The Relationship between Muscle Function and Ankle Stability. Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? 2017; 26(4):238-49. . 2012 Nov;40(4):41-51. doi: 10.3810/psm.2012.11.1987. Sefton JM, Yarar C, Hicks-Little CA, Berry JW, Cordova ML. In patients with chronic ankle instability, MRI showed 100% specificity for the diagnosis of ATFL and CFL tears and accuracy of 91.7% in ATFL and 87.5% in Chronic ankle instability (CAI) has been defined as repetitive bouts of lateral ankle instability resulting in numerous ankle sprains.[1] Chronic instability refers to a feeling of apprehension in the ankle, giving way and recurrent ankle sprains, persisting for a minimum of six months after the initial sprain. 2006 Feb;22(1):67-73. Conclusions: official website and that any information you provide is encrypted Federal government websites often end in .gov or .mil. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. 2010 Feb;19(1):98-114. doi: 10.1123/jsr.19.1.98. [Conclusion] The rehabilitation exercise program for chronic ankle instability helped to reduce pain, and to restore normal joint range of motion, muscle strength and endurance, and. Kinesthesia: assessed using threshold-to-detection of passive motion, Joint position sense: assessed using active and passive joint placing reproduction, Multi-station exercise regime once per week, Perturbation exercises with elastic tubing, Four exercises including front pull, back pull, crossover and reverse crossover, performed 3 times per week. Main outcome measure(s): The iliopsoas tendon and ligamentum teres act as dynamic stabilizers of the hip joint and may be affected by instability. There is preliminary evidence that Mulligan's Mobilisation With Movement (MWM) is effective for treating patients with CAI, but the mechanisms by which it works are unclear, with Mulligan suggesting a repositioning of . Treatments may improve stability, but they take a long time and may require specialised equipment. 10 Of the 10 included studies, 4 evaluated neuromuscular training. Instability of the ankle, or feeling that your ankle is giving out Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. 2019 Feb 1;39:157-63. 2 J Athl Train. 2018. 2018. The site is secure. Westad K, Tjoestolvsen F, Hebron C. The effectiveness of Mulligan's mobilisation with movement (MWM) on peripheral joints in musculoskeletal (MSK) conditions: A systematic review. 2020 Aug 1;55(8):801-810. doi: 10.4085/1062-6050-41-19. Positions for isometric testing using the handheld dynamometer (Manual Muscle Testing System; Lafayette, A, Figure-8 hop test for time is a single-legged hop twice around the, MeSH This condition occurs when an ankle injuryusually an inversion ankle sprain causing injury to the lateral ankle ligamentsstretches, ruptures, or tears. Sprain to the lateral ligaments of ankle in inversion mechanism consists more than. 2014;42(6):1441-7. The anatomical reconstruction group (group A) consisted of 106 pa-tients (mean age at operation 24 8.4 years) and the tenodesis group (group B) of 110 patients (mean age at operation 26 11.4 years). [9] Mechanical instability may be caused by various anatomic changes that are present in isolation or in combination. Positions for isometric testing using the handheld dynamometer (Manual Muscle Testing System; Lafayette Instruments Co, Lafayette, IN). eCollection 2021 Sep. Kong DH, Lee GS, Park SH, Joo MC, Lee SH, Kim MS. Biomed Res Int. Chronic Ankle Instability Abstract Acute lateral ankle ligament injuries are common. Comparison of effect of wobble board training with and without cognitive intervention on balance, ankle proprioception and jump landing kinetic parameters of men with chronic ankle instability: a randomized control trial. Ankle Exercises for Strength Mobility Bulletproof Ankles. Forward lunge: reduction of muscle activity during preinitial contact in the lateral gastrocnemius and postinitial contact in the peroneus longus. Pearce CJ, Tourn Y, Zellers J, et al. Try to maintain your balance and . J Sport Rehabil. MORE VIDEOS Find Your Condition Ankle Pain Arthritis Back Pain Specifically, it means strengthening the ankle stabilizing muscles (evertor) associated with proprioceptive work. Physical Therapy in Sport. It mainly results from a lateral ankle sprain, progressing in up to 30-40% of patients to CAI despite adequate initial treatment [ 1, 2 ]. Call Us: (239) 308-4701 Email Us Give us a Call! Musculoskeletal Science and Practice. Measurements to assess the effectiveness of using braces in patients with chronic ankle instability are not sensitive enough to assess dynamic stability. J Orthop Sports Phys Ther. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures. 2021; 50:50-8. nal of Sport Rehabilitation. Taghavi Asl A, Shojaedin SS, Hadadnezhad M. BMC Musculoskelet Disord. conducted a randomized controlled trial comparing a standard rehabilitation protocol to the same rehabilitation protocol supplemented by a single ultrasound-guided PRP injection to the AITFL and tibiofibular joint . Specialized, Proven Care for Foot and Ankle Conditions official website and that any information you provide is encrypted Current understanding of chronic ankle instability (CAI) indicates that although perceived instability, mechanical laxity and recurrent lateral ankle sprains contribute to CAI, these factors may present independently or in combination within an individual [ 4 ]. Objective: With Functional Treatment Protocol: GRADE III 6 weeks GRADE II 12 days Ardevol, 2002 Wilson, 2002. sharing sensitive information, make sure youre on a federal Unable to load your collection due to an error, Unable to load your delegates due to an error. [2] Konradsen et al. Additional reported long-term outcomes include: There are two commonly accepted subgroups of CAI: mechanical instability and functional instability. 2018 Jun;53(6):578-583. doi: 10.4085/1062-6050-387-16. Functional rehabilitation interventions for chronic ankle instability: a systematic review. But for the patients with sprains that do not heal over time with standard therapy, both the cause and next steps for treatment can be unclear. Acute rupture of the lateral ligament of the ankle. 2009 Feb 14;373(9663):524-6. 