Therapeutic interventions for chronic ankle instability
are the most prevalent musculoskeletal injury of the lower limb in physical active individuals. A large proportion of individuals with a previous experienced ankle injury history will experience persistent pain, swelling, and develop what is commonly referred as chronic ankle instability (CAI). Individuals with a CAI experience greater self-reported functional limitations. Although the international ankle consortium advocated the evaluation of effectiveness of therapies, the results are inconsistent. Thus, a systematic review was needed that identified the most effective therapeutic interventions for improving self-reported function.
A comprehensive literature search was carried out by the authors. The PRISMA guidelines were followed for the systematic review. A total of 17 articles were included into the final analysis.
6 articles assessed balance training. While there is preliminary evidence to support the use of balance training to decrease the subjective feeling of ‘giving-way’ at the ankle, this review provided additional support for the use of balance training to improve subjective functional limitations for those with CAI. Although a large variety within balance training programmes could be identified, specifically, balance training programmes that progressively challenges the sensorimotor system through purposeful manipulation of the task and environment to foster the development of new movement strategies is recommended. Multimodal therapy showed inconclusive results, and more research is needed to identify which combination of exercises produces improvements in patients with CAI.
Joint mobilisation showed mixed evidence. Joint mobilisations may be more effective at restoring objective measures such as range of motion or dynamic postural control and should be used in combination with other therapeutic interventions. Although strength training improves ankle strength, resistive training did not lead to clinically meaningful improvements in self-reported function. Orthotics and stretching showed mixed evidence and need further research to prove an effect on self-reported function.
In summary, progressive balance training was the most consistent form of therapeutic intervention and thus, clinicians should implement a progressive balance training programme that challenges continuously the sensorimotor system by increasing the difficulty of the task or by changing the task-environment.
> From: Kosik et al., Br J Sports Med 51 (2017) 105-112. All rights reserved to BMJ Publishig Group Ltd. Click here for the online summary.