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Jessica L. Schaefer and Michelle A. Sandrey


A dynamic-balance-training (DBT) program supplemented with the Graston instrument-assisted soft-tissue mobilization (GISTM) technique has not been evaluated collectively as a treatment in subjects with chronic ankle instability (CAI).


To examine the effects of GISTM in conjunction with a DBT program on outcomes associated with CAI, including pain and disability, range of motion (ROM), and dynamic postural control.


Pretest/posttest, repeated measures.


High school and a Division I mid-Atlantic university.


Thirty-six healthy, physically active individuals (5 female, 31 male; age 17.7 ± 1.9 y; height 175.3 ± 14.6 cm) with a history of CAI as determined by an ankle-instability questionnaire volunteered to be in this study.


Subjects were randomly assigned to 1 of 3 intervention groups: both treatments (DBT/GISTM, n = 13), DBT and a sham GISTM treatment (DBT/GISTM-S, n = 12), or DBT and control—no GISTM (DBT/C, n = 11). All groups participated in a 4-wk DBT program consisting of low-impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 min before performing the DBT program. Pretest and posttest measurements included the Foot and Ankle Ability Measure (FAAM), FAAM Sport, the visual analog scale (VAS), ankle ROM in 4 directions, and the Star Excursion Balance Test (SEBT) in 3 directions.

Main Outcome Measures:

FAAM and FAAM-Sport scores, VAS, goniometric ROM (plantar flexion, dorsiflexion, inversion, eversion), and SEBT (anterior, posteromedial, posterolateral).


Subjects in all groups posttest demonstrated an increase in FAAM, FAAM Sport, ROM, and SEBT in all directions but not in VAS, which decreased. No other results were significant.


For subjects with CAI, dynamic postural control, ROM, pain and disability improved pretest to posttest regardless of group membership, with the largest effects found in most measures in the DBT/GISTM group.

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

plane ankle joint position sense. Similarly, Terada et al 33 concluded that kinematic movement patterns during a drop jump with a feed-forward visual intervention were altered in those with CAI. Therefore, clinicians should focus their treatment interventions in those with mechanical deficits on feed

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Ji-Hyun Lee and Tae-Lim Yoon

initial injury, 1 in 3 patients shows progression to CAI. 5 Patients with CAI exhibit common symptoms (feeling of recurrent instability and repeated episodes of giving way), 6 , 7 mechanical deficits (joint laxity and muscle weakness), 8 and sensorimotor deficits (proprioception and balance

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Abbis Jaffri, John J. Fraser, Rachel M. Koldenhoven, and Jay Hertel

residual symptoms in the ankle after a lateral ankle sprain. 4 Mechanical deficits may include joint laxity, arthrokinematics restrictions, osteoarthritic changes, and synovial changes. 2 , 4 Functional instability is a consequence of neurophysiological impairments that include proprioceptive deficits