Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial

Proprioceptive training methods (PTM) in female soccer players - a systematic review

BACKGROUND

Although previous studies have reported that proprioceptive training methods (PTM) have positive effects, there is a relatively small number of studies regarding the impact of PTM in women's soccer. Therefore, there is a need to systematize the given results. In this regard, this systematic review aimed to investigate the effect of proprioceptive training methods in female soccer players.

METHODS

The studies' search and analysis were done according to the PRISMA guidelines. The following databases were checked (Google Scholar, PubMed Cochrane and ProQuest), with additional publication time criteria (2000-2023) using the following keywords: proprioceptive, balance, neuromuscular, training, exercise, intervention, method, activity, female football players, female soccer players, woman soccer players.

RESULTS

A total of 7 studies were included in the quantitative synthesis that meet all the criteria with the number of participants being 2.247. Based on the analysis of the previous research and detailed discussion, the main findings of the study resulted in the partial improvement of explosive strength (66%), strength (50%), muscle imbalance and flexibility (50%) and the prevention and reduction of lower extremity injuries in female soccer players (60%). Only one study reported no significant differences between groups, where rate of major injuries was higher in experimental group.

CONCLUSION

The obtained results indicate the necessity to implement proprioceptive training in female soccer training programs, in order to influence the prevention and reduction of injuries and improve balance, proprioceptive ability and body control.

Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis

AIM

To identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI).

METHOD

Five databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale.

RESULTS

A total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39-1.22; balance training: SMD = 0.79, 95%CI = 0.41-1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03-1.40; posterolateral: SMD = 0.84, 95%CI = 0.22-1.46; posteromedial: SMD = 0.88, 95%CI = 0.45-1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT.

CONCLUSIONS

Available evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI.

TRIAL REGISTRATION

( http://www.crd.york.ac.uk/PROSPERO , Registration No. CRD42022371396).

The relationship between joint kinematic patterns during single-leg drop landing and perceived instability in individuals with chronic ankle instability

BACKGROUND

Perceived instability is a primary symptom among individuals with chronic ankle instability. However, the relationship between joint kinematics during landing remains unclear. Therefore, we investigated the relationships between landing kinematics and perceived instability in individuals with chronic ankle instability.

METHODS

In 32 individuals with chronic ankle instability, we recorded ankle, knee, and hip joint angles during a single-leg drop landing. Joint angle waveforms during 200 ms before and after initial contact were summarized into single values using two methods: peak joint angles and principal component scores via principal component analysis. Using Spearman's rank correlation coefficient (ρ), we examined the relationships of peak joint angles and principal component scores with the Cumberland Ankle Instability Tool score, with a lower score indicating a greater perceived instability (α = 0.05).

FINDINGS

The second principal component scores of ankle angle in the horizontal and sagittal planes significantly correlated with the Cumberland Ankle Instability Tool score (Horizontal: ρ = 0.507, P = 0.003; Sagittal: ρ = -0.359, P = 0.044). These scores indicated the differences in the magnitude of angles before and after landing. Significant correlations indicated a greater perceived instability correlated with smaller internal rotation and plantarflexion before landing and smaller external rotation and dorsiflexion after landing. In contrast, no peak joint angles correlated with the Cumberland Ankle Instability Tool score (P > 0.05).

INTERPRETATION

In individuals with chronic ankle instability, ankle movements during landing associated with perceived instability may be a protective strategy before landing and potentially cause ankle instability after landing.

Randomized controlled trial study of intelligent rehabilitation training system for functional ankle instability

To investigate the intervention effect of an intelligent rehabilitation training system on patients with functional ankle instability (FAI) and to advance the research to optimise the effect of FAI rehabilitation training. Thirty-four FAI patients who participated in this trial in Guilin City from April 2023 to June 2023 were recruited as research subjects, and all subjects were randomly divided into the control group (n = 17) and the observation group (n = 17). Both groups received the conventional rehabilitation training intervention for 6 weeks, and the observation group received the additional training using the intelligent rehabilitation training system training invented by our team. Visual analogue scale (VAS), ankle active mobility, ankle muscle strength and Y-balance test (YBT) were assessed before and after treatment. Two-way repeated measures ANOVA shows that the interaction effect between time and group of VAS scores was significant (F = 35.644, P < 0.05). The interaction effect between time and group of plantar flexion mobility was significant (F = 23.948, P < 0.05), the interaction effect between time and group of dorsiflexion mobility was significant (F = 6.570, P < 0.05), the interaction effect between time and group of inversion mobility was significant (F = 8.360, P < 0.05), the interaction effect between time and group of eversion mobility was significant (F = 10.113, P < 0.05). The interaction effect between time and group of inversion muscle strength was significant (F = 18.107, P < 0.05). The interaction effect between time and group of YBT scores was significant (F = 33.324, P < 0.05). The Intelligent Rehabilitation Training System can effectively reduce pain in FAI patients, improve joint range of motion, increase inversion strength, and improve dynamic balance of the affected limb.

A systematic review and meta-analysis of balance training in patients with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients.

METHODS

Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis.

RESULTS

Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004].

CONCLUSION

The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.

Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability

BACKGROUND

The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored.

METHODS

A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ.

CONCLUSION

Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

Rehabilitation increases cortical activation during single-leg stance in patients with chronic ankle instability

Background

Chronic ankle instability (CAI) has been considered a neurophysiological disease, having as symptoms dysfunction in somatosensory and motor system excitability. Rehabilitation has been considered an effective treatment for CAI. However, few studies have explored the effects of rehabilitation on neuroplasticity in the CAI population.

Objective

The purpose of this study was to investigate the effects of rehabilitation on cortical activities for postural control in CAI patients and to find the correlation between the change in cortical activities and patient-reported outcomes (PROs).

Methods

Thirteen participants with CAI (6 female, 7 male, age = 33.8 ± 7.7 years, BMI = 24.7 ± 4.9 kg/m2) received a home exercise program for about 40 min per day, four days per week and six weeks, including ankle range-of-motion exercise, muscle strengthening, and balance activities. Cortical activation, PROs and Y-balance test outcomes were assessed and compared before and after rehabilitation. Cortical activation was detected via Functional near-infrared spectroscopy (fNIRS) while the participants performed single-leg stance tasks.

Results

The participants had better PROs and Y balance test outcomes after rehabilitation. Greater cortical activation was observed in the primary somatosensory cortex (S1, d = 0.66, p = 0.035), the superior temporal gyrus (STG, d = 1.06, p = 0.002) and the middle temporal gyrus (MTG, d = 0.66, p = 0.035) in CAI patients after rehabilitation. Moreover, significant positive correlations were observed between the recovery of ankle symptoms and the change of cortical activation in S1 (r = 0.74, p = 0.005) and STG (r = 0.72, p = 0.007) respectively.

Conclusion

The current study reveals that six weeks of rehabilitation can cause greater cortical activation in S1, STG and MTG. This increase in cortical activation suggested a better ability to perceive somatosensory stimuli and may have a compensatory role in function improvement.

