title: Prevalence and impact of chronic musculoskeletal ankle disorders in the community. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Six weeks of balance training improves sensorimotor function in individuals with chronic ankle instability. Effects of balance training on gait parameters in patients with chronic ankle instability: a randomized controlled trial A comparison of electromyography of gluteus medius and maximus in subjects with and without chronic ankle instability during two functional exercises. Deficits in peroneal latency and electromechanical delay in patients with functional ankle instability. Balance training for persons with functionally unstable ankles. Persistent Disability Associated with Ankle Sprains: A Prospective Examination of an Athletic Population Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. Gait termination control strategies are altered in chronic ankle instability subjects. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial The Effect of a Proprioceptive Balance Board Training Program for the Prevention of Ankle Sprains The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. Effects of strength training on strength development and joint position sense in functionally unstable ankles. Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. Manipulative therapy and rehabilitation for recurrent ankle sprain with functional instability: a short-term, assessor-blind, parallel-group randomized trial. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Functional instability of the ankle: differences in patterns of ankle and knee movement prior to and post landing in a single leg jump. Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. Effects of joint mobilization on chronic ankle instability: a randomized controlled trial A multi-station proprioceptive exercise program in patients with ankle instability. Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial. Balance training improves function and postural control in those with chronic ankle instability. Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability. The epidemiology of ankle sprains in the United States. A Randomized Controlled Trial Comparing Rehabilitation Efficacy in Chronic Ankle Instability. The effectiveness of strain counterstrain in the treatment of patients with chronic ankle instability: A randomized clinical trial Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial. Plantar Cutaneous Sensitivity With and Without Cognitive Loading in People With Chronic Ankle Instability, Copers, and Uninjured Controls. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability.
abstract: OBJECTIVE To determine the point prevalence of chronic musculoskeletal ankle disorders in the community . DESIGN Cross-sectional stratified ( metropolitan vs regional ) r and om sample . SETTING General community . PARTICIPANTS  Population -based computer-aided telephone survey of people ( N=2078 ) aged 18 to 65 years in New South Wales , Australia . Of those contacted , 751 participants provided data . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Point prevalence for no history of ankle injury or chronic ankle problems ( no ankle problems ) , history of ankle injury without residual problems , and chronic ankle disorders . Chronic musculoskeletal ankle disorders due to ankle sprain , fracture , arthritis , or other disorder compared by chi-square test for the presence of pain , weakness , giving way , swelling and instability , activity limitation , and health care use in the past year . RESULTS There were 231 ( 30.8 % ) participants with no ankle problems , 342 ( 45.5 % ) with a history of ankle injury but no chronic problems , and 178 ( 23.7 % ) with chronic ankle disorders . The major component of chronic ankle disorders was musculoskeletal disorders ( n=147 , 19.6 % of the total sample ) , most of which were due to ankle injury ( n=117 , 15.6 % of the total ) . There was no difference among the arthritis , fracture , sprain , and other groups in the prevalence of the specific complaints , or health care use . Significantly more participants with arthritis had to limit activity than in the sprain group ( Chi-square test , P=.035 ) . CONCLUSIONS Chronic musculoskeletal ankle disorders affected almost 20 % of the Australian community . The majority were due to a previous ankle injury , and most people had to limit or change their physical activity because of the ankle disorder CONTEXT Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability ( CAI ) , strength-training rehabilitation protocol s may improve the deficits often associated with CAI . OBJECTIVE To determine whether strength-training protocol s affect strength , dynamic balance , functional performance , and perceived instability in individuals with CAI . DESIGN R and omized 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 Question naire , and participants were r and omly assigned to a resistance-b and - protocol group ( n = 13 [ 33 % ] age = 19.7 ± 2.2 years , height = 172.9 ± 12.8 cm , weight = 69.1 ± 13.5 kg ) , a proprioceptive neuromuscular facilitation strength- protocol group  ( n = 13 [ 33 % ] , age = 18.9 ± 1.3 years , height = 172.5 ± 5.9 cm , weight = 72.7 ± 14.6 kg ) , or a control group  ( n = 13 [ 33 % ] , age = 20.5 ± 2.1 years , height = 175.2 ± 8.1 cm , weight = 70.2 ± 11.1 kg ) . INTERVENTION(S ) Both rehabilitation groups completed their protocol s 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 , repeated- measures analyses of variance , followed by univariate analyses on any significant findings . RESULTS The resistance-b and 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 Y-Balance tests for either intervention group or in the control group for any dependent variable ( P > .05 ) . CONCLUSIONS Although the resistance-b and protocol is common in rehabilitation , the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI . Both protocol s showed clinical benefits in strength and perceived instability . To improve functional outcomes , clinicians should consider using additional multiplanar and multijoint exercises BACKGROUND AND PURPOSE Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains . A r and omized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization , the anteroposterior glide on the talus , on increasing pain-free dorsiflexion and 3 gait variables : stride speed ( gait speed ) , step length , and single support time . SUBJECTS Forty-one subjects with acute ankle inversion sprains ( < 72 hours ) and no other injury to the lower limb entered the trial . METHODS Subjects were r and omly assigned to 1 of 2 treatment groups . The control group received a protocol of rest , ice , compression , and elevation ( RICE ) . The experimental group received the anteroposterior mobilization , using a force that avoided incurring any increase in pain , in addition to the RICE protocol . Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met , and all subjects were given a home program of continued RICE application . Outcomes were measured before and after each treatment . RESULTS The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion . The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions . The experimental group also had greater increases in stride speed during the first and third treatment sessions . DISCUSSION AND CONCLUSION Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone . Improvement in step length symmetry and single support time was similar in both groups STUDY DESIGN Prospect i ve cohort study . OBJECTIVE To assess the effect of 6 weeks of balance training on sensorimotor measures previously found to be deficient in participants with chronic ankle instability ( CAI ) . BACKGROUND CAI is the tendency toward repeated ankle sprains and recurring symptoms , occurring in 40 % to 70 % of individuals who have previously sustained a lateral ankle sprain . Recent studies have found deficits in sensorimotor measures in individuals with CAI . As balance training is a common component of ankle rehabilitation , underst and ing its effect on the sensorimotorsystem in individuals with CAI may enable us to optimize protocol s to better utilize this rehabilitation method . METHODS Twelve participants with CAI and 9 healthy volunteers participated . Independent variables were group ( CAI , control ) and time ( pretraining , posttraining ) . Participants with CAI who completed a 6-week balance training program and healthy controls who did not get any training were pretested and posttested at the beginning and at the end of 6 weeks . RESULTS The individuals in the CAI group who performed balance training demonstrated better performance than control participants on baseline adjusted posttraining measures of dynamic balance in the anterior medial ( P = .021 ) , medial ( P = .048 ) , and posterior medial directions ( P = .030 ) ; motoneuron pool excitability Hmax/Mmax ratio ( P = .044 ) and single-limb presynaptic inhibition ( P = .012 ) ; and joint position sense inversion variable error ( P = .017 ) . It may be of note that no systematic differences were detected for static balance or plantar flexion joint position sense tasks . CONCLUSIONS After 6 weeks of balance training , individuals with CAI demonstrated enhanced dynamic balance , inversion joint position sense , and changes in motoneuron pool excitability compared to healthy controls who did not train . LEVEL OF EVIDENCE Therapy , level 2b Objective : To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability . A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability . Design : R and omized controlled trial . Setting : Laboratory . Subjects/ patients : Twenty-nine participants ( 12 males , 17 females ) with self-reported chronic ankle instability were r and omly assigned to a balance training group or a control group . Intervention : Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance . The control group received no intervention . Main outcome measures : Kinematic measures of rearfoot inversion/eversion , shank rotation , and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill . Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness . Results : No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training . There was , however , a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training ( balance training posttest : 13.1 ° ± 6.2 ° , balance training pretest : 16.2 ° ± 3.3 ° , P = 0.03 ) , indicating improved shank/rearfoot coupling stability . The control group did not significantly change . ( posttest : 16.30 ° ± 4.4 ° , pretest : 18.6 ° ± 7.1 ° , P40.05 ) There were no significant changes in laxity measures for either group . Conclusions : Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability OBJECTIVE To determine how gluteus medius ( Gmed ) and maximus ( Gmax ) activate during closed-chain functional rehabilitative exercises in those with and without chronic ankle instability ( CAI ) . DESIGN Cohort study . Subjects performed ten repetitions of a rotational lunge and single-leg rotational squat while surface electromyography was used to collect mean muscle activity  of the Gmed and Gmax . MAIN OUTCOME MEASURES Mean electromyography activity of the Gmed and Gmax at maximum excursion was compared between Groups and Exercises using a separate 2-way repeated measures analysis of variance design for each muscle . SETTING University biomechanics lab . PARTICIPANTS Nine healthy ( 8F , 1 M ) and nine CAI subjects ( 8F , 1 M ) RESULTS : For Gmax activation , there was a statistically significant Group by Exercise interaction ( F(3,48 ) = 4.84 , p = 0.043 ) . A Scheffe 's post-hoc test revealed that during the rotational squat , the CAI group had significantly lower Gmax activation ( 51.1 ± 31.0 % ) than the healthy group ( 78.6 ± 44.8 % ) . There were no statistically significant findings for the Gmed . In the healthy group , the Gmax produced significantly higher activation during rotational squat ( 78.6 ± 44.8 % ) compared to the rotational lunge ( 57.6 ± 31.9 % ) . CONCLUSION Because the CAI group had significantly less Gmax activation than the healthy group during the rotational squat at the point of maximum excursion , and because the rotational squat showed significantly higher Gmax activation compared to the rotational lunge , it may be important for clinicians to implement the rotational squat during rehabilitation for those with CAI . Future prospect i ve and intervention research involving hip musculature in those with CAI is recommended The purpose of this study was to compare alterations in peroneal latency and electromechanical delay ( EMD ) following an inversion perturbation during walking in patients with functional ankle instability ( FAI ) and with a matched control group .  Peroneal latency and EMD  were measured from 21 patients with unilateral FAI and 21 controls .  Latencies were collected during a r and om inversion perturbation while walking . EMD measures  were collected during stance using a percutaneous stimulus . Two-way ANOVAs were used to detect differences between leg ( affected , unaffected ) and group ( FAI , Control ) . Functionally unstable ankles displayed delayed peroneus longus ( PL ) latencies and EMD when compared to the unaffected leg and a matched control group . Peroneal latency and EMD deficits could contribute to recurrence of ankle injury in FAI subjects . How these deficits are associated with the chronic symptoms associated with FAI remains unclear , but gamma activation and subsequent muscle spindle sensitivity likely play a role STUDY DESIGN A nonr and omized 2-group pretest-posttest design . OBJECTIVES To determine the effects of a 4-week balance training program during stance on a single leg . BACKGROUND Individuals who have experienced multiple episodes of inversion ankle sprains often participate in balance training programs . Balance training is performed to treat existing proprioceptive deficits and to restore ankle joint stability , presumably by retraining altered afferent neuromuscular pathways . The effectiveness of such programs on individuals with functionally unstable ankles has yet to be established . METHODS AND MEASURES Prior to and following training , subjects with self-reported functionally unstable ankles ( 5 women and 8 men , mean age = 21.9 + /- 3.1 years ) and nonimpaired subjects ( 6 women and 7 men , mean age = 21.2 + /- 2.5 years ) completed a  static balance assessment  for both limbs as well as the  ankle joint functional assessment tool question naire ( AJFAT ) . The subjects from both groups participated in a unilateral , multilevel , static and dynamic balance training program 3 times a week for 4 weeks . Subjects from the experimental group trained only the involved limb , and the nonimpaired group  trained a r and omly selected limb . A stability index ( SI ) was calculated during the balance assessment to indicate the amount of platform motion . Compared to low stability indices , high stability indices indicate greater platform motion during stance and therefore less stability . RESULTS Following training , subjects from both groups demonstrated significant improvements in balance ability . When balance was assessed at a low resistance to platform tilt ( stability level 2 ) , the posttraining scores of both the subjects with unstable ankles ( mean SI = 2.63 + /- 1.92 ) and the nonimpaired subjects ( mean SI = 2.69 + /- 2.32 ) were significantly better than their pretraining scores ( mean SIs = 5.93 + /- 3.65 and 4.67 + /- 3.43 , respectively ) . Assessed at a high resistance to platform tilt ( stability level 6 ) , the posttraining scores of both subjects with unstable ankles ( mean SI = 1.27 + /- 0.66 ) and the nonimpaired subjects ( mean SI = 1.37 + /- 0.66 ) were significantly better than their pretraining scores ( mean SIs = 2.30 + /- 1.88 and 2.04 + /- 1.43 , respectively ) . Additionally , the posttraining AJFAT scores of subjects with unstable ankles ( 25.78 + /- 3.80 ) and the nonimpaired subjects ( 29.15 + /- 5.27 ) were significantly greater than their pretraining scores ( 17.11 + /- 3.44 and 22.92 + /- 5.22 , respectively ) , indicating an overall improvement in perceived ankle joint functional stability . CONCLUSIONS This study suggests that balance training is an effective means of improving joint proprioception and single-leg st and ing ability in subjects with unstable and nonimpaired ankles The purpose of this study was to examine a young athletic population to up date the data regarding epidemiology and disability associated with ankle injuries . At the United States Military Academy , all cadets presenting with ankle injuries during a 2-month period were included in this prospect i ve observational study . The initial evaluation included an extensive question naire , physical examination , and radiographs . Ankle sprain treatment included a supervised rehabilitation program . Subjects were reevaluated at 6 weeks and 6 months with subjective  assessment , physical  examination  , and functional testing . The mean age for all subjects was 20 years ( range , 17–24 years ) . There were 104 ankle injuries accounting for 23 % of all injuries seen . There were 96 sprains , 7 fractures , and 1 contusion . Of the 96 sprains , 4 were predominately medial injuries , 76 were lateral , and 16 were syndesmosis sprains . Ninety-five percent had returned to sports activities by 6 weeks ; however , 55 % of these subjects reported loss of function or presence of intermittent pain , and 23 % had a decrement of > 20 % in the lateral hop test when compared with the uninjured side . At 6 months , all subjects had returned to full activity ; however , 40 % reported residual symptoms and 2.5 % had a decrement of > 20 % on the lateral hop test . Neither previous injury nor ligament laxity was predictive of chronic symptomatology . Furthermore , chronic dysfunction could not be predicted by the grade of sprain ( grade I vs. II ) . The factor most predictive of residual symptoms was a syndesmosis sprain , regardless of grade . Syndesmosis sprains were most prevalent in collision sports . This study demonstrates that even though our knowledge and underst and ing of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years , chronic ankle dysfunction continues to be a prevalent problem . The early return to sports occurs after almost every ankle sprain ; however , dysfunction persists in 40 % of patients for as long as 6 months after injury . Syndesmosis sprains are more common than previously thought , and this confirms that syndesmosis sprains are associated with prolonged disability CONTEXT A dynamic-balance-training ( DBT ) program supplemented with the Graston instrument-assisted soft-tissue mobilization ( GISTM ) technique has not been evaluated collectively as a treatment in subjects with chronic ankle instability ( CAI ) . OBJECTIVE To examine the effects of GISTM in conjunction with a DBT program on outcomes associated with CAI , including pain and disability , range of motion ( ROM ) , and dynamic postural control . DESIGN Pretest/posttest , repeated measures . SETTING High school and a Division I mid-Atlantic university . PARTICIPANTS Thirty-six healthy , physically active individuals ( 5 female , 31 male ; age 17.7 ± 1.9 y ; height 175.3 ± 14.6 cm ) with a history of CAI as determined by an ankle-instability question naire volunteered to be in this study . INTERVENTIONS Subjects were r and omly assigned to 1 of 3 intervention 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-wk 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 min before performing the DBT program . Pretest and posttest measurements included the Foot and Ankle Ability Measure ( FAAM ) , FAAM Sport , the visual analog scale ( VAS ) , ankle ROM in 4 directions , and the Star Excursion Balance Test ( SEBT ) in 3 directions . MAIN OUTCOME MEASURES FAAM and FAAM-Sport scores , VAS , goniometric ROM ( plantar flexion , dorsiflexion , inversion , eversion ) , and SEBT ( anterior , posteromedial , posterolateral ) . RESULTS Subjects in all groups posttest demonstrated an increase in FAAM , FAAM Sport , ROM , and SEBT in all directions but not in VAS , which decreased . No other results were significant . CONCLUSION For subjects with  CAI , dynamic postural control , ROM , pain and disability improved pretest to posttest regardless of group membership , with the largest effects found in most measures in the DBT/GISTM group UNLABELLED Despite the high incidence of chronic ankle instability ( CAI ) , the underlying neurophysiologic mechanism is unknown . Evidence suggests that both feed-forward and feedback mechanisms may play a role . However , no investigation has examined both control mechanisms during the same movement task in the same cohort of CAI patients . PURPOSE To