Chronic ankle instability (CAI) is diagnosed when symptoms (perceptions of the ankle ‘giving way’, pain, weakness, or limited ankle range of motion) have persisted for more than 1 year after an initial lateral ankle sprain. Therapeutic exercise is a key treatment for overcoming neuromuscular deficits in CAI. In this study, researchers from Israel’s Ariel University wanted to compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with CAI. They hypothesized that due to the potential effects on muscle strength and augmented sensory feedback of muscle contraction associated with NMES, greater improvement would be observed in this group versus a group using TENS.
They randomly assigned 34 participants with CAI to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex-TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAM).
The results showed significant improvements in both groups in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI −8.1, −0.2]) and FAAM (13.7 [95% CI 2.2,25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT.
While noting that their results do not allow for a definitive conclusion, the authors observed a consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit for reducing disability in this patient population.
Source: Gottlieb U, Hayek R, Hoffman JR, Springer S. Exercise combined with electrical stimulation for the treatment of chronic ankle instability – a randomized controlled trial. J Electromyogr Kinesiol. 2024;74:102856. doi: 10.1016/j.jelekin.2023.102856. Used with permission.