Efficacy of resistance training with elastic bands compared to proprioceptive training on balance and self-report measures in patients with chronic ankle instability: A systematic review and meta-analysis

BACKGROUND

Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI).

OBJECTIVE

To compare the efficacy of proprioceptive training to resistance training with elastic bands for treating CAI as measured by the Star Excursion Balance Test (SEBT), the Foot and Ankle Ability Measure (FAAM), and the Cumberland Ankle Instability Tool (CAIT).

METHOD

Our systematic study and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, and ScienceDirect databases were searched for randomized clinical trials on proprioceptive and resistance training. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE).

RESULTS

Five studies involving 259 patients were included in the review. According to the findings of the meta-analysis, proprioceptive training was similarly effective with resistance training in SEBT and FAAM measures. Compared with resistance exercise, proprioceptive training demonstrated some benefits in CAIT scores (weighted mean difference [WMD] = -2.21, 95% CI = -4.05-0.36), but these intervention results were not clinically significant (MDC, MCID score >3 points).

CONCLUSION

Low-quality evidence from studies showed that neither of the interventions was superior on the SEBT or the FAAM scores in individuals with CAI because no clinically significant differences were found. More high-quality studies comparing the two interventions are needed to draw firm conclusions.

Effects of A Single Balance Training Session on Neural Excitability in Individuals With Chronic Ankle Instability

CONTEXT

Individuals with chronic ankle instability (CAI) demonstrate reduced spinal reflex modulation and corticospinal excitability of the soleus, which may contribute to decreased balance performance.

OBJECTIVE

To determine the effects of a single session of balance training on Spinal-reflexive excitability modulation and corticospinal excitability in those with CAI.

DESIGN

Randomized controlled trials.

SETTING

Research laboratory.

PARTICIPANTS

Thirty participants with CAI were randomly assigned to the balance training (BAL) or control (CON) group.

MAIN OUTCOME MEASURES

Modulation of soleus spinal-reflexive excitability was measured by calculating relative change in normalized Hoffmann reflexes (ratio of the H-reflex to the M-wave) from prone to single-leg standing. Corticospinal excitability was assessed during single-leg stance using transcranial magnetic stimulation, outcomes of which included active motor threshold (AMT), motor evoked potential, and cortical silent period (CSP). Balance performance was measured with center of pressure velocity in anterior to posterior and medial to lateral directions. Separate 2 × 2 repeated-measures analyses of variance were employed to determine the effect of group (BAL and CON) and time (baseline and posttraining) on each dependent variable.

RESULTS

There were significant group by time interactions in the modulation of soleus spinal-reflexive excitability (F1,27 = 4.763, P = .04); CSP at 100% AMT (F1,27 = 4.727, P = .04); and CSP at 120% AMT (F1,27 = 16.057, P < .01). A large effect size suggests increased modulation of spinal-reflexive excitability (d = 0.81 [0.03 to 1.54]) of the soleus in BAL compared with CON at posttest, while CSP at 100% (d = 0.95 [0.17 to 1.70]) and 120% AMT (d = 1.10 [0.29 to 1.84]) was reduced in BAL when compared with CON at posttest.

CONCLUSION

After a single session of balance training, individuals with CAI initiated increases in spinal reflex modulation and corticospinal excitability of the soleus. Thus, individuals with CAI who undergo balance training exhibit positive neural adaptations that are linked to improvements in balance performance.

Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.

METHODS

Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.

RESULTS

Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.

CONCLUSIONS

The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

Effects of Ankle Stabilization Exercises Using Sonic Balance Pad on Proprioception and Balance in Subjects with Ankle Instability

Sound waves generate acoustic resonance energy that penetrates deeply and safely into body areas normal mechanical vibrations cannot reach. The sonic balance pad utilizes these sound waves to create an optimal musculoskeletal response. The purpose of this study was to investigate the effects of a 4-week ankle stabilization exercise program using a sonic balance pad on proprioceptive sense and balance ability in individuals with ankle instability. This study was conducted as a randomized control-group pre-and post-test design in 30 participants (21 females and 9 males) who had experienced an ankle fracture or sprain within the last 5 years or who scored 11 points or more on The Identification of Functional Ankle Instability. The ankle stabilization exercise program was conducted for 4 weeks in the experimental group (n = 15), to which sonic pads were applied, and the control group (n = 15), to which balance pads were applied. All participants were assessed for their intrinsic proprioceptive sense of dorsiflexion and plantarflexion, static balance test, dynamic balance test, and long jump test were measured before and after 4 weeks as dependent variables. After 4 weeks of training, a significant difference was shown in the right dorsiflexion error (Balance pad = PRE: 2.47 ± 0.92; POST: 2.33 ± 1.40, Sonic pad = PRE: 3.27 ± 1.39; POST: 1.20 ± 0.77) and the left plantar flexion error (Balance pad = PRE: 2.00 ± 1.36; POST: 2.73 ± 1.22, Sonic pad = PRE: 3.53 ± 1.25; POST: 2.20 ± 1.01) (p < 0.05) between the experimental and control groups in the proprioception test. In the static balance test, there was no significant difference between the experimental and control groups during the pre, post, and variation stages. However, in the Y-Balance test, which is one of the dynamic balance tests, there was a significant difference between the experimental and control groups at various points, including anterior left (Balance pad = PRE: 72.85 ± 19.95; POST: 63.41 ± 8.66, Sonic pad = PRE: 68.16 ± 6.38; POST: 76.17 ± 3.67), posteromedial right (Balance pad = PRE: 78.59 ± 15.34; POST: 81.41 ± 10.37, Sonic pad = PRE: 86.33 ± 16.44; POST: 102.23 ± 11.53), posteromedial left (Balance pad = PRE: 78.00 ± 16.99; POST: 83.36 ± 10.15, Sonic pad = PRE: 88.96 ± 19.92; POST: 102.45 ± 12.98), posterolateral right (Balance pad = PRE: 78.16 ± 14.33; POST: 82.61 ± 10.73, Sonic pad = PRE: 87.95 ± 17.51; POST: 101.34 ± 15.37), and posterolateral left (Balance pad = PRE: 80.86 ± 14.96; POST: 81.31 ± 7.16, Sonic pad = PRE: 91.23 ± 17.35; POST: 104.18 ± 11.78) (p < 0.05). Moreover, in the single-leg long jump test, which is another dynamic balance test, the experimental group (Sonic pad = PRE: 100.27 ± 29.00; POST: 116.80 ± 28.86) also demonstrated a significant difference in the right single-leg long jump compared to the control group (Balance pad = PRE: 91.87 ± 17.74; POST: 97.67 ± 17.70) (p < 0.05). When a sonic balance pad using sound waves was applied in addition to a 4-week ankle stabilization exercise program for participants with ankle stability, it helped to improve proprioception and dynamic balance ability.

