Effect of Ankle Neuromuscular Exercises and Mat Exercises on Chronic Ankle Instability and Balance in Overweight and Obese Individuals.

Background: Obesity has become a global epidemic and a major life-threatening issue that cannot be ignored. Overweight and obese individuals are at higher risk for lateral ankle sprains and instabilities. Objective: To determine the efficacy of a structured training program on ankle ROM, pain, and balance in obese individuals having chronic ankle instability (CAI). Study design: Experimental study, simple random sampling. Participants: 60 participants (41 females, 19 males, age=21.5±2.3 years, BMI=32.36±2 kg/m2) were included in the study. The participants were selected according to an inclusion and exclusion criteria. Cumberland ankle instability tool (CAIT) and a questionnaire was used to assess the severity of chronic ankle instability. Procedure: The pre-test scores of visual analogue scale (VAS), star excursion balance test (SEBT), and ankle dorsiflexion range of motion were taken. The training program was given 3 times per week for 6 weeks, per session 40- 60 minutes and then the post-test assessment was taken. Analysis: Data was calculated as mean, standard deviation, range for quantitative variables and frequency, and percentage for qualitative variables by using the software Instat. All variables were compared using the chi-square test. Results: The pre-test VAS scores at rest and on activity were 3.43±1.5 and 5.5±1.4 respectively and the post-test scores at rest and on activity were 1.1±0.8 and 1.5±0.8 respectively. The pre-test ROM score was 31.37±2.9 whereas the post-test score was 33.12±2.9. A significant difference was found in VAS scores and ROM scores with a P value <0.0001 for each. Significant differences were found between the pre-test and post-test SEBT scores in an involved limb of subjects with CAI (p value <0.0001). Conclusion: This study has shown that there was a significant improvement in ROM, pain and SEBT scores of obese individuals having chronic ankle instability when the subjects underwent a structured training program. KEYWORDS: Obesity, Cumberland Ankle Instability Tool, Star Excursion Balance Test.

BackgroundThe Cumberland Ankle Instability Tool (CAIT) is used to screen patients with chronic ankle instability (CAI) and to quantify the severity of ankle instability. Neuromuscular deficits are common in CAI, including proprioception, strength, and balance issues. The relationship between CAIT scores and neuromuscular factors is unclear. The purpose of this study was to investigate the correlation between ankle instability and ankle muscle strength, proprioception, and dynamic balance.MethodsThirty-four individuals with chronic ankle instability were included in this study. The participants’ CAIT scores, muscle strength (isokinetic) and proprioception in plantarflexion (PF), dorsiflexion (DF), inversion (IV), and eversion (EV), and dynamic balance (Star Excursion Balance Test in anterior, posteromedial, and posterolateral directions) were assessed. Bivariate correlations were used to determine the relationship between CAIT scores and ankle muscle strength, proprioception, and dynamic balance.ResultsIn terms of muscle strength, ankle PF (r = 0.378, 95%CI: 0.046–0.635, P = 0.027) and IV (r = 0.527, 95%CI: 0.233–0.736, P = 0.001) strength were positively correlated with CAIT Score, whereas ankle DF and EV strength had no significant correlation with CAIT Score. In terms of proprioception, ankle IV proprioception (r = -0.340, 95%CI: -0.608–0.002, P = 0.027) was negatively correlated with CAIT Score, while ankle PF, DF, and EV proprioception had no significant correlation with CAIT Score. In terms of dynamic balance, the SEBT posteromedial (r = 0.444, 95%CI: 0.124–0.680, P = 0.001) was positively correlated with CAIT Score. The SEBT anterior and posterolateral were not significantly correlated with the CAIT Score.ConclusionThis study found that increasing ankle plantarflexion and inversion muscle strength, improving dynamic balance in the posteromedial direction, and decreasing ankle inversion proprioceptive thresholds may help improve the subjective stability of CAI. This provides data support for targeted ankle neuromuscular function rehabilitation training for patients.Trial registrationChinese Clinical Trial Registry ChiCTR2100044089. Registered on 10 March 2021.

