Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial. A Randomized Controlled Trial Comparing Rehabilitation Efficacy in Chronic Ankle Instability. Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. The effectiveness of strain counterstrain in the treatment of patients with chronic ankle instability: A randomized clinical trial Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Effects of joint mobilization on chronic ankle instability: a randomized controlled trial Six weeks of balance training improves sensorimotor function in individuals with chronic ankle instability. Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial. Evaluation of an Intervention to Increase Self-Efficacy for Independent Exercise in Cardiac Rehabilitation Altered visual focus on sensorimotor control in people with chronic ankle instability Balance training improves function and postural control in those with chronic ankle instability. Gait termination control strategies are altered in chronic ankle instability subjects. Functional balance training, with or without exercise sandals, for subjects with stable or unstable ankles. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle.
CONTEXT Individuals with chronic ankle instability ( CAI ) have deficits in neuromuscular control and altered movement patterns . Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function . OBJECTIVE To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function , range of motion ( ROM ) , strength , and balance than rehabilitation without devices in patients with CAI . DESIGN R and omized controlled clinical trial . SETTING Laboratory . PATIENTS OR OTHER PARTICIPANTS A total of 26 patients with CAI ( 7 men , 19 women ; age = 21.34 ± 3.06 years , height = 168.96 ± 8.77 cm , mass = 70.73 ± 13.86 kg ) . INTERVENTION(S ) Patients completed baseline measures and were r and omized into no-device and device groups . Both groups completed 4 weeks of supervised , impairment-based progressive rehabilitation with or without devices and then repeated baseline measures . MAIN OUTCOME MEASURE(S ) We assessed self-reported function using the Foot and Ankle Ability Measure . Ankle ROM was measured with an inclinometer . Ankle strength was assessed using a h and held dynamometer during maximal voluntary isometric contractions . Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance . We compared each dependent variable using a 2 × 2 ( group × time ) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05 . The Hedges g effect sizes and associated 95 % confidence intervals were calculated . RESULTS We observed no differences between the no-device and device groups for any measure . However , both groups had large improvements in self-reported function and ankle strength . CONCLUSIONS Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions result ed in similar improvements . Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI CONTEXT There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability ( CAI ) . In addition , clinicians aim ing to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy . OBJECTIVE To assess the comparative efficacy of 2 common ankle rehabilitation techniques ( wobble-board [ WB ] balance training and ankle strengthening using resistance tubing [ RT ] ) using patient-oriented outcomes . DESIGN R and omized controlled trial . SETTING Laboratory . PATIENTS 40 patients with CAI r and omized into 2 treatment groups :  RT and WB .  CAI inclusion criteria included a history of an ankle sprain , recurrent " giving way , " and a Cumberl and Ankle Instability Tool ( CAIT ) score ≤25 . INTERVENTIONS Participants completed 5 clinician-oriented tests  ( foot-lift test , time-in-balance , Star Excursion Balance Test , figure-of-8 hop , and side-hop ) and 5  patient-oriented question naires ( CAIT , Foot and Ankle Ability Measure [ FAAM ] , Activities of Daily Living [ ADL ] and FAAM Sport scale , Short-Form 36 [ SF-36 ] , and Global Rating of Function [ GRF ] ) . After baseline testing , participants completed 12 sessions over 4 wk of graduated WB or RT exercise , then repeated baseline tests . MAIN OUTCOME MEASURES For each patient- and clinician-oriented test , separate 2 × 2 RMANOVAs analyzed differences between groups over time ( alpha set at P = .05 ) . RESULTS There was a significant interaction between group and time for the FAAM-ADL ( P = .04 ) . Specifically , the WB group improved postintervention ( P < .001 ) whereas the RT group remained the same ( P = .29 ) . There were no other significant interactions or significant differences between groups ( all P > .05 ) . There were significant improvements postintervention for the CAIT , FAAM-Sport , GRF , SF-36 , and all 5 clinician-oriented tests ( all P < .001 ) . CONCLUSIONS A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI . Limited evidence indicates that WB training was more effective than RT . LEVEL OF EVIDENCE Therapy , level 1b We examined the effect of a 2-week anterior-to-posterior ankle joint