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The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Effect of Accelerated Rehabilitation with Anti-Gravity Treadmill Exercise on Ankle Joint Function After Surgery of Modified Brostrom Operation in Chronic Ankle Instability Patients

변형된 Brostrom 수술 후, Anti-gravity treadmill 가속재활운동이 만성발목불안정성 환자의 발목기능 회복에 미치는 영향

  • Choi, In-Hyuk (Dept. of Exercise Prescription & Rehabilitation, Dankook University) ;
  • Lee, Jang-Kyu (Dept. of Exercise Prescription & Rehabilitation, Dankook University)
  • 최인혁 (단국대학교 운동처방재활학과) ;
  • 이장규 (단국대학교 운동처방재활학과)
  • Received : 2019.04.23
  • Accepted : 2019.07.05
  • Published : 2019.07.31
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Abstract

The purpose of this study was to investigate the effect of 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise on VAS, ROM, isokinetic myofunction, and dynamic stability after surgery of modified brostrom operation in chronic ankle instability patients. The subjects of this study were 12 chronic ankle instability patients who underwent modified Brostrom operation(MBO) by the same doctor. 6 weeks' accelerated rehabilitation program is scheduled to perform for 60min, everyday, and also anti-gravity program performed for 15~30min, everyday. The visual analog scale(VSA) and significantly decreased(p<.001) and ROM in all of dorsal flexion, plantar flexion, inversion and eversion significantly increased(p<.05) after 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise. Both inversion and eversion peak torque at $60^{\circ}/sec$(p<.001, p<.01) and at $180^{\circ}/sec$(p<.001) significantly increased after 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise respectively. In muscle defect, although inversion(p<.01) and eversion(p<.001) at $60^{\circ}/sec$ and inversion(p<.01) at $180^{\circ}/sec$ significantly decreased, eversion at $180^{\circ}/sec$ tended to decrease but did not change significantly after 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise. The dynamic stability significantly increased after 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise(p<.001). These results suggest that 6 weeks' accelerated rehabilitation with anti-gravity treadmill exercise has positive effect of VAS, ROM, isokinetic myofunction, and dynamic stability after surgery of modified brostrom operation in chronic ankle instability patients. Therefore, we consider that the accelerated rehabilitation with anti-gravity treadmill exercise, which is safely and fast method, has effect on more faster recovery of ankle stability, play ground and normal daily activities.

이 연구의 목적은 만성발목불안정성 환자의 변형된 Brostrom 수술 후, 6주간의 Anti-gravity treadmill을 이용하여 조기체중부하를 포함하는 가속재활운동 프로그램이 발목관절의 통증지수와 발목 관절가동범위, 등속성 근기능, 동적 안정성에 어떠한 영향을 미치는지에 대하여 구명하고자 실시되었다. 연구대상자는 만성발목불안정성에 의해 변형된 Brostrom 수술을 받은 환자 12명을 대상으로 하였으며, 6주간의 가속재활운동 프로그램은 매일 60분씩 실시되었고 Anti-gravity treadmill 프로그램 또한 매일 15~30분간 실시되었다. 이 연구의 결과에서, 시각적 사상척도(VAS)를 이용한 주관적 통증지수는 가속재활운동 프로그램 적용 후, 유의하게 감소한 것으로 나타났으며(p<.001) 발목 관절가동범위 또한 가속재활운동 후, 배측 굴곡과 저측 굴곡, 내번, 외번 모두에서 유의하게 증가하였다(p<.05). 등속성 근기능은 가속재활운동 후, 내반력과 외반력 모두 $60^{\circ}/sec$(p<.001, p<.01)와 $180^{\circ}/sec$(p<.001)에서 유의하게 증가하였으며 건측에 대한 환측의 근결손율은 $60^{\circ}/sec$의 내반력(p<.01)과 외반력(p<.001), $180^{\circ}/sec$(p<.01)의 내반력에서 유의하게 감소하였고 외반력에서는 다소 감소하는 경향을 보였지만 통계적으로 유의한 차이는 보이지 않았다. 동적 안정성은 6주간의 가속재활운동 프로그램 적용 후, 유의하게 증가한 것으로 나타났다(p<.001). 이러한 결과는 6주간의 Anti-gravity treadmill을 이용하여 조기체중부하를 포함하는 가속재활운동 프로그램이 변형된 Brostrom 수술을 받은 만성발목불안정성 환자들의 통증과 발목 관절가동범위, 등속성 근기능, 동정 안정성에 긍정적인 효과가 있는 것으로 사료되며 또한 Anti-gravity treadmill을 이용한 조기체중부하의 재활운동 보다 안전하고 빠르게 발목의 안정성을 회복하여 일상생활 및 스포츠 현장으로의 빠른 복귀를 가능하게 할 것으로 사료된다.

