Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Sports Medicine
Published in: Sports Medicine 4/2018

01-04-2018 | Systematic Review

Balance Training Does Not Alter Reliance on Visual Information during Static Stance in Those with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Authors: Kyeongtak Song, Evan Rhodes, Erik A. Wikstrom

Published in: Sports Medicine | Issue 4/2018

Login to get access

Abstract

Background

Visual, vestibular, and somatosensory systems contribute to postural control. Chronic ankle instability (CAI) patients have been observed to have a reduced ability to dynamically shift their reliance among sources of sensory information and rely more heavily on visual information during a single-limb stance relative to uninjured controls. Balance training is proven to improve postural control but there is a lack of evidence regarding the ability of balance training programs to alter the reliance on visual information in CAI patients.

Objective

Our objective was to determine if balance training alters the reliance on visual information during static stance in CAI patients.

Methods

The PubMed, CINAHL, and SPORTDiscus databases were searched from their earliest available date to October 2017 using a combination of keywords. Study inclusion criteria consisted of (1) using participants with CAI; (2) use of a balance training intervention; and (3) calculation of an objective measure of static postural control during single-limb stance with eyes open and eyes closed. Sample sizes, means, and standard deviations of single-leg balance measures for eyes-open and eyes-closed testing conditions before and after balance training were extracted from the included studies. Eyes-open to eyes-closed effect sizes [Hedges’ g and 95% confidence intervals (CI)] before and after balance training were calculated, and between-study variability for heterogeneity and potential risks of publication bias were examined.

Results

Six studies were identified. The overall eyes-open to eyes-closed effect size difference between pre- and post-intervention assessments was not significant (Hedges’ g effect size = 0.151, 95% CI = − 0.151 to 0.453, p = 0.26). This result indicates that the utilization of visual information in individuals with CAI during the single-leg balance is not altered after balance training. Low heterogeneity (Q(5) = 2.96, p = 0.71, I 2 = 0%) of the included studies and no publication bias were found.

