The Effects of Exercise on Non-Accident Related Chronic Ankle Instablitiy in Participants With Collagen Disorders

Abstract

Chronic functional instability is the inability of an individual to perform routine daily activities, such as standing, walking, or rising from a chair, due to the instability of joint structures. Several genetic and neuromuscular disorders exist that result in severe ankle instability (hypermobility) without a prior history of traumatic injuries (Ehlers-Danlos Syndrome, Marfan's Syndrome, Osteogenesis Imperfecta, and Benign Hypermobility Syndrome). Individuals with hypermobility are susceptible to recurring injury and have been previously treated with extensive rest, a treatment that has been shown to increase chronic instability. PURPOSE: To determine the effects of exercise and movement on non-accident-related chronic ankle instability, particularly in participants who have Ehlers-Danlos Syndrome or Benign Hypermobility Syndrome. METHODS: Five female participants (32±12 yrs) were recruited for this study and all completed the full study; three of the participants had Benign Hypermobility Syndrome and two had Ehlers-Danlos Syndrome. Participants took part in an eight-week exercise regimen, with ankle stability measurements taken at the pre-, 4-weeks, and post-study. The exercise regimen included four sections: resistance training, reactive neuromuscular training, proprioception exercises, and active stabilization exercises. Participants underwent two days of resistance training with reactive neuromuscular training and proprioception exercises, and a third day of resistance training with active stabilization exercises each week. Range of motion (using a goniometer) of the ankle was tested, and functional strength assessment included single-weight-bearing tests for dorsiflexion, plantar flexion, inversion, and eversion. Stability tests included anterior draw, posterior draw, talar tilt, wedge, and Thompson, and Kleiger's tests. RESULTS: Functional strength was increased for the five subjects, and pain levels were reduced in every subject, for each of the tests. Not only were pain levels reduced, but also joint popping was reduced and participants reported feeling higher levels of stability and balance. Subjects showed a generally reduced range of motion, from 25% to 65%, in all areas of the ankle joint. This overall decrease in the range of movement indicates a tightening of the joint capsule and an increase in joint stability. CONCLUSION: Strength exercises lead to decreased range of motion, strengthening of the ankle, increased balance, decreased pain, and an overall increase in daily function.