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Background Previous studies have confirmed that patients with functional ankle instability (FAI) have inadequate hip abductor muscle strength. Muscle strength training is a commonly used intervention in people with FAI. The effects investigated by previous studies have shown conflicting results. However, whether hip adduction and abduction isokinetic muscle strength training can improve muscle strength, balance, and gait in patients with FAI remains unclear. Objective The aim of this study was to observe whether muscle strength, balance, Cumberland Ankle Instability Tool (CAIT) score, plantar pressure, and gait can be improved in patients with FAI via isokinetic muscle strength training of the peri-ankle muscle groups combined with hip abduction and adductor muscle groups. Participants FAI ( n =70). Interventions The 70 FAI patients were randomly divided into an ankle isokinetic strength training (AIT) group and a hip isokinetic strength training (HIT) group. The AIT group underwent inversion/eversion and dorsiflexion/plantar flexion isokinetic concentric strength training; the HIT group underwent hip abduction and abduction isokinetic strength training based on ankle isokinetic strength training for six weeks. Main outcome measures Before and after training, isokinetic concentric force tests around the ankle and hip adduction and abduction, the Star Excursion Balance Test (SEBT), and plantar pressure and gait assessments were performed. Results After 6 weeks of training, significant changes in muscle strength were observed in ankle inversion, eversion, dorsiflexion, plantarflexion, and abduction for both the AIT and HIT groups (Group*Time, P  < 0.05). Furthermore, the HIT group exhibited greater increases in muscle strength compared to the AIT group (Group, P  < 0.05). Additionally, both groups showed varying degrees of improvement in dynamic balance, CAIT scores, and gait patterns (Time, P  < 0.05), with the HIT group demonstrating superior improvement compared to the AIT group (Group, P  < 0.05). Conclusions Isokinetic strength training through the peri-ankle muscles combined with the hip adductor and abductor muscles was more effective than peri-ankle strength training alone in improving muscle strength, balance, plantar pressure, gait, and self-reported scores in FAI patients. Trial registration This study is a randomized controlled clinical trial and has been registered in the China Clinical Trial Registry on 07/04/2022 with registration number ChiCTR2200058341.

Functional ankle instability (FAI) patients often experience restricted ankle dorsiflexion, increased inversion angle, and elevated ground reaction forces during walking, all related to altered kinematics of the talocrural and subtalar joints. This study aimed to investigate the potential positive impact of joint mobilization on FAI patients from a biomechanical perspective. The experimental group (EG, n = 17; Age: 20.06 ± 1.34 years; Height: 1.74 ± 0.07 m; Weight: 69.79 ± 11.20 kg; BMI:22.88 ± 2.63 kg/m 2 ; CAIT:15.59 ± 2.58; M/F: 15/2) received joint mobilization + routine rehabilitation training, while the control group (CG, n = 16; Age: 20.50 ± 0.73 years; Height: 1.73 ± 0.09 m; Weight: 64.59 ± 7.21 kg; BMI: 21.65 ± 2.47 kg/m 2 ; CAIT: 16.75 ± 2.21; M/F: 14/2) only received regular rehabilitation training. Biomechanical tests were performed in both groups after the 4-week intervention. The spatial parameters during walking (including step length, stride length, step width, step time, cadence, step speed, support time, and swing time), ankle flexion and dorsiflexion angle, inversion, and eversion angles, internal and external rotation angles, ankle torque, as well as the vertical ground reaction force were measured before and after the intervention. The results of the two-way ANOVA showed that the main effect of time was significant for step length (P < 0.001), stride length (P = 0.008), step speed (P < 0.001), the sagittal plane angle at touchdown (P < 0.001), maximum dorsiflexion angle (P = 0.005), sagittal plane toe off-ground angle (P < 0.001), peak flexion-dorsiflexion torque (P = 0.033), the first peak vGRF (P = 0.013), and second peak vGRF (P = 0.011). The main effect of Time * Group was significant for step speed (P = 0.044). The EG demonstrated significant improvements in step speed (P = 0.047), maximum dorsiflexion angle (P = 0.047), and the first peak vGRF (P = 0.028) compared to the CG. This study reveals that joint mobilization intervention enhances gait spatiotemporal parameters, kinematics, and kinetics, particularly in step speed, maximum dorsiflexion angle, and the first vGRF peak for the EG compared to the CG. Therefore, the rehabilitation strategy for patients with functional ankle instability should appropriately increase the use of joint movement to promote the functional recovery of FAI patients.

Considering the rapid motor-cognitive changes and increased risk of injury in preadolescent athletes, this study investigated the effects of neurocognitive training (NT) on pain, proprioception, injury-related anxiety, and functional and neurocognitive performance in athletes with chronic ankle instability (CAI). Randomized controlled trial. Sports training facilities in Balıkesir, Türkiye. Thirty preadolescent athletes with CAI (mean age 11.10 ± 1.06 years) were randomly assigned to an NT group (n = 15) or a control group (n = 13). The Identification of Functional Ankle Instability (IdFAI), Cumberland Ankle Instability Tool (CAIT), pain severity, proprioception (dorsiflexion/plantarflexion), injury-related anxiety, Y Balance Test (YBT), Side Hop Test, Reactive Balance Test (RBT), and Upper Extremity Choice Reaction Time Test were evaluated pre- and post-intervention. The NT group demonstrated significant improvements in IdFAI (p < 0.001), CAIT (p = 0.004), dorsiflexion (p = 0.003) and plantarflexion proprioception (p = 0.018), injury-related anxiety (p = 0.013), YBT anterior reach (p = 0.048), RBT reaction time (p = 0.030), and accuracy (p = 0.003). The control group showed improvement only in plantarflexion proprioception (p = 0.028), with an increase in post-training pain (p = 0.030). NT reduced ankle instability symptoms and injury-related anxiety while improving proprioception and neurocognitive performance. NT may enhance functional adaptation by addressing sport-specific cognitive-motor demands. •NT reduced instability severity and injury-related anxiety in CAI athletes.•Proprioception and neurocognitive performance significantly improved after NT.•NT enhanced reactive balance and reduced lateral hop test time.•Control group showed limited gains in proprioception and post-training pain.•NT may support multidimensional rehab by targeting both motor and cognitive skills.

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

Purpose The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions. Methods A questionnaire was sent to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects. Results Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3–6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered. Conclusions Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI. Level of evidence V.

Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI).   To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI.   Randomized controlled clinical trial.   Athletic training research laboratory.   Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg).   Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout.   Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05.   We observed time-by-group interactions in concentric ( P = .02) and eccentric ( P = .01) inversion, eccentric eversion ( P = .01), concentric ( P = .001) and eccentric ( P = .03) plantar flexion, BESS ( P = .01), SEBT ( P = .02), and side hop ( P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable.   Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.

Purpose The purpose of this study was to clinically validate the Hill–Sachs interval to glenoid track width ratio (H/G ratio) compared with the instability severity index (ISI) score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Methods A retrospective evaluation was performed using data from patients with anteroinferior shoulder instability who underwent arthroscopic Bankart repair with a follow-up period of at least 24 months. A receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the H/G ratio and the ISI score to predict an increased risk of recurrent instability. The area under the ROC curve (AUC) of the two methods and the sensitivity and specificity of their optimal cut-off values were compared. Results A total of 222 patients were included, among whom 31 (14.0%) experienced recurrent instability during the follow-up period. The optimal cut-off values for predicting an increased risk of recurrent instability were an H/G ratio of ≥ 0.7 and ISI score of ≥ 4. There were no significant differences between the AUC of the two methods (H/G ratio AUC = 0.821, standard error = 0.035 and ISI score AUC = 0.792, standard error = 0.04; n.s.) nor between the sensitivity and specificity of the optimal cut-off values (n.s. and n.s., respectively). Conclusions The H/G ratio is comparable to the ISI score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Surgeons are recommended to consider other strategies to treat anterior shoulder instability if H/G ratio is ≥ 0.7. Level of evidence III.

