Effects of a 4-Week Dynamic Balance-Training Program Supplemented with Graston Instrumented-Assisted Soft Tissue Mobilization for Chronic Ankle Instability

Abstract

A dynamic balance training program (DPT) and Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) technique are interventions that have been implemented as treatment options for chronic ankle instability (CAI). Although both have been evaluated individually, there are no published reports with the two treatments combined in a population with CAI. PURPOSE: To investigate the effects of a dynamic balance training program with GISTM technique on improving dynamic postural control, range of motion, pain and disability in subjects with CAI. METHODS: Thirty-six healthy, physically active individuals (5 female, 31 male; age= 17.7±1.9 yrs; ht=175.3±14.6 cm) with a history of CAI as determined by an Instability Questionnaire and orthopedic special tests volunteered to be in this study. Subjects were randomly assigned to three groups: both treatments (DBT/GISTM, n=13), DBT and a sham GISTM treatment (DBT/GISTM-S, n=12), or DBT and control- no GISTM (DBT/C, n=11). All groups participated in a 4-week DBT program consisting of low impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 minutes before performing the DBT program. Pre- and Post-test measurements included the Foot and Ankle Ability Measures (FAAM), FAAM Sport, the Visual Analog Scale (VAS), ankle range of motion (ROM) in four movements, and the Star Excursion Balance Test (SEBT) in three directions. RESULTS: Subjects in all groups demonstrated differences between pre to post-test with post-test results showing improvement for disability (FAAM, P<0.001 and FAAM Sport, P<0.001) and pain (VAS, P<0.001). ROM improvements were noted for plantarflexion (P=0.001), inversion (P<0.001) and eversion (P<0.001) and SEBT in the direction of anterior (P<0.001), posteromedial (P<0.001) and posterolateral (P<0.001) pre to post-test as well. The ranges with percent change scores for groups were disability (10.4%-30.6%), pain (87.2%-100%), ROM (0% to 44.9%), and SEBT (5.7% to 17.4%). No other results were significant, especially differences between groups. CONCLUSIONS: Dynamic postural control, ROM, pain and disability improved pre to post-test for subjects with CAI following a 4-week dynamic balance-training program with GISTM.