Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 6, pp 1269–1278 | Cite as

Local anaesthetics use does not suppress muscle activity following an ankle injection

  • David A. Stone
  • John P. AbtEmail author
  • Anthony J. House
  • Jonathan S. Akins
  • Jonathan J. Pederson
  • Karen A. Keenan
  • Scott M. Lephart
Ankle

Abstract

Purpose

To determine if peroneus longus (PL), peroneus brevis (PB), medial gastrocnemius (MG) and tibialis anterior (TA) muscle activation patterns during inversion perturbation and running tasks are suppressed following lidocaine injection to the anterior talofibular (ATF) and calcaneofibular (CF) ligament regions.

Methods

Fourteen recreationally active male subjects (age, 24.8 ± 2.9 years; height, 177.0 ± 6.0 cm; mass, 77.7 ± 6.7 kg) participated. Testing was performed under five injection conditions to the ATF and CF regions: 1 ml saline, 1 ml lidocaine, 3 ml saline, 3 ml lidocaine or no injection. Following injection condition, traditional ankle taping was applied. Electromyography patterns of the PL, PB, MG and TA were collected while subjects performed continuous lateral jumps on a custom-built device which elicited an ankle inversion perturbation and treadmill running (3.35 m s−1, 0.5 % incline).

Results

No significant differences were demonstrated in muscle activation patterns of the PL (n.s.), PB (n.s.), MG (n.s.) or TA (n.s.) for any variable across injected conditions during both tasks. Statistical power was 0.214–0.526 for the PL, 0.087–0.638 for the PB, 0.115–0.560 for the MG and 0.118–0.410 for the TA.

Conclusions

Injection of lidocaine up to 3 ml to the ATF and CF regions did not suppress muscle activity of the PL, PB, MG or TA during the inversion perturbation or running tasks. Injection up to 3 ml of 1 % lidocaine to the ATF and CF regions may be used without sacrificing the muscle activation patterns about the ankle. This finding is clinically relevant since the use of the injection does not put the patient at any higher risk of reinjury to the site.

Level of evidence

I.

Keywords

Ankle sprain Injection Anaesthetics EMG Perturbation 

Notes

Acknowledgments

The investigators wish to thank Bob and Gerri Martin for funding this research study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Albright JP, Powell JW, Martindale A, Black R, Crowley E, Schmidt P, Monroe J, Locy D, Aggler T, Davis WR, Salvaterra G, Miller D, Helwig D, Soboroff S, Nivens J, Carpenter J, Kovan J, Arndt E, Sweeney H, Lombardo J, Sebastianelli WJ, Krauss M, Landry G (2004) Injury patterns in big ten conference football. Am J Sports Med 32(6):1394–1404PubMedCrossRefGoogle Scholar
  2. 2.
    Benesch S, Putz W, Rosenbaum D, Becker HP (2000) Reliability of peroneal reaction time measurements. Clin Biomech (Bristol, Avon) 15(1):21–28Google Scholar
  3. 3.
    De Carlo MS, Talbot RW (1986) Evaluation of ankle joint proprioception following injection of the anterior talofibular ligament. PMID: 18802238. J Orthop Sports Phys Ther 8(2):70–76PubMedGoogle Scholar
  4. 4.
    Deandrade JR, Grant C, Dixon AS (1965) Joint distension and reflex muscle inhibition in the knee. PMID: 14261807. J Bone Joint Surg Am 47:313–322PubMedGoogle Scholar
  5. 5.
    Down S, Waddington G, Adams R, Thomson M (2007) Movement discrimination after intra-articular local anaesthetic of the ankle joint. Br J Sports Med 41(8):501–505PubMedCrossRefGoogle Scholar
  6. 6.
    Eechaute C, Vaes P, Duquet W, Van Gheluwe B (2007) Test-retest reliability of sudden ankle inversion measurements in subjects with healthy ankle joints. J Athl Train 42(1):60–65PubMedGoogle Scholar
  7. 7.
    Eechaute C, Vaes P, Duquet W, Van Gheluwe B (2009) Reliability and discriminative validity of sudden ankle inversion measurements in patients with chronic ankle instability. Gait Posture 30(1):82–86PubMedCrossRefGoogle Scholar
  8. 8.
    Fahrer H, Rentsch HU, Gerber NJ, Beyeler C, Hess CW, Grunig B (1988) Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining. PMID: 3403614. J Bone Joint Surg Br 70(4):635–638PubMedGoogle Scholar
  9. 9.
    Ferber R, McClay Davis I, Williams Iii D, Laughton C (2002) A comparison of within- and between-day reliability of discrete 3D lower extremity variables in runners. J Orthop Res 20(6):1139–1145PubMedCrossRefGoogle Scholar
  10. 10.
    Feuerbach JW, Grabiner MD, Koh TJ, Weiker GG (1994) Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception. PMID: 8198191. Am J Sports Med 22(2):223–229PubMedCrossRefGoogle Scholar
  11. 11.
    Hall RC, Nyland J, Nitz AJ, Pinerola J, Johnson DL (1999) Relationship between ankle invertor H-reflexes and acute swelling induced by inversion ankle sprain. PMID: 10370917. J Orthop Sports Phys Ther 29(6):339–344PubMedGoogle Scholar
  12. 12.
    Heavner JE (2007) Local anesthetics. Curr Opin Anaesthesiol 20(4):336–342PubMedCrossRefGoogle Scholar
  13. 13.
    Hertel JN, Guskiewicz KM, Kahler DM, Perrin DH (1996) Effect of lateral ankle joint anesthesia on center of balance, postural sway, and joint position sense. J Sport Rehabil 2:111–119Google Scholar
  14. 14.
    Hootman JM, Dick R, Agel J (2007) Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 42(2):311–319PubMedGoogle Scholar
  15. 15.
    Hopkins JT, Ingersoll CD, Krause BA, Edwards JE, Cordova ML (2001) Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability. Med Sci Sports Exerc 33(1):123–126PubMedGoogle Scholar
  16. 16.
    Hopkins JT, Palmieri R (2004) Effects of ankle joint effusion on lower leg function. Clin J Sport Med 14(1):1–7PubMedCrossRefGoogle Scholar
  17. 17.
    Kadaba M, Ramakrishnan H, Wootten M, Gainey J, Gorton G, Cochran G (1989) Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. J Orthop Res 7(6):849–860PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy JC, Alexander IJ, Hayes KC (1982) Nerve supply of the human knee and its functional importance. Am J Sports Med 10(6):329–335PubMedCrossRefGoogle Scholar
  19. 19.
    Konradsen L, Ravn JB, Sorensen AI (1993) Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors. J Bone Joint Surg Br 75(3):433–436PubMedGoogle Scholar
  20. 20.
    Lohkamp M, Craven S, Walker-Johnson C, Greig M (2009) The influence of ankle taping on changes in postural stability during soccer-specific activity. J Sport Rehabil 18(4):482–492PubMedGoogle Scholar
  21. 21.
    Lynch SA, Eklund U, Gottlieb D, Renstrom PAFH, Beynnon B (1996) Electromyographic latency changes in the ankle musculature during inversion moments. Am J Sports Med 24(3):362–369PubMedCrossRefGoogle Scholar
  22. 22.
    McGinley JL, Baker R, Wolfe R, Morris ME (2009) The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture 29(3):360–369PubMedCrossRefGoogle Scholar
  23. 23.
    McKeon PO, Booi MJ, Branam B, Johnson DL, Mattacola CG (2010) Lateral ankle ligament anesthesia significantly alters single limb postural control. Gait Posture 32(3):374–377PubMedCrossRefGoogle Scholar
  24. 24.
    Meeuwisse WH, Sellmer R, Hagel BE (2003) Rates and risks of injury during intercollegiate basketball. Am J Sports Med 31(3):379–385PubMedGoogle Scholar
  25. 25.
    Morey-Klapsing G, Arampatzis A, Bruggemann GP (2004) Choosing EMG parameters: comparison of different onset determination algorithms and EMG integrals in a joint stability study. Clin Biomech (Bristol, Avon) 19(2):196–201Google Scholar
  26. 26.
    Myers JB, Riemann BL, Hwang JH, Fu FH, Lephart SM (2003) Effect of peripheral afferent alteration of the lateral ankle ligaments on dynamic stability. Am J Sports Med 31(4):498–506PubMedGoogle Scholar
  27. 27.
    NCAA Sports Medicine Handbook 2008–09Google Scholar
  28. 28.
    Orchard JW (2002) Benefits and risks of using local anaesthetic for pain relief to allow early return to play in professional football. Br J Sports Med 36(3):209–213PubMedCrossRefGoogle Scholar
  29. 29.
    Orchard JW (2004) Is it safe to use local anaesthetic painkilling injections in professional football. Sports Med 34:209–219PubMedCrossRefGoogle Scholar
  30. 30.
    Palmieri RM, Ingersoll CD, Hoffman MA, Cordova ML, Porter DA, Edwards JE, Babington JP, Krause BA, Stone MB (2004) Arthrogenic muscle response to a simulated ankle joint effusion. Br J Sports Med 38(1):26–30PubMedCrossRefGoogle Scholar
  31. 31.
    Queen RM, Gross MT, Liu HY (2006) Repeatability of lower extremity kinetics and kinematics for standardized and self-selected running speeds. Gait Posture 23(3):282–287PubMedCrossRefGoogle Scholar
  32. 32.
    Refshauge KM, Kilbreath SL, Raymond J (2000) The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc 32(1):10–15PubMedGoogle Scholar
  33. 33.
    Riemann BL, Myers JB, Stone DA, Lephart SM (2004) Effect of lateral ankle ligament anesthesia on single-leg stance stability. Med Sci Sports Exerc 36(3):388–396PubMedCrossRefGoogle Scholar
  34. 34.
    Schache AG, Blanch PD, Rath DA, Wrigley TV, Starr R, Bennell KL (2001) A comparison of overground and treadmill running for measuring the three-dimensional kinematics of the lumbo-pelvic-hip complex. Clin Biomech (Bristol, Avon) 16(8):667–680Google Scholar
  35. 35.
    Spencer JD, Hayes KC, Alexander IJ (1984) Knee joint effusion and quadriceps reflex inhibition in man. Arch Phys Med Rehabil 65(4):171–177PubMedGoogle Scholar
  36. 36.
    Swenson DM, Yard EE, Fields SK, Comstock RD (2009) Patterns of recurrent injuries among US high school athletes, 2005–2008. Am J Sports Med 37(8):1586–1593PubMedCrossRefGoogle Scholar
  37. 37.
    Tsang KKW, Hertel J, Denegar CR, Buckley WE, McGuire DT (2002) The effects of induced effusion of the ankle on EMG activity of the lower leg muscles [abstract]. J Athl Train 37(2 suppl):S-25Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • David A. Stone
    • 1
  • John P. Abt
    • 2
    • 3
    Email author
  • Anthony J. House
    • 4
  • Jonathan S. Akins
    • 5
  • Jonathan J. Pederson
    • 2
  • Karen A. Keenan
    • 2
  • Scott M. Lephart
    • 2
  1. 1.Department of Orthopaedic Surgery, School of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation SciencesUniversity of PittsburghPittsburghUSA
  3. 3.Neuromuscular Research LaboratoryPittsburghUSA
  4. 4.Department of Exercise and Rehabilitation Sciences, College of Health, Environment, and ScienceSlippery Rock UniversitySlippery RockUSA
  5. 5.Neuromuscular Research Laboratory, Department of Bioengineering, Swanson School of EngineeringUniversity of PittsburghPittsburghUSA

Personalised recommendations