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Progress of the Exercise Therapy on Chronic Ankle Instability
- 1 University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
* Author to whom correspondence should be addressed.
Abstract
This research delves into the effectiveness of various exercise therapies for Chronic Ankle Instability (CAI), a condition that frequently develops when initial ankle sprains are not adequately treated. CAI is characterized by repetitive sprains, joint instability, and reduced mobility, which can severely impact an individual's daily activities and sports performance. Different methods of rehabilitation, including muscle strengthening exercises, proprioceptive training, and balance improvement, were evaluated. The study emphasizes the advantages of combining traditional approaches such as resistance band exercises and newer techniques like blood flow restriction (BFR) training. These methods help enhance both strength and functionality in patients with CAI. Additionally, integrating proprioceptive exercises that focus on improving balance through unstable surface training has shown significant progress in restoring postural stability. Further, novel therapeutic interventions, including motor imagery, transcranial direct current stimulation (tDCS), and exergaming, demonstrate promising results in complementing traditional treatments. Ultimately, this review suggests a comprehensive rehabilitation plan that merges conventional and modern therapies to improve functional outcomes for individuals with CAI, though further research is necessary to optimize the combination of these therapies for long-term efficacy.
Keywords
The Chronic Ankle Instability, Proprioception training, Exercise therapy, Functional training
[1]. Herzog, M., Kerr, Z., Marshall, S., & Wikstrom, E. (2019). Epidemiology of ankle sprains and chronic ankle instability. Carolina Digital Repository (University of North Carolina at Chapel Hill). https://doi.org/10.17615/kye2-zr63
[2]. Hertel, J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. PubMed, 37(4), 364–375. https://pubmed.ncbi.nlm.nih.gov/12937557
[3]. Hiller, C. E., Kilbreath, S. L., & Refshauge, K. M. (2011). Chronic Ankle Instability: Evolution of the model. Journal of Athletic Training, 46(2), 133–141. https://doi.org/10.4085/1062-6050-46.2.133
[4]. Hertel, J., & Corbett, R. O. (2019b). An updated model of chronic ankle instability. Journal of Athletic Training, 54(6), 572–588. https://doi.org/10.4085/1062-6050-344-18
[5]. Hou, Z., Miao, X., Ao, Y., Hu, Y., Jiao, C., Guo, Q., Xie, X., Zhao, F., Pi, Y., Li, N., Zhang, Z., & Jiang, D. (2020). Characteristics and predictors of muscle strength deficit in mechanical ankle instability. BMC Musculoskeletal Disorders, 21(1). https://doi.org/10.1186/s12891-020-03754-9
[6]. Ko, D., Choi, Y., & Lee, K. (2024). Effects of Peroneus Brevis versus Peroneus Longus Muscle Training on Muscle Function in Chronic Ankle Instability: A Randomized Controlled Trial. Healthcare, 12(5), 547. https://doi.org/10.3390/healthcare12050547
[7]. Mahmoud, W. S., Radwan, N. L., Ibrahim, M. M., Hasan, S., Alamri, A. M., & Ibrahim, A. R. (2023). Effect of blood flow restriction as a stand-alone treatment on muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability. Medicine, 102(44), e35765. https://doi.org/10.1097/md.0000000000035765
[8]. Werasirirat, P., & Yimlamai, T. (2022). Effect of supervised rehabilitation combined with blood flow restriction training in athletes with chronic ankle instability: a randomized placebo-controlled trial. Journal of Exercise Rehabilitation, 18(2), 123–132. https://doi.org/10.12965/jer.2244018.009
[9]. Liu, Y., & Wang, Y. (2024). Study on the effect of blood flow restriction training combined with IASTAM on ankle strength and function intervention in athletes with chronic ankle instability in sport dance events. BMC Sports Science Medicine and Rehabilitation, 16(1). https://doi.org/10.1186/s13102-024-00873-x