mobilization intervention on weight-bearing dorsiflexion range of motion ( ROM ) , dynamic balance , and self-reported function in subjects with chronic ankle instability ( CAI ) . In this prospect i ve cohort study , subjects received six Maitl and Grade III anterior-to-posterior joint mobilization treatments over 2 weeks . Weight-bearing dorsiflexion ROM , the anterior , posteromedial , and posterolateral reach directions of the Star Excursion Balance Test ( SEBT ) , and self-reported function on the Foot and Ankle Ability Measure ( FAAM ) were assessed 1 week before the intervention ( baseline ) , prior to the first treatment ( pre-intervention ) , 24 - 48 h following the final treatment ( post-intervention ) , and 1 week later ( 1-week follow-up ) in 12 adults ( 6 males and 6 females ) with CAI . The results indicate that dorsiflexion ROM , reach distance in all directions of the SEBT , and the FAAM improved ( p < 0.05 for all ) in all measures following the intervention compared to those prior to the intervention . No differences were observed in any assessment s between the baseline and pre-intervention measures or between the post-intervention and 1-week follow-up measures ( p > 0.05 ) . These results indicate that the joint mobilization intervention that targeted posterior talar glide was able to improve measures of function in adults with CAI for at least 1 week STUDY DESIGN Prospect i ve , r and omized controlled trial . OBJECTIVE To examine the effects of a 4-week rehabilitation program for chronic ankle instability ( CAI ) on postural control and lower extremity function . BACKGROUND CAI is associated with residual symptoms , performance deficits , and reinjury . Managing CAI is challenging and more evidence is needed to guide effective treatment . METHODS AND MEASURES Subjects with unilateral CAI were r and omly assigned to the rehabilitation ( CAI-rehab , n=16 ) or control ( CAI-control , n=13 ) group . Subjects without CAI were assigned to a healthy group ( n=19 ) . Baseline testing included the ( 1 ) center of pressure velocity ( COPV ) , ( 2 ) star excursion balance test ( SEBT ) , and ( 3 ) Foot and Ankle Disability index ( FADI ) and FADI-Sports Subscale ( FADI-Sport ) . The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion , strength , neuromuscular control , and functional tasks . After 4 weeks , all subjects were retested . Nonparametric analyses for group differences and between-group comparisons were performed . RESULTS Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks of the involved limb compared to the uninvolved limb and reported functional deficits of the involved limb compared to healthy subjects . Following rehabilitation , the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADi and FADI-Sport scores . CONCLUSIONS These results demonstrate postural control and functional limitations exist in individuals with CAl . In addition , rehabilitation appears to improve these functional limitations . Finally , there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI Abstract Study Design : R and omized clinical trial . Objective : To determine the effect of strain counterstrain ( SCS ) on dynamic balance and subjective sense of instability in individuals with chronic ankle instability ( CAI ) . Although many studies have been published on CAI , the cause for this common clinical dysfunction remains inconclusive . No studies have assessed the effectiveness of SCS on CAI . Methods : At baseline all participants completed a demographic question naire , the star excursion balance test ( SEBT ) , and the foot and ankle ability measure ( FAAM ) . Following the baseline evaluation , participants were r and omized into the SCS experimental group ( EG ) ( n = 13 ) or the sham SCS group ( SG ) ( n = 14 ) . All participants received the assigned treatment once a week for 4 weeks and participated in a prescribed exercise program . At week 4 , all participants repeated the outcome measures and completed a global rating of change ( GROC ) form . The primary aim was examined with a two-way analysis of variance ( ANOVA ) . Results : A significant group-by-time interaction was found for seven directions in the SEBT ( P<0·031 ) . For subjective measures , no significant group-by-time interaction was found for the FAAM ( P>0·548 ) , but the GROC revealed a significant difference ( P = 0·014 ) in the mean score for the EG ( 3·92±1·66 ) when compared to the SG ( 2·43±1·66 ) . Discussion : Although SCS may not have an effect on subjective ankle function in individuals with CAI , preliminary evidence suggests that SCS may lead to an improvement in dynamic ankle stability and the subjective sense of ankle instability . Level of Evidence : Therapy , Level 1b INTRODUCTION Deficient sensory input from damaged ankle ligament receptors is thought to contribute to sensorimotor deficits in those with chronic ankle instability ( CAI ) . Targeting other viable sensory receptors may then enhance sensorimotor control in these