Effects of 6 Weeks of Balance
Training on Chronic Ankle Instability in Athletes: A Randomized Controlled

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.

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), which 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?

Nicole Cattano
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