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Journal of Athletic Training






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Context Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention have not been evaluated for their effects on a multidimensional profile of health.

Objective To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI.

Design Controlled laboratory study.

Setting Laboratory.

Patients or Other Participants Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of "giving way" in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24.

Intervention(s) Individuals participated in 12 sessions over 4 weeks that consisted of balance training, ankle strengthening, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily.

Main Outcome Measure(s) Dorsiflexion range of motion (weight-bearing–lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure–Activities of Daily Living and Foot and Ankle Ability Measure–Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Belief Questionnaire–Physical Activity and Fear-Avoidance Belief Questionnaire–Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up).

Results Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure–Activities of Daily Living score, the modified Disablement in the Physically Active scale–physical summary component score, and the Fear-Avoidance Belief Questionnaire–Physical Activity score were improved at postintervention (P < .001; effect-size range = 0.72–1.73) and at the 2-week follow-up (P < .001; effect-size range = 0.73–1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001, effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P < .04; effect-size range = 0.61–0.78) and postintervention (P < .04) during the eyes-open condition.

Conclusion A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.


"Journal of Athletic Training and The Athletic Training Education Journal are both open access journals.

Consistent with the Budapest open access initiative (BOAI), all articles are free for users to access, read, download, and print. Information can be used providing that the source is appropriately acknowledged and/or referenced. An institution may post an author's manuscript in a digital repository. Any other posting on servers or replication of any content can be done only after obtaining permission from the NATA's publication office."

Original Publication Citation

Powden, C. J., Hoch, J. M., Jamali, B. E., & Hoch, M. C. (2019). A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes. Journal of Athletic Training, 54(1). doi:10.4085/1062-6050-344-17