusion criterion for all participants was to exercise a minimum of 3 hours per week. Inclusion criteria for the chronic ankle instability group were a self-reported history of ankle sprains and at least two occurrences of giving way sensations within the year prior to enrollment in the study. Participants did not have an acute ankle sprain injury, which was an exclusion criterion for participation. Inclusion criteria for the stable ankle group were no history of giving way at the ankle and no history of any lower extremity injuries. Other participant characteristics that were collected but not used for inclusion or exclusion criteria included functional perceptions, mechanical instability, history of ankle sprains, and giving way episodes. The chronic ankle instability group had greater functional perception impairments on the Ankle Joint Functional Assessment Tool (average score: chronic ankle instability group = 32, stable ankle group = 22).28 One-half of the chronic ankle instability group had mechanical instability (assessed manually with anterior drawer and talar tilt clinical tests).28 On average, participants with chronic ankle instability reported a history of 3.5 ankle sprains and 2 giving way episodes per month.28InstrumentationA customized stochastic resonance stimulation device generated random subsensory mechanical white noise. This signal was sent to vibrating elements known as tactors (C-2 Tactors; Engineering Acoustics, Inc., Casselberry, FL) to transmit mechanical noise into the lower leg. For joint reposition sense testing, a custom-designed electric goniometer measured foot inversion/eversion angular displacement and a 270-degree single-turn 10 KOhm potentiometer (Honeywell, Morris Plains, NJ) permitted the goniometer to measure angular position to a tenth of a degree.Sensory Threshold and OptimizationTo determine the intensity level to use for stochastic resonance stimulation during inversion reposition sense, participants' sensory threshold and optimal stimulation intensity values were determined with a balance protocol as part of another research investigation.28 In short, a portable stochastic resonance stimulation unit was worn around participants' waists and four tactors were held in place atop a neoprene sleeve midway between the origin and insertion of the gastrocnemius (one tactor on each head), peroneus longus, tibialis anterior, and tibialis posterior muscles. Each participant then performed quiet double-leg balance while random subsensory mechanical white noise was applied (the stochastic resonance stimulation condition) and the intensity was increased so that all tactors began vibrating at a sensory level that was felt by the participant. The intensity level was then turned down so that the vibration was just barely felt. This intensity represented the given participant's sensory threshold and was entered into a spreadsheet to compute four stochastic resonance stimulation noise intensity levels (25%, 50%, 75%, and 90%) of the sensory threshold. The tactors were not assessed separately and intensity was adjusted based on the sensation that was felt last under any one of the tactors. Typically, the threshold was based on the last tactor felt by participants.Next, participants performed 20 seconds of quiet double-leg balance without random subsensory mechanical white noise (the no stochastic resonance stimulation condition) and each of the four intensities was set at a percentage of sensory threshold for each participant (25%, 50%, 75%, and 90%). All tactors vibrated at the same intensity as with the stochastic resonance stimulation condition. The order of testing was counterbalanced and the results of three trials for each intensity under both conditions were assessed. The optimal stochastic resonance stimulation intensity was defined as the intensity level (25%, 50%, 75%, or 90%) that produced the greatest percentage change in improvements in double-leg balance as compared to the no stochastic resonance stimulation condition.28 Improvements were defined as decreases in center-of-pressure velocity. The optimal intensity was customized for each participant and used as the stochastic resonance stimulation intensity during the current study. Following optimization, participants completed single-leg balance testing and force sense testing protocols as part of other studies.28,29 An overview of the sensory threshold and optimization protocols and the results of balance (double- and single-leg) and force sense assessments are reported in previous publications.28,29Inversion Joint Reposition Sense TestThe inversion joint reposition sense protocol required participants to reproduce a joint angle with and without stochastic resonance stimulation. The order of testing was determined by a randomized block design.Participants laid in the supine position on a table with their hips and knees slightly flexed to approximately 30 and 60 degrees, respectively. The range of motion of the hip was limited with a bolster between the legs to block femoral internal rotation. The