Predictors of chronic ankle instability: Analysis of peroneal reaction time, dynamic balance and isokinetic strength

Deficits have been observed in patients with chronic ankle instability while performing dynamic balance tasks. Foot orthotic intervention has demonstrated improvements in static balance following lateral ankle sprain, but the effect is unknown in patients with chronic ankle instability during dynamic balance tasks. Twenty patients with self-reported unilateral chronic ankle instability volunteered for participation. They completed a familiarization session and 2 test sessions separated by 4 weeks. The familiarization session consisted of practice trials of the Star Excursion Balance Test (SEBT) and Limits of Stability (LOS) test, orthotic fitting, and the Cumberland Ankle Instability Tool (CAIT) questionnaire. Patients were instructed to wear the custom-fitted orthotics for at least 4 hours a day to a preferred 8 hours a day for the 4 weeks between sessions. There was an increase in distance reached in the posterolateral direction over the 4-week period in the orthotic condition. There was an increase in distance reached in the medial direction, demonstrating an improvement on the injured side in the orthotic condition after 4 weeks of orthotic intervention. No consistent, meaningful results were observed in the LOS. The involved leg had a significantly lower CAIT score than the uninvolved leg during both sessions, but the involved leg CAIT scores significantly improved over 4 weeks compared with the baseline measure. Orthotic intervention may prove beneficial for improving dynamic balance as measured by the SEBT in individuals with chronic ankle instability and may be a useful adjunct to clinical and sport interventions.

Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown. To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI. Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652). High school athletic training facilities. Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups. Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises. Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different. Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P < .05). However, no intervention group was superior. All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

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.Graphical abstract

Functional reach on the Star Excursion Balance Test is decreased in participants with chronic ankle instability (CAI). However, comprehensive 3-dimensional kinematics associated with these deficits have not been reported. To determine if lower extremity kinematics differed in CAI participants during anteromedial, medial, and posteromedial reach on the Star Excursion Balance Test. Case-control study. Sports medicine research laboratory. Twenty CAI participants (age = 24.15 ± 3.84 years, height = 168.95 ± 11.57 cm, mass = 68.95 ± 16.29 kg) and 20 uninjured participants (age = 25.65 ± 5.58 years, height = 170.14 ± 8.75 cm, mass = 69.89 ± 10.51 kg) with no history of ankle sprain. We operationally defined CAI as repeated episodes of ankle "giving way" or "rolling over" or both, regardless of neuromuscular deficits or pathologic laxity. All CAI participants scored ≤26 on the Cumberland Ankle Instability Tool. Star Excursion Balance Test reaches in the anteromedial, medial, and posteromedial directions. The CAI participants used the unstable side as the stance leg. Control participants were sex, height, mass, and side matched to the CAI group. The 3-dimensional kinematics were assessed with a motion-capture system. Group differences on normalized reach distance, trunk, pelvis, and hip-, knee-, and ankle-joint angles at maximum Star Excursion Balance Test reach. No reach-distance differences were detected between CAI and uninjured participants in any of the 3 reach directions. With anteromedial reach, trunk rotation (t(1,38) = 3.06, P = .004), pelvic rotation (t(1,38) = 3.17, P = .003), and hip flexion (t(1,38) = 2.40, P = .002) were greater in CAI participants. With medial reach, trunk flexion (t(1,38) = 6.39, P = .05) was greater than for uninjured participants. No differences were seen with posteromedial reach. We did not detect reach-distance differences in any direction. However, participants with CAI rotated the trunk and pelvis more toward the stance leg than did stable-ankle participants during anteromedial and medial reach, possibly to help maintain a proximal stable posture and compensate for distal instability. These joint-angle differences with Star Excursion Balance Test performance may represent unique compensatory patterns for those with CAI.

