Strength-Training Protocols to Improve Deficits in Participants With Chronic Ankle Instability: A Randomized Controlled Trial

Abstract

Context: Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strengthtraining rehabilitation protocols may improve the deficits often associated with CAI.Objective: To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI.Design: Randomized 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 Questionnaire, and participants were randomly assigned to a resistance-bandprotocol group (n ¼ 13 [33%] age ¼ 19.7 6 2.2 years, height ¼ 172.9 6 12.8 cm, weight ¼ 69.1 6 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n ¼ 13 [33%], age ¼ 18.9 6 1.3 years, height ¼ 172.5 6 5.9 cm, weight ¼ 72.7 6 14.6 kg), or a control group (n ¼ 13 [33%], age ¼ 20.5 6 2.1 years, height ¼ 175.2 6 8.1 cm, weight ¼ 70.2 6 11.1 kg).Intervention(s): Both rehabilitation groups completed their protocols 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, repeatedmeasures analyses of variance, followed by univariate analyses on any significant findings.Results: The resistance-band 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 YBalance tests for either intervention group or in the control group for any dependent variable (P . .05).Conclusions: Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.Key Words: functional ankle instability, functional performance, rehabilitation, Star Excursion Balance Test Key PointsProprioceptive neuromuscular facilitation is an alternate strength-training protocol that was effective in enhancing ankle strength in those with chronic ankle instability. Neither the resistance-band protocol nor the proprioceptive neuromuscular facilitation protocol improved dyn...

The Effectiveness of Strength Training Protocols on Strength Development in Participants With Chronic Ankle Instability: A Critically Appraised Topic

“…Level of evidence 6 demonstrated improvements in only inversion and eversion strength, which was similar to improvements using the RTPTP and MAE protocols. 5 While not a randomized controlled trial and therefore not included in this critically appraised topic, another study 2 used an isokinetic strength training protocol using Cybex Norm isokinetic system (Cybex, Medway, MA), which also yielded positive results.…”

“…Research has examined the resistive tubing progressive training protocol (RTPTP), 3,4 resistance band protocol (RBP), 6 multiaxial ankle exerciser (MAE, Multiaxial, Inc., Lincoln, RI), 5 and proprioceptive neuromuscular facilitation (PNF) 6 strength protocols. The most common protocols, RTPTP and RBP, are performed for three sessions per week for six weeks using elastic tubing or bands 3,5,6 with the amount of sets or resistance increased each week.…”

Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review

“…Rather, timing of muscle activation during functional tasks such as walking,90 jumping91 and balancing92 may be a more important factor in self-reported function. Though strength training programmes have found to improve measures of strength,82 based on the high-quality articles included into this category demonstrating poor-to-moderate effect sizes with large CIs, it would appear that resistive training does not lead to clinically meaningful improvements in self-reported function.…”

“…Therefore, it would appear that balance training might be the most important factor to include in a rehabilitation programme to target self-reported function. Whereas, the inclusion of other exercises including strength and joint mobilisation, might be more suited for targeting objective measures such as strength deficits82 or range of motion restrictions when found within specific patients, self-reported function is not. More research is needed to identify which combination of exercises produces greatest improvements in self-reported function in patients with CAI.…”

A snapshot of chronic ankle instability in a cohort of netball players

“…For clinicians treating patients with established CAI, strength training protocols have been reported to improve multidirectional strength measures and reduce the extent of perceived ankle instability reported by patients. 30 In terms of clinical management of acute ankle sprains, there is evidently a need to further examine the rehabilitation period following an initial sprain to determine the factors influencing the development of CAI.…”