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Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown. To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI. Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652). High school athletic training facilities. Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups. Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises. Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different. Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P < .05). However, no intervention group was superior. All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

Hopping exercises are recommended as a functional training tool to prevent lower limb injury, but their effects on lower extremity biomechanics in those with chronic ankle instability (CAI) are unclear. To determine if jump-landing biomechanics change after a hop-stabilization intervention. Randomized controlled clinical trial. Research laboratory. Twenty-eight male collegiate basketball players with CAI were divided into 2 groups: hop-training group (age = 22.78 ± 3.09 years, mass = 82.59 ± 9.51 kg, height = 187.96 ± 7.93 cm) and control group (age = 22.57 ± 2.76 years, mass = 78.35 ± 7.02 kg, height = 185.69 ± 7.28 cm). A 6-week supervised hop-stabilization training program that consisted of 18 training sessions. Lower extremity kinetics and kinematics during a jump-landing task and self-reported function were assessed before and after the 6-week training program. The hop-stabilization program resulted in improved self-reported function ( < .05), larger sagittal-plane hip- and knee-flexion angles, and greater ankle dorsiflexion ( < .05) relative to the control group. Reduced frontal-plane joint angles at the hip, knee, and ankle as well as decreased ground reaction forces and a longer time to peak ground reaction forces were observed in the hopping group compared with the control group after the intervention ( < .05). The 6-week hop-stabilization training program altered jump-landing biomechanics in male collegiate basketball players with CAI. These results may provide a potential mechanistic explanation for improvements in patient-reported outcomes and reductions in injury risk after ankle-sprain rehabilitation programs that incorporate hop-stabilization exercises.

Limited ankle dorsiflexion range of motion is one of the most important risk factors for lower limb injury, which changes the biomechanics and the neuromuscular control of the lower limb muscles. This study aims to test the effectiveness of a comprehensive corrective exercise program (CCEP) on the range of motion, proprioception, dynamic balance, and muscle activation in female athletes with limited weight-bearing lunge ankle dorsiflexion range of motion. 30 female athletes aged 15 to 25 years with dorsiflexion under 34° were randomized to two groups. The intervention group (n = 15) received eight weeks of CCEP including soft tissue mobilization, joint mobilization, stretching, and strengthening, and the control (n = 15) group did not receive any intervention. range of motion, proprioception, dynamic balance, and muscle activation were assessed before and after the intervention. The training group showed clinically acceptable and statistically significant changes in ankle dorsiflexion range of motion (ES = 0.714), balance (ES = 0.423), and proprioception (ES = 0.253; P < 0.05). There were significant changes in the activity of the tibialis anterior and soleus muscles in the dynamic overhead squat test (descending and ascending phases) and the activity of the medial gastrocnemius in the descending phase decreased significantly (P < 0.05). No significant change was observed in the activity of the peroneus longus muscle (P > 0.05). The findings show that CCEP appears to be beneficial in increasing dorsiflexion range of motion, proprioception, balance, and decreasing ankle muscle activity among individuals with limited ankle dorsiflexion. Improving the dorsiflexion range of motion may be promising for reducing ankle sprain injury.

The primary inquiry of this study was to determine if exergaming is more effective than balance training in improving dynamic postural control during jump-landing movements among athletes with chronic ankle instability (CAI). Additionally, the study aimed to compare the effectiveness of these interventions on clinical and psychological outcomes. This study was a randomized, single-blinded, controlled trial in which participants were assigned to either an exergaming group or a balance training group. Outcome measures were assessed before, after, and one month following the intervention. Primary outcomes included the stability index (SI) and time to stabilization (TTS) in the anteroposterior (AP), mediolateral (ML), and vertical (V) directions, the dynamic postural stability index (DPSI), and the resultant vector time to stabilization (RVTTS). Secondary outcomes included performance, fear of movement, and perceived ankle instability, measured using the side-hop test, the Tampa Scale for Kinesiophobia (TSK), and the Cumberland Ankle Instability Tool (CAIT), respectively. Results indicated a significant decrease in ML SI in both groups one month after treatment compared to before and after treatment (P = 0.013 and P<0.001, respectively). Additionally, one-way ANCOVA revealed a significant difference between the groups post-treatment (F(1,31) = 6.011, P = 0.020, η2 = 0.162) and one month post-treatment (F(1,31) = 4.889, P = 0.035, η2 = 0.136), with ML SI being significantly lower in the exergaming group than the balance training group at both time points. In both group, the DPSI also decreased significantly one month post-treatment compared to before and after treatment (P = 0.040 and P = 0.018, respectively). Both groups showed improvements in performance, severity of perceived ankle instability, and fear of movement. Thus, the study concluded that both exergaming and balance training effectively improved postural control during jump-landing, with exergaming showing superior performance in the ML direction both after and one month post-treatment. In terms of clinical and psychological outcomes, both interventions were effective, with neither showing superiority over the other.

The study aimed to determine if virtual reality (VR) games could enhance neuromuscular control and improve anticipatory and compensatory strategies in ball-kicking for soccer players. It was a single-blind randomized clinical trial involving 32 male soccer players with chronic ankle instability. Participants were divided into two groups: VR games and balance training. The primary outcomes measured were the amplitude and onset time of muscle activities in the peroneus longus (PL), tibialis anterior (TA), soleus (SOL), rectus femoris (RF), biceps femoris (BF), and gluteus medius (GM) in three phases: anticipatory (APA), compensatory 1 (CPA1), and compensatory 2 (CPA2). Secondary outcomes included the Y-balance test and perceived ankle instability. Evaluations were done before and after treatment. Both groups underwent 12 sessions, three times a week, each lasting 60 min. In the VR games group, there was a significant decrease in SOL muscle activity amplitude during CPA2 after treatment (P = 0.033), and the BF muscle activated earlier (P = 0.043). The balance training group showed a significant increase in GM muscle activity amplitude during APA (P = 0.037) and earlier activation of the GM muscle post-treatment (P = 0.050). Additionally, this group demonstrated significant decreases in RF activity during CPA1 and PL activity in CPA1 and CPA2 (P = 0.048, P = 0.030, and P = 0.050, respectively). Between-group comparisons indicated a significant increase in GM muscle activity amplitude during APA and a reduction during CPA1 for the balance training group compared to the VR games group (P = 0.050 and P = 0.012, respectively). Both groups showed significant reductions in perceived ankle instability (VR group: P = 0.002, balance training group: P < 0.001) and improvements on the Y-balance test (VR group: P < 0.021, balance training group: P < 0.033), although neither group showed significant improvement in the anterior direction. Overall, both VR games and balance training effectively enhanced perceived ankle stability and dynamic postural control, with neither approach showing clear superiority. Both groups exhibited improvements in muscle activation timing, though neither outperformed the other. While both interventions led to increased muscle activity amplitude during the anticipatory and compensatory phases, the balance training group achieved somewhat greater improvements. These results suggest that both VR games and balance training are effective rehabilitation approaches for chronic ankle instability, providing comparable benefits for enhancing ankle stability and neuromuscular control, without a distinct advantage of one over the other. RCT Registration: On the Iranian Registry of Clinical Trials (IRCT20230124057197N1). Registration date: 30/06/2023

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI. A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz). KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT. KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

Traditional single-limb balance (SLB) and progressive dynamic balance-training programs for those with chronic ankle instability (CAI) have been evaluated in the literature. However, which training program may be more beneficial is not known.   To investigate the effects of a progressive hop-to-stabilization balance (PHSB) program compared with an SLB program on self-reported function, dynamic postural control, and joint position sense (JPS) where angle and direction were self-reported by participants with CAI.   Randomized controlled clinical trial.   A single testing location in a mid-Atlantic state.   A total of 18 participants (age = 18.38 ± 1.81 years; height = 175.26 ± 6.64 cm; mass = 75.79 ± 12.1 kg) with CAI.   Participants were randomly assigned to the PHSB or SLB program. The PHSB and SLB groups pursued their 4-week programs 3 times a week. The PHSB group performed a battery of single-limb hop-to-stabilization exercises, while the SLB group performed a series of SLB exercises. Exercises were advanced throughout the 4 weeks for both groups.   Pretest and posttest measurements were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living subscale; FAAM-Sports subscale; Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; and weight-bearing JPS blocks (dorsiflexion, plantar flexion, inversion, eversion).   A significant main effect of time was present for the FAAM-Activities of Daily Living, FAAM-Sports, Star Excursion Balance Test (anterior, posteromedial, and posterolateral directions), and JPS (dorsiflexion, plantar flexion, inversion), as posttest results improved for the PHSB and SLB groups. The main effect of group was significant only for the FAAM-Sports, with the SLB group improving more than the PHSB group.   Either a 4-week PHSB or SLB can be used in athletes with CAI, as both programs resulted in similar gains.

Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective: Randomized controlled clinical trial.Design: Laboratory.Setting: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).Patients or Other Participants: Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s): We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:

Objective This study aimed to investigate the effects of four-week individualized transcranial direct current stimulation (tDCS) combined with foot core exercise (FCE) on foot and ankle sensorimotor function and postural control in individuals with chronic ankle instability (CAI). Methods Thirty-four CAI individuals were randomly assigned to a tDCS combined with FCE group (tDCS group, n  = 17) and a sham stimulation combined with FCE group (control group, n  = 17). All participants received individualized stimulation combined with FCE and sham stimulation combined with FCE, respectively, three times a week for 20 min per session over four weeks. Ankle strength, joint position sense, and static and dynamic postural control were assessed at baseline and post-intervention. Results Compared with the control group and baseline, individualized tDCS combined with FCE significantly increased the relative peak torque of plantarflexion, reduced the absolute error of ankle eversion position sense, and decreased the average sway velocity of the center of pressure during single-leg standing with eyes closed in CAI individuals ( p values ranging from < 0.001 to 0.016). Conclusion Four weeks of individualized tDCS combined with FCE can effectively improve foot and ankle sensorimotor function and static postural control in CAI individuals.

Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. Randomized controlled trial. Athletic training research laboratory. A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band-protocol group (n = 13 [33%] age = 19.7 ± 2.2 years, height = 172.9 ± 12.8 cm, weight = 69.1 ± 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 [33%], age = 18.9 ± 1.3 years, height = 172.5 ± 5.9 cm, weight = 72.7 ± 14.6 kg), or a control group (n = 13 [33%], age = 20.5 ± 2.1 years, height = 175.2 ± 8.1 cm, weight = 70.2 ± 11.1 kg). Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions. Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (P < .05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (P < .05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (P > .05). Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.