Effect of Backward Walking Versus Balance Training in Chronic Ankle Instability Patients
Condition: Chronic Ankle Instability
Study type: Interventional

Summary: 
      The goal of this clinical trial is to investigate the effect of backward walking versus
      balance training in patients with chronic ankle instability. The main question it aims to
      answer is:

      Is there a difference between the effect of balance training and BW training on balance,
      ankle proprioception, risk of fall, and functional limitations in CAI patients?
    

Detailed description: 
      Lateral ankle sprains are among the most common musculoskeletal injuries. Approximately 40%
      of individuals who have ever suffered any lateral ankle sprain will develop chronic ankle
      instability which is defined as posterior mechanical and functional deficits in this joint.

      Balance is the process that maintains the center of gravity within the body's support base,
      which needs constant adjustments with joint positioning and muscular activity. Many
      musculoskeletal and nervous system diseases can alter balance control. It has been reported
      that individuals with CAI have poor static and dynamic balance compared to those with normal
      ankles, and this affection of balance, increases the falling risks and leads to serious
      injuries.

      A reversal of normal walking is simply recognized as retro-walking or backward walking (BW),
      where the toes first reach the ground and finish with the heel off. BW training causes
      changes in the motion control system and gait characteristics and exerts a positive effect on
      postural stability.

      Sixty patients with chronic ankle instability will be assigned randomly into 3 equal groups;
      group A will receive BW training in addition to the traditional physical therapy program for
      3 sessions/ week, over 6 weeks periods, Group B: will receive balance training on Biodex
      balance system in addition to the traditional physical therapy program for 3 sessions/ week,
      over 6 weeks periods, group C: will receive the traditional physical therapy program only for
      3 sessions/ week, over 6 weeks periods.
    

Intervention name(s): Backward Walking Training; Balance Training; Conventional treatment
Intervention type(s): Device; Device; Other
Intervention description(s): The subjects in this group will receive BW training program on an electric treadmill. The subject will be asked to walk, arms beside, in a backward manner on a level treadmill, zero inclination, with a warming up and cooling down period (5 minutes for each period). The subject walks at his self-selected and comfortable walking speed. A warm-up and cool-down period, in form of light jogging on a treadmill, will be done at speed of 1-2 m/sec. The total training is 30 minutes, three times a week for six consecutive weeks.; Subjects in this group will receive balance training on Biodex Balance System for 3 sessions/ week, over 6 weeks period. Each subject will be instructed to stand with both legs on the "locked" platform. The researcher advances the platform to an unstable state while instructing the subject to focus on the visual feedback screen. Arms are free at the side of the body and not grasping handrails.
After selecting the stability training program (dynamic balance training), Stability levels are changed depending on the subject's ability to maintain balance, and subjects are instructed to maintain their Center of Pressure (COP) in the smallest concentric rings (balance zones) of the Biodex Balance System monitor, named A zone.
The stability level of the platform is set at level plate stability 8 (the most stable) for the first two sessions. After that, the plate stability is decreased by one level every two sessions to increase the difficulty in training.; Patients in this group will receive the traditional physical therapy program only for 3 sessions/ week, over 6 weeks period. The traditional physical therapy program is (evertors strengthening, short foot ex, heel raise ex, and calf stretch).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Backward Walking Training and Balance Training
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment