As part of a larger investigation and evolution of rehabilitation paradigms for those with chronic ankle instability (CAI), Cameron J. Powden, PhD, LAT, ATC, assistant professor, Department of Applied Medicine and Rehabilitation at Indiana State University, led a research team with colleagues from the University of Kentucky and Old Dominion University, to examine the effects of a 4-week multimodal rehab program on range of motion (ROM), strength, and balance in those with CAI.
“In the literature prior to this, there had been many investigations that examined isolated interventions. However, within a typical rehabilitation setting, we do not use isolated treatment,” Powden said. “We typical combine treatments to strive to reach our patients’ goals. Thus, we felt that one of the natural evolutions was to see what combining the most successful interventions in the literature would do in regards to enhancing the most common CAI deficits.”
The results were reported in the poster, Effects of a Multimodal 4-Week Intervention on Range of Motion, Balance and Ankle Strength in Those With Chronic Ankle Instability,3 which revealed this multi-modal intervention has the ability to lead to robust improvements in a wide range of CAI impairments.
“Many of us suffer from disability due to a previous ankle sprain, it is probably one of the most common conditions in the United States for individuals that are physically active,” Powden said. “While we may not feel these injuries create a large impact, we are beginning to see the long-term health deficits, increased risk of osteoarthritis, and the decreases in physical activity levels in this population.”
This highlights the need for clinically relevant studies to address the situation, which is a reason Powden chose to include measures that were relevant to clinical practice—range of motion, strength, and balance. The researchers used a patient population of 20 physically active adults (15 female, 5 male) with self-reported CAI, and the 4-week intervention consisted of a dozen supervised rehab sessions and daily home exercise. Supervised rehab included progressive balance training, PNF ankle strengthening and Maitland grade III anterior-to-posterior talocrural joint mobilizations. At home rehab included gastroc-soleus complex stretching and resistance-band ankle strengthening.
The researchers concluded that the 4-week program significantly improved ROM, ankle strength and postural control for as much as 2 weeks for those who completed the study. The improvements were equal to or stronger than those demonstrated in the literature for many of the isolated interventions.
Furthermore, the study provided a great model for clinicians as it presents a simple intervention and many meaningful outcomes that could be collected to track progress in this population.
“You are always hoping that an intervention will be effective when you test it. However, the human body is a never as straight forward as we would like,” Powden said. “Also, by combining interventions there was concern that this may be overload for patients or that interventions may negatively affect each other and lead to decreased effects. We are happy to say that this was not the case though and we saw large improvements.”
Keith Loria is a freelance writer
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Cain MS, Goerger BM, Linens SW. A Randomized Controlled Trial Investigating the Effects of a 4-Week Ankle Rehabilitation Program on Static Balance Tasks in High School Athletes With Chronic Ankle Instability.
Powden CJ, Hoch JM, Jamali BE, Hoch MC. Effects of a Multimodal 4-Week Intervention on Range of Motion, Balance and Ankle Strength in Those With Chronic Ankle Instability.
Burcal CJ, Sandrey MA, Hubbard-Turner TJ, McKeon PO. Improving Balance in Patients with Chronic Ankle Instability: A Clinical Prediction Rule for Balance Training.
Joo-Sung K, Dong-Ho P, Chang-Sun K, et.al. Reactive Balance Following Acute Lateral Ankle Sprain.