Unilateral vs Bilateral Strength

Training on Untrained Individuals

with Chronic Ankle Instability
Bo Johnson, BS
Matthew Donahue, PhD, LAT, ATC

Brief Re-Introduction
Chronic Ankle Instability
Components of Function and Mechanics
Shape and Function
Trauma to ankle neuromuscular structures
Decreases strength and proprioceptive components
(ABC)
Decreased reaction time
May result in further trauma

Introduction
There is a relationship between unilateral

vs bilateral strength levels

Base levels bilateral strength ~75% of
combined unilateral strength values (Kuruganti
06)
Bilateral power output (Van Soest 85)
Muscle activation levels (Hay 06)
Additional imbalances exist between quadricep

and hamstring groups

Important for later

Introduction
Single leg stance demands multi-muscle

coordination in order to maintain posture

and balance(Tropp 87)
Gluteus medius keeps hip angles constant
(Tropp 87,Beck 00,Gottschalk 89)
Peroneal muscle prevent sudden inversion

(Tropp 87,Ebig 97)

Taking what we mentioned earlier
CAI=decreased neuromuscular control
Single leg stance becomes difficult
Sudden inversion
Decreased neuromuscular connection

Purpose Statement
The purpose of this study is to examine the

effects of a unilateral, bilateral, and mixed

training program on muscular strength and
activation
We hypothesize that the group tasked with

single leg exercise will achieve a greater

gains in strength and altered levels of
muscle activation. The mixed exercise
group will also score higher in strength and
display altered muscle activation when
compared to the double leg group

Methods
Demographics
Age 18-26 (College aged students)
Height X.XXm +/- .XXm
Weight XX.XXkg +/- X.XXkg

8-week intervention study

Progressive program
1 session of pre-testing and instruction
48-168hr
6 weeks of resistance training
Non consecutive
1 session of post-testing
48-168hr

Clinical Application
The data gained from this research should

suggest what type of strength training to

follow in order to increase neuromuscular
function of muscles in order to facilitate a
quicker return to play.

Methods
Inclusion criteria

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History of CAI
IdFAI
Activity Level-Beginner to Partial Intermediate
(NSCA)

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Methods
Inclusion Criteria
Self-reported Questionnaire
Length

of time resistance training

Previous
Training

experience with resistance training

for sports/competition

Self-rated

proficiency with various exercises

Methods
Exclusion criteria
Lower extremity injury in the past 6 months
History of lower ext surgery
Individuals with a significant history of

resistance training
BMI >29.9

Methods
Participants
N 35=.835
30-45 total participants
3 groups
10-15 participants per group
Group 1(DL)- Double leg variant of exercises
Group 2(SL)- Single leg variant of exercises
Group 3(MX) Mixture of single/double leg

variant of exercises

Methods
Exercises

1L Squat (McCurdy 10)

Tempo- 2-0-2-1
Weight will be held in front of
body as shown
Non balance leg should be
held at 45 degrees of knee
and hip flexion at start
Squat to bench
Set at tibial tuberosity
height

2L Squat

Same tempo
Hold weight in same way
Feet should be shoulder
length apart, facing forward

Methods
Exercises
1L RDL(Wright 99)
Tempo- 2-0-2-1
Non-balance leg held in 45

degrees of knee flexion, hip

extension
Ending movement-90
degrees hip flexion

2L RDL
Same tempo as 1L
Both feet should be
shoulder length apart,
facing forward

Methods
Outcome Measures
RPL-5403 Dual action leg press

Star Excursion Balance Test (SEBT)(Plisky 09)

-3 Reach Directions
-Anterior
-Posterior Medial
-Posterior Lateral

Methods
Independent Variable
Exercise Group

Dependent Variables
Muscle Strength-Kg (Levinger 09)
1RM in leg press (Hoist RPL-5403 Dual Action Leg
Press)
Activation - %MVIC
EMG during SEBT
SEBT score

Methods
Procedures
Day 1- Prescreen/Baseline Pre screening for CAI, healthy range, etc. (Week 1)
Baseline SEBT test (Week 1)
Baseline 1RM Leg Press (Hoist RPL-5403 Dual action leg
press)
Review proper technique exercises (12).
Training Phase
Two 15 minute strength training routines per week for 6
weeks (Weeks 2-7)
Retest
End of 6 week program following same procedure as
baseline measure (Week 8)

Methods
Procedure
Loads increased based on 2x2 method

(Baechle 08, Baechle 06)

Loads will be increased conservatively using the

same ratios and percentages listed before

(Kuruganti 06, Appen 86)
2L Squat-10% BW
2L RDL- 6.6% BW
1L Squat- 7.5% BW
1L RDL- 5% BW

