Sports Medicine Research: In the Lab & In the Field: Put it All Together for Better Outcomes for Patients with Chronic Ankle Instability (Sports Med Res)


Tuesday, September 4, 2018

Put it All Together for Better Outcomes for Patients with Chronic Ankle Instability

Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis

Tsikopoulos K, Mavridis D, Gerogiannos D, and Cain MS. J Sci Med Sport. 2018. [Epub Ahead of Print].

Take Home Message: A patient with chronic ankle instability is likely to get the best gains in dynamic balance when completing a rehabilitation program with balance and supervised strength training.
While many patients with chronic ankle instability (CAI) are treated with non-surgical interventions, there is no consensus on which intervention is best at improving dynamic balance among people with CAI. A better understanding of what non-surgical treatment methods is most effective would allow clinicians to improve function in patients with CAI. Therefore, Tsikopoulos and colleagues completed a systematic review and meta-analysis of randomized trials to compare the results of different non-surgical interventions on dynamic balance in people with CAI. The researchers identified 593 articles through a comprehensive literature search. They then screened the articles and included them if they: (1) used a randomized controlled-trial study design, (2) enrolled patients with a history of ankle sprain and ankle instability, (3) confirmed the diagnosis or quantify the functionality of the unstable ankles, (4) measured the efficacy of at least 1 non-surgical treatment method for CAI, and (5) evaluated dynamic balance with the star-excursion balance test. Nineteen studies met the inclusion criteria and 16  were included in the meta-analysis. The quality of these articles was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Only 7 of 19 included studies were deemed high quality. Two investigators independently extracted demographic data, activity level, geographic location, outcome measurements, and follow-up data from the included studies. Overall, balance training improved dynamic balance compared to a control group. Further, one set of investigators found that ankle mobilizations improved dynamic balance 6 months after treatment. The subsequent network meta-analysis demonstrated that a 4-6-week balance training or supervised strengthening program improved dynamic balance compared to controls. Finally, the authors found that a 6-week rehabilitation protocol that included balance and strength training had the best chance of optimal outcomes.

These findings are important because they highlight that clinicians should consider providing a balance or strengthening program for patients with CAI. As revealed in the network meta-analysis, a program that combines balance exercises and strength exercises would likely yield the best results. Also, an interesting take-away for clinicians and researchers is the low number of studies that were deemed to be of high quality. This also presents an opportunity for clinical research to further explore the best treatment options to further advance these non-surgical interventions. Ultimately, as more studies help bolster the quality and volume of research, clinicians should use a combination of balance and strength training to help patients with CAI regain dynamic balance.

Questions for Discussion: What interventions do you use to treat patients with CAI? Are your protocols in line with the results of this study?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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Unknown said...

I found this to be very beneficial. I am currently researching the importance of balance and its link to heighten awareness. CAI can greatly affect someone's ability to function normally. Knowing that 4-6 weeks of dynamic balance training combined with strength exercises has been proven to help correct that instability is valuable knowledge.

I am still a student, but during CAI rehabilitation's we have used both balance and strengthening exercises. Looking back, I could say we should have varied our strengthening exercises. Made them more diverse and more prevalent in the rehabilitation. Thank you for the summary and article!


Savannah Monette said...

I enjoyed reading this article because I am currently working on my masters thesis which is about chronic ankle instability (with intervention of blood flow restriction). As a graduate athletic training student, I have seen many ankle sprains and injuries at my clinical sites over the years. I most often see these types of injuries being treated with resistance exercises using a theraband or with a BAPS board. Once the inflammatory response and pain ends, I feel it is important to get these patients to work on achieving range of motion, strength, neuromuscular control, and balance. I think incorporating a dynamic balance test, such as the SEBT, is going to be beneficial in any rehab plan for a patient with ankle sprain or CAI. Using the SEBT not only improves neuromuscular control and balance, but it can also improve ROM, specifically dorsiflexion in the anterior direction of the SEBT. Thanks for the article!


Kyle said...


Thanks for your comments. It great to hear about clinicians at all points in their career trying different treatment options and evaluating them. Looking back, what are some exercises that you did/did not use that you thought were beneficial and how would you change what you did?

Thanks again.


Kyle said...


Thank you for your comment. I too have seen the more traditional treatment strategies at work. How you used or read about any other dynamic balance tests that clinicians might also find useful?



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