Evaluating the effects of personalized strength training on isokinetic muscle strength and balance ability in fencers with chronic ankle instability (CAI), focusing on functional outcomes and rehabilitation efficacy. Twenty-one fencers with CAI were randomly assigned to three groups: a control group (CG, n  = 7), a standardized strength training group (SG, n  = 7), and a personalized strength training group (PG, n  = 7). During the six-week intervention, training sessions were performed three times per week. Isokinetic muscle strength was assessed at 30°/s and 120°/s with concentric and eccentric ankle eversion. Balance ability was measured using the single-leg stance (with eyes open and closed) and Y-balance tests. Functional performance was evaluated using the Cumberland Ankle Instability Tool (CAIT). The personalized strength training group presented significant improvements in eccentric eversion peak torques at 30°/s ( p  < 0.001) and 120°/s ( p  = 0.004) and the dynamic control ratio (DCR) at 30°/s ( p  = 0.001) and 120°/s ( p  = 0.012). In terms of balance ability, this group demonstrated apparent improvements in the single-leg stance test with eyes closed ( p  = 0.000) and a trend toward improvement in dynamic balance in the Y-balance test. Additionally, this group showed a highly significant increase in CAIT scores ( p  < 0.001), indicating enhanced functional stability. By comparison, no evident improvements were observed in the control and standardized strength training groups. Personalized strength training is more effective than standardized programs in improving isokinetic muscle strength, balance ability, and functional stability in fencers with CAI. The findings suggest that incorporating personalized strength training into rehabilitation protocols can enhance recovery efficiency and injury prevention among athletes with CAI.

Background Functional ankle instability (FAI) is a common chronic disease after ankle sprains, and exercise intervention can improve symptoms of instability. This research aims to assess the effect of two new ankle balance device training programs on the ankle function and postural control ability in individuals with functional ankle instability. Methods A total of sixty-eight participants with FAI were randomly assigned to three groups: the spherical ankle balance device (SABD) group, the ensiform ankle balance device (EABD) group and the control group. Participants in all three groups engaged in an 8-week exercise intervention, conducting 4 times per week, each lasting 30 min. Variables were assessed before and after the intervention immediately, including the CAIT score, peroneal muscle reaction time, joint position sense, ankle inversion and eversion torques, and postural control ability. A paired t-test was utilized to compare results within each group, while one-way ANOVA was applied for comparisons between groups. Stepwise regression analysis was performed using the changes in CAIT score post-training as the dependent variable, with changes in peroneal muscle reaction time, position sense, postural control ability, and ankle torque as independent variables to establish a regression equation. A p-value of less than 0.05 was considered to indicate statistically significant differences. Results After eight weeks of intervention, the SABD and EABD groups exhibited significant reductions in peroneal muscle reaction time ( P  < 0.05) and increases in ankle eversion torque ( P  < 0.05) compared to the control group. The EABD group demonstrated superior outcomes in ankle inversion and eversion torque and postural control compared to SABD groups ( P  < 0.05). Conclusion Training with new ankle balance devices significantly enhanced postural control and ankle function in patients with FAI, especially for ensiform ankle balance device. Trial registration Current Controlled Trials ChiCTR2500107096, 20,250,804 (Retrospectively registered).

One of the most significant issues in hydrodynamic interfacial instabilities is the growth rate of the interfacial perturbations, which plays an important role in both scientific research (e.g. supernova explosion) and engineering applications (e.g. inertial confinement fusion). Yet the underlying mechanisms of such flow phenomena remain unclear or controversial. In this paper the decoupled mechanisms of two effects are found to dominate the interface growth of the single-mode Rayleigh–Taylor instability (RTI) and Richtmyer–Meshkov instability (RMI) via Layzer's potential-flow model. One is the inertial effect induced by the interfacial density gradient and the acceleration, and the other is the frontal distortion effect stemming from interface shape evolution. The former determines the dominant features of interface evolution, while the latter influences the local concavity and convexity of growth rate such as the overshoot phenomenon. These two effects can be approximated as a linearly decoupled analytical solution if their nonlinear interaction term is neglected. With the decoupled solution, the theoretical growth rates agree well with high-fidelity numerical simulation results. The present result indicates that the long-time evolution of fluid interface in both RTI and RMI at all density ratios can be accurately predicted if both inertia and frontal distortion effects are taken into account. Furthermore, the strong dependence of instability evolution on initial amplitude is quantified based on the effects of decoupling, which sheds light on the physical origin of the overshoot phenomenon.