Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain

Effects of proprioceptive training on sports performance: a systematic review

BACKGROUND

Proprioception, the ability to sense the body's position and movement, is essential for athletic performance and physical well-being. The literature highlights the importance of proprioceptive training in rehabilitation, sports performance, injury prevention, and motor function enhancement. Targeted training programs can improve balance, coordination, motor learning, and overall physical performance. This systematic review aimed to examine the effects of proprioceptive training methods on sports and athletic performance.

METHODS

A comprehensive search was conducted using the Web of Science, PubMed, and Scopus databases, and a literature review was performed based on the PICO criteria outlined in the abstract and title.

RESULTS

Following the search, 178 articles were identified using relevant keywords, of which 19 directly addressed sports performance and were included in this study. The findings revealed that proprioceptive training had a positive influence on various aspects of athletic performance, including physiological capacity, balance, explosive strength, speed, agility, postural stability, knee joint position sense, muscle activation, reduction of chronic joint instability, dribbling, passing, and technical ball-control skills.

CONCLUSIONS

These results indicate that proprioceptive training can be an effective strategy for experts and coaches to enhance athletes' physical performance. Primarily, proprioceptive exercises should be used inside and outside the training sessions to enable athletes to interact more effectively with their bodies, reduce the risk of injury, and improve power transfer.

Effects of Manual Lymphatic Drainage with Mobilization and Myofascial Release on Muscle Activities during Dynamic Balance in Adults with Calf Muscle Shortening

Mobilization with movement (MWM) and myofascial release (MFR) are treatment techniques that increase ankle dorsiflexion range of motion (DFROM). Manual lymphatic drainage (MLD) facilitates waste drainage and improves soft tissue tension in peripheral tissues. To date, no studies have investigated how the combination of MLD, MWM, and MFR influences the human body. The purpose of this study is to determine how the combination of MLD, MWM, and MFR affects DFROM and balance ability. We randomly assigned 16 individuals (26 feet) to one of three groups: MWM-MFR (MR), MWM-MLD (MD), or MWM-MFR-MLD (MRD) intervention. To confirm the intervention effect of each group, DFROM was assessed using a modified lunge test, and dynamic balance was measured using a modified star excursion balance test. In the results, differences were found between the MR and MRD groups in PL and mGCM activities in the 1 section (p = 0.008, p = 0.036) and between the MD and MRD groups in mGCM activity in the 4 and 5 sections (p = 0.049, p = 0.004). We suggest that the application of MRD is the most effective intervention for increasing muscle activation of the PL and mGCM during the modified star excursion balance test.

Randomized controlled trial study of intelligent rehabilitation training system for functional ankle instability

To investigate the intervention effect of an intelligent rehabilitation training system on patients with functional ankle instability (FAI) and to advance the research to optimise the effect of FAI rehabilitation training. Thirty-four FAI patients who participated in this trial in Guilin City from April 2023 to June 2023 were recruited as research subjects, and all subjects were randomly divided into the control group (n = 17) and the observation group (n = 17). Both groups received the conventional rehabilitation training intervention for 6 weeks, and the observation group received the additional training using the intelligent rehabilitation training system training invented by our team. Visual analogue scale (VAS), ankle active mobility, ankle muscle strength and Y-balance test (YBT) were assessed before and after treatment. Two-way repeated measures ANOVA shows that the interaction effect between time and group of VAS scores was significant (F = 35.644, P < 0.05). The interaction effect between time and group of plantar flexion mobility was significant (F = 23.948, P < 0.05), the interaction effect between time and group of dorsiflexion mobility was significant (F = 6.570, P < 0.05), the interaction effect between time and group of inversion mobility was significant (F = 8.360, P < 0.05), the interaction effect between time and group of eversion mobility was significant (F = 10.113, P < 0.05). The interaction effect between time and group of inversion muscle strength was significant (F = 18.107, P < 0.05). The interaction effect between time and group of YBT scores was significant (F = 33.324, P < 0.05). The Intelligent Rehabilitation Training System can effectively reduce pain in FAI patients, improve joint range of motion, increase inversion strength, and improve dynamic balance of the affected limb.

E-health intervention for preventing recurrent ankle sprains: a randomised controlled trial in general practice

BACKGROUND

Ankle sprains are frequent injuries in general practice. However, no effective treatment is available yet.