[10]. Kosik, K. B., Johnson, N. F., Terada, M., Thomas, A. C., Mattacola, C. G., & Gribble, P. A. (2020). Decreased ankle and hip isometric peak torque in young and middle-aged adults with chronic ankle instability. Physical Therapy in Sport, 43, 127–133. https://doi.org/10.1016/j.ptsp.2020.02.014
[11]. Alizamani, S., Ghasemi, G., & Nejadian, S. L. (2023). Effects of eight week core stability training on stable- and unstable-surface on ankle muscular strength, proprioception, and dorsiflexion in athletes with chronic ankle instability. Journal of Bodywork and Movement Therapies, 34, 6–12. https://doi.org/10.1016/j.jbmt.2023.04.005
[12]. Hou, Z., Ao, Y., Hu, Y., Jiao, C., Guo, Q., Li, N., Jiang, Y., & Jiang, D. (2023). Balance training benefits chronic ankle instability with generalized joint hypermobility: a prospective cohort study. BMC Musculoskeletal Disorders, 24(1). https://doi.org/10.1186/s12891-023-06179-2
[13]. Ardakani, M. K., Wikstrom, E. A., Minoonejad, H., Rajabi, R., & Sharifnezhad, A. (2019a). Hop-Stabilization training and landing biomechanics in athletes with chronic ankle instability: a randomized controlled trial. Journal of Athletic Training, 54(12), 1296–1303. https://doi.org/10.4085/1062-6050-550-17
[14]. Lee, H., Han, S., & Hopkins, J. T. (2023). Balance training with stroboscopic glasses and neuromechanics in patients with chronic ankle instability during a Single-Legged Drop landing. Journal of Athletic Training, 59(6), 633–640. https://doi.org/10.4085/1062-6050-0605.22
[15]. Hu, X., Feng, T., Li, P., Liao, J., & Wang, L. (2024). Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Medicine - Open, 10(1). https://doi.org/10.1186/s40798-024-00702-y
[16]. Lawry-Popelka, B., Chung, S., & McCann, R. S. (2022b). Cross-Education balance Effects after Unilateral Rehabilitation in Individuals with Chronic ankle instability: a Systematic review. Journal of Athletic Training, 57(11–12), 1055–1061. https://doi.org/10.4085/1062-6050-625-21
[17]. Tan, J., Wu, X., Clark, C. C. T., Barton, V., Chen, S., Liu, S., Zhou, X., Xu, C., Ma, T., Qi, B., Han, J., & Zou, Y. (2022). The effect of whole body vibration on sensorimotor deficits in people with chronic ankle instability: A systematic review and meta-analysis. Clinical Rehabilitation, 36(8), 1016–1031. https://doi.org/10.1177/02692155221095651
[18]. Coelho-Oliveira, A. C., Taiar, R., Pessanha-Freitas, J., Reis-Silva, A., Ferreira-Souza, L. F., Jaques-Albuquerque, L. T., Lennertz, A., Moura-Fernandes, M. C., Lacerda, A. C. R., Mendonça, V. A., Sañudo, B., Seixas, A., Boyer, F. C., Bernardo-Filho, M., Rapin, A., & Sá-Caputo, D. (2023). Effects of Whole-Body Vibration Exercise on Athletes with Ankle Instability: A Systematic Review. International Journal of Environmental Research and Public Health, 20(5), 4522. https://doi.org/10.3390/ijerph20054522
[19]. Hoveidaei, A. H., Hashemi, S. M., Pazoki, S., Nakhostin-Ansari, A., Ghorbani, Z. M., Eghdami, S., Bahari, H., Sarzaeim, M., & Forogh, B. (2023). Effects of whole-body vibration on chronic ankle instability: a systematic review. Annals of Medicine and Surgery, 86(1), 401–411. https://doi.org/10.1097/ms9.0000000000001510
[20]. Sofla, F. S., Hadadi, M., Rezaei, I., Azhdari, N., & Sobhani, S. (2021). The effect of the combination of whole body vibration and shoe with an unstable surface in chronic ankle instability treatment: a randomized clinical trial. BMC Sports Science Medicine and Rehabilitation, 13(1). https://doi.org/10.1186/s13102-021-00256-6
[21]. Chang, S., Tan, Y., Cheng, L., Zhou, L., Wang, B., & Liu, H. (2024). Effect of strength training with additional acupuncture on balance, ankle sensation, and isokinetic muscle strength in chronic ankle instability among college students. Frontiers in Physiology, 15. https://doi.org/10.3389/fphys.2024.1324924
[22]. Mullins, J. F., Nitz, A. J., & Hoch, M. C. (2019). Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability. Physiotherapy Theory and Practice, 37(6), 672–681. https://doi.org/10.1080/09593985.2019.1641870
