SLR - October 2022 - Victoria H Liew, DPM
Mollà-Casanova S, Inglés M, Serra-Añó P. Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis. Clin Rehabil. 2021 Dec;35(12):1694-1709. doi: 10.1177/02692155211022009. Epub 2021 May 31. PMID: 34058832.Level of Evidence: 1
Reviewed by: Victoria H Liew, DPM
Program: Scripps Mercy San Diego Podiatry Residency California
Podiatric relevance: Chronic ankle instability is traumatizing to a patient and a long-term pathology. External supports are available however the pathology tends to cause alternative discomfort elsewhere on the body. The authors inquired if there were immediate effects of various therapeutic physical exercise interventions in patients with chronic ankle instability, on instability outcomes, functional outcomes, and dynamic balance.
Methods: Systematic search for articles that studied therapeutic exercise interventions in patients with chronic ankle instability until April 2021, inclusion criteria of randomized controlled design studies, and those involving recruitment methods based on the chronic ankle instability classification criteria. Excluded participants that reported acute symptomatology, lower extremity surgery, rheumatic problems, neurologic diseases, and balance deficits due to vestibular problems, vertebrobasilar insufficiency or visual deficits. Ultimately 15 randomized controlled trials with 457 volunteers included, validity of studies were assessed by physiotherapy evidence database scale. Clinical outcomes considered were ankle functionality, instability, and dynamic balance.
Results:
Different types of techniques were applied to balance training groups (unstable surface training, hope to stabilization training, single limb stance combined with unstable surface training, single limb stance with hope to stabilization training). Strength intervention included resistive tubing training and short foot exercise protocol.
Studies showed significant differences in functionality between the balance training group and control group. There were also significant differences between balance training and strength training for functionality, balance training more effective.
In balance training compared to control for functionality, instability improved greater in the balance training. Effectiveness of a balance intervention compared strength training for functionality, no significant difference for instability.
Balance training compared to control on instability showed instability improved in the balance training. When comparing effectiveness of balance to strength training, no significant difference for instability.
Balance training compared to control intervention had significant effect of balance training for improving dynamic balance. However, comparing the effectiveness of balance vs strength training there is no significant difference.
Conclusion: There is evidence that shows balance training significantly improves all the assessed outcomes reviewed. When compared to strength training, balance intervention was reported as more beneficial for functionality but not for instability nor dynamic balance, since no differences were seen. Authors concluded that balance training had similar benefits to strength training programs on dynamic balance. This is beneficial in the patient’s ability to sense motion and improve on joint mobility to compensate for an altered activity of the ankle ligament mechanoreceptors.
This prevents patients from undergoing surgical intervention. The risk for further damage to nearby anatomical structures is possible and any conservative measure is always sought after prior to surgery. This will help keep patients out of the OR longer and may even lead to a normalized alternative protocol for chronic ankle instability treatment. Although strength is equally as important, balance is the main factor. Proprioception is what keeps us alert and oriented to external factors around us. It is important to recreate the sense of balance and preventing further injuries.