Conclusion

On the basis of our systematic review with meta-analysis, it appears that traditional balance training protocols do not alter the reliance on visual information used by CAI patients during a single-leg stance.
Literature
1.
Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.PubMedPubMedCentral
2.
Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.CrossRefPubMed
3.
Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med. 2007;14(7):641–5.CrossRefPubMed
4.
Cameron K, Owens BD, DeBerardino TM. Incidence of ankle sprains among active-duty members of the United States Armed Services from 1998–2006. J Athl Train. 2010;45:29–38.CrossRefPubMedPubMedCentral
5.
Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Jt Surg Am. 2010;92(13):2279–84.CrossRef
6.
7.
Soboroff SH, Pappius EM, Komaroff AL. Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clin Orthop Relat Res. 1984;183:160–8.
8.
Doherty C, Bleakley C, Hertel J, et al. Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med. 2016;44(4):995–1003.CrossRefPubMed
9.
Delahunt E, Monaghan K, Caulfield B. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res. 2006;24(10):1991–2000.CrossRefPubMed
10.
Gutierrez GM, Knight CA, Swanik CB, et al. Examining neuromuscular control during landings on a supinating platform in persons with and without ankle instability. Am J Sports Med. 2012;40(1):193–201.CrossRefPubMed
11.
Hass CJ, Bishop MD, Doidge D, et al. Chronic ankle instability alters central organization of movement. Am J Sports Med. 2010;38(4):829–34.CrossRefPubMed
12.
Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture. 2010;32(2):82–6.CrossRefPubMed
13.
Wikstrom EA, Hass CJ. Gait termination strategies differ between those with and without ankle instability. Clin Biomech. 2012;27(6):619–24.CrossRef
14.
Wikstrom EA, Tillman MD, Chmielewski TL, et al. Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability. Scand J Med Sci Sports. 2010;20(1):137–44.CrossRef
15.
Hoch MC, McKeon PO, Andreatta RD. Plantar vibrotactile detection deficits in adults with chronic ankle instability. Med Sci Sports Exerc. 2012;44(4):666–72.CrossRefPubMed
16.
Powell MR, Powden CJ, Houston MN, et al. Plantar cutaneous sensitivity and balance in individuals with chronic ankle instability. Clin J Sports Med. 2014;24(6):490–6.CrossRef
17.
Burcal CJ, Wikstrom EA. Plantar cutaneous sensitivity with and without cognitive loading in people with chronic ankle instability, copers, and uninjured controls. J Orthop Sports Phys Ther. 2016;26:1–24.
18.
Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015;50(10):1019–33.CrossRefPubMedPubMedCentral
19.
20.
Verhagen RA, de Keizer G, Van Dijk CN. Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg. 1995;114:92–6.CrossRefPubMed
21.
Hubbard-Turner T, Wikstrom EA, Guderian S, et al. An acute lateral ankle sprain significantly decreases physical activity across the lifespan. J Sports Sci Med. 2015;14(3):556–61.PubMedPubMedCentral
22.
23.
Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 international ankle consortium consensus statement on the prevalence, impact, and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–505.CrossRefPubMed
24.
Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2013;43(8):585–91.CrossRefPubMed
25.
Valderrabano V, Hintermann B, Horisberger M, et al. Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med. 2006;34(4):612–20.CrossRefPubMed
26.
Hirose K, Murakami G, Minowa T, et al. Lateral ligament injury of the ankle and associated articular cartilage degeneration in the talocrural joint: anatomic study using elderly cadavers. J Orthop Sci. 2004;9(1):37–43.CrossRefPubMed
27.
Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.PubMedPubMedCentral
28.
Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med. 2008;27(3):353–70.CrossRefPubMed
29.
McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing. J Athl Train. 2008;43(3):293–304.CrossRefPubMedPubMedCentral
30.
Wikstrom EA, Brown CN. Minimum reporting standards for copers in chronic ankle instability research. Sports Med. 2014;44(2):251–68.CrossRefPubMed
31.
Wikstrom EA, Naik S, Lodha N, et al. Balance capabilities after lateral ankle trauma and intervention: a meta-analysis. Med Sci Sports Exerc. 2009;41(6):1287–95.CrossRefPubMed
32.
Arnold BL, De La Motte S, Linens S, et al. Ankle instability is associated with balance impairments: a meta-analysis. Med Sci Sports Exerc. 2009;41(5):1048–62.CrossRefPubMed