knee was secured with a belt that was fastened to the table. Participants were barefoot during testing with their eyes closed and tactors were placed in the same location as for the sensory threshold/optimization procedure. An electric goniometer and footplate device held the foot in 15 degrees of plantar flexion to allow for only inversion and eversion of the foot.10 The foot was actively moved to 5 degrees from the end range of motion of inversion of the foot; this position was the target angle.10 For each trial, a block was placed at the target angle and participants moved their foot until the footplate hit the block, clicked a hand-held trigger to mark the data file, and concentrated on the position for 15 seconds.10 The foot was then moved back to the starting position, the block was removed, and participants were instructed to reproduce the target angle (reproduction angle) and hold their foot in place once they reached this angle. Participants then clicked a hand-held trigger to mark in the data file the point at which they believed that the target angle was reproduced.Participants performed two practice trials and three test trials with and without stochastic resonance stimulation with a 60-second period of rest between trials and conditions. Both conditions were performed with the tactors on participants; participants were blind to each test condition because stochastic resonance stimulation is subsensory.Data Collection and ProcessingThe potentiometer on the electric goniometer recorded voltage, which was then converted to angular position (1 V = 22.30 degrees). Joint reposition sense data were acquired and analyzed with a laptop computer and BIOPAC MP150 AcqKnowledge software (version 3.7.2; BIOPAC Systems, Inc., Goleta, CA). Only the last second of the target angle and the first second of the reproduction angle (which occurred after participants clicked the trigger) were used for analysis.10Data AnalysisAll statistical tests were computed in SPSS software (version 20.0; IBM Corporation, Armonk, NY). The alpha level was set a priori at a P value of .05 or less to indicate statistical significance. Three calculations were used for outcome measures related to joint position sense: accuracy, overall performance, and consistency. Accuracy was defined by constant error, which was the difference between the target angle and reproduction angle. The constant error measure assessed both the magnitude and direction of error (negative values indicated undershooting the target angle and positive values indicated overshooting the target angle). Therefore, the measure provided critical information on the direction of deficits. However, when averaging trials together, this measure has the potential to have a washout effect. Thus, it was also critical to assess overall performance with absolute error, which was defined as the absolute values of each trial error. This measure assessed only the magnitude of reposition sense errors without defining the direction of error, thus eliminating washout effects when averaging trials. Variability, or the variable error, was the standard deviation of each trial, capturing participants' ability to precisely reproduce joint angles. For each dependent measure, the average of three trials for both stochastic resonance stimulation conditions were used for data analysis.To analyze the main purpose of this study, a multivariate analysis of variance (ANOVA) test with one within factor (condition: stochastic resonance stimulation, no stochastic resonance stimulation) and one between factor (group: chronic ankle instability, stable ankle) was used to examine joint position sense errors (absolute error, variable error, and constant error). The results of this analysis were statistically insignificant, and data were then explored by examining participants' individual responses to stochastic resonance stimulation. Subsequently, improvements (percentage of increase with over without stochastic resonance stimulation) and decrements (percentage of decrease with over without stochastic resonance stimulation) were computed for all dependent measures.Trends in the data indicated a potential washout effect from participants who had large decrements with stochastic resonance stimulation and participants who had a range of improvements (moderate to large). Thus, two subgroups were determined and participants were then categorized into these two subgroups (positive and negative response) based on the improvement or decrement, respectively, with the constant error measure. The positive response subgroup was defined as participants who enhanced constant error values with stochastic resonance stimulation (positive percent improvement with vs without stochastic resonance stimulation). The negative response subgroup was defined as participants who did not enhance constant error values with stochastic resonance stimulation (negative percent improvement with vs without stochastic resonance stimulation). The constant error measure was selected because negative and positive values demonstrate the directionality of the error and the distance away from the zero-point (ie, the target angle). The measure was used to define how accurate participants were in reproducing the angle by accounting for both the magnitude and direction (undershoot and overshoot).A second multivariate ANOVA test with one within factor (condition: stochastic resonance stimulation, no stochastic resonance stimulation) and two between factors (group: chronic ankle instability, stable ankle; response: positive response, negative response) was then used to examine the two additional joint reposition sense errors (absolute error and variable error). Constant error was not used in the analysis because it defined the groups. Tukey post-hoc testing was used to analyze statistically significant interactions without versus with stochastic resonance stimulation. Finally, effect size values were computed using Cohen's d (mean difference divided by pooled standard deviation). Effect size values of 0.20, 0.50, and 0.80 were considered low, medium, and high, respectively.32ResultsThe first multivariate ANOVA test indicated that no statistically significant results were found for the main effect for condition (Wilk's lambda = 0.82; F(3,20) = 1.52; P = .24), condition–group interaction (Wilk's lambda = 0.82; F(3,20) = 1.45; P = .26), or group (Wilk's lambda = 0.92; F(3,20) = 0.55; P = .65). At the individual level, participants had improvements with stochastic resonance stimulation ranging between 9% and 132%, whereas decrements with stochastic resonance stimulation ranged between −6% and −706% (Table 1). In using the constant error measure to define response, there were 9 and 3 participants in the positive and negative response subgroups, respectively, within the chronic ankle instability group, and there were 6 and 6 participants in the positive and negative response subgroups, respectively, within the stable ankle group.Table 1 Improvements and Decrements Associated With Stochastic Resonance StimulationParticipantsResponseAEVECEChronic ankle instability group 1Positive48%42%86% 2Positive55%52%56% 3Positive52%45%82% 4Negative−46%61%−87% 5Positive9%−41%22% 6Negative−170%−289%−229% 7Positive−83%−189%99% 8Positive11%40%11% 9Positive56%−16%56% 10Negative−200%−149%−706% 11Positive15%−29%15% 12Positive33%16%33%Stable ankle group 1Positive68%66%96% 2Positive14%−13%14% 3Positive−46%−97%132% 4Positive23%26%23% 5Negative−16%15%−16% 6Positive17%−117%17% 7Negative−141%−94%−286% 8Positive60%63%58% 9Negative−21%−43%−6% 10Negative48%58%−223% 11Negative−43%23%−79% 12Negative−73%−30%−150%AE = absolute error; VE = variable error; CE = constant error; chronic ankle instability group = participants with chronic ankle instability; stable ankle group = participants without chronic ankle instabilityFor the second multivariate ANOVA, no statistically significant within-factor results were found for the main effect for condition (Wilk's lambda = 0.92; F(2,19) = 0.80; P = .46), condition–group interaction (Wilk's lambda = 0.86; F(2,19) = 1.60; P = .27), or condition–group–response interaction (Wilk's lambda = 0.93; F(2,19) = 0.71; P = .51). However, a significant condition–response interaction (Wilk's lambda = 0.37; F(2,19) = 15.98; P < .001) was found. Tukey post-hoc testing revealed that stochastic resonance stimulation improved absolute error values in the positive response subgroup (without vs with stochastic resonance stimulation). The negative response subgroup trended toward having absolute error deficits with stochastic resonance stimulation (Tukey honest significance critical difference = 0.66; without vs with stochastic resonance stimulation difference = 0.63). No significant within-participant comparisons were found for the variable error dependent measure. Finally, no statistically significant between-factor results were found for the main effect for group (Wilk's lambda = 0.96; F(2,19) = 0.43; P = .66), response (Wilk's lambda = 0.84; F(2,19) = 1.82; P = .19), or group–response interaction (Wilk's lambda = 0.94; F(2,19) = 0.60; P = .56).The means, standard deviations, and 95% confidence intervals for the main effects for condition and condition–group interaction are presented in Tables 2–3, respectively (data for absolute error and variable error are representative of both multivariate ANOVA tests). Table 4 presents data associated with the condition–response interaction from the second multivariate ANOVA.Table 2 Inversion Joint Reposition Sense for the Main Effect With and Without Stochastic Resonance StimulationaMain EffectWithout Stochastic Resonance StimulationWith Stochastic Resonance StimulationEffect Size (Within)Absolute error (degrees)2.31 ± 1.16 (1.90 to 2.72)2.10 ± 0.92 (1.78 to 2.42)0.20Variable error (degrees)1.82 ± 1.02 (1.46 to 2.18)1.85 ± 1.02 (1.49 to 2.21)−0.03Constant error (degrees)0.58 ± 2.31 (−0.23 to 1.39)0.70 ± 1.93 (0.02 to 1.38)−0.06aValues are presented as mean ± standard deviation (95% confidence interval).Table 4 Inversion Joint Reposition Sense With and Without Stochastic Response Stimulation by