AIM

To examine the effectiveness of an unsupervised e-health-supported neuromuscular training programme in combination with usual care compared with usual care alone in patients with acute lateral ankle sprains in general practice.

DESIGN AND SETTING

Randomised controlled trial with 1-year follow-up among patients (14-65 years) who visited the GP with an acute lateral ankle sprain within 3 weeks of injury.

METHOD

The intervention group received, in addition to usual care, an unsupervised e-health-supported neuromuscular training programme and the control group received usual care alone. The primary outcome was self-reported re-sprains during 52 weeks of follow-up. Secondary outcomes were ankle function, pain in rest and during activity, subjective recovery, and return to the same type and level of sport.

RESULTS

In total, 165 participants (mean age 38.3 years and 69 [41.8%] male) were included. No statistically significant difference in the occurrence of a re-sprain were found between the intervention 20.7% (17/82) and control group 24.1% (20/83) (hazard ratio 1.14, 95% confidence interval = 0.59 to 2.21). Also, no statistically significant differences in secondary outcomes were found between groups. The adherence rate to the programme was low (6.1%, 5/82).

CONCLUSION

The rate of re-sprains was relatively high and an unsupervised e-health-supported neuromuscular training programme does not yield meaningful effects and does not encourage adherence in preventing re-sprains in patients in general practice. More research is necessary to indicate the best treatment modality and way of delivery for these patients.

The effect of neuromuscular and vestibular-ocular reflex training program on balance, isokinetic muscle strength and proprioception in people with chronic ankle instability

OBJECTIVE

This study aimed to compare and investigate the effectiveness of neuromuscular exercise combined with vestibular-ocular reflex training and only neuromuscular exercise training on balance, isokinetic muscle strength, and proprioception in chronic ankle instability (CAI).

METHOD

The study included 20 patients with unilateral CAI. The functional status was evaluated with the Foot and Ankle Ability Measure (FAAM). The star-excursion balance test was used for dynamic balance, and the joint position sense test assessed proprioception. Ankle concentric muscle strength was measured by an isokinetic dynamometer. The subjects were randomly divided into neuromuscular and vestibular-ocular reflex training (VOG, n = 10) and neuromuscular training group (NG, n = 10). Both rehabilitation protocols were applied for four weeks.

RESULTS

Although VOG had higher means of all parameters, no superiority was found between the two groups in post-treatment results. However, the VOG significantly improved FAAM scores at the sixth-month follow-up than NG (P < .05). In the linear regression analysis, the post-treatment proprioception inversion-eversion for unstable side and FAAM- S were found to be independent factors of FAAM-S scores at the six months follow -up in VOG. Post-treatment isokinetic strength for inversion of unstable side (120 º /s) and FAAM- S were determined as predictor factors of FAAM- S scores at the six months follow -up (p < .05) in NG.

CONCLUSION

The Neuromuscular combined with vestibular-ocular reflex training protocol effectively managed unilateral CAI. Furthermore, it may be considered an effective strategy for clinical outcomes for a long-term period in terms of functional status.

Ankle Sprain and Chronic Lateral Ankle Instability: Optimizing Conservative Treatment

The management protocol for each case of ankle sprain should be individualized and optimized in order to reduce the likelihood of development of chronic instability. Initial treatment aims to address pain, swelling, and inflammation and facilitates regaining pain-free joint motion. Short-term joint immobilization is indicated in severe cases. Subsequently, muscle strengthening, balance training, and targeted activities to develop proprioception are added. Gradually, sports-related activities are added with the ultimate goal of bringing the individual back to preinjury level of activity. This protocol of conservative treatment should always be offered before considering any surgical intervention.

Determining key clinical predictors for chronic ankle instability and return to sports with cost of illness analysis: protocol of a prospective cohort study

INTRODUCTION

Ankle sprains are common in sports and the general population. Although considered innocuous, a large proportion has residual complaints such as recurrent ankle sprains and develop chronic ankle instability. Although some predicting factors are identified, there is no unequivocality regarding the development of chronic ankle instability, nor about the optimal rehabilitation for an acute ankle sprain. Alongside the biomechanical impairments, ankle sprains are a burden on society due to substantial economic costs. Therefore, we aim to identify key clinical predictors of chronic ankle instability or recovery after acute lateral ankle sprain. Additionally, we aim to determine cost-of-illness of patients who developed chronic ankle instability.

METHODS AND ANALYSIS

This prospective cohort study (Clinicaltrials.gov: NCT05637008 - pre-results) aims to recruit adult (18-55 years) patients with an acute lateral ankle sprain who are active in sports. Clinical assessments and patient-reported outcome measures will be used to collect data at 7-14 days, 6 weeks, 12 weeks and 12 months after enrolment in the study. The primary outcome will be chronic ankle instability at 12-month follow-up. Salient outcomes will be analysed by logistic regression to determine association with the development of chronic ankle instability. Participants will fill in a cost diary containing direct and indirect costs related to their injury.

ETHICS AND DISSEMINATIONS

The ethical committee of the Antwerp University Hospital (B3002022000138) has given approval of the protocol and consent forms on 10 October 2022. We perform this study according to the Helsinki Declaration. We will present results at conferences or webinars and publish in peer-reviewed articles.NCT05637008.

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

OBJECTIVES

1) determine the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients with an acute ankle sprain; 2) Determine whether prescribed exercises incorporate complex tasks associated with ankle sprain injury mechanisms?

METHODS

We searched databases CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar for RCT's including patients with acute ankle sprains, managed through exercise-based rehabilitation. Risk of bias was assessed by the Risk of Bias 2 tool. Exercises were analysed based on: the primary impairment(s) addressed; direction of movement; base of support; weightbearing status; flight phase. (PROSPERO: CRD42020210858) RESULTS: We included fourteen RCT's comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises incorporated a flight phase.

CONCLUSIONS

Rehabilitation after LAS comprises simple exercises in the sagittal plane that do not reflect mechanisms of re-injury. Future interventions should incorporate more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.

The effects of pain relief on proprioception and muscle strength for tibial plateau fractures: A randomized controlled trial

OBJECTIVES

To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with proprioceptive neuromuscular facilitation (PNF) on postural stability, muscle strength and pain in patients with tibial plateau fracture.

METHOD

A 3-arm randomized controlled trial was conducted in 60 patients with tibial plateau fracture. Participants received one of the following interventions: standard treatment (ST group, n = 20), ST + PNF training (ST + PNF group, n = 20), ST + PNF training + TEAS intervention (ST + PNF + TEAS group, n = 20). All treatments lasted for six weeks. Participants' postural stability, muscle strength and pain were evaluated at baseline, after 3 and 6 weeks of intervention.

RESULTS

After 3 weeks of intervention, Between-group comparisons showed that both the ST + PNF group and ST + PNF + TEAS group showed significantly greater performance than the ST group in the postural stability measure (P < 0.02) and pain score(P < 0.05). The peak torque of quadriceps extensors and flexors at the velocity of 60°/s was significantly higher in the ST + PNF + TEAS group than in the ST group (P < 0.02). After 6 weeks of intervention, only the ST + PNF + TEAS group was superior to the ST group in postural stability measure(P < 0.04) and in pain score (P < 0.05). The ST + PNF + TEAS group was significantly higher than the ST + PNF group and the ST group in the peak torque of quadriceps extensors at the velocity of 60°/s and 180°/s (P < 0.01).

CONCLUSION

PNF training could improve dynamic postural stability and relieve pain at three weeks, while TEAS combined with PNF was more effective in relieving pain, strengthening muscle strength and improving dynamic postural stability at six weeks post-intervention.

Changes in balance due to mild lateral ankle sprain measured by parts of the JESS-Score: a case report

BACKGROUND

By chance, one participant of a norm value study concerning the Jenaer-Standing-Stability-Score (JESS-Score) could be measured before and after a lateral ankle sprain (LAS, Grade I). Therefore, a complete comparison of the initial function, the situation after the LAS and even after additional therapy with focus on balance and postural control, was possible.

CASE PRESENTATION

A 34-year-old woman, working as medical doctor was measured her standing stability by use of the JESS-Score. A few weeks after, she experienced a mild LAS. There was no physical therapy in the first 3 months after the LAS. In the following, the patient received 7 sessions of physical therapy with focus on balance and postural control. The 2 used parts of the stability assessment (JESS-Score: 1-unipedal stance test; 2-target-step-test) changed in the course of time. Before the ankle sprain both tests on balance and postural control reached the standard value and were inconspicuous. There was no medically prescribed therapy due to the LAS, based on the minor complaints. However, after the LAS the number of deviating test items increased and was even 6 weeks and 3 months after the LAS inconsistent. Only after additional physiotherapy, the score result improved to the initial situation again.

