PROPRIOCEPTIVE TRAINING IN THE COMPLEX FUNCTIONAL RECOVERY AFTER LATERAL ANKLE SPRAIN

Abstract

The lateral ankle sprain is one of the most common injuries, especially in competitive sports and
recreational activities, and often leads to residual symptoms, such as pain, subjective instability, loss of function,
repetitive injury and risk of developing chronic ankle instability. One of the most effective methods of improving
the dynamic stabilization and the complex function of the ankle is proprioceptive training. The aim of this report is
to present a physiotherapeutic program for functional recovery, with an emphasis on proprioception and balance
training, and to evaluate its effectiveness on static and dynamic postural control in patients with lateral ankle sprain.
Material and methods: Nine patients (mean age 25,6 years) with grade II lateral ankle sprain, treated non-operatively
participated in the study. The specialized physiotherapeutic program included exercises and techniques for
reactivation of the fibular muscles, and balance and proprioceptive training, performed on unstable surfaces. The
progression was made by moving from non-weight-bearing to weight-bearing position, and by decreasing the base
of support from bilateral to unilateral stance on the affected lower limb. Patients were challenged by incorporating
trunk perturbations, head, upper and lower extremity movements, as well as functional activities, performed on
unstable surfaces. The functional outcome and static and dynamic postural balance control were assessed using
static (One-leg stance) and dynamic (Y balance test) balance tests. Results: The baseline One leg stance and Y
balance test measures of our patients showed in general diminished static balance and impaired dynamic postural
control. The results of the last follow up after 8 weeks of proprioceptive training showed a statistically significant
improvement in all the investigated indicators, but a presence of a certain deficit was found in the assessment of
both static and dynamic stabilization. In order to achieve optimal functional results, the implementation of
specialized proprioceptive training should continue until the functional deficit is completely overcome. Conclusion:
Early inclusion of a specialized individualized physiotherapy and training of the proprioception and dynamic
stabilization could successfully reduce the deficit in neuromuscular control and static and dynamic balance. The
proprioceptive training should start as early as possible, should be individualized according to functional limitations
and arthrokinematic changes of the whole kinetic chain of the injured lower limb and patients’ capabilities, and
designed to provide successful return to previous functional level of activity and participation in recreational and
sports activities.