Six Weeks of Balance Training Improves Sensorimotor Function in Individuals With Chronic Ankle Instability

Abstract

T he tendency toward repeated ankle sprains and recurring symptoms (eg, pain, weakness, giving way) has been termed "chronic ankle instability" (CAI) 35 and reported to occur in as high as 40% to 70% of individuals who have sustained a lateral ankle sprain. 7,23,45 Changes in sensorimotor system function are thought to be involved in the decreased postural control and joint position awareness and increased instability found in individuals with CAI. 13,24,46 T T STUDY DESIGN: Prospective cohort study. T T OBJECTIVE:To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability (CAI). T T BACKGROUND:CAI is the tendency toward repeated ankle sprains and recurring symptoms, occurring in 40% to 70% of individuals who have previously sustained a lateral ankle sprain. Recent studies have found deficits in sensorimotor measures in individuals with CAI. As balance training is a common component of ankle rehabilitation, understanding its effect on the sensorimotor system in individuals with CAI may enable us to optimize protocols to better utilize this rehabilitation method. T T METHODS:Twelve participants with CAI and 9 healthy volunteers participated. Independent variables were group (CAI, control) and time (pretraining, posttraining). Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks. T T RESULTS:The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baselineadjusted posttraining measures of dynamic balance in the anterior medial (P = .021), medial (P = .048), and posterior medial directions (P = .030); motoneuron pool excitability Hmax/Mmax ratio (P = .044) and single-limb presynaptic inhibition (P = .012); and joint position sense inversion variable error (P = .017). It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks. T T CONCLUSIONS:After 6 weeks of balance training, individuals with CAI demonstrated enhanced dynamic balance, inversion joint position sense, and changes in motoneuron pool excitability compared to healthy controls who did not train. T T LEVEL OF EVIDENCE:Therapy, level 2b.

Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability

“…For instance, individuals with CAI improved their dynamic postural control (ie, increased excursion during a Star Excursion Balance Test) after training involving various balance activities in a single-legged stance 11 or balancing on an unstable surface. 10 Therefore, the results of these studies suggested that increased COP excursion while performing dynamic tasks might not necessarily indicate decreased postural stability, as observed in static conditions. This hypothesis needs to be tested, as it could affect the way postural instability is tested in patients with CAI.…”

Effects of a Proximal or Distal Tibiofibular Joint Manipulation on Ankle Range of Motion and Functional Outcomes in Individuals With Chronic Ankle Instability

“…31 Rehabilitation programs are typically geared toward improving ankle motion, increasing strength of the lateral stabilizers, and regaining neuromuscular control. 9,45,54 Despite efforts to restore strength and function, many individuals resprain their ankle. 58 Repetitive sprains may increase the risk of ankle osteoarthritis.…”

Effect of Balance Training on Postural Stability in Subjects With Chronic Ankle Instability

“…Two studies used the Foot and Ankle Disability Index to determine self-reported symptoms of CAI. 7,8 The other 2 studies did not include information about the assessment tools used to determine CAI. 4,6 • Three studies demonstrated improvement in static postural stability in single-limb stance after the training protocol.…”

“…• Two randomized controlled trials 4,5 and 2 cohort studies 6,7 were included. • The definition of CAI in all 4 studies included a history of more than 1 ankle sprain with residual symptoms, as well as a subjective feeling of the ankle "giving way."…”