Factores físicos y psicológicos relacionados con la inestabilidad crónica de tobillo en jugadores de balonmano de categorías inferiores

Resumen

Background: Handball is a sport with high injury rate. One of the most frequent injuries is the lateral ankle sprain. Due to these sprains, a high percentage of patients end up suffering from chronic ankle instability. Multiple factors contribute to the patology, but the possible role of the intrinsic foot muscles is yet to be studied. Furthermore, there is not a lot of research about the influence of the abdominal wall muscles involved in this type of injury. This is an aspect already demonstrated in different pathologies of the lower limb. Furthermore, in any sport injury, and specially in chronic lesions, the psychological factor is very important; it is also considered necessary to investigate about the relevance that some psychological variables may have in chronic ankle instability in athletes. Objetive: In this study, the main objective is to compare sonographic morphology and the functionality of the intrinsic foot muscles between healthy handball players and those who suffer from chronic ankle instability. Additionally, the study aims to consider the existence of more differences between both groups in other physical and psychological variables, considering the sonographic morphology and function of the abdominal wall muscles and levels of anxiety, depression and kinesiophobia as one of the main ones. Methodology: A case-control observational descriptive study was carried out. The sample consisted of 100 subjects (50 cases and 50 controls). Handball players subjected to the study were aged from 13 to 17 years and were the same number of subjects regarding gender (50 men and 50 women). Both groups involve a series of physical and psychological measurements whose results are next compared between the separate groups: subjects denominated as cases (players with chronic ankle instability) and the ones denominated as controls (players without this pathology). The physical variables measured in this study are sonographic morphology and functionality of the abductor hallucis (AbH), flexor hallucis brevis (FHB), abductor digiti minimi (AbDM), quadratus plantae (QP) and flexor digitorum brevis (FHB) muscles; sonographic morphology and functionality of the transverse abdominis (TrA), internal oblique (OI), external oblique (OE) and rectus abdominis (RA) muscles and of the inter-rectus distance; thickness and compressibility of the heel fat pad; flexion strength of the hallux and 2nd-5th toes; force sense error in ankle eversion; range of ankle dorsiflexion with the knee flexed and extended; foot posture in load defined by the Foot Posture Index test (FPI); and foot functionality by the Bristol Foot Score questionnaire (BFS). On the one hand, these evaluations are performed on the affected side in subjects with unilateral chronic ankle instability and on a randomly selected foot in subjects with bilateral instability and in control players. On the other hand, the abdominal muscles asessments are performed bilaterally in all the subjects. Moreover, the psychological variables assessed were: anxiety using the State Trait Anxiety Inventory (STAI), personality traits using the Eysenck Personality Questionnaire-Revised Abbreviated (EPQ-RA), depression using version II of the Beck Depression Inventory (BDI-II) and kinesiophobia using the Tampa Scale for Kinesiophobia (TSK-11). In the statistical analysis, the Student’s t-test was used to compare quantitative variables whereas Pearson's chi-squared test was used for qualitative variables. Subsequently, two-factor ANOVA models were used to assess the effect of group and gender on the different study variables. Finally, correlations between some of the dependent variables in the sample are studied using the Pearson´s correlation coefficient. In this specific case, statistical associations are sought between hallux flexion strength and AbH activation index; toe flexion strength and FDB activation index; and the relationship between static foot posture with ankle dorsiflexion range and with heel fat pad compressibility index. Results: The sample shows a normal distribution in therms of demographic variables. The physical variables in which significant differences can be found depending on the group, that is, between subjects with chronic ankle instability and healthy athletes are as follows: AbH and FHB ultrasound morphology (p 0,013 and 0,005 respectively); ultrasound morphology of the inter- rectus distance (p 0,049), of the right and left RA (p 0,049 and 0,037), of the left TrA (p 0,039) and of the left OI (p 0,012); foot function (p<0,001), hallux and toes flexion strength (p 0,005 and 0,004 respectively) and ankle dorsiflexion with the knee extended and flexed (p<0,001 in both). Furthermor, the psychological variables in which we notice significant differences between the experimental and control group are stait and trait anxiety levels (p 0,006 and p<0,001 respectively), neuroticism as a personality trait (p 0,008), depression (p 0,006) and kinesiophobia avoidance, kinesiophobia harm and total courage (p≤0,001). In other physical variables, such as ultrasound morphology of AbDM, FDB and OI and OE bilaterally, we found significant differences concerning the gender, but as for the values between subjects with and without chronic ankle instability, we found not significant differences. Finally, other physical variables such as functionality of other muscles of the foot, morphology and compressibility of the heel fat pad, or the static foot posture did not show relevant distinctions for the group or gender. Statistical significance differences was not found in any of the correlations studied. Conclusions: There are a few morphological differences in the intrinsic foot muscles between subjects who suffer from chronic ankle instability and subjects who do not. Moreover, no differences were found at a functional level. However, further morphological differences are found in the abdominal wall musculature, although there are no differences in the functionality of this region between players from both groups. Subjects with chronic ankle instability present lower values of foot functionality and ankle dorsiflexion range of motion compared to controls. On the contrary, higher levels of toes flexion strength are found in the experimental group. The most significant differences between groups are observed in the psychological variables; handball players with chronic ankle instability show higher levels of anxiety, depression, neuroticism, and kinesiophobia. Both men and women have slightly different results. There are some significant differences in the muscle morphology of the foot and abdominal wall between both genders.