patients . The purpose of this r and omized controlled trial was to evaluate the effects of 2 wk of sensory-targeted ankle rehabilitation strategies ( STARS ) on patient- and clinician-oriented outcomes in those with CAI . METHODS Eighty patients with self-reported CAI participated . All patients completed patient-oriented question naires capturing self-reported function as well as the weight-bearing lunge test and an eyes-closed single-limb balance test . After baseline testing , patients were r and omly allocated to four STARS groups : joint mobilization , plantar massage , triceps surae stretching , or control . Each patient in the intervention groups received six 5-min treatments of their respective STARS over 2 wk . All subjects were reassessed on patient- and clinician-oriented measures immediately after the intervention and completed a 1-month follow-up that consisted of patient-oriented measures . Change scores of the three STARS groups were compared with the control using independent t-tests and Hedges ' g effect sizes with 95 % confidence intervals . RESULTS The joint mobilization group had the greatest weight-bearing lunge test improvement . Plantar massage  had the most meaningful single-limb balance improvement . All STARS groups improved patient-oriented outcomes with joint mobilization having the most meaningful effect immediately after the intervention and plantar massage at the 1-month follow-up . CONCLUSION Each STARS treatment offers unique contributions to the patient- and clinician-oriented rehabilitation outcomes of those with CAI . Both joint mobilization and plantar massage appear to demonstrate the greatest potential to improve sensorimotor function in those with CAI CONTEXT Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability ( CAI ) , strength-training rehabilitation protocol s may improve the deficits often associated with CAI . OBJECTIVE To determine whether strength-training protocol s affect strength , dynamic balance , functional performance , and perceived instability in individuals with CAI . DESIGN R and omized controlled trial . SETTING Athletic training research laboratory . PATIENTS OR OTHER PARTICIPANTS A total of 39 individuals with CAI ( 17 men [ 44 % ] , 22 women [ 56 % ] ) participated in this study . Chronic ankle instability was determined by the Identification of Functional Ankle Instability Question naire , and participants were r and omly assigned to a resistance-b and - protocol group ( n = 13 [ 33 % ] age = 19.7 ± 2.2 years , height = 172.9 ± 12.8 cm , weight = 69.1 ± 13.5 kg ) , a proprioceptive neuromuscular facilitation strength- protocol group  ( n = 13 [ 33 % ] , age = 18.9 ± 1.3 years , height = 172.5 ± 5.9 cm , weight = 72.7 ± 14.6 kg ) , or a control group  ( n = 13 [ 33 % ] , age = 20.5 ± 2.1 years , height = 175.2 ± 8.1 cm , weight = 70.2 ± 11.1 kg ) . INTERVENTION(S ) Both rehabilitation groups completed their protocol s 3 times/wk for 6 weeks . The control group did not attend rehabilitation sessions . MAIN OUTCOME MEASURE(S ) Before the interventions , participants were pretested by completing the figure-8 hop test for time , the triple-crossover hop test for distance , isometric strength tests ( dorsiflexion , plantar flexion , inversion , and eversion ) , the Y-Balance test , and the visual analog scale for perceived ankle instability . Participants were again tested 6 weeks later . We conducted 2 separate , multivariate , repeated- measures analyses of variance , followed by univariate analyses on any significant findings . RESULTS The resistance-b and protocol group improved in strength ( dorsiflexion , inversion , and eversion ) and on the visual analog scale ( P < .05 ) ; the proprioceptive neuromuscular facilitation group improved in strength ( inversion and eversion ) and on the visual analog scale ( P < .05 ) as well . No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable ( P > .05 ) . CONCLUSIONS Although the resistance-b and protocol is common in rehabilitation , the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI . Both protocol s showed clinical benefits in strength and perceived instability . To improve functional outcomes , clinicians should consider using additional multiplanar and multijoint exercises OBJECTIVE To compare the effect of two manual therapy techniques , mobilization with movement ( WB-MWM ) and talocrural manipulation ( HVLA ) , for the improvement of ankle dorsiflexion in people with chronic ankle instability ( CAI ) over 48 h. DESIGN R and omized controlled clinical trial . SETTING University research laboratory . PARTICIPANTS Fifty-two participants ( mean ± SD age , 20.7 ± 3.4 years ) with CAI were r and omized  to WB-MWM ( n = 18 ) , HVLA ( n = 19 ) or placebo group ( n = 15 ) . MAIN OUTCOME MEASURES Weight-bearing ankle dorsiflexion measured with the weight-bearing lunge . Measurements were obtained prior to intervention , immediately after intervention , and 10 min , 24 h and 48 h post-intervention . RESULTS There was a significant effect × time ( F4,192 = 20.65 ; P < 0.001 ) and a significant time × group interactions ( F8,192 = 6.34 ; P < 0.001 ) . Post hoc analysis showed a significant increase of ankle dorsiflexion in  both WB-MWM and HVLA groups with respect to the placebo group with no differences between both active treatment groups . CONCLUSION A single application of WB-MWM or HVLA manual technique improves ankle dorsiflexion in people with CAI , and the effects persist for at least two days . Both techniques have similar effectiveness for improving ankle dorsiflexion  although WB-MWM demonstrated greater effect sizes Abstract Purpose : To evaluate the effects of joint mobilization , in which movement is applied to the ankle 's dorsiflexion range of motion , on dynamic postural control and on the self-reported instability of patients with chronic ankle instability ( CAI ) . Methods : A double-blind , placebo-controlled , r and omized trial with repeated measures and a follow-up period . Ninety patients with a history of recurrent ankle sprain , self-reported instability , and a limited dorsiflexion range of motion , were r and omly assigned to either the intervention group ( Joint Mobilizations , 3 weeks , two sessions per week ) the placebo group ( Sham Mobilizations , same duration as joint mobilization ) or the control group , with a 6 months follow-up . Dorsiflexion Range of Motion ( DFROM ) , Star Excursion Balance Test ( SEBT ) and CAI Tool ( CAIT ) were outcome measures . A separate 3 × 4 mixed model analysis of variance was performed to examine the effect of treatment conditions and time , and intention-to-treat ( ITT ) analysis was applied to evaluate the effect of the independent variable . Results : The application of joint mobilization result ed in better scores of DFROM , CAIT , and SEBTs in the intervention group when compared with the placebo or the control groups ( p < 0.001 ) . The effect sizes of group-by-time interaction , measured with eta-squared , oscillated between 0.954 for DFROM and 0.288 for SEBT posteromedial distance . In within-group analysis , the manipulation group showed an improvement at 6 months follow-up in CAIT [ mean = 5.23 , CI 95 % ( 4.63–5.84 ) ] , DFROM [ mean = 6.77 , CI 95 % ( 6.45–7.08 ) ] , anterior SEBT [ mean = 7.35 , CI 95 % ( 6.59–8.12 ) ] , posteromedial SEBT [ mean = 3.32 , CI 95 % ( 0.95–5.69 ) ] , and posterolateral SEBT [ mean = 2.55 , CI 95 % ( 2.20–2.89 ) ] . Conclusion : Joint mobilization techniques applied to subjects suffering from CAI were able to improve ankle DFROM , postural control , and self-reported instability . These results suggest that joint mobilization could be applied to patients with recurrent ankle sprain to help restore their functional stability . Implication s for Rehabilitation Functional instability is a very common sequela in patients with CAI , result ing in reduced quality of living due to the limitations it imposes on daily life activities . The mobilization with movement technique presented by Mulligan , and based on the joint mobilization accompanied by active movement , appears as a valuable tool to be employed by physical therapists to restore ankle function after a recurrent ankle sprain history . ROM restriction , subjective feeling of instability and dynamic postural control are benefiting from the joint mobilization application STUDY DESIGN Prospect i ve cohort study . 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 ) . 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 , underst and ing its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocol s to better utilize this rehabilitation method . 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 . RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted 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 . 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 . LEVEL OF EVIDENCE Therapy , level 2b The objective of the present study was to determine the effectiveness of a 6-week balance training program on patients with Chronic Ankle Instability ( CAI ) in relation to the results obtained in Dynamic Balance , subjective feeling of instability and pain using a single-blind r and omized controlled trial . 70 athletes were r and omly assigned to control or intervention group . The control group performed their usual training , and the intervention group was administered the same usual activity in addition to a balance program . The paired t-test was performed to evaluate the change scores in each group . The t-test for independent sample s was performed to evaluate between-group differences in change scores . Significance level was assigned for p-values less than 0.05 for all analyses . There were significant differences between groups in change scores in CAIT and all of the SEBTs reach distances ( p<0.001 ) but not in Pain ( p=0.586 ) . The effect sizes were larger for the outcomes measures that showed significant differences . In the within-group change , the experimental groups showed larger effect sizes in CAIT , SEBT posteromedial and SEBT posterolateral , and moderate effect sizes in SEBT anterior .  Exercise therapy training based on multi-station balance tasks led to significant improvements in dynamic balance and self-reported sensation of instability in patients with CAI Adherence to independent exercise is an essential outcome of cardiac rehabilitation ( CR ) , yet limited theory-based interventions to improve adherence exist . This study tested the effects of an intervention based on B and ura 's conceptualization of self-efficacy . The self-efficacy coaching intervention ( SCI ) , a supplement to st and ard care , was design ed to increase self-efficacy for independent exercise and independent exercise behavior in CR . We examined whether the SCI vs. attention control ( AC ) result ed in improved exercise self-efficacy ( ESE ) , barriers self-efficacy ( BARSE ) , and minutes of independent exercise for CR participants ( n = 65 ) . While between-group differences did not reach significance ( p > .10 ) for any of the outcome measures , significant within-group changes were noted in BARSE scores and independent exercise ( p < .001 ) for the SCI group . Change in independent exercise for the AC group was also significant ( p = . 006 ) . Further study is needed to explore whether short-term changes translate into maintenance of independent exercise participation after program completion Abstract The purpose of this investigation was to examine the effects of the combination of  chronic ankle instability ( CAI ) and altered visual focus on strategies for dynamic stability during a drop-jump task . Nineteen participants with self-reported CAI and 19 healthy participants performed a drop-jump task  in looking-up and looking-down conditions . For the looking-up condition , participants looked up and read a r and om number that flashed on a computer monitor . For the looking-down condition , participants focused their vision on the force plate . Sagittal- and frontal-plane kinematics in the hip , knee and ankle were calculated at the time points of 100 ms pre-initial foot contact to ground and at IC . The result ant vector time to stabilisation was calculated with ground reaction force data . The CAI group demonstrated less hip flexion at the point of 100 ms pre-initial contact ( P < 0.01 ) , and less hip flexion ( P = 0.03 ) and knee flexion at initial contact ( P = 0.047 ) compared to controls . No differences in kinematics or dynamic stability were observed in either looking-up or looking-down conditions ( P > 0.05 ) . Altered visual focus did not influence movement patterns during the drop-jump task , but the presence of CAI did . The current data suggests that central ly mediated changes associated with CAI may lead to global alterations in the sensorimotor control PURPOSE The purpose of this r and omized controlled trial was to determine the effect of a 4-wk balance training program on static and dynamic postural control and self-reported functional outcomes in those with chronic ankle instability ( CAI ) . METHODS Thirty-one young adults with self-reported CAI were r and omly assigned to an intervention group ( six males and 10 females ) or a control group ( six males and nine females ) . The intervention consisted of a 4-wk supervised balance training program that emphasized dynamic stabilization in single-limb stance . Main outcome measures included the following : self-reported disability on the Foot and Ankle Disability Index ( FADI ) and the FADI Sport scales ; summary center of pressure ( COP ) excursion measures including area of a 95 % confidence ellipse , velocity , range , and SD ; time-to-boundary ( TTB ) measures of postural control in single-limb stance including the absolute minimum TTB , mean of TTB minima , and SD of TTB minima in the anteroposterior and mediolateral directions with eyes open and closed ; and reach distance in the anterior , posteromedial , and posterolateral directions of the Star Excursion Balance Test ( SEBT ) . RESULTS The balance training group had significant improvements in the FADI and the FADI Sport scores , in the magnitude and the variability of TTB measures with eyes closed , and in reach distances with the posteromedial and the posterolateral directions of the SEBT . Only one of the summary COP-based measures significantly changed after balance training . CONCLUSIONS Four weeks of balance training significantly improved self-reported function , static postural control as detected by TTB measures , and dynamic postural control as assessed with the SEBT . TTB measures were more sensitive at detecting improvements in static postural control compared with summary COP-based measures UNLABELLED Despite the high incidence of chronic ankle instability ( CAI ) , the underlying neurophysiologic mechanism is unknown . Evidence suggests that both feed-forward and feedback mechanisms may play a role . However , no investigation has examined both control mechanisms during the