Keywords

Table 1. The characteristics of subjects

SHGSCZ_2019_v20n7_228_t0001.png 이미지

Table 2. Anti-gravity treadmill program

SHGSCZ_2019_v20n7_228_t0002.png 이미지

Table 3. Accelerated Rehabilitation Program

SHGSCZ_2019_v20n7_228_t0003.png 이미지

Table 4. VAS score

SHGSCZ_2019_v20n7_228_t0004.png 이미지

Table 5. range of motion

SHGSCZ_2019_v20n7_228_t0005.png 이미지

Table 6. Isokinetic myofunction

SHGSCZ_2019_v20n7_228_t0006.png 이미지

Table 7. muscle deficit

SHGSCZ_2019_v20n7_228_t0007.png 이미지

Table 8. dynamic stability

SHGSCZ_2019_v20n7_228_t0008.png 이미지

References

  1. J. S, Cox, "Surgical and nonsurgical treatment of acute ankle sprains," Clinical Orthopedic, vol. 98, pp. 118-126, 1985. DOI: http://dx.doi.org/10.1097/00003086-198509000-00018
  2. K. T, Lee, B. Y, Song, K. W, Yang, N. M, Kim, J. R, Kim, S. R, Park, "Analysis of the Injuries in Professional Soccer Player," The Korean Journal of Sports Medicine, vol. 18, no. 2, pp. 176-180, 2000.
  3. S. H, Cha, W. W, Kim, M. Y, Lim, "Effects of training mode on range of motion and isokinetic muscle function during ankle rehabilitation," The official journal of the korean association of certified exercise professionals, vol. 1, no. 1, pp. 43-52, 2009.
  4. S. E, Ross, K. M, Guskiewicz, "Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects with functional ankle instability and subjects with stable ankle," Clinical Journal of Sport medicine, vol. 16, no. 4, pp. 323-8, 2006. DOI: http://dx.doi.org/10.1097/00042752-200607000-00007
  5. J. Karlsson, B. I, Eriksson, T. Bergsten, O. Rudholm, L. Sward, "Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint," Am. J. Sports Med, vol. 25, pp. 48-53, 1997. DOI: http://dx.doi.org/10.1177/036354659702500109
  6. L. K, Drewes, P. O, Mckeon, K. D, Casey, J. Hertel, "Dorsiflexion deficit during jogging with chronic ankle instability," Sports Medicine, vol. 12, no. 6, pp. 685-687, 2009. DOI: http://dx.doi.org/10.1016/j.jsams.2008.07.003
  7. J. Hertel, "Functional instability following lateral ankle sprain," Sports Medicine, vol. 29, pp. 361-371, 2000. DOI: http://dx.doi.org/10.2165/00007256-200029050-00005
  8. J. Karlsson, "Ligament injuries of the ankle what happens later? Non-surgical treatment is effective in 80-90 per cent of cases," Lakartidningen, vol. 95, no. 40, pp. 4376-8, 1998.
  9. T. M, Messer, C. A, Cummins, J. Ahn, A. S, Kelikian, "Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors," Foot Ankle Int, vol. 21, pp. 996-1003, 2000. https://doi.org/10.1177/107110070002101203
  10. L. Xinning, K. Heather, G. D, patrick, D. B, Brian, "Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete," The American Journal Sports Medicine, vol. 37, no. 3, pp. 488-494, 2009. DOI: http://dx.doi.org/10.1177/0363546508327541
  11. N. Gould, D. Seligson, J. Gassman, "Early and late repair of lateral ligament of the ankle," Foot Ankle, vol. 1, pp. 84-9, 1980. DOI: http://dx.doi.org/10.1177/107110078000100206
  12. J. H, Ahn, Y. G, Lee, S. H, Jung, W. S, Choy, "Treatment of chronic ankle lateral instability using modified Brostrom procedure," J Korean Orthop Assoc, vol. 42, pp. 91-97, 2007. DOI: http://dx.doi.org/10.4055/jkoa.2007.42.1.91
  13. A. Saxena, A. Granot, "Use of an Anti-Gravity treadmill in the Rehabilitation of the Operated Achilles Tendon: A Pilot Study." The journal of foot and ankle surgery, vol. 50, no. 5, pp. 558-561, 2011. DOI: http://dx.doi.org/10.1053/j.jfas.2011.04.045
