Ankle Rehabilitation Strategies for Chronic Ankle Instability

PO & Wikstrom EA. Med Sci Sports
. Published Online First: December 10, 2015; DOI: 10.1249/MSS.0000000000000859

Take Home Message: Sensory-targeted rehabilitation
strategies (STARS) result in improvements in patient-reported and clinical outcomes.  Certain deficits may be specifically targeted
by different techniques.

ankle instability (CAI) with recurrent episodes of giving way and functional
limitations can cause long-term complications. 
Sensorimotor deficits may play a significant role in those with
CAI.  Therefore, the authors of this
randomized control study compared the effects of 3 sensory-targeted ankle
rehabilitation strategies (STARS; i.e., ankle joint mobilization, plantar
massage, or triceps surae stretching) on improvements in clinician- and
patient-reported outcomes among individuals with CAI.  The authors randomized 80 participants to 4
groups (3 STARS interventions and a control group). 75 participants completed
the entire duration of the study at the 1-month follow-up.  STARS programs consisted of six total
treatment sessions over the course of 2 weeks. 
Joint mobilization participants received 2 two-minute sets of grade III (one-second
large amplitude) oscillations. 
Participants within the plantar massage group received 2 two-minute sets
of effleurage and petrissage on the plantar aspect of the foot.  Trcieps surae stretching participants
performed 2 sets of three 30-second stretches with their knee flexed.  Control participants received no treatments. Participants
were assessed at baseline, within 72 hours of their last treatment, and at a 1-month
follow-up.  Patient reported outcomes
included self-reported disability (
Foot and Ankle Ability Measure;
FAAM) and self-reported physical activities levels (NASA Physical activity
status scale).  Clinician measures of
interest were dorsiflexion range of motion (weight-bearing lunge test) and
single-limb balance.  Overall, the
plantar massage and calf stretching groups had the best improvements in patient
and clinician reported outcomes.  After 2
weeks, all 3 STARS programs had improvements compared with the control group. The
plantar massage and calf stretching groups had the largest improvements in
patient-reported disability and number of episodes of giving way.  The calf stretching and joint mobilization
groups had improvements in range of motion, while all 3 groups had improvements
in single leg balance. The plantar massage group had the most pronounced
improvement in balance after two weeks. 

STARS group had unique improvements.  For
example, joint mobilization offered the most meaningful benefit for improving
dorsiflexion, plantar massage led to the most meaningful change in balance, and
stretching offered benefits in various outcomes. Amazingly, these benefits were
achieved with just six 5-minute treatment sessions during a 2-week period.  Clinicians could carefully add a specific
treatment to their rehabilitation protocol based on deficits found during
assessment.  It would have been
interesting to see if any of the clinical findings (i.e., single limb balance
& range of motion) had lasting effects at the 1-month follow-up.  It would also be interesting to see if a
combination of these techniques resulted in better short and long-term
outcomes.  For example, the joint
mobilizations showed the best outcomes immediately post-treatments, while
plantar massage showed better outcomes at the 1-month follow-up.  The findings of this study help to confirm
that clinicians should consider STARS to target improvements in certain areas
for patients with CAI. 

for Discussion:  Are there any other therapy
decisions that you have used with individuals with CAI?  What has your experience been with trying to improve
patient and clinical outcomes in patients with CAI?

Nicole Cattano
by: Jeffrey Driban


McKeon, P., & Wikstrom, E. (2015). Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability Medicine & Science in Sports & Exercise DOI: 10.1249/MSS.0000000000000859