title: Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation.
abstract: METHODS
  Cross-sectional repeated-measures design.
  
  
  OBJECTIVE
  Determine the effects of circumferential ankle pressure (CAP) intervention on proprioceptive acuity, ankle stiffness, and postural stability.
  
  
  BACKGROUND
  The application of CAP using braces, taping, and adaptive shoes or military boots is widely used to address chronic ankle instability (CAI). An underlying assumption is that the CAP intervention might improve ankle stability through increased proprioceptive acuity and stiffness in the ankle. METHOD AND MEASURES: A convenience sample of 10 subjects was recruited from the local university community and categorized according to proprioceptive acuity (high, low) and ankle stability (normal, CAI). Proprioceptive acuity was measured when blindfolded subjects were asked to accurately reproduce a self-selected target ankle position before and after the application of CAP. Proprioceptive acuity was determined in 5 different ankle joint position sense tests: neutral, inversion, eversion, plantar flexion, and dorsiflexion. Joint position angles were recorded electromechanically using a potentiometer. Passive ankle stiffness was computed from the ratio of applied static moment versus angular displacement. Active ankle stiffness was determined from biomechanical analyses of ankle motion following a mediolateral perturbation. Postural stability was quantified from the center of pressure displacement in the mediolateral and the anteroposterior directions in unipedal stance. All measurements were recorded with and without CAP applied by a pediatric blood pressure cuff. Data were analyzed using a separate mixed-model analysis of variance (ANOVA) for each dependent variable. Post hoc comparison using Tukey's honestly significant difference (HSD) test was performed if significant interactions were obtained. Significance level was set at P<.05 for all analyses.
  
  
  RESULTS
  Significant group (high versus low proprioceptive acuity) x CAP interactions were identified for postural stability. Passive ankle stiffness was not increased by an application of CAP. Active ankle stiffness was significantly different between the high and low proprioceptive acuity groups and was not affected by an application of CAP. Significant group (normal versus CAI) x CAP interactions were observed for mediolateral center-of-pressure displacement with a main effect of group on neutral joint position sense.
  
  
  CONCLUSIONS
  Application of CAP increased proprioceptive acuity and demonstrated trends toward increased active stiffness in the ankle, hence improved postural stability. The effects tend to be limited to individuals with low proprioceptive acuity.
authors.affiliation: Hampton University Physical Therapy Department, Hampton, VA, USA.
authors.forename: Sung H
authors.initials: SH
authors.lastname: You
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Granata
authors.forename: Linda K
authors.initials: LK
authors.lastname: Bunker
mesh_terms: D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000502:physiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011312:Pressure; D011434:Proprioception / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology