The Effectiveness of Unilateral and Bilateral Exercise Training in Patients With Lateral Ankle Instability
Condition: Chronic Ankle Instability
MeSH terms: Joint Instability
Study type: Interventional

Summary: 
      70% of the general population suffers ankle injuries at least once in their lifetime. The
      ankle lateral ligament injuries cause an average of 6.9 days of work loss, and it has been
      reported that the quality of life of these patients is affected by their long-term results.
      Exercise training is important to prevent job loss, increase individuals' quality of life, or
      speed up their return to work. Functional or chronic insufficiency resulting from ankle
      ligament injury results in various abnormalities in the lower extremity. Motor coordination
      disorders due to instability, adhesions, peroneal muscle weakness, and loss of proprioception
      can be seen in the talus or subtalar joint. Instabilities are usually caused by loss of
      strength after an acute lateral ligament injury, hypomobility in the joint, inadequate
      improvement in proprioception, or inadequate healing of the ligament.

      Almost 40% of patients with lateral ankle injury develop a condition known as chronic ankle
      instability. The cause of chronic ankle instability is classified as mechanical ankle
      instability (MAI) and functional ankle instability (FAI). While MAI is caused by ligament
      laxity, other factors such as proprioceptive problems, neuromuscular problems, postural
      control deficiencies, and muscle weakness are caused by FAI. For this reason, peroneal muscle
      strengthening, Achilles tendon stretching, balance training, and proprioceptive training are
      shown as the most important components of the treatment program in the rehabilitation of
      ankle instabilities. (5) It has been reported by many researchers that functional instability
      can be reduced and repetitive injuries can be prevented in patients given proprioceptive
      training and peroneal muscle strengthening on the balance board. In the results of another
      study evaluating bilaterally in the lower limb after balance training given to the intact
      side in individuals with chronic ankle instability, it was stated that the balance function
      of the unstable ankle was developed.

      Although the treatment methods of ankle instability vary, there are very limited studies
      comparing treatment methods unilaterally and bilaterally in the ankle lateral instability in
      the literature. Our study will contribute to the literature to the next rehabilitation
      programs by comparing unilateral and bilateral exercise training prepared by rehabilitation
      protocols in many ways in two different groups.
    

Detailed description: 
      Ankle ligament injuries are one of the most common musculoskeletal injuries among physically
      active people, accounting for ~ 14% of all sports-related orthopedic clinic visits. And it is
      stated that injuries that delay the return to sports the most. 4% of these injuries and the
      most common are the lateral ankle ligament injuries. 70% of the general population, not only
      specific to sports, suffers ankle injuries at least once in their lifetime. The ankle lateral
      ligament injuries cause an average of 6.9 days of work loss, and it has been reported that
      the quality of life of these patients is affected by their long-term results. When people who
      play sports are taken into consideration, an ankle sprain can affect the quality of life of
      the individual, as well as reduce performance and keep it away from education and
      competition.

      Ankle sprains often occur during physical activities such as basketball and football, which
      require sudden stops, bounces, landings, and swings around a stable foot. Most lateral ankle
      sprains occur when combined with excessive inversion or adduction with additional plantar
      flexion.

      Functional or chronic deficiencies develop in the lower limbs as a result of ankle ligament
      injury, resulting in various abnormalities. Motor coordination disorders due to instability,
      adhesions, peroneal muscle weakness, and loss of proprioception can be seen in the talus or
      subtalar joint. Instabilities are usually caused by loss of strength after an acute lateral
      ligament injury, hypomobility in the joint, inadequate improvement in proprioception, or
      inadequate healing of the ligament. Almost 40% of patients with lateral ankle injury develop
      a condition known as chronic ankle instability (CAI). CAI is characterized by the occurrence
      of recurrent cases of instability that cause constant ankle sprain and the giving-way
      sensation of the ankle after the first ankle sprain. The diagnostic criteria are detailed in
      the International Ankle Consortium, Cumberland Ankle Instability Tool (CAIT) is often used to
      evaluate functional ankle instability.

      Among the most important factors causing instability in the ankle are proprioceptive
      disorders, pain, and muscle weakness. Therefore, rehabilitation programs generally focus on
      exercises that include muscle strengthening, balance training, neuromuscular training, and
      proprioceptive training protocols. In another combined supporting study, Huang et al.
      investigated the effects of combined balance exercises with plyometric exercise against
      plyometric exercise in individuals with functional ankle instability and showed that the
      combined program will reduce postural oscillation in static conditions, and improve stability
      and energy propagation models in dynamic postural control. One of the factors contributing to
      CAI is thought to be the loss of strength of the ankle circumference muscle groups in both
      concentric and eccentric directions. It is assumed that a decrease in the strength of the
      muscles of the more proximal joints, such as knee and hip, not just ankle oriented, may also
      be effective in the formation of CAI.

      It has been shown in systematic review and meta-analysis that proprioception disorder
      contributes to chronic ankle imbalance. In another study in individuals with unilateral
      chronic ankle instability, both extremities were evaluated in terms of strength and
      proprioception, a decrease in the sensation of kinesthesia was observed, and loss of eversion
      force and proprioceptive disorders were reported on both sides.

      Although ankle instability treatment approaches vary widely in all these studies, there is no
      detailed study comparing applications unilaterally and bilaterally in the literature. Our
      study will contribute to the literature to the next rehabilitation programs by comparing
      unilateral and bilateral exercise training prepared by rehabilitation protocols in many ways
      in two different groups
    

Intervention name(s): Unilateral Exercise Group; Bilateral Exercise Group
Intervention type(s): Other; Other
Intervention description(s): Exercise programs will be practiced 60 days, 2 days a week for 4 weeks. The entire exercise protocol will be carried out under the supervision of a physiotherapist. During the treatment session, participants exercises will only be done for 60 minutes with the affected lower extremities.; Exercise programs will be practiced 60 days, 2 days a week for 4 weeks. The entire exercise protocol will be carried out under the supervision of a physiotherapist. During the treatment session, participants will complete their exercises with both lower extremities for 30 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Lateral Ankle Instability; Unilateral Exercise; Billateral Exercise; Ankle