Arthrogenic Muscle Inhibition (AMI) is a major challenge in the treatment of chronic ankle instability (CAI). It can lead to muscle weakness and impaired motor function. Proper management of these motor inhibitions Therefore, it is essential to prevent the risks of complications and chronicity, and to improve patients' quality of life. Innovative solutions, such as the Allyane method, which combines motor imaging and low-frequency sounds (generated by a patented medical device), offer promising prospects for accelerating the return to mobility for people suffering from this type of disorder. We invite you to discover more about this in the rest of this article.
What is the impact of Arthrogenic Muscle Inhibitions (AMI) on chronic ankle instability?
In France, nearly 70% of the population has already suffered an ankle sprain. It is important to keep in mind that, in the case of a first sprain, the risk of recurrence is approximately 3,5 times higher within a year and can affect up to 70% of athletes. Furthermore, approximately 40% of patients develop chronic ankle instability (CAI) following this specific injury.
Arthrogenic Muscle Inhibition (AMI) These motor inhibitions play a central role in chronic ankle instability. They are often considered adaptations made by the brain following an injury. However, when they reach a pathological level, they can lead to muscle weakness, impaired motor function, and sometimes a reduced range of motion. These changes can persist over time and often require additional rehabilitation approaches.
Ankle sprain: a common condition that can induce Arthrogenic Muscle Inhibition
An ankle sprain primarily refers to ligament damage caused by a forced inversion movement. This injury is linked to several risk factors, such as the patient's age, potential proprioceptive and muscular deficits, or the use of unsuitable footwear in daily life or during sports activities.
While ankle sprains are the most common injury to this joint, they particularly affect young and active patients, with nearly 73% of registered patients suffering from persistent symptoms (pain and instability) leading to CCI.
Complications and costs associated with chronic ankle instability
Chronic ankle instability (CAI) can sometimes lead to significant complications, potentially affecting proprioception and neuromuscular control. These factors are then considered to increase the risk of recurrent injuries. While the cost of treating CAI can reach €12,000, it's important to remember that patients require surgery in 20% of cases. Effective management is therefore essential to reduce the costs of these interventions and improve the quality of life for affected patients.
Impact of AMI on ankle instability
As mentioned previously, AMI (arthrogenic muscle inhibition, or motor inhibition) is initially considered a natural protective mechanism implemented by our brain. However, when it reaches a pathological stage, it can cause muscle weakness and impair the patient's motor function. Studies tend, in particular, to demonstrate a deficit in excitability and a latency in the ankle muscle reflex, suggesting a central origin of AMI. These motor changes can therefore persist even after physical recovery, necessitating the implementation of specific rehabilitation strategies.
What are the strategies for managing AMI?
Rehabilitation of the medially articulating muscles (MIs) in the context of chronic ankle instability is complex and costly. It requires, among other things, repeated physiotherapy sessions. Traditional approaches include flexion, extension and proprioception exercisesIt can be noted that there are new methods, such as cryotherapy, transcranial stimulation and the Allyane neuromotor reprogramming method, which can help accelerate the patient's return to mobility and complement the care pathway.
The Allyane method in the context of managing ankle motor inhibition
The Allyane method combines motor imagery and low-frequency sounds to reprogram altered motor patterns. This approach has already shown promising results in the rehabilitation of medially articulating injuries (MIIs), particularly after anterior cruciate ligament (ACL) rupture of the knee. It is also currently being evaluated for chronic ankle instability.
Studies highlight significant improvements in muscle strength and functional tests in patients who have undergone a few rehabilitation sessions using the Allyane method.
Motor inhibition disorders (MIDs) have a major impact on central nervous system dysfunction (CNS), necessitating the implementation of complementary rehabilitation solutions. The Allyane method represents a significant advancement in the treatment of motor inhibition and CNS, offering a tailored response to persistent MIDs and accelerating patients' functional recovery. It can therefore be considered an additional and effective tool available to healthcare practitioners.
Would you like to learn more about the Allyane method? do not hesitate to contact usAlso discover our training dedicated to the diagnosis of these motor inhibitions to enable you to accelerate the return to mobility of your patients on a daily basis.
Bibliography
1. French National Authority for Health. Lateral Ankle Sprains: Diagnosis, Rehabilitation and Return to Sport. (2023).
2. Fong, DT-P., Hong, Y., Chan, L.-K., Yung, PS-H. & Chan, K.-M. A Systematic Review on Ankle Injury and Ankle Sprain in Sports: Sports Medicine 37, 73-94 (2007).
3. Doherty, C. et al. The Incidence and Prevalence of Ankle Sprain Injury: A Systematic Review and Meta-Analysis of Prospective Epidemiological Studies. Sports Med 44, 123-140 (2014).
4. Safran, MR, Benedetti, RS, Bartolozzi, AR & Mandelbaum, BR Lateral ankle sprains: a comprehensive review Part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis: Medicine & Science in Sports & Exercise 31, S429–S437 (1999).
5. Gribble, PA et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium: Table 1. Br J Sports Med 48, 1014-1018 (2014).
6. Alghadir, A., Iqbal, Z., Iqbal, A., Ahmed, H. & Ramteke, S. Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes. IJEPH 17, 5318 (2020).
7. Knowles, SB et al. Cost of injuries from a prospective cohort study of North Carolina high school athletes. Inj Prev 13, 416-421 (2007).
8. Mugno, AT & Constant, D. Recurrent Ankle Sprain. in Stat Pearls (StatPearls Publishing, Treasure Island (FL), 2023).
9. Simon, J., Hall, E. & Docherty, C. Prevalence of Chronic Ankle Instability and Associated Symptoms in University Dance Majors: An Exploratory Study. J Dance Med Sci 18, 178-184 (2014).
10. Kim, K.-M. et al. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disability and Rehabilitation 1–16 (2023) doi:10.1080/09638288.2022.2161643.
11. Kim, J.-S. et al. Spinal Reflex Excitability of Lower Leg Muscles Following Acute Lateral Ankle Sprain: Bilateral Inhibition of Soleus Spinal Reflex Excitability. Healthcare 10, 1171 (2022).
12. Kim, J.-S. et al. Conduction Velocity of Spinal Reflex in Patients with Acute Lateral Ankle Sprain. Healthcare 10, 1794 (2022).
13. Pelletier, R., Higgins, J. & Bourbonnais, D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskeletal Disorder 16, 25 (2015).
14. Wang, Y. et al. Neuroplasticity of pain processing and motor control in CAI patients: A UK Biobank study with clinical validation. Front. Mol. Neurosci. 16, 1096930 (2023).
15. Dos Anjos, T., Gabriel, F., Dutra Vieira, T., Hopper, GP & Sonnery-Cottet, B. Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery. Sports Health: A Multidisciplinary Approach 194173812311692 (2023) doi:10.1177/19417381231169285.
16. Colombié, J.-B. & Ladoucette, S. Changing a Reflex Motor Pattern Using the Allyane Technique: Case Report of a Dancer's Chronic Ankle Instability. JOCR 13, 32-36 (2023).
17. Dos Anjos, T., Colombié, J.-B., Di Rienzo, F., Delahunt, E. & Guillot, A. Neuromotor treatment for chronic ankle instability in young pre-professional dancers: a retrospective study. Preprint at (2024).18. Roos, K.G. et al. The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports. Am J Sports Med45, 201-209 (2017).