Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial.
Cruz-Diaz D, Lomas-Vega R, Osuna-Perez MC, Contreras FH, and Martinez-Amat A. Int J Sports Med. 2015; E pub ahead of print. DOI: 10.1055/s-0034-1398645.
Take Home Message: A 6-week lower-extremity training program that incorporates progressive balance exercises is effective in reducing feelings of instability and improving dynamic balance in athletes with chronic ankle instability.
Ankle sprains are very common within the athletic and physically active populations and can lead to chronic issues such as chronic ankle instability (CAI). CAI results in residual symptoms and “giving way”, which can leave someone susceptible to further injury, decreased quality of life, and potential degenerative joint changes. Balance training may help mitigate some of these short- and long-term issues. The authors of this randomized clinical trial investigated whether a 6-week balance training program helped improve feelings of instability, pain, and dynamic balance in athletes with CAI. One of the main study outcome measures was the Cumberland Ankle Instability Tool (CAIT) is a self-reported measure of a patient’s perception of ankle instability. Seventy participants with a history of a unilateral ankle sprain that had residual pain, instability, and a CAIT score less than 27 were randomly assigned and completed a 6-week strength-training workout routine, while the intervention group completed additional balance training (balance group). The balance exercises consisted of a progression through unstable surfaces (e.g., exercise mat to minitramp to foam roller) while progressing in difficulty (e.g., double leg to single leg to dynamic activities). Participants were assessed with the CAIT, star excursion balance test, and pain symptoms pre and post program. Athletes in the balance group improved three times as much as the control group, which just did a strength-training routine, in CAIT and star excursion balance test scores. There were no differences between groups for pain.
The authors of this study found that balance training can be effective at improving dysfunction, specifically CAIT and balance scores among individuals with CAI. The improved CAIT scores indicate that participants felt more stable after completing the 6-week program. It would be interesting to continue to follow these patients longer than 6 weeks to see if there were any cumulative effects of the training program that resulted in long-term pain reduction. Furthermore, a longer follow-up would let us know if the balance training reduced the number of episodes of “giving way” and the number of ankle re-injuries. The authors provide great examples of a balance training progression but unfortunately provided little information about the lower-extremity exercises in the strengthening program. As clinicians, it is important to incorporate some balance training for patients reporting ankle instability or residual symptoms after a lateral ankle sprain because it can help improve the patient’s balance and perception of their ankle stability.
Questions for Discussion: Are there certain balance activities that you typically incorporate into post-ankle sprain rehabilitation? Are there certain things that you use as “red flags” (e.g., repetitive sprains, chronic pain) that make you choose to intervene for CAI athletes?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Related Posts:Cruz-Diaz, D., Lomas-Vega, R., Osuna-Pérez, M., Contreras, F., & Martínez-Amat, A. (2015). Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial International Journal of Sports Medicine DOI: 10.1055/s-0034-1398645