Table 2. Methodologic summary of the studies included in the review (continued on next page).
Author Study design Comparison group Ankle instability group inclusion criteria Exclusion criteria Task Outcome measures Results
Brown et al (2004) Case-control study FI (n = 10) CON (n = 10) Skill level from recreational to club sport who perform 30 minutes, 3 times per week Recurrent ankle sprain at least 2 in the 1 year Feeling of “giving way” with activity AJFAT A 20 Had lower extremity injury in 3 months before History of lower extremity surgery Single-leg jump landing (50% of maximum jump height) Percentage of mean EMG amplitude for TA, PL, GCM, SOL in pre-landing (200 ms before) and during landing phase (1000 ms after) No significant differences between groups were found in the 200 ms before landing for any muscle Only the SOL exhibited significant differences between groups in the 1000 ms after landing. The CON had significantly higher mean EMG amplitude after landing compared with the FI group
Brown et al (2008) Case-control study FI (n = 21) MI (n = 21) Coper (n = 21) Recreational activity at least 1.5 total hours of cardiovascular, resistance, sport-related, or other physical activity per week. History of acute inversion ankle sprain requiring immobilization or non–weight bearing for at least 3 days. Repeated episodes of “giving way” Complaints of ankle instability secondary to the initial sprain, with a minimum of 2 episodes of giving way or spraining in the past 12 months Positive anterior drawer and/or talar tilt test (MI) Negative anterior drawer and/or talar tilt test (FI) History of surgery or any ankle fracture Had lower extremity injury in the past 3 months Obvious swelling or discoloration Ankle pain, gross limitations in ankle ROM, self-reported instability of the knee or hip Current enrollment in a rehabilitation program Single-leg drop jump landing (from 32 cm height) & running stop jump landing Normalized magnitude of peak V, A, P, M, L GRF (xBW) TTP V, A, P, M, L GRF (ms) Drop jump landing: No significant difference between groups in peak GRF and TTP GRF Running stop jump: No significant difference between groups in peak GRF and TTP GRF
Caulfield et al (2004) Case-control study FI (n=12) CON (n=10) Involved in sporting activities History of a minimum of 2 inversion injuries requiring a period of protected weight bearing and/ or immobilization Chronically weaker, more painful, and less function Complaints are reported to be secondary to past history of inversion sprain History of fracture to the lower extremity History of neurological or vestibular illness Single-leg jump landing (from 40 cm height) & forward jump landing (from 100 cm distance) IEMG for SOL, PL, TA in pre-landing (150 ms before) and during landing phase (150 ms after) No significant differences between the groups in terms of SOL or TA IEMG activity before or after impact in either jumping activity Increase in TA activity before impact in downward jump and a decrease in TA before impact in the jump for distance in the FI group compared with controls The FI group exhibited a statistically significant reduction in PL IEMG compared with the control group during the pre-impact period in both jumping activities
Caulfield and Garrett (2004) Case-control study FI (n=10) CON (n=14) Participants in recreational sporting activities History of a minimum of 2 inversion injuries Chronically weaker, more painful, and less function of ankle Giving way during sporting activities Receiving rehabilitation at the time of the study History of fracture to the lower extremity Single-leg jump landing (from 40 cm height) Normalized magnitude of peak V, A, P, M, L GRF (%BM) TTP V, A, P, M, L GRF (ms) Peak L and A peak GRF occurred significantly earlier in subjects with FI. Significant differences in time-averaged vertical, frontal and sagittal components of GRF
Delahunt et al (2006) Case-control study FI (n = 24) CON(n = 21) History of a minimum of 2 inversion injuries requiring a period of protected weight-bearing and/or immobilization Chronically weaker, more painful, and less function Reports a tendency for the ankle to give way during sporting activities Complaints are reported to be secondary to past history of inversion sprain History of fracture to the lower extremity History of neurological or vestibular impairments Receiving formal rehabilitation program Single-leg drop landing(from 35 cm height) IEMG activity for SOL, PL, TA in pre-landing (200 ms before) and during landing phase (200 ms after) TTP V L, M, P GRF (ms) Significant decrease in pre-landing of PL IEMG FI subjects had an increase in the V GRF during the time period of 35–60 ms after IC and a more medially directed GRF during the time period of 85–105 ms after IC FI subjects had an increased P GRF during the time period after IC and reached their TTP P GRF earlier than CON
De Ridder et al (2015) Case-control study CAI (n = 30) CON (n = 30) Coper (n = 28) History of at least one ankle sprain which resulted in pain, swelling and stiffness prohibiting participation in sport, recreational or other activities for at least 3 weeks Repeated ankle sprains Presence of giving way Feeling of weakness around the ankle Decreased functional participation as result of ankle sprains History of ankle fracture or surgery, lower-limb pain Having equilibrium deficits Single-leg drop landing (from 40 cm height) Normalized magnitude of peak V GRF TTP V GRF (sec) The CAI group displayed a higher peak vertical GRF and reached this vertical peak faster than the CON for the vertical drop
Doherty et al (2015) Case-control study CAI (n = 28) Coper (n = 42) CAIT < 24 Severe lower extremity injury in the past 6 months History of ankle fracture and surgery History of neurological disease, vestibular or visual disturbance Single-leg drop landing (from 40 cm height) Normalized magnitude of peak V GRF No significant differences for peak V GRF
Lee et al (2017) Case-control study CAI (n = 19) CON (n = 19) History of at least 1 acute lateral ankle sprain that resulted in swelling, pain, and temporary loss of function At least 1 episode of the ankle giving wayin the previous 6–24 months CAIT < 27 History of lower extremity injury. History of other lower extremity injury within the past 6 months History of lower extremity fracture or surgery Single-leg drop landing (from 40 cm height) Normalized magnitude of peak V GRF The peak V GRF was significantly reduced at post fatigue in both athletes with CAI and control
Lin et al (2011) Case-control study CAI (n = 15) CON (n = 15) Having at least 1 ankle sprain that resulted in swelling, pain, and protected weight bearing and/or immobilization of the injured ankle Having episodes of the ankle “suddenly giving way” and at least 2 ankle sprains within the past 2 years Suffering from ankle sprain at least once in the past 6 months CAIT C 27 The ligamentous integrity of the ankle joint was evaluated for each participant via an anterior drawer test, a posterior drawer test, and a talar tilt test. History of lower extremity fractures or any serious orthopedic injury Acute inflammation in the lower extremities Double-leg running stop jump landing RMS of PL in pre-landing (100 ms to IC) and during landing (IC to 100 ms) phase No significant differences for RMS of PL in both phase
Suda et al (2009) Case-control study FI (n = 21) CON (n = 19) History of at least 1 sprain needing practice leave more than 3 months Instability complaints: tendency for the ankle to give way during sports activities Difficulties in walking and running on irregular surfaces Difficulty to jump and change directions and sprain recurrence. Negative results in the ADT No information Double-leg vertical jump landing after volleyball blocking RMS values for TA, PL, GCM in pre-landing (200 ms before) and during landing (200 ms after) phase The RMS value of PL was significantly lower in FI in the before landing phase, and the RMS value of the TA muscle was significantly higher in the after landing phase
Zhang et al (2012) Case-control study CAI (n = 10) CON (n = 10) Screening use AJFAT Arch index measurements Multiple ankle sprains in past 12 months and beyond Ankle sprains in past 3 months Double-leg drop landing (from 60 cm height) Normalized magnitude of peak V GRF TTP V GRF (sec) The peak V GRF for no brace was smaller than a semi rigid ankle brace The TTP V GRF was significantly shorter in semi rigid ankle brace compared with no brace and a soft ankle brace and in a soft ankle brace compared with no brace
A, anterior; ADL, activity of daily living; AII, ankle instability instrument; AJFAT, ankle joint junctional assessment tool; ATSF, anterior tibial shear force; xBW, normalized to multiple of body weight; CAI, chronic ankle instability; CAIT, Cumberland ankle instability tool; CON, control group; EMG, electromyography; FI, functional instability; GCM, gastrocnemius; GRF, ground reaction force; IC, initial contact; IEMG, integrated electromyography; L, lateral; M, medial; MI, mechanical instability; P, posterior; PL, peroneus longus; RMS, root mean square; SOL, soleus; TA, tibialis anterior; TTP, time to peak; V, vertical.