  14. M. N, Moore, C. Vandenakker-Albanese, M. D, Hoffman, "Use of partial body-weight support for aggressive return to running after lumber disk herniation: A case report," Arch Phys Med Rehabil, vol. 91, no. 5, pp. 803-5, 2010. DOI: http://dx.doi.org/10.1016/j.apmr.2010.01.014
  15. A. Saxena, A. Granot, "Use of an Anti-gravity Treadmill in the Rehabilitation of the Operated Achilles Tendon: A Pilot Study," Journal of Foot and Ankle Surgery, vol. 50, no. 5, pp. 558-561, 2011. DOI: http://dx.doi.org/10.1053/j.jfas.2011.04.045
  16. D. H, Moon, D. H, Oh, S. A, Zhang, J. K, Lee, "Effect of Backward Walking Exercise on ROM, VAS score and Proprioception in Anterior Cruciate Ligament Reconstruction Patients," Journal of the Korea Academia-Industrial cooperation Society, vol. 17, no. 5, pp. 522-529, 2016. DOI: http://dx.doi.org/10.5762/KAIS.2016.17.5.522
  17. S. Hesse, C. Bertelt, M. T, Jahnke, A. Schaffrin, P. Baake, M. Malezic, K. H, Mauritz, "Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients." Stroke, vol. 26, pp. 976-981, 1995. DOI: http://dx.doi.org/10.1161/01.STR.26.6.976
  18. C. G, Mattacola, M. K, Dwyer, "Rehabilitation of the ankle after acute sprain or chronic instability," Journal of Athletic Training, vol. 37, no. 4, pp. 413-429, 2002.
  19. S. Y, Lee, J. S, Jung, Y. S, Kim, "The Effects of Early Rehabilitation Exercise after Modified Brostrom Operation on Ankle Muscle Recovery in Chronic Ankle Instability Patients," The Korean Journal of Growth and Development, vol. 19, no. 1, pp. 43-48, 2011.
  20. J. P, Pillip, P. G, Paul, J. B, Robert, B. K, Kyle, B. U, Frank, E. Bryant, "The reliability of an instrumented device for measuring components of the star excursion balance test," J Phsiother, vol. 4, pp. 92-99, 2009.
  21. J. Hertel, L. C, Olmsted-Kramer, J. H, Challis, "Time-to-boundary measures of postural control during single leg quiet standing," J Appl Biomech, vol. 22, no. 1, pp. 67-73, 2006. DOI: http://dx.doi.org/10.1123/jab.22.1.67
  22. P. A, Grobble, J. Hertel, "Considerations for normalizing measures of the star excursion balance test," measurement in physical education and exercise science, vol. 7, no. 2, pp. 89-100, 2003. DOI: http://dx.doi.org/10.1207/S15327841MPEE0702_3
  23. S. F, Van, K. H, Stappaerts, L. Janssens, "Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance," Am J sport Med, vol. 35, no. 2, pp. 274-281, 2007. DOI: http://dx.doi.org/10.1177/0363546506294470
  24. S. B, Kim, S. K, Jung, J. Y, Hyun, Y. H, Yoon, J. H, Moon, "The Treatment of Chronic Ankle Instability," Journal of the Korean orthopaedic association, vol. 26, no. 5, pp. 1391-1395, 1991. https://doi.org/10.4055/jkoa.1991.26.5.1391
  25. K. T, Lee, H. Jegal, H. W, Chung, Y. U, Park, "Return to Play after Modified Brostrom Operation for Chronic Ankle Instability in Elite Athletes," The Journal of the Korean orthoaedic association, pp. 126-130, 2019.
  26. A. A, Suchak, G. P, Bostick, L. A, Beaupre, D. C, Durand, N. M, Jomha, "The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon," J Bone Joint Surg A, vol. 90, no. 9, pp. 1976-83, 2008. DOI: http://dx.doi.org/10.2106/JBJS.G.01242
  27. S. I, Shin, G. R, Kim, J. S, Cho, H. B, Lee, J. W, Kwon, "Modified Brostrom Procedure with Suture Anchor & PushLock Anchor in Lateral Ankle Instability," Journal of Korean Foot and Ankle Society, vol. 16, no. 4, pp. 241-246, 2012.
  28. W. M, Glasoe, M. K, Allen, B. F, Awtry, H. J, Yack, "Weight-bearing immobilization and early exercise treatment following a grade II latera l ankle sprain" J Orthop Sports Phys Ther, vol. 29, no. 7, pp. 394-9, 1999. DOI: http://dx.doi.org/10.2519/jospt.1999.29.7.394
  29. H. S, Cho, D. H, Oh, J. W, Lee, S. A, Zang, J. K, Lee, "Effect of Accelerated Rehabilitation with Anti-Gravity Treadmill Program : Isokinetic Myofuction and Functional Score of Knee Joint, ROM, and VAS Score in Meniscus Repair Patients," Journal of the Korea AcademiaI ndustrial cooperation Society, vol. 17, no. 8, pp. 46-54, 2016. DOI: http://dx.doi.org/10.5762/KAIS.2016.17.8.46
  30. G. P, Bostick, N. M, Jomha, A. A, Suchak, L. A, Beaupre, "Factors associated with calf muscle endurance recovery 1 year after achilles tendon rupture repair," J Orthop Sports Phys Ther, vol. 40, no. 3, pp. 45-51, 2010. DOI: http://dx.doi.org/10.2519/jospt.2010.3204
  31. J. Chalmers, "Treatment of achilles tendon ruptures," The Journal of Orthopaedic Surgery, vol. 8, no. 1, pp. 97-99, 2000. https://doi.org/10.1177/230949900000800118
  32. J. A, Nicholas, E. B, Hershman, V. J, Turco, G. G, Gallant, "The lower Extremity and spine in sports medicine," 2nd ed, 1995.
  33. C. G, Mattacola, L. C, Mccluskey, "Management of ankle sprains," Americans Family Physiciam, vol. 63, no. 1, pp. 93-104, 2001.
  34. H. M, Mortensen, O. Skov, P. E, Jensen, "Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study," J Bone Joint Surg Am, vol. 81, no. 7, pp. 983-90, 1999. DOI: http://dx.doi.org/10.2106/00004623-199907000-00011
  35. T. Willems, E. Witvrouw, J. Verstuyft, P. Vaes, D. Clercq, "Proprioception and Muscle Strength in Subjects With a History of Ankle Sprains and Chronic Instability," Journal of Athletic Training, vol. 37, no. 4, pp. 487-493, 2002.
  36. C. L, Docherty, J. H, Moore, B. L, Arnold, "Effects of strength training on strength developmentand joint position sensein functionally unstable ankles," Journal of Athletic Training, vol. 33, no. 4, pp. 310-314, 1998.
  37. K. W, Kim, K. K, Jeon, "Comparisons of Static Balance and Gait, Isokinetic Muscular Function of Involved& Non-involved Side for Chronic Ankle Instability," The Society of Sport Science, vol. 24, no. 2, pp. 1463-1472, 2015.
  38. E. R, Scott, "Noise-enhanced postural stability in subjects with functional ankle instability," British Journal of Sports Medicine, vol. 41, pp. 656-659, 2007. https://doi.org/10.1136/bjsm.2006.032912
  39. S. H, Cha, J. S, Kim, "The effects of Balance exercises on functional ankle stability with ankle sprained patients," The official journal of the korean association of certified exercise professionals, vol. 11, no. 2, pp. 73-83, 2009.
  40. S. A, Hale, J. Hertel, L. C, Olmsted-Kramer, "The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability," Journal of Orthopedic and Sports Physical Therapy, vol. 37, no. 6, pp. 303-311, 2007. DOI: http://dx.doi.org/10.2519/jospt.2007.2322
  41. S. J, Kim, H. J, Nam, J. K, Kim, H. S, Nho, "Original Aryicle : Characteristics of Lipid Metabolism during and after a Bout of Prolonged Exercise in Two Types of Obese Women," Korean Journal of Sport Science, vol. 24, no. 3, pp. 428-435, 2013. DOI: http://dx.doi.org/10.24985/kjss.2013.24.3.428
  42. U. Sekir, Y. Yildiz, B. Hazneci, F. Ors, T. Aydin, "Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability," Knee Surgery Sports and Traumatology Arthroscop, vol. 15, no. 5, pp. 654-664, 2007. DOI: http://dx.doi.org/10.1007/s00167-006-0108-8