Improving dynamic postural stability after lateral ankle sprain due to chronic ankle instability helps prevent recurrence, and changes in dynamic postural stability can be assessed with the Star Excursion Balance Test. To date, no studies have examined the change in Star Excursion Balance Test score after the end of a balance training program or whether chronic ankle instability affects the rate of change. To examine the effect of chronic ankle instability on changes in Star Excursion Balance Test. score over time after a balance training program. Fifteen collegiate soccer players with chronic ankle instability selected with the Cumberland Ankle Instability Tool and ultrasonography. Participants completed a 6-week balance training program. We assessed the Star Excursion Balance Test 5 times (before and immediately after the program and 2, 4, and 6 weeks later) and examined differences in the duration of training effects by a 2-way analysis of variance, with Bonferroni correction for post hoc comparisons to explain any significant interactions. The significance level for all analyses was set at P<0.05. We performed statistical analyses with SPSS v. 25. Analysis of the posterolateral and posteromedial scores in Star Excursion Balance Test showed a significant effect of time. Post hoc analysis of the posterolateral score showed that for each leg, participants reached significantly farther after the program than before (P=0.012). The posterolateral scores at 2, 4, and 6 weeks after the training program did not differ from before the program, but the posteromedial score was significantly improved immediately after the program (P=0.008) and also 2 (P=0.004) and 4 weeks later (P=0.006). A 6-week balance training program to improve dynamic postural control can improve posterolateral and posteromedial scores in people with chronic ankle instability, and the improvements in posteromedial are still present 4 weeks after program completion.

Deficits have been observed in patients with chronic ankle instabil- ity while performing dynamic balance tasks. Foot orthotic intervention has demonstrated improvements in static balance following lateral ankle sprain, but the effect is unknown in patients with chronic ankle instability during dynamic balance tasks. Twenty patients with self-reported unilateral chronic ankle instability volunteered for partic- ipation. They completed a familiariza- tion session and 2 test sessions separated by 4 weeks. The familiarization ses- sion consisted of practice trials of the Star Excursion Balance Test (SEBT) and Limits of Stability (LOS) test, orthotic fitting, and the Cumberland Ankle Instability Tool (CAIT) questionnaire. Patients were instructed to wear the custom-fitted orthotics for at least 4 hours a day to a preferred 8 hours a day for the 4 weeks between sessions. There was an increase in distance reached in the posterolateral direction over the 4-week period in the orthotic condition. There was an increase in distance reached in the medial direction, demonstrat- ing an improvement on the injured side in the orthotic condition after 4 weeks of orthotic intervention. No consistent, meaningful results were observed in the LOS. The involved leg had a signifi- cantly lower CAIT score than the unin- volved leg during both sessions, but the involved leg CAIT scores significantly improved over 4 weeks compared with the baseline measure. Orthotic interven- tion may prove beneficial for improving dynamic balance as measured by the SEBT in individuals with chronic ankle instability and may be a useful adjunct to clinical and sport interventions.

Purpose This study aimed to determine the responsiveness of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire in students who received an eight-week treatment for chronic ankle instability (CAI). Methods Twenty-five college students (aged 23.12 ± 2.80 years) with CAI, as identified by the IdFAI questionnaire, were recruited. We used distribution and anchor-based methods to assess the responsiveness of the questionnaire, and its ability to determine clinical changes in participants. Eleven anchors were used: Visual Analog Scale for instability (VAS-i); Cumberland Ankle Instability Tool (CAIT); Isometric dorsiflexion, plantar flexion, inversion, and eversion muscle strength measured using a manual dynamometer; Dynamic balance as assessed through the Star Excursion Balance Test (SEBT-Y); Active ankle dorsiflexion range of motion as measured using the weight-bearing lunge test; and Functional performance assessment using three hop tests: single hop, triple crossover hop, and side hop. The distribution-based method used effect size (ES) and standardized response mean (SRM), whereas the anchor-based method used paired t-tests. Both methods allowed the calculation of the minimal important difference (MID). Results The Brazilian IdFAI showed high responsiveness, with a large magnitude of change (ES = 1.34) and a high responsiveness index (SRM = 1.28) when assessed after a treatment for CAI. The IdFAI total score (p < .001) and all the 11 anchors [VAS-i (p < .001); CAIT (p < .001); Isometric dorsiflexion (p < .001), plantar flexion (p < .001), inversion (p < .001), and eversion (p < .001) muscle strength; SEBT-Y (p < .001); Lunge test (p = .002); Single hop (p < .001); triple crossover hop (p < .001); and side hop tests (p < .001)] showed significant differences. The anchor and distribution-based methods demonstrated MID values of 3.72 and 1.49–2.27, respectively. Conclusion The Brazilian IdFAI questionnaire is a patient-reported outcome measure sensitive to clinical changes in individuals with CAI. It can be used as an identification of patients with CAI, and as a parameter to verify clinical changes of clinical trials or therapeutic interventions in the population with CAI.