determine the neuromuscular and biomechanical control alterations present in CAI patients during planned ( feed-forward ) and unplanned ( feedback ) gait termination . METHODS Twenty subjects with CAI and 20 uninjured controls completed planned and unplanned gait termination protocol s. Both tasks began with subjects walking at a self-selected speed across a 12-m walkway . Unplanned gait termination required subjects to stop during r and omly selected trials on two adjacent force plates when cued . Planned gait termination required purpose ful stopping on the force places . Propulsive and braking force magnitude and the dynamic postural stability index were calculated from the result ing ground reaction forces . In addition , muscle activity from the soleus , tibialis anterior , and gluteus medius was collected bilaterally . RESULTS Both maximum propulsive ( CAI = 99.8 + /- 40.8 N , control = 88.6 + /- 33.6 N ) and braking ( CAI = 207.1 + /- 80.9 N , control = 161.6 + /- 62.2 N ) forces were significantly higher in the CAI group . The dynamic postural stability index revealed higher scores in the CAI group ( 0.24 + /- 0.03 ) compared with the control group ( 0.22 + /- 0.03 ) . Muscle activation of the soleus and tibialis anterior differed during unplanned and planned gait termination between groups ( P < 0.05 ) and between the limbs of the CAI group ( P < 0.05 ) . CONCLUSIONS Altered biomechanical strategies during both planned and unplanned gait termination indicate that patients with CAI have alterations in feed-forward neuromuscular control and suggest the presence of feedback neuromuscular control deficits Objective . To compare the effects of combined trigger point dry needling ( TrP-DN ) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability . Methods . Twenty-seven ( 44 % female , mean age : 33 ± 3 years ) individuals with unilateral ankle instability were r and omly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone . Outcome included function assessed with the Foot and Ankle Ability Measure ( FAAM ) and ankle pain intensity assessed with a numerical pain rate scale ( NPRS ) . They were captured at baseline and 1-month follow-up after the intervention . Results . The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM ( ADL : F = 8.211 ; P = 0.008 ; SPORTS : F = 13.943 ; P < 0.001 ) and for pain ( F = 44.420 ; P < 0.001 ) : patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone . Between-groups effect sizes were large in all outcomes ( SMD > 2.1 ) in favor of the TrP-DN group . Conclusions . This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program result ed in better outcomes in pain and function 1 month after the therapy in ankle instability Background Ankle sprains are the most common injuries in a variety of sports . Hypothesis A proprioceptive balance board program is effective for prevention of ankle sprains in volleyball players . Study Design Prospect i ve controlled study . Methods There were 116 male and female volleyball teams followed prospect ively during the 2001 - 2002 season . Teams were r and omized by 4 geographical regions to an intervention group ( 66 teams , 641 players ) and control group ( 50 teams , 486 players ) . Intervention teams followed a prescribed balance board training program ; control teams followed their normal training routine . The coaches recorded exposure on a weekly basis for each player . Injuries were registered by the players within 1 week after onset . Results Significantly fewer ankle sprains in the intervention group were found compared to the control group ( risk difference = 0.4/1000 playing hours ; 95 % confidence interval , 0.1 - 0.7 ) . A significant reduction in ankle sprain risk was found only for players with a history of ankle sprains . The incidence of overuse knee injuries for players with history of knee injury was increased in the intervention group . History of knee injury may be a contraindication for proprioceptive balance board training . Conclusions Use of proprioceptive balance board program is effective for prevention of ankle sprain recurrences STUDY DESIGN Prospect i ve , r and omized controlled trial . OBJECTIVE To examine the effects of a 4-week rehabilitation program for chronic ankle instability ( CAI ) on postural control and lower extremity function . BACKGROUND CAI is associated with residual symptoms , performance deficits , and reinjury . Managing CAI is challenging and more evidence is needed to guide effective treatment . METHODS AND MEASURES Subjects with unilateral CAI were r and omly assigned to the rehabilitation ( CAI-rehab , n=16 ) or control ( CAI-control , n=13 ) group . Subjects without CAI were assigned to a healthy group ( n=19 ) . Baseline testing included the ( 1 ) center of pressure velocity ( COPV ) , ( 2 ) star excursion balance test ( SEBT ) , and ( 3 ) Foot and Ankle Disability index ( FADI ) and FADI-Sports Subscale ( FADI-Sport ) . The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion , strength , neuromuscular control , and functional tasks . After 4 weeks , all subjects were retested . Nonparametric analyses for group differences and between-group comparisons were performed . RESULTS Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks of the involved limb compared to the uninvolved limb and reported functional deficits of the involved limb compared to healthy subjects . Following rehabilitation , the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADi and FADI-Sport scores . CONCLUSIONS These results demonstrate postural control and functional limitations exist in individuals with CAl . In addition , rehabilitation appears to improve these functional limitations . Finally , there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI OBJECTIVE To examine the effects of ankle-strengthening exercises on joint position sense and strength development in subjects with functionally unstable ankles . DESIGN AND SETTING Subjects were r and omly assigned to a training or control group . The training group participated in a 6-week strength-training protocol using rubber tubing 3 times a week throughout the training period . The control group did not participate in the strength-training protocol . SUBJECTS Twenty healthy college students ( 10 females , 10 males , age = 20.6 + /- 2.23 years ; ht = 176.40 + /- 7.14 cm ; wt = 74.18 + /- 10.17 kg ) with a history of functional ankle instability volunteered to participate in this study . MEASUREMENTS We pretested and posttested  dorsiflexor and evertor isometric strength  with a h and held dynamometer and collected joint position sense ( JPS ) data at 20 degrees for inversion and plantar flexion and at 10 degrees for eversion and dorsiflexion . RESULTS Statistical tests for strength and JPS revealed significant group-by-time interactions for dorsiflexion strength , eversion strength , inversion JPS , and plantar flexion JPS . Simple main-effects testing revealed improvements in training group strength and JPS at posttesting . There were no significant effects for eversion JPS , but the group main effect for dorsiflexion JPS was significant , with the experimental group having better scores than the control group . CONCLUSIONS Ankle-strengthening exercises improved strength , inversion JPS , dorsiflexion JPS , and plantar flexion JPS in subjects with functionally unstable ankles The purpose of this study was to examine the effects of a single joint mobilization treatment on dorsiflexion range of motion ( DF ROM ) , posterior talar glide , and dynamic and static postural control in individuals with self-reported chronic ankle instability ( CAI ) . In this r and omized cross-over study , subjects received a  Maitl and Grade III anterior-to-posterior joint mobilization treatment and a control treatment of rest for 5 min . Weight-bearing DF ROM , instrumented posterior talar displacement and posterior stiffness , the anterior , posteromedial , and posterolateral reach directions of the Star Excursion Balance Test ( SEBT ) , and time-to-boundary ( TTB ) single-limb stance static postural control  were assessed on both treatment days in 9 males and 11 females with CAI . The results indicated that the joint mobilization treatment was associated with significantly greater DF ROM ( p = 0.01 ) and TTB in the anterior-posterior direction with eyes-open ( p < 0.05 ) . Although not significant , trends were identified in posterior talar displacement ( p = 0.08 ) and the mean of TTB in the medial-lateral ( ML ) direction ( p = 0.07 ) . No significant differences were observed in the st and ard deviation of TTB in the ML direction , the SEBT , or posterior stiffness ( p > 0.05 ) . This indicates that a single joint mobilization treatment has mechanical and functional benefits for addressing impairments in sensorimotor function and arthrokinematic restrictions commonly experienced by individuals with CAI OBJECTIVE The purpose of this study was to compare manipulative therapy ( MT ) plus rehabilitation to rehabilitation alone for recurrent ankle sprain with functional instability ( RASFI ) to determine short-term outcomes . METHODS This was an assessor-blind , parallel-group r and omized comparative trial . Thirty-three eligible participants with RASFI were r and omly allocated to receive rehabilitation alone or chiropractic MT plus rehabilitation . All participants undertook a daily rehabilitation program over the course of the 4-week treatment period . The participants receiving MT had 6 treatments over the same treatment period . The primary outcome measures were the Foot and Ankle Disability Index and the visual analogue pain scale , with the secondary outcome measure being joint motion palpation . Data were collected at baseline and during week 5 . Missing scores were replaced using a multiple imputation method . Statistical analysis of the data composed of repeated- measures analysis of variance . RESULTS Between-group analysis demonstrated a difference in scores at the final consultation for the visual analogue scale and frequency of joint motion restrictions ( P ≤ .006 ) but not for the Foot and Ankle Disability Index ( P = .26 ) . CONCLUSIONS This study showed that the patients with RASFI who received chiropractic MT plus rehabilitation showed significant short-term reduction in pain and the number of joint restrictions in the short-term but not disability when compared with rehabilitation alone OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity The aim of this study was to investigate  motor control  in subjects with functional instability of the ankle joint . This was achieved by analysing patterns of lower extremity motion prior to and immediately following l and ing during single leg jumping in subjects with functional instability of the ankle . Fourteen subjects with unilateral functional instability and 10 healthy control subjects performed single leg jumps from a 40 cm height whilst angular displacement of their ankle and knee joints were recorded . Subjects with functional instability demonstrated significantly greater ankle dorsiflexion over the period encompassing 10 ms pre l and ing to 20 ms post l and ing ( p < 0.05 ) . They also exhibited a significantly greater level of knee flexion than controls over the period from 20 ms pre l and ing to 60 ms post l and ing ( p < 0.05 ) . The timing of these significant differences leads us to conclude that they do not arise as a result of reflexively mediated peripheral events following l and ing We examined the effect of a 2-week anterior-to-posterior ankle joint mobilization intervention on weight-bearing dorsiflexion range of motion ( ROM ) , dynamic balance , and self-reported function in subjects with chronic ankle instability ( CAI ) . In this prospect i ve cohort study , subjects received six Maitl and Grade III anterior-to-posterior joint mobilization treatments over 2 weeks . Weight-bearing dorsiflexion ROM , the anterior , posteromedial , and posterolateral reach directions of the Star Excursion Balance Test ( SEBT ) , and self-reported function on the Foot and Ankle Ability Measure ( FAAM ) were assessed 1 week before the intervention ( baseline ) , prior to the first treatment ( pre-intervention ) , 24 - 48 h following the final treatment ( post-intervention ) , and 1 week later ( 1-week follow-up ) in 12 adults ( 6 males and 6 females ) with CAI . The results indicate that dorsiflexion ROM , reach distance in all directions of the SEBT , and the FAAM improved ( p < 0.05 for all ) in all measures following the intervention compared to those prior to the intervention . No differences were observed in any assessment s between the baseline and pre-intervention measures or between the post-intervention and 1-week follow-up measures ( p > 0.05 ) . These results indicate that the joint mobilization intervention that targeted posterior talar glide was able to improve measures of function in adults with CAI for at least 1 week Abstract Purpose : To evaluate the effects of joint mobilization , in which movement is applied to the ankle 's dorsiflexion range of motion , on dynamic postural control and on the self-reported instability of patients with chronic ankle instability ( CAI ) . Methods : A double-blind , placebo-controlled , r and omized trial with repeated measures and a follow-up period . Ninety patients with a history of recurrent ankle sprain , self-reported instability , and a limited dorsiflexion range of motion , were r and omly assigned to either the intervention group ( Joint Mobilizations , 3 weeks , two sessions per week ) the placebo group ( Sham Mobilizations , same duration as joint mobilization ) or the control group , with a 6 months follow-up . Dorsiflexion Range of Motion ( DFROM ) , Star Excursion Balance Test ( SEBT ) and CAI Tool ( CAIT ) were outcome measures . A separate 3 × 4 mixed model analysis of variance was performed to examine the effect of treatment conditions and time , and intention-to-treat ( ITT ) analysis was applied to evaluate the effect of the independent variable . Results : The application of joint mobilization result ed in better scores of DFROM , CAIT , and SEBTs in the intervention group when compared with the placebo or the control groups ( p < 0.001 ) . The effect sizes of group-by-time interaction , measured with eta-squared , oscillated between 0.954 for DFROM and 0.288 for SEBT posteromedial distance . In within-group analysis , the manipulation group showed an improvement at 6 months follow-up in CAIT [ mean = 5.23 , CI 95 % ( 4.63–5.84 ) ] , DFROM [ mean = 6.77 , CI 95 % ( 6.45–7.08 ) ] , anterior SEBT [ mean = 7.35 , CI 95 % ( 6.59–8.12 ) ] , posteromedial SEBT [ mean = 3.32 , CI 95 % ( 0.95–5.69 ) ] , and posterolateral SEBT [ mean = 2.55 , CI 95 % ( 2.20–2.89 ) ] . Conclusion : Joint mobilization techniques applied to subjects suffering from CAI were able to improve ankle DFROM , postural control , and self-reported instability . These results suggest that joint mobilization could be applied to patients with recurrent ankle sprain to help restore their functional stability . Implication s for Rehabilitation Functional instability is a very common sequela in patients with CAI , result ing in reduced quality of living due to the limitations it imposes on daily life activities . The mobilization with movement technique presented by Mulligan , and based on the joint mobilization accompanied by active movement , appears as a valuable tool to be employed by physical therapists to restore ankle function after a recurrent ankle sprain history . ROM restriction , subjective feeling of instability and dynamic postural control are benefiting from the joint mobilization application PURPOSE The aim of the present study was to investigate the effects of a 6-wk multi-station proprioceptive exercise program that is easy to integrate in normal training programs . METHODS Patients with chronic ankle instability were used , and results of three testing procedures before and afterward were compared : joint position sense , postural sway , and muscle reaction times to sudden inversion events on a tilting platform . A total of 30 subjects with 48 unstable feet were evaluated ( exercise group : N = 31 ; control group : N = 17 ) . RESULTS In the exercise group , the results showed a significant improvement in joint position sense and postural sway as well as significant changes in muscle reaction times . CONCLUSION Based on the present results , a multi-station proprioceptive exercise program can be recommended for prevention and rehabilitation of recurrent ankle inversion injuries The objective of the present study was to determine the effectiveness of a 6-week balance training program on patients with Chronic Ankle Instability ( CAI ) in relation to the results obtained in Dynamic Balance , subjective feeling of instability and pain using a single-blind r and omized controlled trial . 70 athletes were r and omly assigned to control or intervention group . The control group performed their usual training , and the intervention group was administered the same usual activity in addition to a balance program . The paired t-test was performed to evaluate the change scores in each group . The t-test for independent sample s was performed to evaluate between-group differences in change scores . Significance level was assigned for p-values less than 0.05 for all analyses . There were significant differences between groups in change scores in CAIT and all of the SEBTs reach distances ( p<0.001 ) but not in Pain ( p=0.586 ) . The effect sizes were larger for the outcomes measures that showed significant differences . In the within-group change , the experimental groups showed larger effect sizes in CAIT , SEBT posteromedial and SEBT posterolateral , and moderate effect sizes in SEBT anterior .  Exercise therapy training based on multi-station balance tasks led to significant improvements in dynamic balance and self-reported sensation of instability in patients with CAI PURPOSE The purpose of this r and omized controlled trial was to determine the effect of a 4-wk balance training program on static and dynamic postural control and self-reported functional outcomes in those with chronic ankle instability ( CAI ) . METHODS Thirty-one young adults with self-reported CAI were r and omly assigned to an intervention group ( six males and 10 females ) or a control group ( six males and nine females ) . The intervention consisted of a 4-wk supervised balance training program that emphasized dynamic stabilization in single-limb stance . Main outcome measures included the following : self-reported disability on the Foot and Ankle Disability Index ( FADI ) and the FADI Sport scales ; summary center of pressure ( COP ) excursion measures including area of a 95 % confidence ellipse , velocity , range , and SD ; time-to-boundary ( TTB ) measures of postural control in single-limb stance including the absolute minimum TTB , mean of TTB minima , and SD of TTB minima in the anteroposterior and mediolateral directions with eyes open and closed ; and reach distance in the anterior , posteromedial , and posterolateral directions of the Star Excursion Balance Test ( SEBT ) . RESULTS The balance training group had significant improvements in the FADI and the FADI Sport scores , in the magnitude and the variability of TTB measures with eyes closed , and in reach distances with the posteromedial and the posterolateral directions of the SEBT . Only one of the summary COP-based measures significantly changed after balance training . CONCLUSIONS Four weeks of balance training significantly improved self-reported function , static postural control as detected by TTB measures , and dynamic postural control as assessed with the SEBT . TTB measures were more sensitive at detecting improvements in static postural control compared with summary COP-based measures STUDY DESIGN R and omized clinical trial . OBJECTIVES To determine whether manipulation of the proximal or distal tibiofibular joint would change ankle dorsiflexion range of motion and functional outcomes over a 3-week period in individuals with chronic ankle instability . BACKGROUND Altered joint arthrokinematics may play a role in chronic ankle instability dysfunction . Joint mobilization or manipulation may offer the ability to restore normal joint arthrokinematics and improve function . METHODS Forty-three participants ( mean ± SD age , 25.6 ± 7.6 years ; height , 174.3 ± 10.2 cm ; mass , 74.6 ± 16.7 kg ) with chronic ankle instability were r and omized  to proximal tibiofibular joint manipulation , distal tibiofibular joint manipulation , or a control group . Outcome measures included ankle dorsiflexion range of motion , the single-limb stance on foam component of the Balance Error Scoring System , the step-down test , and the Foot