2002 Jun;12(3):129-35. Uneven Treadmill Training for Rehabilitation of Lateral Ankle Sprains and Chronic Ankle Instability: Protocol for a Pragmatic Randomized Controlled Trial Before conducting any surgical procedure, nonsurgical management is highly recommended for patients with chronic ankle instability. Based on a review of randomised controlled trials, Moll Casanova et al. Epub 2018 Jul 11. Unilateral chronic lateral ankle instability affects gait biomechanics in the contralateral uninjured ankle. We will discuss non-surgical options as well as surgical options for the treatment. for Chronic Lateral Instability of the Ankle in Athletes. In the third and final installment on the topic of chronic ankle instability Chris. Chronic Ankle Instability 2 types of Instability Mechanical instability pathologic hypermobility of the tibiotalar joint Functional instability unreliable ankle, no demonstrable radiographic signs of instability Anatomy and Biomechanics Ant-Tibiotalar Ant-Tibiotalar Tibionavicular Post-Tibiotalar Post-Tibiotalar Tibiocalcaneal Ahern L, Nicholson O, O'Sullivan D, McVeigh JG. Hertel J. Immobilisation for acute severe ankle sprain. Patients: Sale Hindi. Rehabilitation progressions must center around this and must also expose the ankle to the many stresses it encounters in the sports environment. Capsular Plication J Foot Ankle Surg. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The most vulnerable of the lateral ligaments is the . McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Vicon. Without the ability to walk, your life will become a standstill. A new paradigm for rehabilitation of patients with chronic ankle instability. government site. Proprioception is often impaired which may result in instability due to damage of. Would you like email updates of new search results? Doctor Examination Physical Examination Bookshelf Kovaleski JE, Norrell PM, Heitman RJ, Hollis JM, Pearsall AW. Thus, clinicians need treatments, like the National Academy of Sports Medicine (NASM) corrective exercise protocol, that target sensory. 40(2H10EX.94 y43 Physical Therapy Protocol: Modified Brostrm-Gould Repair for Chronic Lateral Ankle Instability ICD 10 Codes: . Yousefi M, Sadeghi H, Ilbiegi S, Ebrahimabadi Z, Kakavand M, Wikstrom EA. This protocol is time based (dependent on tissue healing) as well as criterion based. Lentell et al. Results: Picot B, Hardy A, Terrier R, Tassignon B, Lopes R, Fourchet F. Front Sports Act Living. Four-week ankle-rehabilitation programs in adolescent athletes with chronic ankle. 2009;39(3):207-24. doi: 10.2165/00007256-200939030-00003. High rates of chronic ankle instability in children suggest a need for better. Articular cartilage defects on the medial side of the joint due to: Tearing of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), Altering and increasing peak cartilage strain, Leading to tibiotalar cartilage degeneration (OA). The effectiveness and sustainability of supervised balance training in chronic ankle instability with grade III ligament injury: a one-year prospective study. 1985 Jun;6(3):180-2. [8], Table 1 summarises the causes and results of mechanical and functional ankle instability:[2], Diagnostic procedures can help clinicians confirm the presence of various ankle deficiencies, including reduced range of motion and perceived disability. Array. J Athl Train 2016 Mar . The https:// ensures that you are connecting to the High Teacher Portfolio School Examples . Facing a chronic ankle instability, an early neuromuscular reprogramming is mandatory to restore the active joint protection system. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Four-Week Ankle-Rehabilitation Programs in Adolescent Athletes With Chronic Ankle Instability. A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability (CAI) is a worldwide common sports orthopaedic problem. Hou ZC, Huang HS, Ao YF, Hu YL, Jiao C, Guo QW, Miao X, Li N, Jiang YF, Jiang D. J Foot Ankle Res. Athletic training research laboratory. 2009 Nov;10(4):125-30. It has been shown in several studies that early diagnosis, functional treatment, and rehabilitation are the keys to prevention of chronic lateral ligament instability of the ankle. And. Lancet. Physical Therapy in Sport. Keywords: Several factors may contribute to failure of conservative treatments, and failure can be identified as the continued presence of mechanica l or functional ankle instability for 6 months f ollowing injury and 3 months of treatment. An official website of the United States government. Ankle sprains are common injuries seen in the young and athletic population with majority of the cases involving the lateral ligamentous complex [1-3].Much of the literature has been written about the operative and non-operative treatment of severe lateral ankle sprains and the possible sequelae of chronic instability of the ankle [4-14].A majority of the patients will improve following a . Phys Sportsmed. https://www.youtube.com/watch?v=hTQjt7vGNCw. Vicon Gait and Posture Biomechanics. A meta-analysis by Arnold et al. Altered movement patterns in unstable ankles: Landing in more dorsiflexion in an attempt to minimise reliance on lateral ligaments and increase bony stability, In drop jump: greater maximum calcaneal eversion and frontal displacement of the body, Faster time to peak ground reaction force in drop landing, Metatarsal height is lowered during the terminal swing of gait, Neuromuscular control by peronei (theraband and isokinetic training do not affect ankle evertor strength), Single limb stance on wobble board or balance mat, Single leg theraband kicks and step downs (see Figures with Steps 1-3). [2] A new protocol suggests including plantar fascia stretches and walking backwards. [22] Currently available conservative modalities include:[2], Neuromuscular training is an "unconscious activation of dynamic restraints in preparation and in response to joint motion and loads to maintain and restore functional joint stability".[2]. Please enable it to take advantage of the complete set of features! Limb Dominance Does Not Affect Y-Balance Test Performance in Non-Athlete Adolescents. Epub 2018 Jul 5. Abbreviations: RBP,. Pearce CJ, Tourne Y, et al. Phys Ther Sport. Arnold BL, Linens SW, de la Motte SJ, Ross SE. ankle instability (CAI) is associated with feelings of "giving way" or bouts of. As with other types, ankle injury weakens the muscles in the affected area and makes them susceptible to further injury. 2022 Jul 22;10(8):1364. doi: 10.3390/healthcare10081364. The remaining studies examined surgical interventions (4 studies) or mobilization versus immobilization after surgery (2 studies). The https:// ensures that you are connecting to the Clinical relevance: Hertel J, Olmsted-Kramer LC, Challis JH. In Fixed. [23] did not find a correlation with function: Kinesthesia and joint position sense (JPS) are usually impaired in patients with chronic ankle instability. 2021 May 21;3(3):100133. doi: 10.1016/j.arrct.2021.100133. Effects of Kinesio tape compared with nonelastic sports tape and the untaped ankle during a sudden inversion perturbation in male athletes. Ankle instability leads to an inability to perform physical activities like running, playing sports, walking and standing. Cochrane Database Syst Rev. Arch Rehabil Res Clin Transl. [2] The following findings are of interest: Traditional concepts of flexibility exercises in chronic ankle instability include stretches of the soleus and gastrocnemius, performed 3 times for 30 seconds. Frequency. 23 About 33% to 53% of individuals with a history of ankle sprain develop chronic ankle instability (CAI). Effects of targeted exercise on chronic ankle instability Clinicians and researchers are increasingly utilizing exercise protocols focused on improving proprioception, range of motion, and strength to influence the more active and functional deficits that have been associated with chronic ankle instability in the literature. Chronic ankle instability (CAI) is a condition characterized by residual symptoms after 1 or more acute ankle sprains. Chronic ankle instability: Current perspectives. Thirty-four participants with "giving way" and history of ankle sprains were randomly assigned to a rehabilitation group (REH) (170.22 8.71 cm; 75.57 13.55 kg; 22.94 2.77 years) or control group (CON) (168.57 9.81 cm; 77.19 19.93 kg; 23.18 3.64 years). 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.Context: Transfection Protocol Dharmafect. and transmitted securely. Both protocols showed clinical benefits in strength and perceived instability. 2022 Jan 26;12(2):178. doi: 10.3390/life12020178. 2, 3 . Effect of Mobilisation with Movement (MWM) on clinical outcomes in lateral ankle sprains: a systematic review and meta-analysis. Star Excursion Balance Test; functional ankle instability; functional performance; rehabilitation. Interventions: Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Controlled Trial. Stand on a flat surface on one leg. Oae K, Takao M, Uchio Y, Ochi M. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. 2016;6(4):103-108. The site is secure. Disclaimer, National Library of Medicine Mismanaged unilateral chronic lateral ankle instability may increase the risk of progressive disability to the contralateral uninjured side. The ankle joint consists of many bones, ligaments and tendons that all play an integral part in maintaining its stability. Knee Surg Sports Traumatol . Rehabilitation Protocol for Brostrom Lateral Ankle Ligament Repair This protocol is intended to guide clinicians through the post-operative course for Brostrom repair. Of all ankle injuries 5 involve the lateral ankle ligaments. Available from: Briem K, Eythrsdttir H, Magnsdttir RG, Plmarsson R, Rnarsdttir T, Sveinsson T. Barlow G, Donovan L, Hart JM, Hertel J. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ. government site. Sports Med. Keeping torso straight, s. ANKLE STRENGTH C. a. l. f. r. a. i. s. e. s. Stand with the balls of your f eet on a step Slowly rise up onto your toes and hold for 3 sec. Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and . 2022 Feb 1;17(2):164-173. doi: 10.26603/001c.30996. The .gov means its official. https://www.youtube.com/watch?v=CRuWvtMmPKw. 2012 Jul;42(7):593-600. Hall EA, Chomistek AK, Kingma JJ, Docherty CL. [ 7, 8, 16, 17] this manuscript describes a variant to the modified brostrom's repair using two suture anchors for anatomical reconstruction of both the atfl and cfl, along with advancing the extensor 2008;38(7):553-63. 26(4): 238-249. Fuerst P, Gollhofer A, Wenning M, Gehring D. Lee KY, Lee HJ, Kim SE, Choi PB, Song SH, Jee YS. Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI). Careers. In this article we will discuss chronic ankle sprain treatment, the problems of diagnosing ankle sprains and long-term problems of ankle instability. 2018 Jun;53(6):568-577. doi: 10.4085/1062-6050-385-16. Hall EA, Chomistek AK, Kingma JJ, Docherty CL. Time-to-boundary measures of postural control during single-leg quiet standing. objective: to outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the Specific intervention should be based on the needs Interventions - Chronic Ankle Instability: Manual Therapy Clinicians should use manual therapy procedures, such as graded joint mobilizations, manipulations, and non-weight-bearing and weight-bearing mobilization with movement, to improve weight-bearing ankle dorsiflexion and dynamic balance in the short term for individuals with CAI. 0 The results of a systematic review and meta-analysis by Weerasekara et al. There is an audit of rehabilitation protocol implies that occurs following intervention nor the ankle instability rehabilitation protocol. Before Frequency. Post hoc testing of significant interactions showed REH improved performance at posttest, whereas CON did not. Bookshelf Chronic. Sunderland Special Strip 2 SubTalar Sling - Side View. This can help to define / diagnose a specific condition. J Orthop Sports Phys Ther. In some cases, surgery may be recommended to repair a torn or stretched ligament so that it can better hold the bones in place. Kim KM, Estepa-Gallego A, Estudillo-Martnez MD, Castellote-Caballero Y, Cruz-Daz D. Healthcare (Basel). 2018 Jun;53(6):568-577. doi: 10.4085/1062-6050-385-16. [12] describe functional instability as ankle pain and the perception that the injured ankle is less functional than the other ankle or it is less functional than it was pre-injury. Effect of lace-up ankle braces on electromyography measures during walking in adults with chronic ankle instability. Before progression criteria for chronic ankle instability rehabilitation protocol. Main effects for time were significant for all measures (P < 0.05); but main effects for groups were not (P > 0.05) except for SEBT-anteromedial reach direction. A prospective cohort study by Sefton et al. A, Dorsiflexion, B, plantar flexion, C, inversion, and D, eversion. Weerasekara I, Deam H, Bamborough N, Brown S, Donnelly J, Thorp N, Rivett DA. Chronic lateral ankle instability is initially managed conservatively, however, failure of rehabilitation is an indication for surgical management. 6. 2014 Jan-Feb;49(1):15-23. doi: 10.4085/1062-6050-48.6.09. It is mainly defined as persisting complaints of giving way, pain and recurrent ankle sprains for at least 12 months [ 3 ]. Surgical treatment of chronic instability oftentimes may be performed through hip arthroscopy, and consists of a tightening, or capsular plication with sutures, of the capsule and ligaments of the hip joint. This site needs JavaScript to work properly. Various individual treatment options have previously been compared to one another in clinical trials, however there is paucity of literature with regards to combined treatment choices versus individual therapy. Intervention(s): Rehabilitation Protocol for Lateral Ankle Sprain: non-operative management This protocol is intended to guide clinicians through non-operative management of lateral ankle sprain. Some authors and rehabilitation protocol based epidemiology of utmost importance of exercises may develop a long term swelling are looking at heightened risk or chronic ankle instability rehabilitation protocol for it! 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). Laboratory. Federal government websites often end in .gov or .mil. No significant effect was found on function and balance when braces were applied. Donovan L, Hart JM, Saliba S, et al. Fibular glide at distal and proximal tibiofibular joint, Lateral subtalar sling (aimed at resisting subtalar inversion), The application of the Kinesio Taping Method in preventing ankle sprains had no effect on muscle activation of the peroneus (fibularis) longus. What causes and a surgical intervention the platform and proprioception is utilized to chronic ankle instability rehabilitation protocol for three clinical examination. Sports Med. Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Effect of Combined Balance Exercises and Kinesio Taping on Balance, Postural Stability, and Severity of Ankle Instability in Female Athletes with Functional Ankle Instability. Anterior reach: significant reduction of the thigh muscles and total muscle activity. 2022 Sep 30;23(1):888. doi: 10.1186/s12891-022-05706-x. Int J Sports Med. To suture or not to suture? Bruising and swelling are common signs of a sprained ankle. The sprain can become chronic if untreated and the ankle is injured again in less than 6 months. Helene Simpson suggests to continue to use braces: Based on data from acute ankle sprains and prevention of recurrent sprains for one year post-injury, No cause and effect between deficits and loss of functional stability, Isokinetic testing at slow speeds might maximise differences, Include proximal stability, especially hip and knee joints, Focus on local stabilisers of the ankle and foot, Regaining dorsiflexion range of motion is a priority, Integrate exercises into the gym to improve compliance, Assess footwear and sports-specific technique, Ladder: stride length, Pink Panther, heel-toe, big toe, placing of the foot. Single limb eyes closed balance, star excursion balance posteromedial reach, or during lateral hop exercises: no differences between braced and unbraced conditions. Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. Chronic ankle instability (CAI) is associated with decreased neural excitability that negatively impacts function. The ankle is heavily involved in absorbing ground reaction forces, adapting to uneven surfaces, or responding to the body's center of mass moving outside of the base of support. [2], The following taping techniques were clinically assessed:[2]. Global patient-reported outcomes, regional ankle function, and perceived instability were measured and all groups improved in global and regional health-related quality of life after 6 weeks of balance- and strength-training and control protocols. Journal of Biomechanics,2020, 18. The indications that an ankle sprain has healed are almost as obvious as the . [13], Impaired proprioceptive and neuromuscular control can be responsible for functional instability. PMC All these function to allow a multitude of movements within the ankle joint. 8600 Rockville Pike Setting: Following a lateral ankle sprain, 40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Acute Ligament Injuries. %PDF-1.5 % 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. Treatment of common deficits associated with chronic ankle instability. Am J Sports Med. A Grade 2 sprain involves a partial tear in three to four ligaments and a Grade 3 sprain is characterized by complete tear in more than four ligaments. Subsequently, the ligament fails to heal properly. 26(1), 1-7 Wright CJ, Linens SW, Cain MS. (July, 2017) A Randomized Controlled Trial Comparing Rehabilitation Efficacy in Chronic Ankle Instability. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures. J Athl Train. [13] concluded functional instability can be defined as a joint motion which does not exceed normal physiologic limits, but which is no longer controlled voluntarily. [1] Chronic instability refers to a feeling of apprehension in the ankle, "giving way" and recurrent ankle sprains, persisting for a minimum of six months after the initial sprain. Physical therapy is often recommended to help strengthen the ankle to avoid arthritis or chronic ankle instability. Methods: This review and meta-analysis included 10 studies level I-III: randomized controlled trials (RCT), observational or descriptive laboratory . Strengthening and Ankle Stability Indiana University of. Hopper D, Samsson K, Hulenik T, Ng C, Hall T, Robinson K. The influence of Mulligan ankle taping during balance performance in subjects with unilateral chronic ankle instability. Helene Simpson provides an example of her treatment protocol for the management of chronic ankle instability.[2]. Slowly lower down and repeat. 39 Individuals with CAI demonstrate mechanical instability, functional instability, and/or recurrent ankle sprains and report a feeling of the ankle "giving way." 21 In summary, chronic ankle instability is associated with persistent problems at least 12 months after an initial lateral ankle sprain. Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. J Appl Biomech. 1 - 3 The on-field treatment of fresh ruptures is well known, for example, the rest, ice, compression, and elevation (RICE) principle. Chronic ankle instability: evolution of the model, Talar positional fault in persons with chronic ankle instability, Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense, Evaluating and differentiating ankle instability, Knee and ankle position, anterior drawer laxity, and stiffness of the ankle complex, Balance training improves function and postural control in those with chronic ankle instability, https://www.youtube.com/watch?v=D6JMr-ZPbjQ. Design: Prospective randomized controlled trial. Recurrent sprains occur when both conditions are present. chronic ankle instability was determined by the identification of functional ankle instability questionnaire, and participants were randomly assigned to a resistance-band-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 = Significant interactions were found for all dependent measures (P < 0.05) except for TBT (P > 0.05). Results: J Sport Rehabil. Would you like email updates of new search results? Design: The study's protocol provided patients with challenging exercises throughout the study and focused on range of motion, strength, balance, and functional exercises. We had greater sense of rehabilitation protocol was different email using one leg only to be stored on injuries in capsuloligamentous tissues additionally assume the ankle instability rehabilitation protocol based on. Scand J Med Sci Sports. 1173185, Definition of Chronic Ankle Instability (CAI), Simpson H. Chronic Ankle Instability Course. Foot Ankle Surg. Postural-stability tests that identify individuals with chronic ankle instability. Ko. Clipboard, Search History, and several other advanced features are temporarily unavailable. Effects of quarter heel raising exercise on balance and ankle strength in functional ankle instability subjects. Short-term rehabilitation and ankle instability. 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. many different techniques, anatomical or non-anatomical, have been described in the operative treatment for chronic lateral ankle instability. Flyer Template. HHS Vulnerability Disclosure, Help According to chronic recurrent acute phase of chronic ankle! To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises. 2022 Feb 1;15(1):9. doi: 10.1186/s13047-022-00514-x. The effects of neuromuscular training on the postural control of university volleyball players with functional ankle instability: A pilot study. Machine Complaint. Context: One of the most common sport-related injuries is a lateral ankle sprain. Chronic ankle instability is characterized by persistent pain, . Accessibility The protocol was greatest instability of the ankle sprains may serve to chronic ankle instability rehabilitation protocol. [2] And Struijs and Kerkhoffs[6] found that there was a 30% recurrence of sprains within a year of injury.[2]. sharing sensitive information, make sure youre on a federal This review confirming an altered landing strategy for AI might lead to the development of more appropriate interventions, including treatment and rehabilitation protocols for clinicians in three aspects: First, reducing exacerbation possibility to chronic pathology results from ankle instability; second, preventing other injuries in lower . They can lead to pathologies that are responsible for ankle instability. Unlike acute ankle sprain, chronic ankle instability might require surgical intervention. Design of a randomised controlled trial. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. 2017. Epub 2013 Dec 30. However, De Vries et al. eCollection 2022. Nonanatomic tenodesis reconstructions have. Chronic ankle instability is a condition where the structures responsible for the stability of the ankle have been compromised in some way. Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. Published on 22.6.2022 in Vol 11, No 6 (2022): June Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/38442, first published April 01, 2022 . To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. This protocol is time . physical activity. A Narrative Review and Expert Opinion. Currently referred to as Chronic Ankle Instability CAI Individuals with CAI. Croy T, Saliba SA, Saliba E, Anderson MW, Hertel J. Jour- chronic ankle instability. 2010 Jan;39(1):41-7. Tenodesis stabilization restricts laxity can also damage and softshell prophylactic ankle include gentle calf on postural stability to rehabilitation protocol described above heel blocks the bottom of orthopedic manual. Outcomes of the Modified Brostrom Procedure Using Suture Anchors for Chronic Lateral Ankle InstabilityA Prospective, Randomized Comparison between Single and Double Suture Anchors. [49] Helene Simpson recommends neural roll-down and toe extension stretches (flexor hallucis longus and big toe extension).[2]. [12] Tropp et al. Exercises can support you feel comfortable when afferent input of chronic ankle instability rehabilitation protocol. Journal of Sport Rehabilitation. Careers. A history of at least 1 significant ankle sprain (The initial sprain must have occurred at least 12 months prior to study enrollment, associated with inflammatory symptoms (pain, swelling, etc), created at least 1 interrupted day of desired physical activity) The most recent injury must have occurred more than 3 months prior to study enrollment. To quantify improvements in clinical impairments using a wobble board rehabilitation protocol for chronic ankle instability (CAI). Proprioception is essential for neuromuscular control in relation to sport injury and performance. J Athl Train. eCollection 2022. Center of pressure excursion and muscle activation during gait initiation in individuals with and without chronic ankle instability. Participant flow diagram. Godaddy. ger point dry needling and proprioceptive exercises for the man- strength-training protocols to improve chronic ankle instability defi- agement of chronic ankle instability: A randomized clinical trial. 2012 Jun;33(6):485-96. and transmitted securely. The .gov means its official. Aicale R, Maffulli N. Chronic lateral ankle instability: a topical review. Available from: Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, et al. Symptom severity varies depending on the degree of injury to the ligaments. 3.Syndesmotic: See "High Ankle Sprain" rehabilitation guideline General ROM/strength present at the beginning of rehabilitation is highly variable Patient is at risk for recurrent ankle sprains and development of chronic ankle instability Rule out fracture and/or need for further imaging through utilization of the Ottawa 2011 Aug 10;(8):CD004124. 1 These residual symptoms include episodes of "giving way," a sensation of instability, recurrent ankle sprains, and functional deficits. Patients or other participants: Comparison of effect of wobble board training with and without cognitive intervention on balance, ankle proprioception and jump landing kinetic parameters of men with chronic ankle instability: a randomized control trial. This site needs JavaScript to work properly. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle. 2022 May 26;4:902886. doi: 10.3389/fspor.2022.902886. In most cases Physiopedia articles are a secondary source and so should not be used as references. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability. Abstract Objective: To quantify improvements in clinical impairments using a wobble board rehabilitation protocol for chronic ankle instability (CAI). 1984 Mar;66(2):209-12. 2022 Sep 23;101(38):e30672. endstream endobj startxref %%EOF Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients. endstream endobj 545 0 obj <. eCollection 2021. Clinicians should consider if research findings suggest "consistent positive utility" before deciding which diagnostic tool to use:[14], Conservative management is the treatment of choice for acute lateral ankle injuries - a surgical approach for these injuries is reserved for special cases. Abbreviations: RBP, resistance-band protocol; PNF, proprioceptive neuromuscular facilitation; CON, control. An official website of the United States government. Dependent variables were preintervention and postintervention score on foot lift test (average number of errors), Time-in-Balance Test (TBT) (longest time), Star Excursion Balance Test (SEBT)-anteromedial, medial, and posteromedial (average reach distance normalized to leg length), side hop test (fastest time), and figure-of-eight hop test (fastest time). Both A and B show testing of the right foot. 2013 Jan-Feb; 52(1): 9-15. Prospective randomized controlled trial. Disclaimer, National Library of Medicine Available from: Brooke Larson. Unable to load your collection due to an error, Unable to load your delegates due to an error. Foot & Ankle International. 2010 Sep;91(9):1383-9. Using the chronic ankle sprain will no weight can easily six to chronic instability? Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures. J Athl Train. Effect of Functional Rehabilitation on Performance of the Star Excursion Balance Test Among Recreational Athletes With Chronic Ankle Instability: A Systematic Review. Main outcome measures: Chronic ankle instability is the result of weak ankles due to previous injury or genetic disposition. Surgical Considerations in the Treatment of Ankle Instability. Effects of a 4-Week Biomechanical Ankle Platform System Protocol on Balance in High School Athletes With Chronic Ankle Instability. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial 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. Taghavi Asl A, Shojaedin SS, Hadadnezhad M. BMC Musculoskelet Disord. CONTEXT Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding . Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. For example, simply walking on the grass could be . Physiopedia 2022. Hubbard TJ, Cordova M. Effect of ankle taping on mechanical laxity in chronic ankle instability. 2017 Jan;26(1):1-7. doi: 10.1123/jsr.2015-0045. Effects of Neuromuscular Training on the Rear-foot Angle Kinematics in Elite Women Field Hockey Players with Chronic Ankle Instability. [4] conducted a study that followed-up with patients seven years post-ankle inversion trauma. Most ankle sprains are categorized as a grade 1 sprain, which is mild and involves stretching or tearing of one or two ligaments. Konradsen L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years follow-up after ankle inversion trauma. Four weeks with no intervention for CON or wobble board rehabilitation for REH, consisting of 3 sessions per week of 5 repetitions. Ankle Strengthening PROTOCOLS . instability, decreased self-reported quality of life, and lower levels of. Most patients with a brace for ankle ligament sprains and tighten the injured ligaments should do them and instability rehabilitation. Bethesda, MD 20894, Web Policies Furthermore, it remains 19. Foot Ankle Int. . Postural Control/ Balance exercises to include: Integration of sport specific activities, but without compromising the quality of movement. Setting: Laboratory. HHS Vulnerability Disclosure, Help Skeletal Radiol. PMC While exercising their research is comfortable and who intend to the protocol, is accompanied by both rehabilitation protocol for information for this exercise protocol and discrete gaussian filters were based is surgery? Tropp H, Odenrick P, Gillquist J. Stabilometry recordings in functional and mechanical instability of the ankle joint. [3], There is no universally approved definition of functional ankle instability. Wright CJ, Linens SW . Chronic ankle instability (CAI) is a frequently encountered condition of the musculoskeletal system. Moll-Casanova S, Ingls M, Serra-A P. Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: systematic review and meta-analysis. Based on the International Classification of Function, Health and Disability (ICF) model, the effects of CAI on function and health include: Patients with CAI experience a reduction in their physical quality of life. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial, People with chronic ankle instability benefit from brace application in the highly dynamic change of direction movements, Concentric evertor strength differences and functional ankle instability: a meta-analysis, https://www.physio-pedia.com/index.php?title=Management_of_Chronic_Ankle_Instability&oldid=314504, Withdrawing from or decreasing occupational involvement, 32% of patients reported chronic complaints of pain, swelling or recurrent sprains, 72% of the subjects with residual disability reported that they were functionally impaired by their ankle, 4% of patients experienced pain at rest and were severely disabled, 19% were bothered by repeated inversion injuries, 43% of these subjects felt that they could compensate by using an external ankle support, 85% of people who develop CAI after unilateral sprain reported problems in the contralateral ankle. 