The influence of circadian variation on aetiological markers of ankle injury

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Context: Clinical and functional assessments are performed regularly in sporting environments to screen for performance deficits and injury risk. Circadian rhythms have been demonstrated to affect human performance, however the influence of time of day on a battery of multiple ankle injury risk factors has yet to be established within athletic populations. Objectives: To investigate the influence of circadian variation on a battery of tests, used to screen for ankle aetiological risk factors. Design: Randomised crossover design. Setting: University laboratory. Participants: Thirty-three semi-professional soccer players (age 24.9 ± 4.4 years; height 1.77 ± 0.17 m; body mass 75.47 ± 7.98 kg) completed three randomized experimental trials (07:00 h, 12:00 h, 19:00 h) Main Outcome Measures: Trials involved the completion of a standardized test battery comprising Biodex Stability System (BSS), Star Excursion Balance Test (SEBT), isokinetic inversion: eversion ratio, joint position sense, and a drop landing inversion cutting manoeuvre. Results: Repeated measures analysis of variance revealed significantly (P < 0.05) lower values for all BSS indicia; Overall Stability Index (1.10 ± 0.31 a.u), Anterior-Posterior (0.76 ± 0.21 a.u) and Medio-Lateral (0.68 ± 0.23) at 12:00 h when compared to 07:00 h. (1.30 ± 0.45 a.u; 0.96 ± 0.26 a.u; 0.82 ± 0.40 a.u) respectively. However, no significant (P ≥ 0.05) main effects for time of day were reported for any other test. Conclusions: Circadian influence on ankle aetiological risk factors was task dependent, with measures of proprioception, strength and SEBT displaying no circadian variation, indicating no association between time of day and markers of injury risk. However, the BSS displayed improved performance at midday, indicating postural stability tasks requiring unanticipated movements to display a time of day effect and potential increased injury risk. Consequently, time of testing for this task should be standardized to ensure correct interpretations of assessments and/or interventions.
Original languageEnglish
Pages (from-to)488-493
JournalJournal of Sport Rehabilitation
Issue number5
Early online date12 Dec 2018
Publication statusE-pub ahead of print - 12 Dec 2018


  • Screening
  • Soccer
  • Time of day

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