Approximately 40-70% of individuals who suffer an ankle sprain report residual symptoms 6 weeks to 18 months post injury [1]. Balance training is often the first choice of treatment in patients with functional ankle instability (FAI); however the effect of balance training on the ankle proprioceptive sensation in these patients is debatable [2].
Purpose
To examine the effect of 4-week balance training intervention on self-reported ankle instability using Cumberland ankle instability tool questionnaire (CAIT) and ankle joint position sense (JPS) using joint position-reposition test in patients with FAI.
Methods
Twenty-four recreationally active patients with unilateral FAI were randomized to either the control (n = 12, 34.6±9.04 years, CAIT score = 13.9±4.3) or experimental (n = 12, 33.8±6.4 years, CAIT score = 13.4±3.3) group. Patients in the experimental group were trained on the affected limb using static and dynamic balance components with Biodex balance stability system. CAIT questionnaire was administered at baseline and 6-week post-intervention. The passive ankle JPS at 15 and 30 degrees of ankle inversion on the affected and unaffected limbs was measured at baseline and 4-week post-intervention using Biodex dynamometer. CAIT questionnaire score and mean error in angular displacement at baseline and post-intervention were compared using two-tailed paired Student t tests.
Results
At baseline, CAIT questionnaire scores were similar between the two groups. There was a significant side-to-side difference in the mean error at 30° (4.1±2.6 vs. 2.5±2.0, p=0.03, 95% CI [0.170, 3.024]) of ankle inversion. Following balance training, the experimental group showed significant improvement in CAIT questionnaire score (22.3±2.5, p=0.001, 95% CI [2.983, 9.183]). The experimental group also showed significant reduction in mean error on the affected limb following intervention at both 15° (1.9±1.4, p = 0.008, 95% CI [-5.376, -1.013]) and 30° (1.4±1.2, p = 0.001, 95% CI [-4.531, -1.580]) of ankle inversion. When compared to the affected limb in the control group, affected limb in the experimental group demonstrated significant reduction in mean error at 30° (p=0.002) but not at 15° of ankle inversion following balance training intervention (Figure 1).
Figure 1
Reduction in mean replication error in both the groups following balance training intervention
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Conclusion
The 4-week balance training program was effective in reducing the self-reported ankle instability and improving the deficit of ankle joint position sense in patients with FAI.
Level of evidence: Therapy, 2b
ClinicalTrials.gov Identifier: NCT00703456
Supported by NIH Grant R21 AR062205 and Kansas Partners in Progress, Inc.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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