same movement task in the same cohort of CAI patients . PURPOSE To determine the neuromuscular and biomechanical control alterations present in CAI patients during planned ( feed-forward ) and unplanned ( feedback ) gait termination . METHODS Twenty subjects with CAI and 20 uninjured controls completed planned and unplanned gait termination protocol s. Both tasks began with subjects walking at a self-selected speed across a 12-m walkway . Unplanned gait termination required subjects to stop during r and omly selected trials on two adjacent force plates when cued . Planned gait termination required purpose ful stopping on the force places . Propulsive and braking force magnitude and the dynamic postural stability index were calculated from the result ing ground reaction forces . In addition , muscle activity from the soleus , tibialis anterior , and gluteus medius was collected bilaterally . RESULTS Both maximum propulsive ( CAI = 99.8 + /- 40.8 N , control = 88.6 + /- 33.6 N ) and braking ( CAI = 207.1 + /- 80.9 N , control = 161.6 + /- 62.2 N ) forces were significantly higher in the CAI group . The dynamic postural stability index revealed higher scores in the CAI group ( 0.24 + /- 0.03 ) compared with the control group ( 0.22 + /- 0.03 ) . Muscle activation of the soleus and tibialis anterior differed during unplanned and planned gait termination between groups ( P < 0.05 ) and between the limbs of the CAI group ( P < 0.05 ) . CONCLUSIONS Altered biomechanical strategies during both planned and unplanned gait termination indicate that patients with CAI have alterations in feed-forward neuromuscular control and suggest the presence of feedback neuromuscular control deficits CONTEXT Improving postural stability through balance training may prevent ankle sprains .  Exercise S and als may increase the dem and s placed on ankle muscles during rehabilitation , which could improve postural stability . OBJECTIVE To examine the effects of functional balance training , with and without the use of Exercise S and als , on postural stability in subjects with stable or unstable ankles . DESIGN Prospect i ve , nonr and omized clinical trial . SETTING Sports medicine research laboratory . PATIENTS OR OTHER PARTICIPANTS Sixteen subjects with functional ankle instability and 16 subjects with no history of ankle sprains . INTERVENTION(S ) Subjects were assigned to an Exercise S and al functional balance training group or a shoe functional balance training group . Subjects trained 3 times per week for 8 weeks and then performed a single-limb stance posttest . MAIN OUTCOME MEASURE(S ) Subjects were required to remain as motionless as possible during a single-limb stance pretest . Anterior-posterior and medial-lateral center-of-pressure excursions were measured . RESULTS Exercise S and al balance training improved anterior-posterior postural stability in both ankle groups ( P < .05 ) . Both training interventions improved medial-lateral postural stability in stable and unstable ankles ( P < .05 ) . CONCLUSIONS Postural stability improved after subjects performed functional balance training programs , both with and without Exercise S and als . Training with Exercise S and als might not be any more effective in improving postural stability than performing functional balance training without Exercise S and als . However , Exercise S and als did not impair postural stability and , consequently , might serve as an alternative therapy to improve postural stability Functional instability is a common complication following an acute ankle sprain . Three potential contributing factors underlying the ankle which chronically gives way are proprioceptive deficits , muscle weakness , and ligamentous laxity . This study 's purpose was to document the presence or absence of these concerns in a sample of subjects with unilateral functional ankle instability . Both ankles of 42 subjects were r and omly assessed for passive movement sense into inversion and generation of peak torque by the evertors isokinetically . Thirty-four subjects were available for documentation of talar tilt of both ankles through inversion stress radiographs . Analysis found significantly greater mean values for passive movement sense and talar tilt for the involved ankles compared with the uninvolved , while no significant strength differences in peak torque of the evertors were present . Fifty-eight percent of the sample demonstrated clinical impairments in at least one of these three categories . In conclusion , deficits in passive movement sense and anatomic stability are greater concerns than strength deficits when managing the ankle with functional instability
Conclusions The main findings from this systematic review were balance training provided the most consistent improvements in self-reported function for patients with CAI
Objective To identify which therapeutic intervention may be most effective for improving self-reported function in patients with chronic ankle instability ( CAI ) .