and Ankle Ability Measure sports subscale . Measurements were obtained prior to the intervention ( before day 1 ) and following the intervention ( on days 1 , 7 , 14 , and 21 ) . RESULTS There was no significant change in dorsiflexion between groups across time . When groups were pooled , there was a significant increase ( P<.001 ) in dorsiflexion at each postintervention time interval . No differences were found among the Balance Error Scoring System foam , step-down test , and Foot and Ankle Ability Measure sports subscale scores . CONCLUSIONS The use of a proximal or distal tibiofibular joint manipulation in isolation did not enhance outcome effects beyond those of the control group . Collectively , all groups demonstrated increases in ankle dorsiflexion range of motion over the 3-week intervention period . These increases might have been due to practice effects associated with repeated testing . LEVEL OF EVIDENCE Therapy , level 2b- BACKGROUND Ankle sprain has been studied in athletic cohorts , but little is known of its epidemiology in the general population . A longitudinal , prospect i ve epidemiological data base was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States . It was our hypothesis that ankle sprain is influenced by sex , race , age , and involvement in athletics . METHODS The National Electronic Injury Surveillance System ( NEISS ) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006 . Incidence rate ratios were then calculated with respect to age , sex , and race . RESULTS During the study period , an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States . The peak incidence of ankle sprain occurred between fifteen and nineteen years of age ( 7.2 per 1000 person-years ) . Males , compared with females , did not demonstrate an overall increased incidence rate ratio for ankle sprain ( incidence rate ratio , 1.04 ; 95 % confidence interval , 1.00 to 1.09 ) . However , males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts ( incidence rate ratio , 1.53 ; 95 % confidence interval , 1.41 to 1.66 ) , whereas females over thirty years old had a higher incidence compared with their male counterparts ( incidence rate ratio , 2.03 ; 95 % confidence interval , 1.65 to 2.65 ) . Compared with the Hispanic race , the black and white races were associated with substantially higher rates of ankle sprain ( incidence rate ratio , 3.55 [ 95 % confidence interval , 1.01 to 6.09 ] and 2.49 [ 95 % confidence interval , 1.01 to 3.97 ] , respectively ) . Nearly half of all ankle sprains ( 49.3 % ) occurred during athletic activity , with basketball ( 41.1 % ) , football ( 9.3 % ) , and soccer ( 7.9 % ) being associated with the highest percentage of ankle sprains during athletics . CONCLUSIONS An age of ten to nineteen years old is associated with higher rates of ankle sprain . Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts , whereas females over thirty years old have higher rates than their male counterparts . Half of all ankle sprains occur during athletic activity CONTEXT There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability ( CAI ) . In addition , clinicians aim ing to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy . OBJECTIVE To assess the comparative efficacy of 2 common ankle rehabilitation techniques ( wobble-board [ WB ] balance training and ankle strengthening using resistance tubing [ RT ] ) using patient-oriented outcomes . DESIGN R and omized controlled trial . SETTING Laboratory . PATIENTS 40 patients with CAI r and omized into 2 treatment groups :  RT and WB .  CAI inclusion criteria included a history of an ankle sprain , recurrent " giving way , " and a Cumberl and Ankle Instability Tool ( CAIT ) score ≤25 . INTERVENTIONS Participants completed 5 clinician-oriented tests  ( foot-lift test , time-in-balance , Star Excursion Balance Test , figure-of-8 hop , and side-hop ) and 5  patient-oriented question naires ( CAIT , Foot and Ankle Ability Measure [ FAAM ] , Activities of Daily Living [ ADL ] and FAAM Sport scale , Short-Form 36 [ SF-36 ] , and Global Rating of Function [ GRF ] ) . After baseline testing , participants completed 12 sessions over 4 wk of graduated WB or RT exercise , then repeated baseline tests . MAIN OUTCOME MEASURES For each patient- and clinician-oriented test , separate 2 × 2 RMANOVAs analyzed differences between groups over time ( alpha set at P = .05 ) . RESULTS There was a significant interaction between group and time for the FAAM-ADL ( P = .04 ) . Specifically , the WB group improved postintervention ( P < .001 ) whereas the RT group remained the same ( P = .29 ) . There were no other significant interactions or significant differences between groups ( all P > .05 ) . There were significant improvements postintervention for the CAIT , FAAM-Sport , GRF , SF-36 , and all 5 clinician-oriented tests ( all P < .001 ) . CONCLUSIONS A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI . Limited evidence indicates that WB training was more effective than RT . LEVEL OF EVIDENCE Therapy , level 1b Abstract Study Design : R and omized clinical trial . Objective : To determine the effect of strain counterstrain ( SCS ) on dynamic balance and subjective sense of instability in individuals with chronic ankle instability ( CAI ) . Although many studies have been published on CAI , the cause for this common clinical dysfunction remains inconclusive . No studies have assessed the effectiveness of SCS on CAI . Methods : At baseline all participants completed a demographic question naire , the star excursion balance test ( SEBT ) , and the foot and ankle ability measure ( FAAM ) . Following the baseline evaluation , participants were r and omized into the SCS experimental group ( EG ) ( n = 13 ) or the sham SCS group ( SG ) ( n = 14 ) . All participants received the assigned treatment once a week for 4 weeks and participated in a prescribed exercise program . At week 4 , all participants repeated the outcome measures and completed a global rating of change ( GROC ) form . The primary aim was examined with a two-way analysis of variance ( ANOVA ) . Results : A significant group-by-time interaction was found for seven directions in the SEBT ( P<0·031 ) . For subjective measures , no significant group-by-time interaction was found for the FAAM ( P>0·548 ) , but the GROC revealed a significant difference ( P = 0·014 ) in the mean score for the EG ( 3·92±1·66 ) when compared to the SG ( 2·43±1·66 ) . Discussion : Although SCS may not have an effect on subjective ankle function in individuals with CAI , preliminary evidence suggests that SCS may lead to an improvement in dynamic ankle stability and the subjective sense of ankle instability . Level of Evidence : Therapy , Level 1b CONTEXT Individuals with chronic ankle instability ( CAI ) have deficits in neuromuscular control and altered movement patterns . Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function . OBJECTIVE To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function , range of motion ( ROM ) , strength , and balance than rehabilitation without devices in patients with CAI . DESIGN R and omized controlled clinical trial . SETTING Laboratory . PATIENTS OR OTHER PARTICIPANTS A total of 26 patients with CAI ( 7 men , 19 women ; age = 21.34 ± 3.06 years , height = 168.96 ± 8.77 cm , mass = 70.73 ± 13.86 kg ) . INTERVENTION(S ) Patients completed baseline measures and were r and omized into no-device and device groups . Both groups completed 4 weeks of supervised , impairment-based progressive rehabilitation with or without devices and then repeated baseline measures . MAIN OUTCOME MEASURE(S ) We assessed self-reported function using the Foot and Ankle Ability Measure . Ankle ROM was measured with an inclinometer . Ankle strength was assessed using a h and held dynamometer during maximal voluntary isometric contractions . Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance . We compared each dependent variable using a 2 × 2 ( group × time ) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05 . The Hedges g effect sizes and associated 95 % confidence intervals were calculated . RESULTS We observed no differences between the no-device and device groups for any measure . However , both groups had large improvements in self-reported function and ankle strength . CONCLUSIONS Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions result ed in similar improvements . Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI STUDY DESIGN Controlled laboratory study . BACKGROUND Deficits in light touch have recently been identified on the plantar surface of the foot in those with chronic ankle instability ( CAI ) but not in uninjured controls . It is unknown whether copers display similar deficits . Similarly , cognitive loading has been shown to impact postural control in different population s , but it is unclear how it may impact sensory perception . OBJECTIVES To evaluate the difference in cutaneous sensation thresholds at rest and under cognitive loading , using Semmes-Weinstein monofilaments ( SWMs ) , among uninjured controls , copers , and those with CAI . METHODS A total of 45 participants ( mean ± SD age , 20.2 ± 2.8 years ; height , 167.6 ± 9.9 cm ; mass , 66.3 ± 14.7 kg ) were recruited and categorized to a  CAI , coper , or control group  , based on Ankle Instability Instrument scores . Participants were assessed with SWMs for cutaneous thresholds using a 4 - 2 - 1 stepping algorithm at the head of the first metatarsal , base of the fifth metatarsal , calcaneus , and sinus tarsi . Each participant was then retested while generating r and om digits to the beat of a metronome in order to simulate cognitive loading . RESULTS Participants with CAI displayed significantly higher SWM thresholds at the head of the first metatarsal , base of the fifth metatarsal , and sinus tarsi than those of the control participants , and significantly higher thresholds at the base of the fifth metatarsal and calcaneus than those of copers ( all , P<.05 ) . Copers showed higher thresholds than those of controls at the sinus tarsi only ( P<.05 ) . A main effect of cognitive loading was identified at all 4 sites ( P<.05 ) . CONCLUSION People with CAI have deficits in plantar sensation relative to controls and copers . Cognitive loading increases plantar cutaneous sensation thresholds irrespective of CAI status Functional instability is a common complication following an acute ankle sprain . Three potential contributing factors underlying the ankle which chronically gives way are proprioceptive deficits , muscle weakness , and ligamentous laxity . This study 's purpose was to document the presence or absence of these concerns in a sample of subjects with unilateral functional ankle instability . Both ankles of 42 subjects were r and omly assessed for passive movement sense into inversion and generation of peak torque by the evertors isokinetically . Thirty-four subjects were available for documentation of talar tilt of both ankles through inversion stress radiographs . Analysis found significantly greater mean values for passive movement sense and talar tilt for the involved ankles compared with the uninvolved , while no significant strength differences in peak torque of the evertors were present . Fifty-eight percent of the sample demonstrated clinical impairments in at least one of these three categories . In conclusion , deficits in passive movement sense and anatomic stability are greater concerns than strength deficits when managing the ankle with functional instability INTRODUCTION Deficient sensory input from damaged ankle ligament receptors is thought to contribute to sensorimotor deficits in those with chronic ankle instability ( CAI ) . Targeting other viable sensory receptors may then enhance sensorimotor control in these patients . The purpose of this r and omized controlled trial was to evaluate the effects of 2 wk of sensory-targeted ankle rehabilitation strategies ( STARS ) on patient- and clinician-oriented outcomes in those with CAI . METHODS Eighty patients with self-reported CAI participated . All patients completed patient-oriented question naires capturing self-reported function as well as the weight-bearing lunge test and an eyes-closed single-limb balance test . After baseline testing , patients were r and omly allocated to four STARS groups : joint mobilization , plantar massage , triceps surae stretching , or control . Each patient in the intervention groups received six 5-min treatments of their respective STARS over 2 wk . All subjects were reassessed on patient- and clinician-oriented measures immediately after the intervention and completed a 1-month follow-up that consisted of patient-oriented measures . Change scores of the three STARS groups were compared with the control using independent t-tests and Hedges ' g effect sizes with 95 % confidence intervals . RESULTS The joint mobilization group had the greatest weight-bearing lunge test improvement . Plantar massage  had the most meaningful single-limb balance improvement . All STARS groups improved patient-oriented outcomes with joint mobilization having the most meaningful effect immediately after the intervention and plantar massage at the 1-month follow-up . CONCLUSION Each STARS treatment offers unique contributions to the patient- and clinician-oriented rehabilitation outcomes of those with CAI . Both joint mobilization and plantar massage appear to demonstrate the greatest potential to improve sensorimotor function in those with CAI
target: Conclusions The main findings from this systematic review were balance training provided the most consistent improvements in self-reported function for patients with CAI
background: Objective To identify which therapeutic intervention may be most effective for improving self-reported function in patients with chronic ankle instability ( CAI ) .