33.
Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport. 2010;13:2–12.CrossRefPubMed
34.
Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol. 2002;88(3):1097–118.CrossRefPubMed
35.
Nashner L, Berthoz A. Visual contribution to rapid motor responses during postural control. Brain Res. 1978;150(2):403–7.CrossRefPubMed
36.
Hazime FA, Allard P, Ide MR, et al. Postural control under visual and proprioceptive perturbations during double and single limb stances: insights for balance training. J Bodyw Mov Ther. 2012;16(2):224–9.CrossRefPubMed
37.
Wikstrom EA, Song K, Pietrosimone BG, et al. Visual utilization during postural control in anterior cruciate ligament- deficient and -reconstructed patients: systematic reviews and meta-analyses. Arch Phys Med Rehabil. 2017;98(10):2052–65.CrossRefPubMed
38.
Popa T, Bonifazi M, Della Volpe R, et al. Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res. 2007;177(3):411–8.CrossRefPubMed
39.
McKeon JM, McKeon PO. Evaluation of joint position recognition measurement variables associated with chronic ankle instability: a meta-analysis. J Athl Train. 2012;47(4):444–56.CrossRefPubMedPubMedCentral
40.
McKeon PO, Booi MJ, Branam B, et al. Lateral ankle ligament anesthesia significantly alters single limb postural control. Gait Posture. 2010;32(3):374–7.CrossRefPubMed
41.
McKeon PO, Stein AJ, Ingersoll CD, et al. Altered plantar-receptor stimulation impairs postural control in those with chronic ankle instability. J Sport Rehabil. 2012;21(1):1–6.CrossRefPubMed
42.
Riemann BL, Myers JB, Stone DA, et al. Effect of lateral ankle ligament anesthesia on single-leg stance stability. Med Sci Sports Exerc. 2004;36(3):388–96.CrossRefPubMed
43.
Hertel J, Guskiewicz KM, Kahler DM, et al. Effect of lateral ankle joint anesthesia on center of balance, postural sway, and joint position sense. J Sport Rehabil. 1996;2:111–9.CrossRef
44.
Corbin DM, Hart JM, McKeon PO, et al. The effect of textured insoles on postural control in double and single limb stance. J Sport Rehabil. 2007;16(4):363–72.CrossRefPubMed
45.
Song K, Burcal C, Hertel J, et al. Increased visual utilization in chronic ankle instability: a meta-analysis. Med Sci Sports Exerc. 2016;48(10):2046–56.CrossRefPubMed
46.
Wang HK, Chen CH, Shiang TY, et al. Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility. Arch Phys Med Rehabil. 2006;87(6):821–5.CrossRefPubMed
47.
McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? J Athl Train. 2008;43(3):305–15.CrossRefPubMedPubMedCentral
48.
Delahunt E, Coughlan GF, Caulfield B, et al. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc. 2010;42(11):2106–21.CrossRefPubMed
49.
Bernier JN, Perrin DH. Effect of coordination training on proprioception of the functionally unstable ankle. J Orthop Sports Phys Ther. 1998;27(4):264–75.CrossRefPubMed
50.
Lee AJ, Lin WH. Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin Biomech (Bristol, Avon). 2008;23(8):1065–72.CrossRef
51.
Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2013;48(13):1014–8.CrossRefPubMed
52.
Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.PubMed
53.
Morris SB. Estimating effect sizes from the pretest-posttest-control group designs. Organ Res Methods. 2007;11(2):364–86.CrossRef
54.
Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic Press; 1985.
55.
Borenstein M, Hedges LV, Higgins JP, et al. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.CrossRefPubMed
56.
57.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Erlbaum; 1988.
58.
59.
Rothstein H, Sutton AJ, Borenstein M, et al. Publication bias in meta-analysis : prevention, assessment and adjustments. Hoboken: Wiley; 2005.CrossRef
60.
61.
Huang PY, Chen WL, Lin CF, et al. Lower extremity biomechanics in athletes with ankle instability after a 6-week integrated training program. J Athl Train. 2014;49(2):163–72.CrossRefPubMedPubMedCentral
62.
Burcal CJ, Trier AY, Wikstrom EA. Balance training vs. balance training with STARS in CAI patients: a randomized controlled trial. J Sport Rehabil. 2017;26(5):347–57.CrossRefPubMed
63.
McKeon PO, Ingersoll CD, Kerrigan DC, et al. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):1810–9.CrossRefPubMed
64.
Drewes LK. Effects of rehabilitation incorporating short foot exercises on functional outcomes for chronic ankle instability [PhD]. Ann Arbor: University of Virginia; 2009.
65.
Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2007;37(6):303–11.CrossRefPubMed
66.
Rozzi SL, Lephart SM, Sterner R, et al. Balance training for persons with functionally unstable ankles. J Orthop Sports Phys Ther. 1999;29(8):478–86.CrossRefPubMed
67.
Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113–25.CrossRefPubMed
68.
Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurological physical therapy. J Neurol Phys Ther. 2006;30(3):120–9.CrossRefPubMed
69.
McKeon PO. Dynamic systems theory as a guide to balance training development for chronic ankle instability. Athl Train Sports Health Care. 2012;4(5):230–6.CrossRef
70.
Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 2013;43(6):385–93.CrossRefPubMed
71.
LeClaire JE, Wikstrom EA. Massage for postural control in those with chronic ankle instability. Athl Train Sports Health Care. 2012;4(5):213–9.CrossRef
72.
73.
Wikstrom EA, Song K, Lea A, Brown N. Comparative effectiveness of plantar massage techniques on postural control in those with chronic ankle instability. J Athl Train. 2017;52(7):629–35.CrossRefPubMed
74.
Hoch MC, McKeon PO. Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. J Orthop Res. 2011;29(3):326–32.CrossRefPubMed
75.
Hoch MC, Andreatta RD, Mullineaux DR, et al. Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. J Orthop Res. 2012;30(11):1798–804.CrossRefPubMed
76.
Cruz-Diaz D, Lomas Vega R, Osuna-Perez MC, et al. Effects of 6 weeks of balance training on chronic ankle instability in athletes: a randomized controlled trial. Int J Sports Med. 2015;36(9):754–60.CrossRefPubMed
77.
78.
Ross SE, Arnold BL, Blackburn JT, et al. Enhanced balance associated with coordination training with stochastic resonance stimulation in subjects with functional ankle instability: an experimental trial. J Neuroeng Rehabil. 2007;4:47.CrossRefPubMedPubMedCentral
79.
Ross SE, Guskiewicz KM. Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects with functional ankle instability and subjects with stable ankles. Clin J Sport Med. 2006;16:323–8.CrossRefPubMed
80.
Ashton-Miller JA, Wojts EM, Huston LJ, et al. Can proprioception really be improved by exercises? Knee Surg Sports Traumatol Arthrosc. 2001;9:128–36.CrossRefPubMed
81.
Ivanenko YP, Talis VL, Kazennikov OV. Support stability influences postural responses to muscle vibration in humans. Eur J Neurosci. 1999;11(2):647–54.CrossRefPubMed
82.
Lubetzky-Vilnai A, McCoy SW, Price R, et al. Young adults largely depend on vision for postural control when standing on a BOSU ball but not on foam. J Strength Cond Res. 2015;29(10):2907–18.CrossRefPubMed
83.
Hazime FA, Allard P, Ritomy Ide M, et al. Postural control under visual and proprioceptive perturbations during double and single limb stances: insights for balance training. J Bodyw Mov Ther. 2012;16:224–9.CrossRefPubMed
84.
Schut IM, Engelhart D, Pasma JH, et al. Compliant support surfaces affect sensory reweighting during balance control. Gait Posture. 2017;53:241–7.CrossRefPubMed
85.
Hutt K, Reding E. The effect of an eyes-closed dance-specific training program on dynamic balance in elite pre-professional ballet dancers. J Dance Med Sci. 2014;18(1):3–11.CrossRefPubMed
86.
Lefaivre SC, Almeida QJ. Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD? Gait Posture. 2015;41(2):630–3.CrossRefPubMed
87.
Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97(6):643–63.CrossRefPubMed
Metadata
Title
Balance Training Does Not Alter Reliance on Visual Information during Static Stance in Those with Chronic Ankle Instability: A Systematic Review with Meta-Analysis
Authors
Kyeongtak Song
Evan Rhodes
Erik A. Wikstrom
Publication date
01-04-2018
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 4/2018
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-017-0850-8

Other articles of this Issue 4/2018

Sports Medicine 4/2018 Go to the issue

Letter to the Editor

Author’s Reply to Lv: Comment on: “Genetic Variants and Anterior Cruciate Ligament Rupture: A Systematic Review”

Systematic Review

Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis

Original Research Article

Tanner–Whitehouse Skeletal Ages in Male Youth Soccer Players: TW2 or TW3?

Review Article

The Importance of Muscular Strength: Training Considerations

Systematic Review

Injuries in Field Hockey Players: A Systematic Review

Current Opinion

Periodization Theory: Confronting an Inconvenient Truth