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Journal of Electromyography and Kinesiology

Volume 20, Issue 2, April 2010, Pages 348-353

doi:10.1016/j.jelekin.2009.03.012 | How to Cite or Link Using DOI Cited By in Scopus (0)


Copyright © 2009 Elsevier Ltd All rights reserved.
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Cryotherapy and ankle bracing effects on peroneus longus response during sudden

inversion

Mitchell L. Cordovaa, Lance W. Bernardb, Kira K. Auc, Timothy J. Demchakd, Marcus B.

Stonee and JoEllen M. Seftonf


a
Biodynamics Research Laboratory, Department of Kinesiology and Center for Biomedical

Engineering Systems, The University of North Carolina at Charlotte, Charlotte, NC 28223, United

States
b
Brewer High School, Fort Worth, TX 76108, United States
c
Bishop Amat Memorial High School, La Puente, CA 91744, United States
d
Sports Injury Research Laboratory, Athletic Training Department, Indiana State University, Terre

Haute, IN 47809, United States


e
Alegius Consulting, LLC, Avon, IN 46123, United States
f
Neuromechanics Research Laboratory, Department of Kinesiology, Auburn University, Auburn,

AL 36849, United States

Received 25 October 2008;

revised 18 March 2009;

accepted 31 March 2009.

Available online 8 May 2009.

Abstract

Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No

studies have evaluated the combined effect of these treatments on reflex responses during

inversion perturbation. This study examined the combined influence of ankle bracing and joint

cooling on peroneus longus (PL) muscle response during ankle inversion. A 2 × 2 RM factorial

design guided this study; the independent variables were: ankle brace condition (lace-up brace,
control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex

latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants

completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle

brace and cryotherapy treatment condition. No two-way interaction was observed between ankle

brace and treatment conditions on PL latency (P = 0.283) and amplitude (P = 0.884). The ankle

brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint

did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined

with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during

an inversion perturbation in normal subjects.

Keywords: Reflex activation; Ankle joint; Cold

Article Outline

1. Introduction

Ankle sprains are one of the most common injuries in sports and public health in general

(Denegar and Miller, 2002). Approximately 85% are acute and involve the lateral structures of

the ankle (Garrick, 1977). The predominant mechanism of injury involving lateral ankle sprains is

forced inversion of the foot while the ankle is plantar flexed ([Cordova et al., 2002] and [Sitler et

al., 1994]), causing injury to the anterior talofibular (ATF) ligament in 66% of cases and the

calcaneofibular (CF) ligament in 17% of all ankle sprains (Sitler et al., 1994). The peroneus

longus muscle (PL) is believed to function as the dynamic defense mechanism against this

injurious etiology (Konradsen et al., 1997). Due to the responsibility of the PL to stabilize and

protect the ankle/foot complex during inversion displacement, the response of this muscle and

the effect of prophylactic ankle support has been studied extensively ([Cordova and Ingersoll,

2003], [Cordova et al., 2002], [Isakov et al., 1986], [Nishikawa and Grabiner, 1999] and [Sefton

et al., 2006]).

The response time of the PL during inversion may affect its ability to protect the ankle joint. PL

stretch reflex latency represents the time required for the PL response to be initiated after a

perturbation, providing an indication of changes in PL response time ([Konradsen and Ravn,

1991] and [Konradsen et al., 1997]). PL stretch reflex amplitude represents the magnitude of the

PL response to the inversion perturbation, indicating the strength of response of the PL during an

inversion perturbation (Cordova and Ingersoll, 2003). Several studies ([Karlsson and Andreasson,

1992], [Konradsen and Ravn, 1991] and [Ricard et al., 2000]) have reported that individuals with
unstable ankles have a longer PL stretch reflex latency than healthy ankles, while other

researchers have reported finding no differences ([Isakov et al., 1986] and [Vaes et al., 2002]).

Protective measures such as taping and bracing are thought to decrease ankle sprain incidence

by providing mechanical support ([Anderson et al., 1995] and [Cordova et al., 2002]) and

enhanced proprioception ([Cordova and Ingersoll, 2003] and [Heit et al., 1996]). It has been

shown that external ankle support decreases PL stretch reflex latency in individuals with

unstable ankles, producing a quicker defense against inversion perturbation ([Cordova et al.,

2000a] and [McKenzie et al., 2004]). Interestingly, other studies ([Alt et al., 1999] and [Cordova

et al., 2000a]) have shown no such effect on PL stretch reflex latency in subjects with healthy

ankles. Some controversy also exists regarding ankle bracing’s potential effect on PL stretch

reflex amplitude. Some of this work has shown bracing to increase the amplitude of the PL

muscle ([Cordova and Ingersoll, 2003] and [Nishikawa and Grabiner, 1999]), while others report

decreases (Alt et al., 1999) or no change (Brooks et al., 2001) in PL amplitude. More recently,

other work indicates ankle bracing does provide sufficient external mechanical support to

normalize the increased reflex response found during sudden ankle inversion (Sefton et al.,

2006). Although ankle taping and bracing do offer similar mechanical effects in limiting frontal

plane motion (Cordova et al., 2000b) the indiscrepancies observed in PL muscle reflex response

may be attributed to different ankle support application techniques as well as different

methodologies used in measuring PL muscle response.

Cryotherapy is a common treatment for musculoskeletal injuries such as lateral ankle sprains

([Bleakley et al., 2004] and [Knight, 1995]). The resulting decreases in internal temperatures

cause decreases on nerve conduction velocity and synaptic transmission (Knight, 1995).

Moreover, decreases in muscle force production (Hatzel and Kaminski, 2000) and decreased

muscle spindle sensitivity ([Bell and Lehmann, 1987] and [Harlaar et al., 2001]) have also been

observed. Cryotherapy is frequently utilized treatment to prepare athletes for return to

participation, as well as for physically-active individuals during rehabilitation. Therefore, it is

important to consider the effect of cryotherapy upon motoneuron pool recruitment and the

stretch reflex response as these factors affect musculoskeletal performance during activity.

Changes resulting in a decreased neuromotor response could potentially render the athlete or

physically active individual more susceptible to injury. Human Achilles tendon ([Bell and

Lehmann, 1987] and [Harlaar et al., 2001]) and rabbit patellar tendon (Lee et al., 2002) stretch
reflex latency and amplitude have been shown to decrease following respective cryotherapy

treatment to the soleus and quadriceps musculature itself. Researchers have also shown that

cooling the ankle joint directly results in significant facilitation of the soleus motoneuron pool

([Krause et al., 2000] and [Hopkins and Stencil, 2002]). Conversely, when specifically

investigating ankle joint cooling’s direct influence on PL stretch reflex latency after sudden

inversion perturbation, no effect was observed (Berg et al., 2007).

The use of external ankle support continues to be the standard of care in trying to prevent acute

ankle sprains, as well as preventing re-injury when athletes or patients are returned to

competition or work. Cryotherapy is commonly used to treat the residual pain and inflammation

associated with ankle injury in athletes or patients prior to practices, games, or work, as well as

to prepare the joint for exercise in a rehabilitation setting. Together, the application of external

ankle bracing and peripheral joint cooling is a mostly widespread practice used by sports

medicine practitioners in preparing athletes for competition. And although these clinical

practices are widely accepted, and each modality has been studied in isolation, no scientific

evidence exists regarding what the combined effects of external ankle bracing and joint cooling

are on PL muscle response during a simulated lateral ankle injury. The purpose of our study was

to investigate the potential effects of ankle joint cooling and ankle bracing on PL muscle

response during a sudden inversion perturbation.

2. Methods

2.1. Subjects

Twenty-four healthy, physically-active individuals participated in this study

(age = 21.9 ± 2.0 years, mass = 73.2 ± 17.1 kg, ht = 170.5 ± 9.7 cm). Subjects were

recreationally active – defined as participating in 30 min of moderate physical activity at least 3

times a week on a regular basis and reported no low back injury or lower extremity joint injury 6

months prior to data collection. Further, subjects self-reported not having allergies to cold,

hypersensitivity to cold, or any circulatory disorders. Additionally, subjects were not on any other

medications than birth control, ibuprofen, or Tylenol® during the course of this study. Subjects

agreed to refrain from any cryotherapy treatment and significant changes in caffeine

consumption 24 h prior to, and throughout testing. All subjects provided written informed

consent, and the protocol use in this study was approved by the University’s Institutional Review

Board.
2.2. Instrumentation

A 16-channel biological signal acquisition system (MP100 MSW; BIOPAC Systems Inc., Santa

Barbara, CA, USA) using disposable 10 mm Ag/AgCl surface electrodes (BIOPAC Systems Inc.,

Santa Barbara, CA, USA), arranged in a bipolar configuration was used to record the electrical

activity of the PL muscle during sudden ankle/foot complex inversion. The raw EMG signal was

amplified (gain set at 500, CMRR 110 dB), band-pass filtered online (2nd order, zero lag,

Butterworth filter with frequency set between 10 and 500 Hz), digitally converted at 1000 Hz,

and full-wave rectified using commercially-available software (Acknowledge V. 3.71, BIOPAC

Systems Inc., Santa Barbara, CA, USA). The analog signal arising from an electrical switch on the

trapdoor was simultaneously sampled and time-matched to the collected EMG signal. When the

trapdoor was released, a deflection of the analog signal identified the start of the inversion

perturbation and allowed for subsequent assessment of the PL reflex response.

Skin interface temperature was measured using a superficial thermocouple TX-29 (Columbus

Instruments, Columbus, OH, USA). The thermocouples were interfaced with a portable

temperature-recording device (PHYSITEMP, Clifton, NJ, USA). This device has been shown to be

accurate within ±0.1 °C according to the manufacturer. A manometer (Aircast Inc., Summit, NJ,

USA) was used to monitor the compression of the ice bags between 42 and 48 mmHg).

2.3. Testing procedures

Each subject reported to the laboratory dressed in shorts and cross training shoes for one hour

each day at approximately the same time of day, for a total of 4 consecutive days. During the

first session, each subject was screened, oriented to the testing procedures, gave written

informed consent, and randomly assigned a treatment order for each day. Subjects were then

familiarized with the platform by experiencing 3 trials of the inversion perturbation. This was

done to ease any pre-existing anxieties about the inversion perturbation. Following this, all

subjects were seated for 30 min before they began treatment and testing on the each day to

equilibrate from any recent physical activity (e.g. walking up the stairs to the laboratory).

Subjects then repeated the 30 min equilibration period, treatment and testing on each of the

next 3 days.

During the equilibration period, the area of PL electrode placement was prepared. Skin

preparation included shaving any hair present, abrading the area with fine sand paper, and

wiping the area clean with a 70% isopropyl alcohol solution (Myers et al., 2003). Surface
electrodes were then placed directly over the muscle belly of the right PL, 4 cm distal to the

fibular head with inter-electrode distance of 2.5 cm (Cordova et al., 2000a). To confirm electrode

placement, the examiner palpated for direct muscle contraction and observed PL EMG activity

while resisting foot eversion for each subject. The reference electrode was placed directly over

the ipsilateral tibial tuberosity as previously described (Myers et al., 2003). The circumference of

the electrode was traced using a permanent marker after the first testing session to ensure

consistent electrode placement for the subsequent testing days. A surface thermocouple was

placed on the skin over the position of the calcaneofibular ligament so that skin surface

temperatures could be recorded throughout the study (Fig. 1). A pre-treatment surface

temperature was recorded immediately after the equilibration period was over.

Full-size image (19K)

Fig. 1. Thermocouple placement.

View Within Article

Subjects were then randomly assigned to one of the treatments for that day (ice only, ankle

brace only, ice and ankle brace, or control). The 30 min ice treatment consisted of two, 1 kg

crushed ice bags (Cramer Products Inc., Gardner, KS, USA) applied to each side of the ankle/foot

complex with a compressive force between 42 and 48 mmHg (Fig. 2). The lace-up style ankle

brace (ASO, Medical Specialties Inc., Charlotte, NC, USA) was applied according to the

manufacturer’s suggestion to the right ankle following the 30 min equilibration period. This brace

was chosen because of its widespread clinical use, as well as to decrease the inherent variability

of ankle taping in experimental research (Cordova et al., 2002). For the combined cooling and

ankle brace treatment, each subject completed the ice treatment first, and then application of

the ankle brace immediately followed. The control treatment consisted of subjects not receiving

the ice or ankle brace treatments during following the 30 min equilibration period. Skin
temperature was monitored throughout each test session at the following time points: at the end

of the initial 30 min equilibration period; 30 s following the treatment; and at the completion of

data collection session. The ankle/foot temperature was assessed after the third platform drop

during each of the cooling treatments to ensure that a consistent temperature remained during

testing. Collectively, these time points were chosen to gather baseline temperature data, record

post-treatment temperature levels, and to maintain the post-treatment temperatures

respectively.

Full-size image (20K)

Fig. 2. Ice bag placement.

View Within Article

A custom-made inversion trapdoor platform was used to perturb the ankle/foot complex into 35°

of inversion (Fig. 3). Following the protocol used previously to assess PL muscle response

([Cordova et al., 2000a], [Cordova and Ingersoll, 2003] and [Sefton et al., 2006]), each subject

was instructed to stand on the platform with his/her weight evenly distributed on both legs

([Konradsen and Ravn, 1991], [Konradsen et al., 1997] and [Ebig et al., 1997]) and toes pointed

straight ahead while wearing a cross training shoe. Each subject stood with their left foot on the

stationary, middle portion of the platform while their right foot was placed on the right trapdoor

of the platform. The participant’s elbows were flexed with their hands resting on ipsilateral iliac

crest. Once the subject was balanced, a blindfold and headphones were applied to the subject to

reduce visual and auditory feedback. When the trapdoor of the platform was unexpectedly

released, the apparatus forced the right ankle/foot complex into 35° of inversion. The trapdoor

was released at random intervals 5 times, tilting the ankle/foot complex into sudden inversion,

with a minimum 30 s between each drop. The trapdoor was dropped in a random fashion to

prevent the subject from anticipating the release and to eliminate PL pre-motor activity. Potential
pre-motor response was objectively assessed by analyzing PL baseline activity to ensure no

heightened activity existed prior to release of the trapdoor ([Cordova et al., 2000a] and [Cordova

and Ingersoll, 2003]). These testing procedures were repeated for each condition so that every

subject performed all 4 conditions.

Full-size image (35K)

Fig. 3. Inversion perturbation platform.

View Within Article

2.4. Data reduction

The PL stretch reflex latency was defined as the time from the onset of the trapdoor release to

the first PL muscle response as recorded by EMG ([Konradsen and Ravn, 1991] and [Cordova and

Ingersoll, 2003]). EMG baseline activity was assessed for 150 ms prior to each inversion

perturbation. An increase in the EMG equal to 5 times the standard deviation of this baseline

value was used to determine the initiation of PL muscle response (Hopper et al., 1998). Stretch

reflex latency was then determined by measuring the amount of time (ms) between the initial

drop of the platform and the start of PL muscle response. The PL stretch reflex amplitude (%

max) was first determined by averaging the amplitude observed over the 5 trials. This value was

then divided (normalized) to the maximum amplitude value obtained during the 5 trials. This

technique was performed to reduce inter-subject variability ([Yang and Winter, 2002] and

[Cordova and Ingersoll, 2003]).

2.5. Statistical analysis

A 2 × 2 repeated measures analysis of variance was used to assess the effects of ankle bracing

(ASO lace-up ankle brace and control-no ankle brace) and cooling (ice bag and control-no ice

bag) on average PL stretch reflex latency (ms), and average peak stretch reflex amplitude (% of
max), following a sudden inversion perturbation. The a priori level of significance was set at P

0.05.

3. Results

The means and standard deviations for PL stretch reflex latency and amplitude by brace

condition and treatment are presented in Table 1. Descriptive statistics for superficial

temperature data for each condition is presented in Table 2. No significant two-way interaction

was observed between brace and treatment conditions on PL stretch reflex latency

(F(1, 23) = 1.21, P = 0.283) and amplitude (F(1, 23) = 0.22, P = 0.884).

Table 1.

Peroneus longus stretch reflex latency and amplitude by treatment condition (Mean ± SD).

PL latency PL amplitude (%
Treatment
(ms) of max)

Control 30.6 ± 7.5 78.4 ± 10.8

Ice only 30.2 ± 7.2 79.0 ± 9.8

Ankle brace
29.5 ± 9.9 76.7 ± 11.2
only

Ice and ankle


31.0 ± 9.5 77.9 ± 8.5
brace
View Within Article

Table 2.

Superficial ankle temperature by treatment condition (°C ± SD).

Pre-treatment Post- Post-


Treatment
(baseline) treatment T1 treatment T2

Control 29.6 ± 1.5 29.0 ± 1.5 28.9 ± 1.5

Ice only 29.8 ± 0.9 9.4 ± 1.0 15.6 ± 1.1

Ankle brace
29.6 ± 1.2 28.6 ± 1.0 28.8 ± 1.0
only

Ice and ankle


30.0 ± 1.6 9.8 ± 1.7 15.6 ± 1.3
brace
View Within Article
There were no significant main effects of brace (F(1, 23) = 0.031, P = 0.862) or treatment

(F(1, 23) = 0.338, P = .567) on PL stretch reflex latency. Additionally, there was no significant

effect of the brace condition (F(1, 23) = 0.614, P = 0.441) or the treatment condition

(F(1, 23) = 0.319, P = 0.578) on PL stretch reflex amplitude. Consequently, the brace and ice

treatment together did not produce and effect on the PL latency or amplitude during the

inversion perturbation.

4. Discussion

The use of cryotherapy by sports medicine practitioners and physiotherapists in treating acute

and sub-acute lower extremity injuries to athletes on a daily basis is very common. Following a

typical 20–30 min application, athletes are returned to participation where large forces are

placed on the joint during dynamic activities. The intent of our study was to establish the effect

of ankle joint cooling and ankle bracing on the muscle’s ability to respond to external demands

by measuring the PL muscle response during a simulated ankle injury perturbation, without

actual ankle injury and strain. Several investigations ([Anderson et al., 1995] and [Cordova et al.,

2000a]; [Cordova and Ingersoll, 2003], [Hopper et al., 1997] and [Knight, 1995]) have examined

the effect of cooling or ankle bracing on various aspects of muscle function; however, no known

research has investigated the specific interaction of these factors; particularly, as the results of

such an investigation have wide clinical implications. It should also be understood that lateral

ankle injuries are complex and extremely difficulty to study in real-time and often implicate the

passive structures of the joint (e.g. ligaments and capsular tissue). Our investigation focused on

studying the primary dynamic defense mechanism against the lateral ankle injury using a

common simulation protocol.

In our investigation, we sought to apply ice directly to the ankle joint and not the muscle belly of

the PL for the following reasons: (1) to focus on understanding joint cooling and muscle response

following a joint perturbation; (2) to potentially influence the joint mechanoreceptors and not

influence the EMG recording on the muscle; and most importantly (3) to make our findings more

applicable to the clinical setting. It was hypothesized that cooling the ankle/foot complex would

result in changes in PL muscle response because under cooled conditions, afferent input from the

receptors in the skin, ligaments, and joint capsule are decreased (Knight, 1995). Additionally,
joint cooling has been shown to increase α motoneuron pool excitability resulting in an increase

in afferent signal to the spinal cord ([Hopkins and Stencil, 2002] and [Krause et al., 2000]).

Cooling the sensory receptors of the ankle would then appear to cause a delay in the efferent

motor response with a resulting increase in PL stretch reflex amplitude (Knight, 1995); therefore,

if an athlete were to return to participation while his/her ankle was still cooled, the nervous

system response to a perturbation would be modified creating a deficit in the neuromuscular

response.

A standard 30 min ice bag treatment at the ankle/foot complex was not found to affect the PL

stretch reflex latency or amplitude during sudden inversion of the ankle/foot complex. According

to our findings, cooling the sensory receptors in the skin and those contained within the soft

tissues of the ankle joint complex was not sufficient to have an appreciable effect on the

collective PL muscle response. The observation that cooling did not adversely affect PL muscle

function can be viewed very positively as it suggests that clinicians can continue the common

practice of cooling the ankle joint prior to activity without the fear that deficits in the primary

defense mechanism against the lateral ankle sprain will occur. This outcome is in complete

agreement with recent findings where a 20 min ice bag application to the lateral ankle resulted

in no change in PL reaction time and RMS amplitude of EMG activity (Berg et al., 2007). Although

the cryotherapy treatment did not directly involve cooling the Ia afferent neurons, it was

reasoned that by cooling the ankle joint itself, excitation of the afferent neurons would be

heightened. Increased muscle spindle sensitivity would then produce a greater response in PL

stretch reflex amplitude. In previous research ([Bell and Lehmann, 1987], [Harlaar et al., 2001]

and [Knutsson and Mattsson, 1969]) stretch reflex latency and amplitude, as measured by

tendon reflex response, was shown to increase following cooling. Each of these studies cooled

the muscle belly of the associated tendon as opposed to cooling the joint. As a result, tendon

reflexes were found to be depressed possibly due to the cooling of γ motor neurons (Knutsson

and Mattsson, 1969). Our results indicate that icing the ankle joint does not produce a decreased

PL stretch reflex during of sudden inversion perturbation.

In the current study, PL stretch reflex latency and amplitude during sudden ankle inversion was

not affected by the application of a lace-up style ankle brace. The lack of change in latency

supports previous studies (Cordova et al., 2000a), while other work found a decrease in latency

(Kernozek et al., 2008). Further, the lack of change observed in the PL amplitude is not in
agreement with previous data studying the effects of semi-rigid and lace-up style ankle braces in

healthy subjects (Cordova and Ingersoll, 2003). Similar to our finding with respect to the PL

stretch reflex latency response, the lack of change observed with PL reflex amplitude may have

occurred due to the apparent normal proprioceptive function offered by the joint

mechanoreceptors and dynamic defense mechanism.

During the platform perturbation, inversion of the ankle/foot complex occurs at angular velocities

approaching 500° sec−1. At the initiation of platform movement, a stretch reflex is elicited within

the PL muscle from the excitation of extrafusal muscle spindle fibers as a result of a high rate of

muscle length change (Cordova et al., 2000a; Isakov et al., 1986). It is believed that application

of an external ankle support stimulates cutaneous nerve receptors and joint mechanoreceptors

in the ankle/foot complex ([Feuerbach et al., 1994] and [Heit et al., 1996]). This may result in an

earlier onset of muscle activity with a stronger amplitude response, potentially decreasing the

amount of strain placed on the joint structures. However, in our study this increased cutaneous

input from ankle bracing did not facilitate the amplitude of the PL stretch reflex enough to

significantly change the latency or amplitude of our measures.

Previous investigations ([Brooks et al., 2001] and [Sefton et al., 2006]) studying the influence of

external ankle bracing on PL muscle response utilizing the Hoffmann reflex (rather than the

stretch reflex) do support the current findings of this study. Use of the Hoffmann reflex involves

electrically stimulating the Ia afferent nerve innervating PL muscle group as opposed to the

deformation of joint mechanoreceptors and muscle spindles using a trapdoor apparatus. Despite

differences in methods, the reflex mechanics are similar allowing comparison of the two

methods. Other researchers (Alt et al., 1999) found external ankle support to decrease the

stretch reflex amplitude of the PL. They attributed the decrease in PL stretch reflex amplitude to

the decrease in inversion velocity found with the application of adhesive ankle tape. By

decreasing the inversion velocity of the ankle/foot complex during perturbation, the associated

response of the PL would be diminished. Others have found that application of adhesive tape

(Ricard et al., 2000) and lace-up style ankle bracing (Cordova et al., 2007) has significantly

reduced inversion velocity 40% and 46%, respectively compared to no support condition during a

sudden inversion perturbation model as well. However, our results are in disagreement with

previous research utilizing similar functional conditions where ankle bracing was found to
increase PL amplitude (Cordova and Ingersoll, 2003). It is possible that varying results may be

due to differences in data collection and analysis procedures.

The application of ankle bracing and cooling is typically done in individuals with acute or

chronically injured ankles, and the response may be quite different in those populations. When

considering ankles that suffer from chronic ankle instability, studies show that the application of

external ankle support does enhance PL stretch reflex latency response during a sudden

inversion perturbation ([Karlsson and Andreasson, 1992] and [McKenzie et al., 2004]).

Collectively, these data above revealed that the greatest improvements in PL stretch reflex

latency were found in the ankles that suffered from the most instability. Thus, it appears that the

application of external ankle support in the form of tape positively influences the PL stretch

reflex latency in ankles that suffer from functional instability, while this may not be the case in

normal healthy ankles.

5. Summary

The results of this study found that 30 min of cooling the ankle joint, application of a lace-up

style ankle brace, and the combination of the external ankle bracing and ankle joint cooling

during an simulated inversion perturbation in healthy subjects did not produce changes in PL

stretch reflex latency or amplitude. Clinically, this is an important finding, implying that an ice

treatment at the ankle does not appear to cause any diminished response of the PL and that

cooling the joint is not detrimental to athletes prior to commencing activity. Additionally, the

application of an ankle brace with or without cooling does not interfere with the dynamic defense

mechanism during ankle inversion.

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Corresponding author. Tel.: +1 704 687 3176; fax: +1 704 687 3350.

Vitae

Cordova serves as Professor, Director of the Biodynamics Research Laboratory

and Chairperson of the Department of Kinesiology at The University of North

Carolina at Charlotte. Additionally, he is an affiliate researcher within the Center

for Biomedical Engineering Systems at UNC Charlotte. He earned his BS degree

in Athletic Training from East Stroudsburg University, his Masters degree in

Athletic Training from Indiana State University and his Doctor of Philosophy

degree in Biomechanics from The University of Toledo. He is a Fellow of the

American College of Sports Medicine and National Athletic Trainers’ Association.

He is an Associate Editor for the Journal of Athletic Training and serves on the
Editorial Board for the Journal of Sport Rehabilitation. Further, he serves as a

manuscript reviewer for the British Journal of Sports Medicine, Journal of

Orthopaedic and Sport Physical Therapy, and Acta Physiologica. His research

focus involves investigating the neuromechanical consequences of lower

extremity joint injury and pathology.

Bernard serves as the Head Athletic Trainer at Brewer High School in Fort

Worth Texas. He earned his BS degree in Athletic Training from the University of

Texas - Austin, and his Masters Degree in Athletic Training from Indiana State

University.

Au serves as the Head Athletic Trainer at Bishop Amat Memorial High School in

la Puente, California. She earned her BS degree in Athletic Training from the

University of La Verne, and her Masters Degree in Athletic Training from Indiana

State University.

Demchak is an Associate Professor and Director of the Graduate Athletic

Training Program in the Athletic Training Department at Indiana State

University. He earned his BS degree in Exercise Science from Manchester

College, his Masters degree in Biomechanics from Ball State University, and his

Doctor of Philosophy degree in Exercise Physiology from The Ohio State

University. He serves as a manuscript review for many journals including:

Journal of Athletic Training, Journal of Sport Rehabilitation and Journal of

Orthopaedic & Sport Physical Therapy. His research area includes studying

tissue temperature effects with therapeutic modalities.


Stone is the CEO and Founder of Alegius Consulting, LLC in Avon, Indianapolis.

He earned his BS degree in Physical Education / Athletic Training from Brigham

Young University, his Masters degree in Athletic Training from Indiana State

University, and his Doctor of Philosophy degree in Sports Medicine from Indiana

State University. He serves as a manuscript review for the Journal of Athletic

Training and Journal of Sport Rehabilitation. His research area includes studying

the effects exercise associated muscle cramping, and tissue temperature effects

with therapeutic modalities.


Sefton is an Assistant Professor, Coordinator of the Masters Degree program in

Sports Medicine, and Director of the Neuromechanics Research Laboratory in

the Department of Kinesiology at Auburn University. She received her Bachelor’s

degree in zoology from Ohio University, Masters degrees in Athletic Training and

Exercise Science from Central Connecticut State University, and her Doctor of

Philosophy Degree in Biomedicine from the University of North Carolina at

Charlotte. She also holds a massage therapy degree from Connecticut Center for

Massage Therapy. Sefton is active in the National Athletic Trainers Association,

American College of Sports Medicine and the Society for Neuroscience and

serves as a reviewer for many scientific journals. Her research interests involve

understanding nervous system adaptations to joint injury and rehabilitation.

Journal of Electromyography and

Kinesiology

Volume 20, Issue 2, April 2010,

Pages 348-353