The effect of neuromuscular and vestibular-ocular reflex training program on balance, isokinetic muscle strength and proprioception in people with chronic ankle instability

OBJECTIVE

This study aimed to compare and investigate the effectiveness of neuromuscular exercise combined with vestibular-ocular reflex training and only neuromuscular exercise training on balance, isokinetic muscle strength, and proprioception in chronic ankle instability (CAI).

METHOD

The study included 20 patients with unilateral CAI. The functional status was evaluated with the Foot and Ankle Ability Measure (FAAM). The star-excursion balance test was used for dynamic balance, and the joint position sense test assessed proprioception. Ankle concentric muscle strength was measured by an isokinetic dynamometer. The subjects were randomly divided into neuromuscular and vestibular-ocular reflex training (VOG, n = 10) and neuromuscular training group (NG, n = 10). Both rehabilitation protocols were applied for four weeks.

RESULTS

Although VOG had higher means of all parameters, no superiority was found between the two groups in post-treatment results. However, the VOG significantly improved FAAM scores at the sixth-month follow-up than NG (P < .05). In the linear regression analysis, the post-treatment proprioception inversion-eversion for unstable side and FAAM- S were found to be independent factors of FAAM-S scores at the six months follow -up in VOG. Post-treatment isokinetic strength for inversion of unstable side (120 º /s) and FAAM- S were determined as predictor factors of FAAM- S scores at the six months follow -up (p < .05) in NG.

CONCLUSION

The Neuromuscular combined with vestibular-ocular reflex training protocol effectively managed unilateral CAI. Furthermore, it may be considered an effective strategy for clinical outcomes for a long-term period in terms of functional status.

A 6-Week Nine-Square Exercise Programme for Collegiate Athletes with Chronic Ankle Instability: A Randomised Controlled Trial

Background

Individuals with chronic ankle instability (CAI) have poor postural stability, functional limitations and low quality of life. Although nine-square exercise can improve postural control, there is limited evidence demonstrating whether it can function as an alternative CAI rehabilitation programme. This study aimed to determine the effects of nine-square exercise on postural stability and self-reported outcomes in individuals with CAI.

Methods

Eighteen male collegiate athletes with CAI participated in either a 6-week nine-square exercise or a control group (n = 9 per group). At baseline and post-intervention, the participants undertook clinical tests to measures dynamic and static postural control, and self-reported outcomes regarding ankle stability and function.

Results

Within-group differences, the nine-square exercise group experienced improved dynamic postural control (P = 0.004), static postural control (P = 0.001) and self-reported outcomes (P < 0.05). For the control group, only static postural control improved (P = 0.018). Post-intervention, the nine-square exercise group experienced significant improvements in dynamic postural control (P < 0.001), ankle stability (P = 0.002) and functional ability (P < 0.05) relative to the control group.

Conclusion

These findings suggest that the nine-square exercise can offer an alternative rehabilitation programme for improving postural control, self-perceived ankle stability and functional ability in CAI.

Auswirkungen des Trainings der intrinsischen Fußmuskulatur bei Patienten*innen mit Sprunggelenkinstabilität – ein narrativer Review

Hintergrund Sprunggelenkdistorsionen stellen eine der häufigsten Verletzungen im Sport dar und können sich als chronische Sprunggelenkinstabilität manifestieren. In der Therapie und Prävention hat sich ein sensomotorischer Trainingsansatz der sprunggelenkumgebenden Strukturen als wirksam erwiesen. Es gibt Hinweise, dass auch ein Training der intrinsischen Fußmuskulatur beispielsweise die Balance verbessern kann.

Ziel Ziel dieses narrativen Reviews ist die Darstellung der Evidenz eines Trainings der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität.

Methode Im Januar 2022 wurde in den Datenbanken PubMed, Cochrane Library, EBSCOhost, PEDro, SPONET und BISp-Surf eine systematische Literaturrecherche durchgeführt, die durch eine Freihandsuche ergänzt wurde. Dabei sollten Metaanalysen, Systematic Reviews und Interventionsstudien inkludiert werden, die Effekte einer Trainingsform der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität untersuchten. Die qualitative Bewertung der Literatur und Evidenz erfolgte anhand des Risk-of-Bias-Tools (RoB-Tool) des Cochrane Handbook sowie angelehnt an das GRADE-System.

Ergebnisse Fünf randomisierte kontrollierte Studien mit insgesamt 150 Proband*innen wurden inkludiert. Vier Studien nutzten die Short-Foot Exercise (SFE), eine Studie die Towel-Curl Exercise (TCE) und eine wandte ein Training der Zehen an. Drei Studien wiesen einen großen, signifikant positiven Effekt (p<0,05) der SFE auf die subjektive Instabilität auf. Die SFE und das Zehentrainingsprogramm hatten signifikant positive Effekte (p<0,05) auf die Balance, wobei die Einbeziehung der SFE in ein Trainingsprogramm zu keinem Vorteil führte. Eine Studie stellte signifikant positive Auswirkungen (p<0,05) der SFE auf die Somatosensibilität fest. Alle 3 Trainingsformen führten zu deutlichen, signifikanten (p<0,05) Verbesserungen funktioneller Aspekte.

Schlussfolgerung Es zeigen sich positive Effekte durch das Training der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität auf die subjektive Instabilität, Balance, Somatosensibilität sowie auf funktionelle Aspekte. Effektive Trainingsformen scheinen die SFE und ein Zehentraining zu sein, diese könnten eine sinnvolle Ergänzung zur konventionellen Therapie darstellen. Die Qualität der Evidenz ist jedoch zu gering, um eine klare Empfehlung aussprechen zu können.

Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis

OBJECTIVE

To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).

DATA SOURCES

PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.

STUDY SELECTION

Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included.

DATA EXTRACTION

Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.

DATA SYNTHESIS

Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence).

CONCLUSIONS

The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.

Cross-Education Balance Effects After Unilateral Rehabilitation in Individuals With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To conduct a systematic review of existing literature on cross-education balance effects after unilateral training in the population with chronic ankle instability (CAI).

DATA SOURCES

PubMed, SPORTDiscus, CINAHL Plus.

STUDY SELECTION

To be included in the systematic review, studies were required to have been published in English, included participants with CAI, had participants undergo a unilateral therapeutic exercise for the lower extremity, and measured balance performance of the untrained lower extremity before and after the intervention.

DATA EXTRACTION

The certainty of evidence in each included study was assessed via the Downs and Black checklist. A score of 24 to 28 indicated excellent or very low risk of bias; 19 to 23, good or low risk of bias; 14 to 18, fair or moderate risk of bias; and <14, poor or high risk of bias. We extracted information from each study regarding design, participant characteristics, inclusion criteria, independent and dependent variables, intervention, and results. Baseline and postintervention balance performance data for participants' untrained limbs were used to calculate the Hedges g effect sizes and 95% CIs.

DATA SYNTHESIS

Our search returned 6 studies that met the inclusion criteria. The articles' risk of bias ranged from high to low (11-19). In 4 of 5 studies that examined unilateral balance training, the authors reported a cross-education effect. In the lone study that examined resistance training at the ankle joint, a cross-education effect was also present. Several cross-education effects were associated with large effect sizes. This systematic review was limited by a small number of studies that varied in methods and quality.

CONCLUSIONS

Our results suggest that unilateral therapeutic exercise can improve balance performance of the untrained limb of individuals with CAI. More work is needed to determine which training protocols are most effective for generating a cross-education effect.

Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Controlled Trial

(1) Background: Chronic ankle instability (CAI) is a complex condition that includes limited mobility, perceived instability, and recurrent ankle sprains are common characteristics that reduce the quality of life in subjects who suffer from CAI. Neuromuscular training and strength training have been recommended in CAI management interventions. However, there are contradictory findings on results when comparing neuromuscular training, strength training, and the control group. The objective of this study was to compare the effectiveness of 8 weeks of neuromuscular intervention training, strength training, and no intervention in a sporting population with reported CAI. (2) Methods: Sixty-seven athletes with CAI were randomly assigned to a neuromuscular training group (NG), strength training group (SG), or control group (CG). Participants completed 8 weeks of neuromuscular training (a combination of static and dynamic exercises), strength training (resistance band exercises), or no training. Outcome measures were assessed at baseline and after 8 weeks and included selfs-reported instability feeling (CAIT), dynamic balance (SEBT), ankle dorsiflexion range of motion (WBLT), and functional status (FAAM and FAAM-SPORT). (3) Results: There were significant differences between strength and control groups in the posteromedial direction of SEBT, FAAM, and FAAM-SPORT after 8 weeks of intervention. (4) Conclusions: Neuromuscular training and strength training based on resistance bands exercises showed significant improvements in ankle dorsiflexion, subjective feeling of instability, functional status, and dynamic balance in patients with CAI.

Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: a systematic review

QUESTION

What is the effect of injury prevention programs that include balance training exercises on the incidence of ankle injuries among soccer players?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

Soccer players of any age, sex or competition level.

INTERVENTIONS

The experimental intervention was an injury prevention program that included balance training exercises. The control intervention was the soccer team's usual warm-up program.

OUTCOME MEASURES

Exposure-based ankle injury rates.

RESULTS

Nine articles met the inclusion criteria. The pooled results of injury prevention programs that included balance training exercises among 4,959 soccer players showed a 36% reduction in ankle injury per 1,000 hours of exposure compared to the control group with an injury risk ratio (IRR) of 0.64 (95% CI 0.54 to 0.77). The pooled results of the Fédération Internationale de Football Association (FIFA) injury prevention programs caused a 37% reduction in ankle injury (IRR 0.63, 95% CI 0.48 to 0.84) and balance-training exercises alone cause a 42% reduction in ankle injury (IRR 0.58, 95% CI 0.41 to 0.84).

CONCLUSIONS

This meta-analysis demonstrates that balance exercises alone or as part of an injury prevention program decrease the risk of ankle injuries. PROSPERO CRD42017054450.

Can therapeutic exercises improve proprioception in chronic ankle instability? a systematic review and network meta-analysis

OBJECTIVE

To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI).

DATA SOURCES

Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021.

STUDY SELECTION

Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included.

DATA EXTRACTION

Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale.

DATA SYNTHESIS

The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated.

RESULTS

Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively.

CONCLUSIONS

Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

PROSPERO REGISTRATION NUMBER

CRD42021240331.

A pilot randomised control trial of the efficacy of stability-based training with visualisation for people with chronic ankle instability

Chronic ankle instability (CAI) is associated with recurring symptoms that inhibit daily activity. Stability-based rehabilitative training is recommended for CAI. Visualisation (VIS) produces real-time feedback using motion capture and virtual reality. This pilot study aimed to determine the feasibility, adherence, safety, and efficacy of incorporating VIS into stability training for people with CAI. Efficacy was examined through effect of VIS training on dynamic stability, perception of stability, and rehabilitative experience. Individuals with CAI completed a 4-week stability-based training programme with VIS, or without visualisation (NO-VIS). Participants completed the Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT) prior to, and after training. Enjoyment of training was recorded using the Physical Activity Enjoyment Scale (PACES-8). Of 17 participants (VIS = 10, NO-VIS = 7), there were 2 drop outs (VIS = 1, NO-VIS = 1). No adverse events were reported, and participant drop-out was due to injury unrelated to the study. The VIS group showed a significantly greater increase in average SEBT reach distance (d = 1.7, p = 0.02). No significant differences were reported for the CAIT or PACES-8. This study supports the feasibility and safety of stability-based training with VIS in those with CAI. The enhanced performance outcome on the SEBT suggests VIS may enhance stability-based training.

Effect of Tai Chi combined with Kinesio taping on posture control of football players with FAI: protocol for a randomized controlled trial

Background

Functional ankle instability (FAI) of college football players is an important risk factor affecting their training and competition. Physical therapy and appropriate sports intervention can improve the stability of FAI patients. Previous studies have shown that Tai Chi (TC) and Kinesio taping (KT) can improve the posture control ability of FAI patients. However, whether Tai Chi combined with Kinesio taping effect patch can be used as an effective exercise for rehabilitation of college football players with FAI is not yet proven.

Methods/design

Fifty-three FAI college football players were randomly assigned to 3 groups: TC+KT (n = 20); TC+KTp (placebo Kinesio taping, KTp, placebo) (n = 17), and KT (n = 16). The TC+KT group received TC and KT functional correction technical intervention, the TC+KTp group received TC and placebo KT technical intervention, and the KT group received KT functional correction technical intervention. Each of the three groups received 30 min each time, 3 times a week, for a total of 6 weeks of intervention training. Star Excursion Balance Test (SEBT) and UniPedal Stance Test (UST) at baseline (before), 4 weeks after intervention (middle), and 6 weeks after intervention (after) and Toe Touch Test (TTT) were evaluated.

Discussion

For the first time in this trial, the impact will be evaluated. If the results are the same as expected, they will provide evidence that Tai Chi combined with Kinesio taping sticking intervention can promote the posture control of college football players with FAI.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900027253. Registered on 6 November 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06083-5.

Effect of Combined Balance Exercises and Kinesio Taping on Balance, Postural Stability, and Severity of Ankle Instability in Female Athletes with Functional Ankle Instability

Ankle sprain is a common musculoskeletal injury, and recurrent ankle sprains often lead to ankle instability. This study aimed to examine whether a 6-week balance training on a wobble board (WB) combined with kinesio taping (KT) is effective in improving balance, postural stability, and ankle stability among female athletes with functional ankle instability (FAI). Twenty-four female athletes with FAI were randomly assigned to study (SG) or control groups (CG). SG attended a 6-week training protocol of combined balance training on the wobble board with KT applied to ankles during exercise. CG only went through a 6-week balance training procedure that was the same as the SG. Before and after the training program, balance and postural stability and the severity of ankle instability were assessed by single-leg Biodex Balance system and Cumberland Ankle Instability Tool (CAIT), respectively. The analysis revealed that the scores of balance and postural stability decreased after the 6-week training for CG (p = 0.002) and SG (p = 0.001), which indicates an improvement for these variables, and the score of CAIT increased, which means the severity of instability reduced (p = 0.001 for both groups). Significant between-group differences were found for balance and postural stability (t = 2.79, p = 0.011, g = −1.99) and the severity of instability (t = 2.082, p = 0.049, g = 1.36), favoring SG compared with CG. This study showed that the addition of KT to balance training is more effective than balance training alone in improving balance, postural stability, and severity of ankle instability in female athletes with FAI. Our findings could provide a preliminary reference for designing combined balance and KT programs for delivering health benefits to females with FAI.

Effect of Virtual Reality on Functional Ankle Instability Rehabilitation: A Systematic Review

Objective

To systematically evaluate the effectiveness of virtual reality (VR) in the rehabilitation of patients with functional ankle instability (FAI).

Methods

Nine databases were researched, including PubMed, Cochrane Library, Web of Science, Embase, OVID, CNKI, VIP, WanFang, SinoMed, ResearchGate, and WorldWildScience. The publication date deadline was May 22, 2021. To analyze the effect of VR rehabilitation of FAI, we systematically reviewed the literature using the RevMan 5.4 software. Main Results. Five randomized controlled trials (RCTs) were included in the analysis, consisting of 137 patients with FAI; 68 of them were in the experimental group, 69 were in the control group, and all were university students. A comparison study was conducted between the two groups in terms of balance function, muscle performance, and proprioception. VR rehabilitation in the treatment of FAI was found to be significantly more effective using a 30-second single-leg standing test than conventional rehabilitation. The angular offset index of VR rehabilitation training was significantly lower than that of conventional balance training (0.66 ± 0.18 vs. 0.95 ± 0.21; P = 0.005).

Conclusion

VR rehabilitation is effective at treating FAI. However, RCTs with higher homogeneity are needed to provide a more reliable evidence-based foundation for clinical rehabilitation.

Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis

INTRODUCTION

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI.

METHODS AND ANALYSIS

We will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines.

ETHICS AND DISSEMINATION

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

Effect of Functional Rehabilitation on Performance of the Star Excursion Balance Test Among Recreational Athletes With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To determine (1) the effectiveness of rehabilitation for chronic ankle instability as measured by the Star Excursion Balance Test (SEBT) and (2) the relative efficacy and the long-term effects of these rehabilitation interventions.

DATA SOURCES

Ten electronic databases were searched (2009-2019).

STUDY SELECTION

Included articles were randomized controlled trials in English investigating recreational athletes aged ≥18 years with chronic ankle instability. At least 1 functional rehabilitation intervention had to be included and the SEBT test (or the modified version) used as an outcome measure.

DATA EXTRACTION

Two researchers (L.A., O.N.) extracted data regarding participant demographics; intervention characteristics; trial size; and results at baseline, postintervention, and at follow-up, where appropriate.

DATA SYNTHESIS

A systematic review and narrative synthesis was conducted. Methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool and the van Tulder scale. The review was registered with PROSPERO (ID: 164468). Ten studies (n=368), 2 high-quality, 1 moderate-quality, and 7 low-quality, were included in the review. Interventions included balance training, strength training, vibration training, and mixed training. Results suggest that rehabilitation of chronic ankle instability that includes wobble board exercises (average percentage change: 14.3%) and hip strengthening exercises (average percentage change: 12.8%) are most effective. Few studies compared different types of rehabilitation for chronic ankle instability. However, improvements on the SEBT suggest that a rehabilitation program focusing on wobble board training and hip strengthening performed 3 times weekly for 4-6 weeks is the optimal rehabilitation program to improve dynamic postural control in recreational athletes with chronic ankle instability.

CONCLUSIONS

Few studies directly compared different rehabilitation interventions, and there was limited long-term follow-up; therefore, the relative efficacy of different rehabilitation programs remains unclear. However, it seems that rehabilitation of chronic ankle instability should include proprioceptive and strengthening exercises of relatively short duration.

Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis

AIM

To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability.

METHOD

The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed.

RESULTS

Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (-0.15, 0.58)).

CONCLUSIONS

Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42021224179.

Short-Term Effects of Balance Training with Stroboscopic Vision for Patients with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

Chronic Ankle Instability (CAI) is one of the most common musculoskeletal dysfunctions. Stroboscopic vision (SV) training has been deemed to enhance somatosensorial pathways in this population group; nevertheless, until recently no studies have addressed the additional effects of this treatment option to the traditional therapeutic approach.

METHODS

To evaluate the effectiveness of a partial visual deprivation training protocol in patients with CAI, a randomized controlled trial was carried out. Patients with CAI (n = 73) were randomized into either a balance training, SV training, or a control (no training) group. For participants assigned into training groups, they received 18 training sessions over 6 weeks. The primary outcome was dynamic balance as measured by the Star Excursion Balance Test assessed at baseline and after 6 weeks of intervention. Secondary outcome measures included ankle dorsiflexion range of motion, self-reported instability feeling, and ankle functional status.

RESULTS

Better scores in stroboscopic training and balance training groups in all outcome measures were observed in comparison with the control group with moderate to large effect sizes. Stroboscopic training was more effective than neuromuscular training in self-reported instability feeling (cohen's d = 0.71; p = 0.042) and anterior reach distance of the star excursion balance test (cohen's d = 1.23; p = 0.001).

CONCLUSIONS

Preliminary findings from the effects of SV Stroboscopic training in patients with CAI, suggest that SV may be beneficial in CAI rehabilitation.

The effects of stroboscopic balance training on cortical activities in athletes with chronic ankle instability

OBJECTIVES

To investigate the effect of a 6-week stroboscopic balance training program on cortical activities in athletes with chronic ankle instability.

DESIGN

Randomized controlled trial.

SETTING

Single-center.

PARTICIPANTS

Thirty-nine participants were assigned to the strobe group (SG, n = 13), non-strobe group (NSG, n = 13), and control group (CG, n = 13).

MAIN OUTCOME MEASURES

Cortical activity and balance velocity were evaluated while the athletes were on the HUBER balance device. Electroencephalographic measurements of cortical activity were made at the transition from bipedal stance to single-leg stance.

RESULTS

The SG showed significant increases in Cz theta and alpha values and COP-v (center of pressure velocity) between pretest and posttest (p < 0.001, p = 0.003, p < 0.001). Posttest Cz theta was significantly higher in the SG compared to the CG (p = 0.009) and posttest Cz alpha was significantly higher in the SG compared to the NSG (p = 0.039) and CG (p = 0.001). Posttest COP-v was significantly higher in the SG than in the CG (p = 0.031) and NSG (p = 0.03).

CONCLUSIONS

Stroboscopic training may be clinically beneficial to improve balance parameters in athletes with CAI, and may have utility in sport-specific activity phases of rehabilitation to reduce visual input and increase motor control.

The effect of the combination of whole body vibration and shoe with an unstable surface in chronic ankle instability treatment: a randomized clinical trial

Background

Chronic ankle instability (CAI) is a common condition following an ankle sprain. This study investigated the effects of whole body vibration (WBV) and shoe with an unstable surface training on balance, functional performance, strength, joint position sense in people with CAI.

Method

Thirty- four peoples with unilateral CAI were randomly assigned to three groups: WBV group, WBV with shoe with an unstable surface (WBV-S), and no treatment control group (CON). The WBV group received 4 weeks progressive WBV training and the WBV-S group received progressive WBV training with shoe with an unstable surface. Modified star excursion balance test (mSEBT)reach distance, Hop-Test, muscle strength, and joint position sense were measured at baseline and after the 4 weeks; Moreover, the mSEBT and Hop-Test were reassessed again 2 weeks post intervention.

Results

The result showed a significant group-by-time interaction for anterior and posterolateral directions of mSEBT. The reach distance of these directions at post-intervention and follow-up increased significantly compare to pre-intervention in the WBV and WBV-S groups but not significantly change in the CON group. The Hop test in the WBV-S group was significantly more at post-intervention and follow-up compared to pre-intervention. However, no significant changes were observed in WBV and CON groups. No significant changes were observed for mSEBT posteromedial direction, muscles strength, and joint position sense errors.

Conclusion

The 4 weeks WBV and WBV-S interventions could improve balance in peoples with CAI. Improvement in Hop test was only observed in the WBV-S group suggesting the added value of combining WBV and shoe with an unstable surface as an effective therapy compared to WBV training alone. The use of WBV and WBV-S were not associated with significant changes in strength and joint position sense variables over a four-week period.

Trial registration

This work registered in the Iranian Registry of Clinical Trials (IRCT20151118025105N4).

Eyes-Open Versus Eyes-Closed Somatosensory Motor Balance in Professional Soccer Players With Chronic Ankle Instability: A Case-Control Study

Background:

Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control.

Purpose:

To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups.

Results:

Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable.

Conclusion:

In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players.

Assessments of Sensorimotor Deficits Used in Randomized Clinical Trials With Individuals With Ankle Sprains and Chronic Ankle Instability: A Scoping Review

The main purpose of this scoping review was to summarize the most common tasks and outcome measures in randomized control trials (RCTs) used to assess sensorimotor function following ankle sprain and chronic ankle instability (CAI). We also aimed to summarize the description of inclusion criteria used in articles. We searched for RCTs published between 2008 and 2018 using the following databases: MEDLINE, PubMed, SPORTDiscus, and Web of Science. Eligible studies included participants of either sex who had had at least one ankle sprain with/without subsequent CAI. All articles assessed sensorimotor function. The tasks, outcome measures, and inclusion criteria were categorized, and frequencies of use in each category were calculated. Of 272 publications, 31 met the eligibility criteria. The most common task was single-limb stance (58% of 31). The most common outcome measure was the posterior-medial reach distance of the Star Excursion Balance Test (SEBT) (13 of 16 articles, 81%). Different inclusion criteria for a history of ankle sprains or CAI were used. A wide range of sensorimotor assessments and inclusion criteria was used among studies involving individuals with a history of ankle sprain with or without CAI, which could make it difficult to compare and generalize study results. This scoping review provides a baseline for planning future studies exploring outcome measures to assess sensorimotor function of individuals with a history of ankle sprain with or without CAI.

Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.

Effects of Taping and Balance Exercises on Knee and Lower-Extremity Function in Amateur Soccer Players: A Randomized Controlled Trial

CONTEXT

Knee injury prevention is a critical aspect in sport rehabilitation sciences, and taping is a widely used technique in this field. Nevertheless, the role and effectiveness of a long-term application of Kinesio Taping (KT) on knee function, disability, and injury prevention remain unclear.

OBJECTIVE

To determine the effect of KT, alone or in combination with balance exercises (BE), on dynamic and static knee balance and flexibility.

DESIGN

Randomized trial design.

SETTING

University of Valencia (Spain).

PARTICIPANTS

Forty-eight male amateur soccer players.

INTERVENTION

Participants were assigned to 3 groups: Sham KT (sKT) + BE, KT + BE, and KT in isolation. The intervention period lasted 4 weeks. Three evaluations were performed: at baseline (pre), at 2 weeks (mid), and at 4 weeks posttreatment (post).

MAIN OUTCOME MEASURES

Y Balance Test, unipedal stance test, the toe touch test, and the Knee Injury and Osteoarthritis Outcome Score.

RESULTS

Both sKT + BE and KT + BE groups achieved significant pre-post improvements in SEBT, unipedal stance test, and toe touch test. The KT group only showed significant intragroup differences in the left and right unipedal stance test variable (P < .05, d = 0.76, d = 0.62, respectively). The sham KT group obtained the strongest results in all physical variables. Regarding the Knee Injury and Osteoarthritis Outcome Score, pre-post significant changes were found in the sham group (P < .05, d = 0.28).

CONCLUSIONS

Both sham and real KT in combination with BE achieved significant improvements on all physical variables, and these differences were significantly greater compared with those found in the KT in the isolation group, suggesting that benefits in knee function are due to the BE.

LEVEL OF EVIDENCE

Therapy level 1b.

Cross-cultural adaptation, reliability, and validation of the Taiwan-Chinese version of Cumberland Ankle Instability Tool

Purpose: To cross-cultural translate the Cumberland Ankle Instability Tool (CAIT) to Taiwan-Chinese version (CAIT-TW), and to evaluate the validity, reliability and cutoff score of CAIT-TW for Taiwan-Chinese athletic population.Materials and methods: The English version of CAIT was translated to CAIT-TW based on a guideline of cross-cultural adaptation. 77 and 58 Taiwanese collegial athletes with and without chronic ankle instability filled out CAIT-TW, Taiwan-Chinese version of Lower Extremity Functional Score (LEFS-TW) and Numeric Rating Scale (NRS). The construct validity, test-retest reliability, internal consistency and cutoff score of CAIT-TW were evaluated.Results: In construct validity, the Spearman's correlation coefficients were moderate (CAIT-TW vs LEFS-TW: Rho = 0.39, p < 0.001) and strong (CAIT-TW vs NRS: Rho= 0.76, p < 0.001). The test retest reliability was excellent (ICC_2.1 = 0.91, 95% confidential interval = 0.87-0.94, p < 0.001) with a good internal consistency (Cronbach's α: 0.87). Receiver operating characteristic curve showed a cutoff score of 21.5 (Youden index: 0.73, sensitivity: 0.87, specificity 0.85).Conclusions: The CAIT-TW is a valid and reliable tool to differentiate between stable and instable ankles in athletes and may further apply for research or daily practice in Taiwan.Implications for rehabilitationFor athletes, chronic ankle instability is prevalent and causes negative sequela, such as lowered quality of daily life, affected functional performance, and may cause post traumatic osteoarthritis.The psychometric properties of the Taiwan-Chinese version of the Cumberland Ankle Instability Tool showed moderate to strong construct validity, excellent test retest reliability, a good internal consistency and a cutoff score of 21.5.The validity and reliability of the Taiwan-Chinese version of the Cumberland Ankle Instability Tool are to enable clinicians to evaluate and manage ankle instability in Taiwanese who speaks Mandarin Chinese.

Ankle-Joint Self-Mobilization and CrossFit Training in Patients With Chronic Ankle Instability: A Randomized Controlled Trial

CONTEXT

Ankle-joint mobilization and neuromuscular and strength training have been deemed beneficial in the management of patients with chronic ankle instability (CAI). CrossFit training is a sport modality that involves these techniques.

OBJECTIVE

To determine and compare the influence of adding self-mobilization of the ankle joint to CrossFit training versus CrossFit alone or no intervention in patients with CAI.

DESIGN

Randomized controlled clinical trial.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group.

INTERVENTION(S)

Participants in the self-mobilization plus CrossFit group and the CrossFit training-alone group pursued a CrossFit training program twice a week for 12 weeks. The self-mobilization plus CrossFit group performed an ankle self-mobilization protocol before their CrossFit training, and the control group received no intervention.

MAIN OUTCOME MEASURE(S)

Ankle-dorsiflexion range of motion (DFROM), subjective feeling of instability, and dynamic postural control were assessed via the weight-bearing lunge test, Cumberland Ankle Instability Tool, and Star Excursion Balance Test (SEBT), respectively.

RESULTS

After 12 weeks of the intervention, both the self-mobilization plus CrossFit and CrossFit training-alone groups improved compared with the control group (P < .001). The self-mobilization plus CrossFit intervention was superior to the CrossFit training-alone intervention regarding ankle DFROM as well as the posterolateral- and posteromedial-reach distances of the SEBT but not for the anterior-reach distance of the SEBT or the Cumberland Ankle Instability Tool.

CONCLUSIONS

Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control and self-reported instability in patients with CAI.

Wobble-Board Balance Intervention to Decrease Symptoms and Prevent Reinjury in Athletes With Chronic Ankle Instability: An Exploration Case Series

Controlled research has shown that a single-exercise wobble-board intervention is effective at reducing symptoms and increasing function in patients with chronic ankle instability. However, the effectiveness of this protocol has not been documented in a realistic intercollegiate athletics environment. Eight intercollegiate athletes with chronic ankle instability participated in an 8-week (3 sessions/wk) wobble-board intervention. In a realistic environment, this simple intervention was feasible to implement and resulted in meaningful improvements in patient-reported stability for more than half of the patients (5 of 8) but only improved the global rating of function and pain for a minority of the patients (2 of 8 and 3 of 8, respectively). Not all patients experienced equal symptom reduction; however, no new ankle sprains occurred during the intervention.

Effect of Kinesio Taping and balance exercises on postural control in amateur soccer players: A randomised control trial

The objective of this study was to determine the effect of Kinesio Taping (KT), alone or together with balance exercises (BE), on parameters related to postural control, such as dynamic balance, static balance and flexibility. Forty-four male amateur soccer players (mean age 24.45 (4.79) years) were randomly allocated to 3 groups: KT+BE that received KT and BE (n = 16); KT_p+BE, in which the KT was used as a placebo (n = 15) and KT alone (n = 13). The intervention period lasted 4 weeks. Star Excursion Balance Test (SEBT), Unipedal Stance Test (UST) and the Toe Touch Test (TTT) were assessed at baseline (pre), two weeks after beginning the treatment (mid) and after the intervention (post). We observed a significant improvement on the SEBT (mid and post-treatment) and the UST (post-treatment), but not on the TTT in either KT+BE or KT_p+BE groups post treatment. No differences were found either in KT group at any time point or between groups in any variable studied. In conclusion, KT functional correction technique does not improve static and dynamic balance when applied alone, whereas BE alone or combined with KT significantly improves these variables. None of these techniques has any effect on flexibility. Abbreviation: KT: Kinesiotaping; BE: Balance exercises; KTp: Placebo Kinesiotaping; UST: Unipedal Stance Test; SEBT: Star Excursion Balance Test; TTT: Toe Touch Test.

The Prevalence of Pain in People With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI.

DATA SOURCES

We searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017.

STUDY SELECTION

Eligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded.

DATA EXTRACTION

Studies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance.

DATA SYNTHESIS

Of the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies.

CONCLUSIONS

Pain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.

Effects of therapeutic exercise on sea sand on pain, fatigue, and balance in patients with chronic ankle instability: a feasibility study

BACKGROUND

Chronic ankle instability (CAI) is a common disease following ankle sprain and appears balance and gait problems, pain, and fatigue. This study aimed to examine the effect of therapeutic exercise performed on sea sand on pain, fatigue, and balance ability in patients with CAI.

METHODS

This study was designed as a randomized controlled trial. Subjects with a Cumberland Ankle Instability Tool (CAIT) score of less than 27 were selected. 22 subjects were randomly assigned to the sea sand (SS) group (N.=11) or the self-management (SM) group (N.=11). The SS group performed the therapeutic exercise on sea sand and the SM group conducted the exercises on a firm surface at home 5 times over the course of a week. To measure static balance, center of pressure (COP) of one-leg standing on the force plate was assessed. Visual Analog Scale (VAS) was used to measure pain and fatigue.

RESULTS

The SS group showed statistically significant improvements in all static balance outcomes (COP-area, COP-average velocity, minor-axis, major-axis) after the intervention (P<0.05), while the SM group did not show a significant change in all static balance parameters (P>0.05). Also, the SS group showed statistically significant improvements in pain and fatigue (P<0.05). All outcomes except major axis showed statistically significant differences between SS group and SM group at change value (P<0.05).

CONCLUSIONS

Therapeutic exercise on sea sand effectively improved balance and decreased pain and fatigue. Thus, it can be considered a rehabilitation method for CAI patients.

A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes

CONTEXT

Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated.

OBJECTIVE

To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI.

DESIGN

Controlled laboratory study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of "giving way" in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24.

INTERVENTION(S)

Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily.

MAIN OUTCOME MEASURE(S)

Dorsiflexion range of motion (weight-bearing-lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure-Activities of Daily Living and Foot and Ankle Ability Measure-Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire-Physical Activity and Fear-Avoidance Beliefs Questionnaire-Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up).

RESULTS

Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure-Activities of Daily Living score, the modified Disablement in the Physically Active scale-physical summary component score, and the Fear-Avoidance Beliefs Questionnaire-Physical Activity score were improved at postintervention (P < .001; effect-size range = 0.72-1.73) and at the 2-week follow-up (P < .001; effect-size range = 0.73-1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P < .04; effect-size range = 0.61-0.78) and postintervention (P < .04) during the eyes-open condition.

CONCLUSION

A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.

Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis

OBJECTIVE:

To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials.

DATA SOURCES:

The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018.

METHODS:

RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations.

RESULTS:

Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense.

CONCLUSION:

Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.

Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures

CONTEXT

  Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI).

OBJECTIVE

  To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI.

DESIGN

  Randomized controlled clinical trial.

SETTING

  Athletic training research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  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).

INTERVENTION(S)

  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.

MAIN OUTCOME MEASURE(S)

  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.

RESULTS

  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.

CONCLUSIONS

  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.

Does Multimodal Rehabilitation for Ankle Instability Improve Patients' Self-assessed Functional Outcomes? A Network Meta-analysis

BACKGROUND

Although there are many nonsurgical treatment options for the primary management of chronic ankle instability, the most effective nonoperative intervention has not been defined.

QUESTIONS/PURPOSES

The purpose of this study was to perform a network meta-analysis to compare the results of different standalone and/or combined nonsurgical interventions on chronic ankle instability as measured by (1) the Cumberland Ankle Instability Tool (CAIT) at 0 to 6 months after treatment and (2) treatment-related complications.

METHODS

We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus in August 2017 for completed studies published between 2005 and 2016. We conducted random-effects pairwise and network meta-analysis considering randomized trials, which compared the effects of various nonoperative therapies for ankle instability. Studies assessing patients with functional ankle instability and/or mechanical ankle instability and/or recurrent ankle sprains were eligible for inclusion. After combining data from self-administered questionnaires, we analyzed patient self-reported outcomes of function at the end of the rehabilitation period and 1 to 6 months after treatment. We thereafter reexpressed standardized mean differences to mean differences with CAIT. For this instrument, scores vary between 0 and 30, and higher scores indicate better ankle stability. We included 21 trials involving 789 chronically unstable ankles. The rehabilitation interventions included, but were not limited to, balance training, strengthening exercises, a combination of the balance and strengthening exercises, manual therapy, and multimodal treatment. The implemented multistation protocols were targeted at four main areas of rehabilitation (ROM, balance, strength, and overall activity). Control was defined as placebo and/or wait and see. Treatment-related complications were defined as any major or minor adverse event observed after rehabilitation as reported by the source studies. Statistically, we did not detect significant inconsistency in the network meta-analysis. We also assessed the quality of the trials using the Cochrane risk of bias tool and judged 12, eight, and one studies to be at a low, unclear, and high risk of bias, respectively. We also considered the quality of evidence to be of moderate strength utilizing the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We defined the minimum clinically important difference (MCID) in the CAIT to be 3 points.

RESULTS

A 4-week supervised rehabilitation program, which included balance training, strengthening, functional tasks, and ROM exercises, was favored over control according to the results of four trials by a clinically important margin (mean difference between multimodal and control groups in the CAIT was -10; 95% confidence interval [CI], -16 to -3; p = 0.001). Among the standalone interventions, only balance training was better than control according to the findings of seven trials (mean difference between balance training and control in the CAIT was -5; 95% CI, -10 to -0.03; p = 0.049); this difference likewise exceeded the MCID and so is believed to be a clinically important difference. Adverse events associated with the enrolled rehabilitation protocols were transient, mild, and uncommon.

CONCLUSIONS

Although a supervised impairment-based program after chronic ankle instability was superior to control, we note that followup in the included trials tended to be short and inconsistent, although the effect size exceeded the MCID and so likely would be identified as clinically important by patients. Future randomized trials should determine whether the short-term benefits of these interventions are sustained over time.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis

OBJECTIVES

To identify non-surgical treatments which were deemed to be more effective in improving dynamic postural control in patients with chronic ankle instability (CAI).

DESIGN

Systematic review and random-effects network meta-analysis.

METHODS

We searched Scopus, CENTRAL, and PubMed until 26 August 2017. We used data from randomized trials comparing the results of different non-surgical interventions for lateral CAI. We assessed dynamic postural control in terms of the star-excursion balance test in the posteromedial direction. We evaluated this outcome at the end of the rehabilitation protocols (i.e., short term) and 6months after treatment (i.e., medium term). We assessed the quality of the included studies with the Cochrane risk of bias tool and evaluated the quality of evidence from the network of interventions using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Nineteen trials were eligible for inclusion in this systematic review. A 4-6-week supervised balance training program and a 4-6-week strengthening rehabilitation protocol provided significant improvements compared to control (8 studies, standardized mean difference [SMD] was -0.75, 95% CIs [-1.28 to -0.23]); and 2 studies, SMD was -1.2, 95% CIs [-2.36 to -0.08], respectively). A 6-week combined intervention that addressed balance and strength had the highest probability of being among the best treatments. However, the latter rehabilitation intervention was included in only one trial.

CONCLUSIONS

The network meta-analysis showed that supervised balance training protocols and strengthening programs significantly improved dynamic balance in patients with CAI. A combination of these interventions may further increase the efficacy of non-surgical treatment options for the first-line management of CAI.

RAD, Rosa LM, Mesquita TRD, Oliveira PRD, Burigo RL, Amorim CF. POSTURAL CONTROL ANALYSIS DURING A STANDARDIZED KICK TASK IN SOCCER ATHLETES

ABSTRACT Introduction: Postural control is a determining factor for functional performance and motor skills during sports activities. Objective: The objective of this study was to investigate postural control during the controlled soccer ball kicking task through a biomechanical analysis system. Methods: The sample consisted of 11 professional male athletes recruited using convenience sampling, with a mean age of 22 years. The athletes performed twenty-five precision kicks at a target, with the ball in vertical motion released by means of a hand-held device synchronized with the computed biomechanical measurements. Marking of the lower limb segments involved in the kick and the ball were analyzed by accelerometry, while postural control measures were quantified by a force platform in three axes of movement. The support leg was investigated in single leg stance during all tests on the force platform. The main variables of postural control calculated by stabilographic analysis and computed during the 25 kicks were: center of pressure (COP) displacement area, velocity and frequency of COP oscillation in the anteroposterior and mediolateral directions. The mean was used for final analysis to determine the differences in the three phases: pre-kick, kick, and post-kick. Results: The results revealed significant differences (p <0.01) between the three phases, with the kick phase presenting higher values of postural COP oscillations than the other phases. The COP area and oscillation velocity were the variables with greatest sensitivity to changes in the kick phase, obtaining an effect size of d = 14 and d = 12, respectively. In clinical terms, the increase in COP values reached 557% between the pre-kick and kick phases; this difference was reduced to 241% when compared to post-kick (i.e., difference between kick and post-kick was 316%). Conclusion . These results have important implications for the perception of postural control responses during soccer ball kicks and consequently, for injury prevention when motor and sensory deficits are diagnosed in soccer players. Level of Evidence III; Study of nonconsecutive patients; without consistently applied reference ‘‘gold’’ standard.