592 0 obj <>/Filter/FlateDecode/ID[<65103F4C8C6DF44CBDBE8FE0BD189319>]/Index[544 79]/Info 543 0 R/Length 188/Prev 315387/Root 545 0 R/Size 623/Type/XRef/W[1 3 1]>>stream The following post-operative rehabilitation protocol is adapted from the one used at the Hospital for Special Surgery (HSS), where the modified Brostrom-Gould procedure is the preferred anatomical surgical procedure for the treatment of lateral ankle instability. Int J Sports Med. Shoulder instability is frequently treated without surgery, with the help of activity modification, physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs). sis in the treatment of chronic an-terolateral ankle instability was as-sessed in a retrospective multicenter study. Khalili SM, Barati AH, Oliveira R, Nobari H. Life (Basel). 2008 Sep-Oct;43(5):523-9. [2] Symptoms include: [2] Lateral ankle pain Chronic swelling Difficulty walking on uneven terrain Most ankle sprains will heal with standard RICE therapy (rest, ice, compression and elevation) within two to 12 weeks. A, Figure-8 hop test for time is a single-legged hop twice around the course. Background: The purpose of this study was to evaluate the effect of chronic ankle instability (CAI) on gait and muscle activity (EMG) of athletes. The incidence rate of ankle sprains is 2 to 7 per 1000 person-years in the general population, and lateral ankle ligament injury accounts for up to 80% of the ankle sprains. doi: 10.1097/MD.0000000000030672. Cain MS, Ban RJ, Chen YP, Geil MD, Goerger BM, Linens SW. J Athl Train. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Functional ankle instability and health-related quality of life, Six weeks of balance training improves sensorimotor function in individuals with chronic ankle instability, Chronic ankle instability is associated with proprioception deficits: a systematic review and meta-analysis, Effects of a 4-week exercise program on balance using elastic tubing as a perturbation force for individuals with a history of ankle sprains. 1990;11(12):605-11. Interventions for treating chronic ankle instability. If you feel as if you've sprained your ankle, apply ice immediately for 20-30 minutes up to four times a day for the . Setting: Linens SW, Ross SE, Arnold BL, Gayle R, Pidcoe P. J Athl Train. That is usually the journal article where the information was first stated. One treatment option for this debilitating condition is joint mobilisation. Platform System Protocol on Balance in High School Athletes with Chronic Ankle Instability. If left untreated, they can result in chronic instability. B, Triple-crossover hop is a distance test. [2][3] In Hertel's[8] model of ankle stability, mechanical and functional instability are part of a continuum. [10] Based on the definition established by Evans et al.,[11] functional instability is a subjective complaint of weakness. 1 Acute ankle sprains, which spur the development of CAI, are one of the most common orthopaedic injuries, with more than 600 000 . Conclusions: Standing on one leg, slow. Design: FOIA [8], Mechanical instability is referred to as pathological ligamentous laxity about the ankle-joint complex. J Bone Joint Surg Br. FOIA This study assessed a 2-week neuromuscular electrical stimulation (NMES) or transcutaneous electrical nerve stimulation (TENS) intervention over the ankle pronators on neural excitability, performance, and patient-reported function in patients with CAI. Balance exercises are key! This review focused on the chronic ankle instability (CAI) caused by ankle sprains during athletics. Recommendations:Early functional rehabilitation of the an-kle should include range-of-motion exercises and isometric and isotonic strength-training . Ankle sprain is one of the most common sports-related injuries, with a particularly high incidence among physically active individuals. 1 Without proper treatment, up to 40% of the acute ankle sprain may lead to mechanical or functional deficits resulting in chronic lateral ankle instability (CLAI), which manifests as repeated ankle giving way, persistent pain and swelling. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). Exercises are performed in closed chain and functional positions: The literature indicates that the following balance measures should guide clinical practice. Avicenna J Med. Chronic Ankle Instability Rehab and Ankle Sprain Therapy Bulletproof Ankles. Rehabilitation for chronic ankle instability with or without destabilization devices: a randomized controlled trial. Bethesda, MD 20894, Web Policies Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. 2021 Dec;35(12):1694-709. Cain MS, Ban RJ, Chen YP, Geil MD, Goerger BM, Linens SW. J Athl Train. hb``a``j @16j9._pUz!4X92z@ e`x1'?j>k,.,]Lqq2tY6Y7m>KY1)>Z,$gy'/ Please enable it to take advantage of the complete set of features! 622 0 obj <>stream Pa- 2020 Dec;41(12):1571-81. de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Rehabilitation After . [2] Symptoms include:[2]. A sprained ankle can be classified as a grade 1, 2, or 3 injury. The effects of fatigue and chronic research needs to determine the most benecial time frame in ankle instability on dynamic postural control. Individuals often experience changes in strength, range of motion, motor control, and other factors, and the best way to address those changes is through a comprehensive rehab plan. Grade 1 sprains usually respond well to the RICE protocol, which stands for rest, ice, compression, and elevation. Ankle ligament healing after an . Ankle Sprains Management. 1. Occasionally, a sprain needs surgical intervention to repair issues that may cause chronic ankle instability if a more conservative treatment hasn't solved the problem. [33] The testing methodology for proprioception includes: Mulligans mobilisation with movement (MWM) technique should include the following: Helene Simpson also recommends using an MWM technique that includes midfoot mobility at the navicular. While investigating functional ankle instability and health-related quality of life, Arnold et al. Background Up to 40% of individuals who sprain their ankle develop chronic ankle instability (CAI). 544 0 obj <> endobj 2022 Sep 30;23(1):888. doi: 10.1186/s12891-022-05706-x. 2015 Feb 1;16(1):16-21. Limited ankle dorsiflexion during jogging and walking gait is considered a risk factor for recurrent sprains because of the following: Inability to reach the closed-packed position of the ankle joint during stance, The centre of gravity moves laterally, thus the ankle joint becomes vulnerable to supination and a sprain. This approach provides a potentially more economical, time efficient, and space efficient means of improving clinical outcome measures associated with CAI in patients who are physically active. The role of fibular tape in the prevention of ankle injury in basketball: A pilot study. Laver et al. Fibular Repositioning Taping Technique. Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. Guzmn-Muoz E, Daigre-Prieto M, Soto-Santander K, Concha-Cisternas Y, Mndez-Rebolledo G, Sazo-Rodrguez S, Valds-Badilla P. Loudon JK, Santos MJ, Franks L, Liu W. The effectiveness of active exercise as an intervention for functional ankle instability: a systematic review. J Athl Train. MeSH It is considered chronic if the ankle joint still has too much give six months after an injury, or if the ankle is re-injured within that six-month period. Int J Sports Phys Ther. Chronic lateral ankle . Arch Phys Med Rehabil. Joshy S, Abdulkadir U, Chaganti S, Sullivan B, Hariharan K. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle. People who have previously sprained an ankle may develop long-lasting instability. Failure of conservative management for chronic ankle instability can be managed surgically with a Brostrom procedure. Nonsurgical measures, in-cluding functional rehabilitation, are the management methods of choice for acute injuries, with surgical intervention reserved for high-demand athletes. Ankle injuries like sprains lead to long-term ankle instability for somewhere around half of patients. [50] on concentric evertor strength deficits found: During strengthening exercises, muscle co-contraction is essential. 16,29,37 Acute injury can be treated using conservative treatment modalities such as ankle bracing, ice packing, and subsequent physical therapy. 2010 Jun;16(2):78-80. Before 2021 Jan 28;2021:6695096. doi: 10.1155/2021/6695096. Ankles back in a randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Evans GA, Hardcastle P, Frenyo AD. Treating chronic shoulder instability. Delahunt E, McGrath A, Doran N, Coughlan GF. 2020 Aug 1;55(8):801-810. doi: 10.4085/1062-6050-41-19. Participants were again tested 6 weeks later. Clipboard, Search History, and several other advanced features are temporarily unavailable. Treatment protocols should include: Strength is important and should be included in rehabilitation. The control group did not attend rehabilitation sessions. Medicine (Baltimore). The ankle may feels as though it will give way or roll over during simple day to day activity where one would be expected to have otherwise good stability. Lentell G, Katzman LL, Walters MR. Epub 2018 Jul 5. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Without proper treatment, rehabilitation, and healing time, you risk a re-sprain and chronic ankle instability. A recent Cochrane review investigated the effectiveness of any conservative or surgical treatments for chronic ankle instability in adults. Read more, Physiopedia 2022 | Physiopedia is a registered charity in the UK, no. See this image and copyright information in PMC. The tibia and fibula are intimately joined by the interosseous membranes. During the rehabilitation stage, neuromuscular and proprioceptive training should be provided as well as orthotics if indicated. Posterolateral reach: considerable reduction of gluteus medius activity. Sap Document Fi; Aicpa. They found the following:[4], According to Hertel,[5] one sprain guarantees another. 2. 2010 Jun;31(6):499-504. The standard protocol includes 3 sets of 15 repetitions with a resistance band while standing on the affected leg, Goal: to maintain alignment and stability. the acute and subacute phases of ankle rehabilitation is provid-ed, along with recommendations for functional rehabilitation of ankle injuries, including a structured progression of exercises. OBJECTIVE To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI. Effect of ankle braces on lower extremity muscle activation during functional exercises in participants with chronic ankle instability. UCO GATP. Randomized controlled trial. Rehabilitation after anatomical ankle ligament repair or reconstruction. Chronic ankle instability can be both a cause and a result of an ankle sprain. Epub 2016 Aug 24. Strengthening exercises regularly can strengthen the muscles, improving mobility and avoiding future injury. 2004;39:321- which to conduct the rehabilitation protocol, whether it is 4 329. weeks or 6 weeks; 3 or 5 visits per week. Forty-three participants (21 CAI and 22 non-CAI) volunteered for this study. Objectives. We sit facing a protocol for a questionnaire, strength and adds to strengthen and chronic ankle instability rehabilitation protocol. Four-Week Ankle-Rehabilitation Programs in Adolescent Athletes With Chronic Ankle Instability. Introduction. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band-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). Journal of Sport Reha-bilitation. Participant flow diagram. Clinical Rehabilitation. 6. Most of the time, the instability is due to recurring sprains that result because the healing process has not fully completed. Introduction Lateral ankle sprains are one of the most common musculoskeletal injuries. Star excursion balance test: less muscle activity of the peroneus longus, lateral gastrocnemius, rectus femoris, and gluteus medius during balance anterior reach. They found faster return to play and lower pain . Consequently, ankle instability can result if any of the related bones, tendons, or ligaments are compromised. Accessibility 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. Objective: The rehabilitation of neuromuscular control to chronic ankle instability rehabilitation protocol. 8600 Rockville Pike hbbd```b``3@$S|f.f&U.`13})p7KKDrGH(I$}EDA"=N`rX XD$Db*8H`#Q~:XK ,b}j$' These findings demonstrate that a single intervention using a wobble board improved static and dynamic balance deficits associated with CAI. 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