August 2018

CAI Is Unique to Each Ankle, Treatment Should Be Too

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“Balance training isn’t a cookie-cutter treatment that should be used for every patient with CAI,” said Christopher J. Burcal, PhD ATC, co-director of Omaha Sports Medicine Research Laboratory and assistant professor of athletic training at the University of Nebraska at Omaha’s School of Health and Kinesiology. “A quick screening of balance and self-reported function can significantly increase the likelihood of your patient having a meaningful improvement in balance after balance training.”

Burcal grew curious after reviewing McKeon’s work on sensory-targeted rehabilitation strategies (STARS), and became curious as to whether his data would exhibit a similar pattern of responders/non-responders with balance training.

“I solicited authors who have published manuscripts using the McKeon balance training protocol and asked if they would be interested in helping me with this project. Then we pooled all of our data together and identified patients who significantly improved their balance after balance training (responders) and those who didn’t (non-responders),” Burcal explained. “We wanted to identify what factors a clinician may be able to screen for, or predict a successful response to balance training, using regression models and contingency tables.”

In his study, data was analyzed from 73 patients with CAI who took part in six previous balance training investigations and the results were presented in the poster, Improving Balance in Patients with Chronic Ankle Instability: A Clinical Prediction Rule for Balance Training.4

Around 40% of patients had a meaningful improvement in balance after completing a 4-week program and a 15% increase in normalized STAR Excursion Balance Test reach distance. That led the team to conclude that while balance training isn’t the ideal treatment for every patient with CAI, for patients who have poor balance, it is a highly effective intervention.

“I think the results reinforce the need for individualized care, especially for patients with CAI,” Burcal said. “We know a lot of treatments are efficacious in this population, and now as a field we’re testing to see how effective they are in patients with CAI as a whole, as well as the different sub-groups of CAI. The hope is to have a set of clinical prediction rules that are validated in large populations of patients with CAI, much like we see with [sacroiliac joint] dysfunction and low back pain.”

Keith Loria is a freelance writer


Farraye B, Herzog V. The Effect of Kinesiology Tape on Balance in Dancers With Ankle

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, Reactive Balance Following Acute Lateral Ankle Sprain.

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