Training of proprioception in patients with chronic ankle instability

Lateral ankle sprains are one of the most common sports related injuries. Especially athletes performing basketball, volleyball and soccer are at risk for that type of injury. A traumatic lateral ankle sprain should not be considered a minor trauma. Up to 34% of patients with a lateral ankle sprain sustain a recurrent injury, 15 to 64% still are not fully recovered after 3 years and may develop chronic ankle instability (CAI). (Van rijn, 2008). Chronically respraining the ankle can cause articular damage requiring arthroscopic surgical intervention (Hintermann, 2002) and may even result in the development of posttraumatic osteoarthritis of the ankle joint (Valderrabano, 2006). It has been shown that lateral ankle sprains cause a substantially high medical cost (Verhagen, 2005). Therefore, the prevention of lateral ankle sprains is an important issue. For an effective prevention, the possible underlying cause(s) of CAI should be revealed. There is yet no consensus regarding which mechanism is responsible for the development of CAI. In literature, an impaired postural control is very often linked to CAI and there are strong indications that the dynamic postural control is impaired in patients with CAI (Munn, 2010). Several investigators used a one-leg stance test protocol for detecting a decreased postural control. However, ankle sprains mostly occur when landing on the ankle during running, jumping or walking. Therefore, research investigating postural control is recently more focussing on the application of dynamic test procedures (like measuring time-to-stabilization). Despite their clinical relevance, the used instruments are difficult to implement in clinical practice because they often require a lab setting with expensive, sophisticated equipment (force plates). Some studies evaluated the dynamic postural control in patients with CAI using a more simple test procedure (Demeritt, 2002; Eechaute, 2008 & 2009). In contrast with the study of Demeritt et al (2002), the multiple hop test has been shown to be a reliable and valid test for the evaluation of impaired dynamic postural control in patients with CAI (Eechaute, 2008 & 2009).