Balance Training vs. Balance Training w/ STARS
Condition: Ankle (Ligaments); Instability (Old Injury)
Study type: Interventional

Summary: 
      Chronic Ankle Instability (CAI) is a health condition that results in repeated ankle sprains
      and other residual impairments. CAI has been linked to many different causative factors
      including sensory and motor deficits that affect the global function of the sensorimotor
      system as well as the patient. Over the past 20 years, strong evidence has been generated to
      support balance training as an effective intervention strategy in the CAI population.
      Unfortunately, most investigations have focused solely on maximizing motor output through
      balance training, while ignoring the full spectrum of sensorimotor dysfunction associated
      with CAI. There may be advantageous sensory-targeted interventions that augment the effects
      of balance training and lead to greater enhancements of functional outcomes for CAI. However,
      this possibility has not been systematically explored. Sensory-targeted ankle rehabilitation
      strategies (STARS), such as joint mobilization and plantar massage have resulted in improved
      sensorimotor function in those with CAI. However, only a single STARS (i.e. stochastic
      resonance) has been investigated in combination with balance training. While the combined
      effects were greater than those of balance training alone, stochastic resonance requires
      relatively expensive equipment that is not commercially available. Thus, the purpose of this
      investigation is to test the hypothesis that combining low cost STARS (e.g. plantar massage
      and joint mobilizations) with balance training will result in greater sensorimotor and
      functional improvements in those with CAI than balance training alone.
    


Intervention name(s): Balance Training; STARS
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is a 4-week supervised balance training program that has been previously validated in those with CAI by improving subjective and objective measures of function. During the 4-week program, subjects will complete three 20-25 minute sessions a week for a total of twelve supervised training sessions. The specific exercises and repetitions that will be performed per training session will include: 1) hop to stabilization (10 repetitions per direction), 2) hop to stabilization and reach (5 repetitions per direction), 3) unanticipated hop to stabilization (3 repetitions), 4) progressive single limb stance balance activities (3 repetitions), and 5) progressive single limb stance activities with eyes closed (3 repetitions).; The STARS intervention will consist of 4 unique sensory-targeted interventions: calf stretching, ankle joint traction, anterior/posterior ankle joint mobilizations, and plantar massage. These four techniques target 3 types of sensory pathways (musculotendinous, articular, and plantar cutaneous, respectively) and will be applied in the same order for all treatment sessions: 1) 60-second calf stretch, 2) 30-second ankle traction, 3) 30-second mobilization, 4) 2-minute plantar massage, 5) 30-second ankle traction, and 6) 30-second mobilization.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chronic Ankle Instability