Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability

Abstract

Introduction: Deficient sensory input from damaged ankle ligament receptors is thought to contribute to sensorimotor deficits in those with chronic ankle instability (CAI). Targeting other viable sensory receptors may then enhance sensorimotor control in these patients. The purpose of this randomized controlled trial was to evaluate the effects of 2 wk of sensory-targeted ankle rehabilitation strategies (STARS) on patient- and clinician-oriented outcomes in those with CAI.

Methods: Eighty patients with self-reported CAI participated. All patients completed patient-oriented questionnaires capturing self-reported function as well as the weight-bearing lunge test and an eyes-closed single-limb balance test. After baseline testing, patients were randomly allocated to four STARS groups: joint mobilization, plantar massage, triceps surae stretching, or control. Each patient in the intervention groups received six 5-min treatments of their respective STARS over 2 wk. All subjects were reassessed on patient- and clinician-oriented measures immediately after the intervention and completed a 1-month follow-up that consisted of patient-oriented measures. Change scores of the three STARS groups were compared with the control using independent t-tests and Hedges' g effect sizes with 95% confidence intervals.

Results: The joint mobilization group had the greatest weight-bearing lunge test improvement. Plantar massage had the most meaningful single-limb balance improvement. All STARS groups improved patient-oriented outcomes with joint mobilization having the most meaningful effect immediately after the intervention and plantar massage at the 1-month follow-up.

Conclusion: Each STARS treatment offers unique contributions to the patient- and clinician-oriented rehabilitation outcomes of those with CAI. Both joint mobilization and plantar massage appear to demonstrate the greatest potential to improve sensorimotor function in those with CAI.

Figure 1

The Sensory-Targeted Ankle Rehabilitation Strategies (STARS) interventions. All subjects allocated to the treatment groups completed 6 sessions of the randomly assigned STARS treatments.

Figure 2

Bias-corrected Hedge’s g estimates of effect size with 95% confidence intervals. All effect sizes were calculated based on the change in the respective STARS group in comparison to the change in the control group from baseline to post-test 2 and the 1 month follow up. Point measures that fall to the right of the zero line indicates that the STARS change was comparatively larger than the control group change. * indicates that the change also exceeded the minimum detectable change calculated from the reliability estimates of the opposite limb change from baseline to post-test 2. † indicates that the change in the STARS group exceeded the established minimum clinically important difference established for the outcome measure.

Figure 3

Bias-corrected Hedge’s g estimates of effect size with 95% confidence intervals. All effect sizes were calculated based on the change in the respective STARS group in comparison to the change in the control group from baseline to post-test 1 and post-test 2. Point measures that fall to the right of the zero line indicates that the STARS change was comparatively larger than the control group change. * indicates that the change also exceeded the minimum detectable change calculated from the reliability estimates of the opposite limb change from baseline to post-test 2.