Methods
For Squat Exercise

For RDL exercise

Week 1 2x10

Week 1-6 2x10

height +

2 inches

Week 2 2x10
Week 3 2x10

height +

1 inch

Week 4 2x10
Week 5 2x10
tuberosity height

Week 6 2x10

tib

Methods
Double leg group (DL)
2 sets of each exercise using two legs

Single leg group (SL)

2 sets on EACH leg (2 sets on the left leg, 2 sets on

the right leg)

Single + double leg group (MX)

Half of sets will be done with two legs, half with one

leg
1 set with two legs, 1 set on EACH leg for each
exercise

Statistical Analysis
Strength

Group x Time ANOVA

EMG

Group X Time X Muscle ANOVA

Separate ANOVAs for each Reach Direction (ANT,

PM, PL)

SEBT Score

Group X Time ANOVA

Separate ANOVAs for each Reach Direction Score

(ANT, PM, PL, Composite)

Tukey Post Hoc on all significant findings.

Funding
None
Potential need for additional electrodes for

EMG
Elevated fitness will be its own reward upon

partaking in this study

Possible extra credit options for classes

Unresolved Issues
Monetary compensation for participants
8 weeks too long?

References
1.

2.

3.
4.
5.
6.
7.
8.

9.
10.

11.

12.

Kuruganti, U. (2006). The bilateral leg strength deficit is present in old, young and adolescent females
during isokinetic knee extension and flexion.European Journal of Applied Physiology,97(3), 322-326.
doi: 10.1007/s00421-006-0188-7
Van Soest, A. J., Roebroeck, M. E., Bobbert, M. F., Huijing, P. A., & Van Ingen Schenau, G. J. (1985). A
comparison of one-legged and two-legged countermovement jumps.Medicine & Science In Sports &
Exercise,17(6), 635-639.
Hay, D., de Souza, V., & Fukashiro, S. (2006). Human bilateral deficit during a dynamic multi-joint leg
press movement.Human Movement Science,25(2), 181-191.
Appen, L. L., & Duncan, P. W. (1986). Strength relationship of the knee musculature: effects of gravity
and sport.Journal Of Orthopaedic & Sports Physical Therapy,7(5), 232-235.
Tropp, H. H., Odenrick, P. P., Gillquist, J. J., & Oertengren, R. R. (1987). Importance of the ankle joint in
postural control of single-limb stance.
Beck, M. (2000). The anatomy and function of the gluteus minimus muscle.Journal of Bone and Joint
Surgery,82(B), 358-363.
Gottschalk, F. (1989). The functional anatomy of tensor fasciae latae and gluteus medius and
minimus.Journal of Anatomy,166, 179-189.
Ebig, M. M., Lephart, S. M., Burdett, R. G., Miller, M. C., & Pincivero, D. M. (1997). The effect of sudden
inversion stress on EMG activity of the peroneal and tibialis anterior muscles in the chronically unstable
ankle.Journal Of Orthopaedic & Sports Physical Therapy,26(2), 73-77.
Baechle, T. (2008).Essentials of strength training and conditioning. (3 ed.). Champagne, IL: Human
Kinetics.
McCurdy, K., O'Kelley, E., Kutz, M., Langford, G., Ernest, J., & Torres, M. (2010). Comparison of Lower
Extremity EMG Between the 2-Leg Squat and Modified Single-Leg Squat in Female Athletes.Journal Of
Sport Rehabilitation,19(1), 57-70.
Wright, G. A., Delong, T. H., & Gehlsen, G. G. (1999). Electromyographic activity of the hamstrings
during performance of the leg curl, stiff-leg deadlift, and back squat movements.Journal Of Strength &
Conditioning Research (Allen Press Publishing Services Inc.),13(2), 168-174.
Levinger, I., Goodman, C., Hare, D. L., Jerums, G., Toia, D., & Selig, S. (2009). The reliability of the 1RM
strength test for untrained middle-aged individuals.Journal Of Science & Medicine In Sport,12(2), 310316.

Questions

Methods
Survey
IdFAI
(Donahue
13)

Progression
Conservative resistance training

progressions
~2.5-10% (NSCA)

2L Quad dominant exercise + 10%

Hamstring strength~2/3 of quadricep

strength
Hamstring dominant exercise + 6.6% (2/3 of 10%)

1L strength~75% of 2L strength
1L exercises progressed at 75% of 2L

exercises
7.5% for 1L quad dominant exercise (75% of 10% is

7.5%
5% for 1L hamstring dominant exercise (2/3 of 7.5%

1RM Testing
Warm up- Livestrong LS5.0 U upright bike

(NSCA)
5min
90rpm
65% heart rate

Start at percieved light weight (Ploutz-

Snyder 01)
10 repetitions
5 repetitions perceived medium weight
Additional attempts (3-8) til 1RM is achieved
2 minutes rest in between