Hop Stabilization Training and Landing Biomechanics in Athletes With Chronic Ankle Instability: A Randomized Controlled Trial

Ardakani MK, Wikstrom EA, Minoonejad H, Rajabi R, Sharifnezhad. J Athl Train. 2019; 5(12).  Published online ahead of print October 16 2019. DOI:10.4085/1062-6050-550-17

Full Text Freely Available

Take-Home Message

A 6-week hop-stabilization training program improved landing mechanics and self-reported outcomes among male collegiate basketball players with chronic ankle instability.


Ankle sprains are one of the most common athletic injuries, particularly in a basketball population, and often result in chronic ankle instability (CAI).  Plyometric training improves lower extremity biomechanics in healthy participants, and balance training improves postural control in people with CAI. However, the effects of plyometric hop training in people with CAI is unknown.  Therefore, these authors conducted a randomized controlled clinical trial with 30 male collegiate basketball players with CAI to determine if jump-landing biomechanics improved after a hop stabilization training program versus no training.  All athletes completed ankle specific patient-reported outcomes and had their lower extremity biomechanics analyzed during a drop-landing task before and after the 6-week period.  The hop stabilization program consisted of 3 sessions per week that gradually progressed in repetitions and difficulty. Exercises consisted of lateral, horizontal, and multi-directional hopping (see article for full program).  One person in each group dropped out of the study.   

The athletes that completed the hop training improved more in most of the patient-reported outcomes (e.g., pain, symptoms, quality of life) and lower extremity biomechanics (e.g., peak ground reaction forces, rate of loading) compared with the control athletes.  Notably, athletes who completed the hop training had increased knee/hip flexion and less knee valgus, ankle inversion, and ankle plantarflexion.


Overall, the authors found that hop-stabilization training successfully improved self-reported outcomes and lower extremity landing biomechanics in male basketball athletes with CAI.  The hope is that these improvements would reduce the risk of injury and long-term complications.  It would be interesting to see how long these improvements last after the program ended and whether their self-reported symptoms were related to any specific biomechanical changes.  In looking at the vertical ground reaction forces, it was interesting to see that there was a slight effect on the rate of loading and peak forces, but it remains unknown what effect this may have on the cartilage or long-term joint health.  The program involved an increase in contacts per week and a gradual progression in the complexity of exercises.  However, it would be interesting to know if there should be certain criteria that each participant should pass before making an exercise progression.  For example, if I had difficulty with the zigzag hopping on 2 legs with balance, I might not be ready to progress to a single leg during the prescribed week.  The progression of exercises and verbal feedback cues seemed effective in male basketball athletes, and it would be interesting to see if the same results would occur in female basketball athletes or other sports.  Hop-stabilization training was successful at improving outcomes and should be considered when treating someone with CAI.

Questions for Discussion

How do you assess whether your patients have chronic ankle instability? What interventions have you utilized for patients with chronic ankle instability?

Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban

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