Response InteractionaMain EffectWithout Stochastic Response StimulationWith Stochastic Response StimulationEffect Size (Within)Absolute error (degrees) Positive response2.77 ± 1.07 (2.28 to 3.26)b,c2.06 ± 1.06 (1.58 to 2.54)b0.64 Negative response1.53 ± 0.90 (0.97 to 2.09)c,d2.16 ± 0.66 (1.75 to 2.57)d−0.76Variable error (degrees) Positive response1.89 ± 1.05 (1.41 to 2.37)1.72 ± 0.88 (1.32 to 2.12)0.18 Negative response1.69 ± 1.03 (1.05 to 2.33)2.06 ± 1.25 (1.29 to 2.84)−0.33aValues are presented as mean ± standard deviation (95% confidence interval).bAbsolute error of the positive response group with stochastic resonance stimulation was significantly lower than without stochastic resonance stimulation.cAbsolute error negative response group with stochastic resonance stimulation was significantly lower than the positive response group without stochastic resonance stimulation.dAbsolute error of the negative response group without stochastic resonance stimulation trended toward being significantly lower than with stochastic resonance stimulation (Tukey honest signficance critical difference = 0.66; without vs with stochastic resonance stimulation difference = 0.63).Table 3 Inversion Joint Reposition Sense With and Without Stochastic Resonance Stimulation by Group InteractionaMain EffectWithout Stochastic Resonance StimulationWith Stochastic Resonance StimulationEffect Size (Within)Absolute error (degrees) Chronic ankle instability group2.18 ± 1.10 (1.61 to 2.75)2.04 ± 0.93 (1.56 to 2.52)0.13 Stable ankle group2.43 ± 1.25 (1.78 to 3.08)2.15 ± 0.94 (1.66 to 2.64)0.26Variable error (degrees) Chronic ankle instability group1.56 ± 0.92 (1.08 to 2.04)1.94 ± 1.39 (1.22 to 2.66)−0.33 Stable ankle group2.08 ± 1.10 (1.51 to 2.65)1.76 ± 0.47 (1.52 to 2.00)0.38Constant error (degrees) Chronic ankle instability group0.06 ± 2.26 (−1.11 to 1.23)0.22 ± 1.89 (−0.76 to 1.20)−0.08 Stable ankle group1.10 ± 2.34 (−0.11 to 2.31)1.18 ± 1.93 (0.18 to 2.18)−0.04chronic ankle instability group = participants with chronic ankle instability; stable ankle group = participants without chronic ankle instabilityaValues are presented as mean ± standard deviation (95% confidence interval).Figures 1–3 present the effect-size analysis on the condition–group–response interaction. In this effect-size analysis, the positive response subgroups within the chronic ankle instability and stable ankle groups had moderate effect sizes, indicating that stochastic resonance stimulation enhanced absolute error, and the negative response subgroups within both ankle groups had small to large decrements associated with the stochastic resonance stimulation condition (Figure 1). Additionally, the negative response subgroups in both ankle groups had smaller absolute error values than the positive response subgroups in both ankle groups during the no stochastic resonance stimulation conditions (positive vs negative response subgroups within the chronic ankle instability groups effect size = 1.55; positive vs negative response subgroups within the stable ankle group effect size = 0.93).Figure 1. Absolute error for joint reposition sense (primary vertical axis) and effect size values (secondary vertical axis). The gray bars represent results obtained under the no stochastic resonance stimulation condition and the white bars represent results obtained under the stochastic resonance stimulation condition. The black circles represent the effect size value for the difference between conditions. CAI-R = positive response subgroup within the chronic ankle instability group; CAI-NR = negative response subgroup within the chronic ankle instability group; Stable-R = positive response subgroup within the stable ankle group; Stable-NR = negative response subgroup within the stable ankle groupFigure 2. Variable error for joint reposition sense (primary vertical axis) and effect size values (secondary vertical axis). The gray bars represent results obtained under the no stochastic resonance stimulation condition and the white bars represent results obtained under the stochastic resonance stimulation condition. The black circles represent the effect size value for the difference between conditions. CAI-R = positive response subgroup within the chronic ankle instability group; CAI-NR = negative response subgroup within the chronic ankle instability group; Stable-R = positive response subgroup within the stable ankle group; Stable-NR = negative response subgroup within the stable ankle groupFigure 3. Constant error for joint reposition sense (primary vertical axis) and effect size values (secondary vertical axis). The gray bars represent results obtained under the no stochastic resonance stimulation condition and the white bars represent results obtained under the stochastic resonance stimulation condition. The black circles represent the effect size value for the difference between conditions. CAI-R = positive response subgroup within the chronic ankle instability group; CAI-NR = negative response subgroup within the chronic ankle instability group; Stable-R = positive response subgroup within the stable ankle group; Stable-NR = negative response subgroup within the stable ankle groupFor variable error, no effect was present for the positive response subgroup within the chronic ankle instability group and a moderate effect size was displayed by the positive response subgroup within the stable ankle group, which indicated that stochastic resonance stimulation enhanced variable error (Figure 2). The negative response subgroup within the chronic ankle instability group had a large decrement (negative effect size) and the negative response subgroup within the stable ankle group had a small positive effect size that demonstrated slight improvements with stochastic resonance stimulation (Figure 2). Similar to the absolute error results, the negative response subgroups in both ankle groups had less variable error values than the positive response subgroups in both ankle groups during the no stochastic resonance stimulation condition (positive vs negative response subgroups within the chronic ankle instability group effect size = 0.46; positive vs negative response subgroups within the stable ankle group effect size = 0.30).Although we did not include the constant error measure in the second multivariate ANOVA, exploring these data indicated that no effects were present for the positive response subgroups within the chronic ankle instability and stable ankle groups. However, the negative response subgroups within both ankle groups had small decrements associated with the stochastic resonance stimulation condition (Figure 3). In comparing the ankle groups during the no stochastic resonance stimulation condition, the negative response subgroup within the chronic ankle instability group did not differ from its respective positive response subgroup (effect size = −0.04) and the negative response subgroup within the stable ankle group had a smaller constant error value than its respective positive response subgroup (effect size = 0.81).DiscussionWe did not find a statistically significant effect with

BACKGROUND:Participation in collegiate American football is physically demanding and may have long-term health implications, particularly in relation to cardiovascular and neurological health. National Collegiate Athletic Association (NCAA) Division III (DIII) football players are a relatively unstudied population, particularly in terms of their dietary habits and knowledge. The aim of the present study was to descriptively evaluate the dietary intake of DIII football players including a subset of linemen and assess the nutritional knowledge and sources of information of these athletes.METHODS:The study sample was 88 DIII football players including a subset of nine linemen. All participants completed a food frequency questionnaire, and a nutritional knowledge questionnaire that included a quiz and questions about their main sources of nutrition information. Heights and body masses were also recorded. The linemen submitted written 3-day diet records for assessment of their dietary intake.RESULTS:Of the 88 participants, >50% reported consuming starches/grains, meat and dairy daily, but <50% reported consuming fruits and vegetables daily. Protein powders were the most commonly used supplements (33% reported daily use). Compared to dietary recommendations, linemen consumed high amounts of total fat, saturated fat, dietary cholesterol, sodium, and potassium, but were low in carbohydrates, fiber, and essential fats. The mean nutrition knowledge quiz score for the 88 participants was 55.2%. Those who had taken a nutrition or health course in college scored significantly higher on the quiz than those who had not. Participants reported relying primarily on coaches, websites, and athletic trainers (ATs) for nutritional guidance; ATs were the most trusted source.CONCLUSIONS:DIII football players had dietary habits that may both mitigate and increase their risk of chronic diseases. These athletes have room to improve their nutrition knowledge. Their reliance on athletic team staff for nutrition guidance highlights the importance of nutrition education for both athletes and staff and the potential role of a registered dietitian nutritionist.

Objective: To establish the minimal detectable change (MDC) and minimal clinically important difference (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI).Design: Experimental cohort.Setting: Laboratory.Participants: A convenience sample of individuals with CAI (N=50; 12 men; 38 women; episodes of giving way, 5.84 +/- 12.54mo). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score <= 25.Interventions: Participants completed demographic information, an injury history questionnaire, and the CAIT.Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants recompleted the CAIT and recorded their global rating of change (GRC).Main Outcome Measures: Dependent variables were pre- and postintervention scores on the CAIT and postintervention GRC. The MDC with 95% confidence interval was calculated. A receiver operating characteristic (ROC) curve identified the optimal CAIT cut point (MCID) between improved and unimproved individuals on the basis of their GRC. The area under the curve was used to identify a significant ROC curve (alpha=.05).Results: The average CAIT score preintervention was 16.8 +/- 5.6, and postintervention, it was 20.0 +/- 5.2. Thirty-one participants (62%) rated themselves as improved on the GRC scale, whereas 19 (38%) were not improved. The ROC curve was significant (area under the curve,.797; P=.001), indicating that the CAIT change score significantly predicted clinical status. The MDC was 3.08, and the MCID was >= 3 points.Conclusions: The CAIT has an MDC and MCID of >= 3 points. When CAIT scores are used to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement (C) 2017 by the American Congress of Rehabilitation Medicine

Objectives: Concerns about the long-term cardiovascular health implications of American football participation have been investigated at the professional and Division I levels, but limited research is available at the less resourced Division III level. Therefore, the objective was to assess the cardiovascular disease risk profile of NCAA Division III intercollegiate football athletes. Methods: Eighty-nine varsity football athletes (age = 19.6 +/- 1.7 years, height = 1.81 +/- 0.07m, weight = 92.7 +/- 16.2kg; n = 21 linemen, n = 68 non-linemen) at a private Division III university volunteered to participate. During a preseason pre-participation physical examination, all participants completed a health history screening form (to assess personal and family history of cardiac related pathologies), and were assessed for height, weight, body mass index (BMI), and blood pressure (BP). Linemen only additionally gave a blood sample for fasting blood glucose and cholesterol analysis, and were assessed for waist and hip circumference, metabolic syndrome, and percent body fat (%BF). These measures were reported as averages and frequencies of elevated cardiovascular. Independent t-tests compared linemen to non-linemen, all other data was presented descriptively. Results: On average, linemen were significantly taller, heavier, had a higher BMI and higher systolic BP than non-linemen (all P < 0.05); there was no difference in diastolic BP between the groups (P = 0.331). The average anthropometric and cardiac risk characteristics for linemen were largely within normal ranges, however analyzed individually, a substantial number of participants were at elevated risk (BMI >= 30 = 85.7%, %BF >= 25 = 71.4%, waist circumference >= 1 = 42.9%, hypertension = 9.5%, high density lipoproteins <40mg/ dL = 42.9%, and triglycerides >= 150mg/ dL = 6.7%; metabolic syndrome prevalence = 19%). Conclusions: Similar to research in elite athletics, linemen at a single Division III university have elevated cardiovascular disease risk. Physicians and other healthcare providers should consider this elevated risk during pre-participation physical examinations and in planning educational or dietary programming targeted to promoting cardiovascular health.

CONTEXT:It has been proposed that altered dynamic-control strategies during functional activity such as jump landings may partially explain recurrent instability in individuals with functional ankle instability (FAI).OBJECTIVE:To capture jump-landing time to stabilization (TTS) and ankle motion using a multisegment foot model among FAI, coper, and healthy control individuals.DESIGN:Cross-sectional study.SETTING:Laboratory.PATIENTS OR OTHER PARTICIPANTS:Participants were 23 individuals with a history of at least 1 ankle sprain and at least 2 episodes of giving way in the past year (FAI), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers), and 23 individuals with no history of ankle sprain or instability in their lifetime (controls). Participants were matched for age, height, and weight (age = 23.3 ± 3.8 years, height = 1.71 ± 0.09 m, weight = 69.0 ± 13.7 kg).INTERVENTION(S):Ten single-legged drop jumps were recorded using a 12-camera Vicon MX motion-capture system and a strain-gauge force plate.MAIN OUTCOME MEASURES:Mediolateral (ML) and anteroposterior (AP) TTS in seconds, as well as forefoot and hindfoot sagittal- and frontal-plane angles at jump-landing initial contact and at the point of maximum vertical ground reaction force were calculated.RESULTS:For the forefoot and hindfoot in the sagittal plane, group differences were present at initial contact (forefoot: P = .043, hindfoot: P = .004). At the hindfoot, individuals with FAI displayed more dorsiflexion than the control and coper groups. Time to stabilization differed among groups (AP TTS: P < .001; ML TTS: P = .040). Anteroposterior TTS was longer in the coper group than in the FAI or control groups, and ML TTS was longer in the FAI group than in the control group.CONCLUSIONS:During jump landings, copers showed differences in sagittal-plane control, including less plantar flexion at initial contact and increased AP sway during stabilization, which may contribute to increased dynamic stability.

Context:There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability (CAI). In addition, clinicians aiming to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy.Objective:To assess the comparative efficacy of 2 common ankle rehabilitation techniques (wobble-board [WB] balance training and ankle strengthening using resistance tubing [RT]) using patient-oriented outcomes.Design:Randomized controlled trial.Setting:Laboratory.Patients:40 patients with CAI randomized into 2 treatment groups: RT and WB. CAI inclusion criteria included a history of an ankle sprain, recurrent “giving way,” and a Cumberland Ankle Instability Tool (CAIT) score ≤25.Interventions:Participants completed 5 clinician-oriented tests (foot-lift test, time-in-balance, Star Excursion Balance Test, figure-of-8 hop, and side-hop) and 5 patient-oriented questionnaires (CAIT, Foot and Ankle Ability Measure [FAAM], Activities of Daily Living [ADL] and FAAM Sport scale, Short-Form 36 [SF-36], and Global Rating of Function [GRF]). After baseline testing, participants completed 12 sessions over 4 wk of graduated WB or RT exercise, then repeated baseline tests.Main Outcome Measures:For each patient- and clinician-oriented test, separate 2 × 2 RMANOVAs analyzed differences between groups over time (alpha set at P = .05).Results:There was a significant interaction between group and time for the FAAM-ADL (P = .04). Specifically, the WB group improved postintervention (P < .001) whereas the RT group remained the same (P = .29). There were no other significant interactions or significant differences between groups (all P > .05). There were significant improvements postintervention for the CAIT, FAAM-Sport, GRF, SF-36, and all 5 clinician-oriented tests (all P < .001).Conclusions:A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI. Limited evidence indicates that WB training was more effective than RT.Level of Evidence:Therapy, level 1b.

Objective:To track the patient-reported efficacy of a 4-wk intervention (wobble board [WB] or resistance tubing [RT]) in decreasing symptoms of chronic ankle instability (CAI) at 6 mo postintervention (6PI) as compared with immediately postintervention (IPI).Design:Randomized controlled trial.Participants:Fourteen of 21 participants (66.7%) responded to an electronic 6-m follow-up questionnaire (age 19.6 ± 0.9 y, height 1.63 ± 0.18 m, weight 70.5 ± 16.3 kg; 2 male, 12 female; 5 WB, 9 RT). All participants met CAI criteria at enrollment, including a history of ankle sprain and recurrent episodes of giving way.Interventions:Participants completed either RT or WB protocols, both 12 sessions over 4 wk of progressive exercise. WB sessions consisted of five 40-s sets of clockwise and counterclockwise rotations. RT sessions consisted of 30 contractions against resistance tubing in each of 4 ankle directions.Main Outcome Measurements:Patient-reported symptoms of “giving way” preintervention and at 6PI, global rating of change (GRC) frequencies at IPI and 6PI, and resprains at 6PI were reported descriptively. Changes in global rating of function (GRF) and giving way were compared using Wilcoxon tests, while GRC was compared with Fisher exact test.Results:All participants reported giving way preintervention, only 57.1% reported giving way at 6PI. Resprains occurred in 21.4% of participants. Giving-way frequency (P = .017), but not GRF or GRC (P > .05), was significantly different at IPI vs 6PI.Conclusions:Simple 4-wk interventions maintained some but not all improvements at 6PI. At least 42.9% of participants would no longer meet the current study’s CAI inclusion criteria due to a reduction in giving way.

Context Force sense impairments are associated with functional ankle instability. Stochastic resonance stimulation (SRS) may have implications for correcting these force sense deficits. Objective To determine if SRS improved force sense. Design Case-control study. Setting Research laboratory. Patients or Other Participants Twelve people with functional ankle instability (age = 23 ± 3 years, height = 174 ± 8 cm, mass = 69 ± 10 kg) and 12 people with stable ankles (age = 22 ± 2 years, height = 170 ± 7 cm, mass = 64 ± 10 kg). Intervention(s) The eversion force sense protocol required participants to reproduce a targeted muscle tension (10% of maximum voluntary isometric contraction). This protocol was assessed under SRSon and SRSoff (control) conditions. During SRSon, random subsensory mechanical noise was applied to the lower leg at a customized optimal intensity for each participant. Main Outcome Measure(s) Constant error, absolute error, and variable error measures quantified accuracy, overall performance, and consistency of force reproduction, respectively. Results With SRS, we observed main effects for force sense absolute error (SRSoff = 1.01 ± 0.67 N, SRSon = 0.69 ± 0.42 N) and variable error (SRSoff = 1.11 ± 0.64 N, SRSon = 0.78 ± 0.56 N) (P < .05). No other main effects or treatment-by-group interactions were found (P > .05). Conclusions Although SRS reduced the overall magnitude (absolute error) and variability (variable error) of force sense errors, it had no effect on the directionality (constant error). Clinically, SRS may enhance muscle tension ability, which could have treatment implications for ankle stability.