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Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial [with consumer summary] |
Hall EA, Docherty CL, Simon J, Kingma JJ, Klossner JC |
Journal of Athletic Training 2015 Jan;50(1):36-44 |
clinical trial |
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
CONTEXT: Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. OBJECTIVE: To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. DESIGN: Randomized controlled trial. SETTING: Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 39 individuals with CAI (17 men (44%), 22 women (56%)) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band-protocol group (n = 13 (33%) age 19.7 +/- 2.2 years, height 172.9 +/- 12.8 cm, weight 69.1 +/- 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 (33%), age 18.9 +/- 1.3 years, height 172.5 +/- 5.9 cm, weight 72.7 +/- 14.6 kg), or a control group (n = 13 (33%), age 20.5 +/- 2.1 years, height 175.2 +/- 8.1 cm, weight 70.2 +/- 11.1 kg). INTERVENTION(S): Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions. MAIN OUTCOME MEASURE(S): Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. RESULTS: The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (p < 0.05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (p < 0.05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (p > 0.05). CONCLUSIONS: Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.
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