CONCLUSIONS

It is assumable that LAS is associated with postural deterioration. Therefore, the effect of exercises focussing on postural control and balance after lateral ankle sprain, even if only mild, should be investigated. Some items of the JESS-Score seem to be sensitive for evaluating changes concerning the balance ability.

Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Controlled Trial

(1) Background: Chronic ankle instability (CAI) is a complex condition that includes limited mobility, perceived instability, and recurrent ankle sprains are common characteristics that reduce the quality of life in subjects who suffer from CAI. Neuromuscular training and strength training have been recommended in CAI management interventions. However, there are contradictory findings on results when comparing neuromuscular training, strength training, and the control group. The objective of this study was to compare the effectiveness of 8 weeks of neuromuscular intervention training, strength training, and no intervention in a sporting population with reported CAI. (2) Methods: Sixty-seven athletes with CAI were randomly assigned to a neuromuscular training group (NG), strength training group (SG), or control group (CG). Participants completed 8 weeks of neuromuscular training (a combination of static and dynamic exercises), strength training (resistance band exercises), or no training. Outcome measures were assessed at baseline and after 8 weeks and included selfs-reported instability feeling (CAIT), dynamic balance (SEBT), ankle dorsiflexion range of motion (WBLT), and functional status (FAAM and FAAM-SPORT). (3) Results: There were significant differences between strength and control groups in the posteromedial direction of SEBT, FAAM, and FAAM-SPORT after 8 weeks of intervention. (4) Conclusions: Neuromuscular training and strength training based on resistance bands exercises showed significant improvements in ankle dorsiflexion, subjective feeling of instability, functional status, and dynamic balance in patients with CAI.

Differences in lower limb muscle activation between global and selective instability devices in single-leg stance in healthy active subjects

Background

Balance and strength training are frequent strategies to address lower limb injuries, including ankle injuries, which are usually performed in single-leg stance on global instability devices, producing generalized muscular activation of the lower limb. In this context, new specific instability devices arise from the need to selectively work the ankle, specifically the peroneus longus. This study aimed to compare the EMG muscle activation of the peroneus longus, as well as other lower limbs muscles, in a single-leg stance on different balance training devices (BOSU, wobble board, power board, and Blackboard) in standing or squatting positions.

Methods

Twenty healthy recreationally trained subjects participated in the study. Subjects performed three repetitions of 15 s (one for familiarization and two for measurement) in standing and squatting positions on the floor, BOSU, wobble board, power board, and Blackboard. Surface electromyography (EMG) was used to record activity of the peroneus longus, soleus, gastrocnemius medialis, tibialis anterior, rectus femoris, and gluteus maximus.

Results

The main outcome was that no differences were found for the peroneus longus normalized EMG, neither between devices (p = 0.09) nor between conditions (p = 0.11), nor in the interaction between them (p = 0.16). For the normalized EMG of the other muscles, there were multiple differences between devices and conditions. Of the devices studied, the Blackboard was the one that implied a lower activation of the lower limb muscles and a lower degree of instability, activating the peroneus longus similarly to global instability devices. The BOSU and wobble board achieved high levels of EMG muscle activation for most muscles of the lower limbs. Therefore, they should be considered as potential devices for work in highly unstable conditions or when high activation levels are sought.

Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis

Research questions

1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume?

Methods

This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed.

Results

Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up.

Conclusion

Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.

Correlation between ankle plantar flexion strength and degree of body sway

[Purpose] The purpose of this study is to consider the correlation between ankle plantar flexion strength and degree of body sway. [Participants and Methods] Twenty-one healthy adult males were targeted. A handheld dynamometer was used to measure ankle plantar flexion strength. The Body Pressure Measurement System was used to measure the degree of body sway. Lastly, correlation between ankle plantar flexion strength and degree of body sway was considered. [Results] A negative correlation was observed between ankle plantar flexion strength and degree of body sway. [Conclusion] Regarding ankle plantar flexion strength and degree of body sway, results of a consideration using a handheld dynamometer and Body Pressure Measurement System were the same as that of previous studies using large equipment.