[23]. Salom-Moreno, J., Ayuso-Casado, B., Tamaral-Costa, B., Sánchez-Milá, Z., Fernández-De-Las-Peñas, C., & Alburquerque-Sendín, F. (2015). Trigger point dry needling and proprioceptive exercises for the management of chronic ankle instability: a randomized clinical trial. Evidence-based Complementary and Alternative Medicine, 2015, 1–9. https://doi.org/10.1155/2015/790209
[24]. Yin, Y., Yu, Z., Wang, J., & Sun, J. (2022). Effectiveness of the Rehabilitation Training Combined with Maitland Mobilization for the Treatment of Chronic Ankle Instability: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 19(22), 15328. https://doi.org/10.3390/ijerph192215328
[25]. Bruce, A. S., Howard, J. S., Van Werkhoven, H., Mcbride, J. M., & Needle, A. R. (2019). The effects of transcranial direct current stimulation on chronic ankle instability. Medicine & Science in Sports & Exercise, 52(2), 335–344. https://doi.org/10.1249/mss.0000000000002129
[26]. Ma, Y., Yin, K., Zhuang, W., Zhang, C., Jiang, Y., Huang, J., Manor, B., Zhou, J., & Liu, Y. (2020). Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study. Brain Sciences, 10(10), 749. https://doi.org/10.3390/brainsci10100749
[27]. Xiao, S., Wang, B., Yu, C., Shen, B., Zhang, X., Ye, D., Deng, L., Xu, Y., Zhou, J., & Fu, W. (2022). Effects of intervention combining transcranial direct current stimulation and foot core exercise on sensorimotor function in foot and static balance. Journal of NeuroEngineering and Rehabilitation, 19(1). https://doi.org/10.1186/s12984-022-01077-5
[28]. Huang, X., Gao, H., & Fu, H. (2024). Effects of transcranial direct current stimulation combined with Bosu ball training on the injury potential during drop landing in people with chronic ankle instability. Frontiers in Physiology, 15. https://doi.org/10.3389/fphys.2024.1451556
[29]. Siemes, L. J., Van Der Worp, M. P., Nieuwenhuijzen, P. H. J., Stolwijk, N. M., Pelgrim, T., & Staal, J. B. (2023). The effect of movement representation techniques on ankle function and performance in persons with or without a lateral ankle sprain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 24(1). https://doi.org/10.1186/s12891-023-06906-9
[30]. Chuadthong, J., Lekskulchai, R., Hiller, C., & Ajjimaporn, A. (2023). A Home-Based exercise program with active video games for balance, motor proficiency, foot and ankle ability, and intrinsic motivation in children with chronic ankle instability: Feasibility randomized controlled trial. JMIR Serious Games, 11, e51073. https://doi.org/10.2196/51073
[31]. Sadaak, M. M., AbdElMageed, S. F., & Ibrahim, M. M. (2024). Effect of aquatic versus conventional physical therapy program on ankle sprain grade III in elite athletes: randomized controlled trial. Journal of Orthopaedic Surgery and Research, 19(1). https://doi.org/10.1186/s13018-024-04855-0
[32]. Naderi, A., & Ahi, K. (2024). Comparative Analysis of Land-Based vs. Water-Based Balance Training on Quality of Life and Physical and Psychological Deficits in Athletes with Chronic Ankle Instability: A Randomized Controlled Trial Assessing the Influence of Exercise Environment. Research Square (Research Square). https://doi.org/10.21203/rs.3.rs-4991597/v1
[33]. Guzmán-Valdivia, C. H., Madrigal-López, O., Désiga-Orenday, O., Talavera-Otero, J., Brizuela-Mendoza, J. A., Chávez-Olivares, C. A., Cruz-Domínguez, O., Blanco-Ortega, A., Berumen-Torres, J. A., & Gómez-Becerra, F. A. (2021). Design, development and control of a therapeutic robot incorporating aquatic therapy for ankle rehabilitation. Machines, 9(11), 254. https://doi.org/10.3390/machines9110254
Cite this article
Ren,H. (2025). Progress of the Exercise Therapy on Chronic Ankle Instability. Theoretical and Natural Science,89,36-43.
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The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.
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