Investigating Sex Difference in 2-Dimensional Ankle Stiffness during Upright Standing Balance

It has been repeatedly shown that females have lower stability and increased risk of ankle injury when compared to males participating in similar sports activities (e.g., basketball and soccer), yet sex differences in neuromuscular control of the ankle, including the modulation of ankle stiffness, and their contribution to stability remain unknown. To identify sex differences in human ankle stiffness, this study quantified 2- dimensional (2D) ankle stiffness in 20 young, healthy men and 20 young, healthy women during upright standing over a range of tasks, specifically, ankle muscle co-contraction tasks (4 levels up to 20% maximum voluntary co-contraction of ankle muscles), weight-bearing tasks (4 levels up to 90% of body weight), and ankle torque generation tasks accomplished by maintaining offset center-of-pressure (5 levels up to +6 cm to the center-of-pressure during quiet standing). A dual-axial robotic platform, capable of perturbing the ankle in both the sagittal and frontal planes and measuring the corresponding ankle torques, was used to reliably quantify the 2D ankle stiffness during upright standing. In all task conditions and in both planes of ankle motion, ankle stiffness in males was consistently greater than that in females. Among all 26 experimental conditions, all but 2 conditions in the frontal plane showed statistically significant sex differences. Further analysis on the normalized ankle stiffness scaled by weight times height suggests that while sex differences in ankle stiffness in the sagittal plane could be explained by sex differences in anthropometric factors as well as neuromuscular factors, the differences in the frontal plane could be mostly explained by anthropometric factors. This study also demonstrates that the sex differences in the sagittal plane were significantly higher as compared to those in the frontal plane. The results indicate that females have lower ankle stiffness during upright standing thereby providing the neuromuscular basis for further investigations on the correlation of ankle stiffness and the higher risk of ankle injury in females.