The Effect of Combining Plyometrics Exercises and Balance Exercises in Improving Dynamic Balance among Female College Athletes: A Randomized Controlled Trial

INTRODUCTION

Plyometrics and balance exercises have been shown to reduce lower limb injury incidence. The effects of combining these exercises on dynamic balance have not been investigated.

OBJECTIVE

This study aimed to evaluate the effect of plyometrics and balance exercises and a combination of both exercises on postural stability among female athletes compared to those who did not perform any specific exercise (control).

DESIGN

Randomized controlled trial.

SETTING

Sports Medicine Laboratory.

PARTICIPANTS

Two hundred female athletes aged 21.9±2.4 years were randomly assigned to a plyometrics exercises group (n = 50), a balance exercises group (n = 50), a combination of both exercises group (n = 50), or a control group (n = 50). One hundred seventy-nine female college athletes completed the study.

INTERVENTIONS

Plyometrics exercises, balance exercises and a combination of both exercises.

OUTCOME MEASURES

Limits of stability, which was assessed using the Biodex Stability System to assess the performance of the dynamic balance. It was measured pre and post-intervention after six weeks.

RESULTS

There were no differences in baseline data between groups (p = .557). All groups showed significant improvements in limits of stability (p < .001). The most marked improvement in the limits of stability was shown in the combination group compared to the control group (MD = 4.1 %, 95% CI [2.8, 5.3], p < .001).

CONCLUSIONS

Combining plyometrics and balance exercises significantly increases the dynamic balance performance post-intervention among female athletes compared to the control group. This article is protected by copyright. All rights reserved.

Effectiveness of Kinesio Taping for Dynamic Postural Stability in Adolescent Athletes with Chronic Ankle Instability: A Pilot Study

OBJECTIVES To determine the effectiveness of K-tape on dynamic postural stability of the injured limb in adolescent athletes with chronic ankle instability (CAI) by measuring reach distance with the modified Star Excursion Balance Test (mSEBT).METHODS Twenty volunteers (20 females [17.78 ± 1.22 yrs], height [163.89 ± 7.69 cm], mass [62.51 ± 9.81 kg]) with CAI. Four strips of K-tape were applied to the injured limb. Participants completed 4 trials of testing (2 with tape, 2 without tape) using the mSEBT as the assessment tool. We applied 4 strips of K-tape to the injured limb and then tested postural stability using the mSEBT to see if there was an increase of reach distance in the mSEBT. Measuring reach distance in Anterior (AN), Posteromedial (PM), Posterolateral (PL) on the injured limb with K-tape and without K-tape condition. We measured the reach distances and then normalized the distance to account for height differences. A repeated measures t-test was used for this study.RESULTS There is no statistically significant different between the condition with K-tape and without K-tape in the reach distances on the mSEBT in adolescent athletes with CAI.CONCLUSIONS Based on the results, there appears to be no improvement of reach distance using the mSEBT in adolescent athletes with CAI. Therefore, clinicians need their thoughtful consideration for applying K-tape to improve dynamic postural stability in adolescent athletes with CAI.

Effects of lateral ankle sprain on range of motion, strength and postural balance in competitive basketball players: a cross-sectional study

BACKGROUND

Lateral ankle sprain is the most common injury in basketball, and many of these sprains resulted in residual functional deficits. This study aimed to compare ankle strength and range of motion, and postural balance between competitive basketball players with and without lateral ankle sprain.

METHODS

This was a cross-sectional study involving 42 male competitive basketball players. Subjects were divided into the injured and uninjured groups based on self-reported questionnaires. Ankle range of motion (ROM) was measured using a goniometer, ankle isokinetic strength testing performed using Biodex System 4 PRO, and single-leg stability tests performed using Biodex Balance System SD.

RESULTS

Between the injured and uninjured ankles, there was a decrease in plantarflexion ROM (44.89±6.85 vs. 50.75±9.31, P<0.05) and an increase in eversion ROM (14.50±5.63 vs. 11.74±4.53, P<0.05). There was a reduction in inversion and plantarflexion strength at 30°/s peak torque and 120 °/s peak torque (P<0.05). However, no significant difference observed in the postural stability indexes between the two groups.

CONCLUSIONS

This study proves that there are residual ROM and strength deficits after an ankle sprain, however, these deficits do not affect their balance ability.