Ultrasound Imaging of the Gluteal Muscles During the Y-Balance Test in Individuals With or Without Chronic Ankle Instability

Context: Impairments in dynamic postural control and gluteal muscle activation have been associated with the development of symptoms related to long-term injury, which are characteristic of chronic ankle instability (CAI). Ultrasound imaging (USI) provides a visual means to explore muscle thickness throughout movement; however, USI functional-activation ratios (FARs) of the gluteal muscles during dynamic balance exercises have not been investigated. Objective: To determine differences in gluteus maximus and gluteus medius FARs using USI, Y-Balance Test (YBT) performance, and lower extremity kinematics in individuals with or without CAI. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: Twenty adults with CAI (10 men, 10 women; age = 21.70 +/- 2.32 years, height = 172.74 +/- 11.28 cm, mass = 74.26 +/- 15.24 kg) and 20 adults without CAI (10 men, 10 women; age = 21.20 +/- 2.79 years, height =173.18 +/- 15.16 cm, mass = 70.89 +/- 12.18 kg). Intervention(s): Unilateral static ultrasound images of the gluteal muscles during quiet stance and to the point of maximum YBT reach directions were obtained over 3 trials. Hip, knee, and ankle sagittal-plane kinematics were collected with motion-capture software. Main Outcome Measure(s): Gluteal thickness was normalized to quiet stance to yield FARs for each muscle in each YBT direction. We averaged normalized reach distances and obtained average peak kinematics. Independent t tests, mean differences, and Cohen d effect sizes were calculated to determine group differences for all outcome measures. Results: The CAI group had anterior-reach deficits compared with the control group (mean difference = 4.37%, Cohen d = 0.77, P= .02). The CAI group demonstrated greater anterior gluteus maximus FARs than the control group (mean difference = 0.08, Cohen d = 0.57, P = .05). Conclusions: The CAI group demonstrated YBT reach deficits and alterations in proximal muscle activation. Increased reliance on the gluteus maximus during dynamic conditions may contribute to distal joint dysfunction in this population.