Effectiveness of Low-Frequency Stimulation in Proprioceptive Neuromuscular Facilitation Techniques for Post Ankle Sprain Balance and Proprioception in Adults: A Randomized Controlled Trial

Abstract

Stretching is an important part of post ankle sprain rehabilitation, as well as an effective exercise for improving general ankle-joint performance. But the combination of stretching alongside low-frequency stimulation has not yet been extensively studied. Therefore, the purpose of the present randomized controlled trial was to compare the combined effects of low-frequency transcutaneous electrical nerve stimulation (TENS) with proprioceptive neuromuscular facilitation (PNF) on strength, balance, and proprioception among individuals with post ankle sprain. Sixty male subjects with lateral ankle sprain were selected and randomly allocated to three groups: group 1, group 2, and the control group (CG). Subjects in group 1 received the PNF stretching technique combined with TENS. TENS stimulation was provided using two electrodes placed 5 cm apart directly on the triceps sural muscle of the affected leg and a biphasic current with a symmetrical waveform at 50 Hz for 15 seconds, tuned for a 3-second ramp up time and a 30-second rest time with a 250-microsecond pulse duration was given with PNF stretching. Subjects in group 2 received the PNF stretching technique alone. Both group 1 and group 2 received these treatments for 4 weeks (4 days/week); follow-up assessments were administered in the third and fifth weeks. CG received no treatment; outcome measures alone were assessed. Outcome measures comprised pain, balance, flexibility, proprioception, range of motion, muscle strength, and functional limitation. A mixed-model ANOVA showed significant interaction (time and group) and the time effect for all the outcome measures (p≤0.05). Group 1 (PNF-TENS) showed significant improvement for all the outcome variables compared to the other groups. The present study showed PNF stretching combined with TENS for the triceps sural muscle to trigger muscle contraction during the muscle contraction phase of the PNF stretch, compared against PNF stretching alone, produced significant improvements in ankle function for post ankle sprain subjects.

The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly

“…The impovement of navicular drop being indirect intrinsic foot muscle weakness seen in this study could be explained that TENS application causes elicited muscle contractions and also allows for the activation of a greater proportion of type II muscle fibers compared with volitional exercise at specific intensity [17]. Kang et al (2013) [33] also claimed that when TENS application for calf muscles was effective in improving balance in terms of increases joint position sense and strength for healthy adults, which concurs with the results of the present study and the previous study who investigated many neurological conditions [34].…”

“…Symmetrical biphasic squared pulses directly generate impulses and sends them to the nerve supply of the targeted muscle for better contraction [16]. The usage of transcutaneous electrical nerve stimulation (TENS) is widespread clinically shown to reduce pain and improve function in different painful conditions and generally being one of the primary tools for managing pain [17]. The timing of TENS application can be used for 30 min long without any adverse effects in vulnerable subjects [18].…”

The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review

“…Relative mean treatment effects were 47% (range 17–92%) for proprioceptive performance and 86% (25–152%) for motor performance. Proprioceptive measures included JPSE and joint position sense detection threshold, while motor measures included clinical rating scales such the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score ( 75 ), postural stability measures including CoP displacement and sway area ( 76 , 77 ), and joint-specific measures such as knee-to-wall distance ( 73 ) and ankle passive ROM in dorsiflexion ( 74 ).…”

Prognostic of Recurrence of Ankle Sprain Injury in Athletes who Return to Sports Early

“…Other factors that contributed to the cause of ankle sprain recurrence were not described in this article. 13,14 Vancolen et al 15 studied high ankle injury (syndesmotic injury) and found that the return rate of the ankle to the pre-injury condition was 93.8% ± 1.2% for conventional therapy and 97.6% ± 1.5% for surgery and that the time required to return to sports overall was 46.6 (95% CI: 15.4-70) days, with a mean of 55.2 ± 15.8 days for operative management and 41.7 ± 9.8 days for nonoperative management. There was no explanation regarding other prognostic factors such as age, sex, and type of rehabilitation exercise performed to return to the pre-injury state.…”