To determine if a single or/and combined clinical tests match group membership based on self-reported ankle function. Cross-sectional. Biomechanics Laboratory. From participants, 58 meeting inclusion/exclusion criteria were divided into a chronic ankle instability (CAI) group (n = 25) who reported ≤25 on the Cumberland Ankle Instability Tool (CAIT) and a history of moderate-severe ankle sprain(s) and a control group (n = 33) who reported ≥29 on the CAIT and no history of ankle sprain(s). Participants completed the following clinical tests: Foot Lift Test (FLT), the Star Excursion Balance Test (SEBT), the Single-Leg Hop Test (SLHT), and the Time in Balance Test (TIB) in a randomized order. A linear regression model was applied to determine measures that matched ankle group membership. The mean of SEBT reach distance was normalized to percentage leg length. The mean of number of errors in the FLT was recorded. The SLHT and TIB were reported as time in seconds, and the means were calculated. The most parsimonious combination of tests (SLHT and SEBT) resulted in correctly matching 70.69% (41/58) of participants into groups, which was significantly better than chance. The multiple correlation coefficients (R value) for combining the SLHT and SEBT was 0.39. Using SLHT and SEBT resulted in improved recognition of participants designated into the CAI or control groups. Self-report perception of ankle function provides limited information for clinicians and researchers. Using multiple clinical function tests may be more helpful in determining deficits and intervention effectiveness.

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. 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. Randomized controlled clinical trial. Research laboratory. Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group. 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. 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. 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. Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control and self-reported instability in patients with CAI.

A dynamic postural stability deficit has been suggested to be present in individuals with chronic ankle instability (CAI). Interventions to improve postural control in individuals with CAI have been reported, but they required a long period of and compliance with interventions. To examine the effect of novel ankle-realigning socks on dynamic postural stability in individuals with CAI using the star excursion balance test (SEBT). Case-control study. Twenty-eight control and 22 subjects with CAI (who were tested in both barefoot and with socks) were enrolled. The weight-bearing ankle dorsiflexion range of motion (DF-ROM) and SEBT were measured in the control group, the barefoot CAI group, and the CAI with socks group. In addition, subjective ankle instability during SEBT was measured using a visual analog scale (0 - 100). DF-ROM was 48.3 ± 7.4 º in the control group, 43.3 ± 8.0 º in the barefoot CAI group, and 45.7 ± 6.8 º in the CAI with socks group. DF-ROM was significantly less in the barefoot CAI group than in the control group. The SEBT scores were significantly less in the barefoot CAI group than in the control group in all directions. The SEBT score was significantly larger in the CAI with socks group than in the barefoot CAI group in the posteromedial, posterior, and posterolateral directions. In addition, there were no significant differences between the control group and the CAI with socks group in six directions. Wearing the novel ankle-realigning socks immediately improved dynamic postural stability as measured by the SEBT and subjective ankle instability in individuals with CAI. Level 3b.

BackgroundThe lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI.MethodsBetween 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus.ResultsThe overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1–3 recurrent sprains or 4–5 recurrent sprains (p < .001).ConclusionsFemales over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.

Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle “giving way” and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions.