Effect of Balance Training Protocols on Balance, Proprioception, ROM, and Pain in Athlete With Chronic Ankle Instability
Condition: Chronic Ankle Instability
Study type: Interventional

Summary: 
      The ankle joint sustains injuries particularly in athletics/sports activities at a high rate,
      resulting in loss of static & dynamic balance, neuromuscular control, and diminished lower
      extremity's function. This study aimed to compare the effectiveness of two balance-training
      protocols on balance, proprioception, range of motion (ROM), and pain in male athletes with
      chronic ankle instability (CAI). Both the balance training protocols were proven to be
      equally effective in improving the static & dynamic balance, proprioception, ROM, and pain in
      athletes with CAI.
    

Detailed description: 
      Injuries to the lower extremity account for 55-90% of all sports injuries. Of these, the
      knee, ankle, and foot are generally the three most commonly injured anatomic parts in sports.
      The incidence of ankle injuries is quite high, constituting 20%-25% of all time-loss injuries
      in every running or jumping sport, including basketball, football, soccer, field hockey, and
      volleyball. Out of all ankle sprains injuries in sport, 85% cases comprised of lateral ankle
      sprain (LAS). Up to 74% sufferers of LAS have been accounted for the incidence of chronic
      ankle instability (CAI). Balance impairments developed as a by-product over extended duration
      of undermined treatment for ankle injuries. Previous study reported that the dynamic balance
      greater affected during performing double-leg stance by the patients with CAI than patient
      with stable ankle when measured by time-to-stabilization (TTS) in the direction of
      anterior-posterior post tibial nerve stimulation. Thus, concluded that that the value of
      longer time-to-stabilization indicate an increased relaxation time and after
      external-perturbation, relatively a longer time needed to identify to a stable pattern.

      The management of CAI include both non-surgical and surgical measures. Non-surgical approach
      includes use of electrical modalities, the rest, ice, compression and elevation of the limb
      (RICE) principle of therapy for pain relief, functional rehabilitation for gaining strength
      of the muscles of foot and ankle complex. Moreover, balance training program have been
      introduced successfully to achieve the static and dynamic balance in order to regain normalcy
      specially in athletes. Failure of functional rehabilitation indicates for the surgical
      intervention such as anatomic repair of the anterior talofibular and calcaneofibular
      ligaments, anatomic reconstruction with autograft or allograft, ankle arthroscopy when
      intra-articular conditions associated with chronic ankle instability.In literature, there is
      lack of focus on the Star Excursion Balance Training (SEBT) as well as Simplified Star
      Excursion Balance Training (SSEBT) which can be used as a balance training protocol for the
      improvement of dynamic balance especially in the cases of chronic ankle instability. Since,
      in addition to the static balance, the dynamic balance plays an important role to assesses
      the balance and neuromuscular control for lower extremity. As lower extremity balance has
      been linked to the ankle injuries and deteriorated performance in sports.[27]. Hence, the
      question arises whether a training program using either star excursion balance training
      (SEBT) or simplified star excursion balance training (SSEBT), can enhance the static and
      dynamic balance among athletes having chronic ankle instability? A total of 32-participants
      (male; aged between 18-25 years) with CAI randomly assigned to two groups to receive their
      postulated balance training protocols. Star excursion balance test, single-leg stance time,
      foot position sense, visual analog scale, and goniometer were used to assess the dynamic and
      static balance, proprioception, pain intensity, and ankle ROM respectively at pre-training
      (baseline) week 1st and post-training week 1st, 2nd, 3rd, and 4th (follow-up).

      Both the SEBT and SSEBT protocol proved to be equally effective in the improvement of static
      & dynamic balance, ankle joint position sense and ROM, and reduction in ankle pain among
      athletes with CAI. However, SSEBT protocol aid more advantage over SEBT protocol in terms of
      time consumption and level of muscle fatigue as it consumes less time and produces less
      fatigue-level because of its (SSEBT) less reaching task (3-directions only) compared to SEBT
      (8-directions only). Therefore, it is advice to the physical therapist to use the SSEBT
      protocol while dealing with the problem of static & dynamic balance, joint position sense,
      ROM, and pain among athletes with CAI.
    

Intervention name(s): star excursion balance training (SEBT); Simplified star excursion balance training (SSEBT)
Intervention type(s): Other; Other
Intervention description(s): The SEBT is aimed to be maintained the single limb stance on one leg while reaching farthest possible with the swing leg. An individual can reach farthest with the swing leg while maintaining the balance on the stance leg; It is one of the training protocols, in a simplified way, with respect to star excursion balance test. It consists a series of reaching tasks for the lower limbs in three-directions i.e., anteromedial, medial and posteromedial.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two-arm, parallel groups randomized comparative Trial.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment