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David Cruz-Díaz, Kyung-Min Kim, Fidel Hita-Contreras, Marco Bergamin, Agustin Aibar-Almazán, and Antonio Martínez-Amat

, chronic pain and swelling, frequent episodes of ankle “giving way,” and a high recurrence rate. 4 , 5 This chronic condition has been defined as chronic ankle instability (CAI), and can be developed in 40% of sprained ankles, with resprain episodes occurring up to 7 years postinjury. 6 CAI includes

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Cameron J. Powden, Rachel M. Koldenhoven, Janet E. Simon, John J. Fraser, Adam B. Rosen, Abbis Jaffri, Andrew B. Mitchell, and Christopher J. Burcal

Chronic ankle instability (CAI) is a condition characterized by repetitive episodes of the ankle giving way and trauma as well as persistent symptoms such as pain, weakness, range of motion deficits, and reduced self-reported function. 1 The evolution and progression of CAI is thought to be due to

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Christopher J. Burcal, Alejandra Y. Trier, and Erik A. Wikstrom


Both balance training and selected interventions meant to target sensory structures (STARS) have been shown to be effective at restoring deficits associated with chronic ankle instability (CAI). Clinicians often use multiple treatment modalities in patients with CAI. However, evidence for combined intervention effectiveness in CAI patients remains limited.


To determine if augmenting a balance-training protocol with STARS (BTS) results in greater improvements than balance training (BT) alone in those with CAI.


Randomized-controlled trial.


Research laboratory.


24 CAI participants (age 21.3 ± 2.0 y; height 169.8 ± 12.9 cm; mass 72.5 ± 22.2 kg) were randomized into 2 groups: BT and BTS.


Participants completed a 4-week progression-based balance-training protocol consisting of 3 20-min sessions per week. The experimental group also received a 5-min set of STARS treatments consisting of calf stretching, plantar massage, ankle joint mobilizations, and ankle joint traction before each balance-training session.

Main Outcome Measures:

Outcomes included self-assessed disability, Star Excursion Balance Test reach distance, and time-to-boundary calculated from static balance trials. All outcomes were assessed before, and 24-hours and 1-week after protocol completion. Self-assessed disability was also captured 1-month after the intervention.


No significant group differences were identified (P > .10). Both groups demonstrated improvements in all outcome categories after the interventions (P < .10), many of which were retained at 1-week posttest (P < .10). Although 90% CIs include zero, effect sizes favor BTS. Similarly, only the BTS group exceeded the minimal detectable change for time-to-boundary outcomes.


While statistically no more effective, exceeding minimal detectable change scores and favorable effect sizes suggest that a 4-week progressive BTS program may be more effective at improving self-assessed disability and postural control in CAI patients than balance training in isolation.

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Adam E. Jagodinsky, Rebecca Angles, Christopher Wilburn, and Wendi H. Weimar

instability is a characterized by chronic symptoms, such as a recurring injury, feelings of the ankle “giving way,” and/or pain in the previously injured ankle. Other individuals who sustain lateral ankle sprain injury, that is, copers, recover in a manner in which recurring symptoms of chronic ankle

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Christina Jones, Kyle B. Kosik, Phillip Gribble, and Matthew C. Hoch

Clinical Scenario Lateral ankle sprains are the most commonly sustained sport-related injury. Approximately 40% of acute ankle sprain patients develop chronic ankle instability (CAI), which is characterized by residual ankle sprain symptoms, recurrent ankle sprains, and repetitive episodes of ankle

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Bethany Wisthoff, Shannon Matheny, Aaron Struminger, Geoffrey Gustavsen, Joseph Glutting, Charles Swanik, and Thomas W. Kaminski

, because these ligaments are a rich source of mechanoreceptors, feed-forward neuromuscular control could be impaired resulting in gait alterations in those with chronic laxity. 8 Laxity, or objective mechanical ankle instability (MAI), can last from 6 weeks to 1 year after injury, with some cases

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Yumeng Li, He Wang, and Kathy J. Simpson

Chronic ankle instability (CAI) is a very common sequela, after ankle sprains. 1 Individuals with CAI exhibit some ankle deficits, including reduced ankle stability, 2 ankle proprioception and muscle strength, 3 range of motion, 4 , 5 and potential changes to the mechanical properties of

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Roel De Ridder, Tine Willems, Jos Vanrenterghem, Ruth Verrelst, Cedric De Blaiser, and Philip Roosen

Chronic ankle instability (CAI) is a frequently reported residual pathology as a result of an initial ankle sprain event. 1 A prevalence study identified CAI in 23.4% of all high school and college athletes. 2 The high prevalence of CAI is caused by a multifactorial underlying mechanism and is

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Diane Madras and J. Bradley Barr


The article presents a focused review of the literature surrounding training methods for addressing the proprioceptive loss and subsequent balance problems that result from inversion ankle sprains.

Data Sources:

The authors searched the MEDLINE and CINAHL databases for the period 1985 through December 2001 using the key words ankle, ankle sprain, and rehabilitation.

Study Selection:

Any study investigating a rehabilitation or prevention program for the proprioceptive or balance aspects of ankle instability was included.

Data Synthesis:

Key components of the training regimen used in each study are described, and major findings are summarized.


Based on the literature reviewed, there is evidence to suggest that training programs for individuals with ankle instability that include ankle-disk or wobble-board activities help improve single-leg-stance balance and might decrease the likelihood of future sprains.

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Alexandra F. DeJong Lempke, Rachel M. Koldenhoven, Abbis H. Jaffri, and Jay Hertel

Chronic ankle instability (CAI) is a prevalent lower-extremity musculoskeletal condition that manifests in approximately 40% of first-time lateral ankle sprain cases. 1 CAI is characterized by residual pain, weakness, and patient-reported episodes of the ankle “giving way” and reinjury. 1 CAI is