Balance training for persons with functionally unstable ankles

Study Design: A nonrandomized 2-group pretest, posttest design. Objectives: To determine the effects of a 4-week balance training program during stance on a single leg. Background: Individuals who have experienced multiple episodes of inversion ankle sprains often participate in balance training programs. Balance training is performed to treat existing proprioceptive deficits and to restore ankle joint stability, presumably by retraining altered afferent neuromuscular pathways. The effectiveness of such programs on individuals with functionally unstable ankles has yet to be established. Methods and Measures: Prior to and following training, subjects with self-reported functionally unstable ankles (5 women and 8 men, mean age = 21.9 ± 3.1 years) and nonimpaired subjects (6 women and 7 men, mean age = 21.2 ± 2.5 years) completed a static balance assessment for both limbs as well as the ankle joint functional assessment tool questionnaire (AJFAT). The subjects from both groups participated in a unilateral, multilevel, static and dynamic balance training program 3 times a week for 4 weeks. Subjects from the experimental group trained only the involved limb, and the nonimpaired group trained a randomly selected limb. A stability index (SI) was calculated during the balance assessment to indicate the amount of platform motion. Compared to low stability indices, high stability indices indicate greater platform motion during stance and therefore less stability. Results: Following training, subjects from both groups demonstrated significant improvements in balance ability. When balance was assessed at a low resistance to platform tilt (stability level 2), the posttraining scores of both the subjects with unstable ankles (mean SI = 2.63 ± 1.92) and the nonimpaired subjects (mean SI = 2.69 ± 2.32) were significantly better than their pretraining scores (mean Sls = 5.93 ± 3.65 and 4.67 ± 3.43, respectively). Assessed at a high resistance to platform tilt (stability level 6), the posttraining scores of both subjects with unstable ankles (mean SI = 1.27 ± 0.66) and the nonimpaired subjects (mean SI = 1.37 ± 0.66) were significantly better than their pretraining scores (mean SIs- 230 ± 1.88 and 2.04 ± 1.43, respectively). Additionally, the posttraining AJFAT scores of subjects with unstable ankles (25.78 ± 3.80) and the nonimpaired subjects (29.15 ± 5.27) were significantly greater than their pretraining scores (17.11 ± 3.44 and 22.92 ± 5.22, respectively), indicating an overall improvement in perceived ankle joint functional stability. Conclusions: This study suggests that balance training is an effective means of improving joint proprioception and single-leg standing ability in subjects with unstable and nonimpaired ankles.