Ha2018 PDF
Ha2018 PDF
Ha2018 PDF
The present study was conducted to investigate the effect of ankle ance ability. In the results, both proprioceptive sense and static dynam-
strengthening exercise applied on unstable supporting surfaces on the ic balance ability were significantly different between before and after
proprioceptive sense and balance in adults with functional ankle insta- the intervention in the experimental group (P< 0.05). When such results
bility. As for the study method, 30 adults with functional ankle instability are put together, it can be seen that ankle strengthening exercise ap-
were randomly assigned to an ankle strengthening exercise group and plied on unstable supporting surfaces may be presented as an effective
a stretching group on unstable supporting surfaces, and the interven- treatment method for enhancing the proprioceptive sense and balance
tions were implemented for 40 min. Before and after the interventions, a ability in adults with functional ankle instability.
digital dual inclinometer was used to measure the proprioceptive sense
of the ankle, the Balancia program was used to measure static balance Keywords: Ankle instability, Ankle strengthening exercise, Proprioception,
ability, and the functional reach test was used to measure dynamic bal- Balance
*Corresponding author: Yun-Hee Sung https://orcid.org/0000-0002-4877-9784 This is an Open Access article distributed under the terms of the Creative Commons At-
Department of Physical Therapy, College of Health Sciences, Kyungnam University, tribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon 51767, Korea which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Tel: +82-55-249-6334, Fax: +82-50-5999-2173, E-mail: [email protected]
Received: February 19, 2018 / Accepted: March 25, 2018
Copyright © 2018 Korean Society of Exercise Rehabilitation 301 http://www.e-jer.org pISSN 2288-176X
eISSN 2288-1778
Ha SY, et al. • Ankle strengthening exercise improves proprioception and balance
likely to be deteriorated (Bennell et al., 2003; Park, 2007). Stud- ter (Dualer IQ Digital Inclinometer, J-Tech, Salt Lake City, UT,
ies reported that ankle instability is attributable to the deficit of USA) was used as a tool to measure the ankle joint proprioceptive
the proprioceptive sense, and that to improve the proprioceptive sense. The test was performed by having the test subject maintain
sense, balance training through unstable supporting surfaces is the set targeted angle for 5 sec. While his/her vision was blocked,
necessary (Han et al., 2006; Willems et al., 2002). come back to the starting point, and actively return to the set an-
To treat FAI and manage activity disorders, proprioceptive gle. The measurement was conducted three times repeatedly in
sense training using balance training and unstable supporting total and the error angle deviated from the set angle was used as
surfaces, muscle strength exercises for strengthening weakened the test result value (Willems et al., 2002).
muscles through elastic band and isokinetic exercise, and manual
therapy are implemented among others (Mattacola and Dwyer, Static balance
2002; Willems et al., 2002). In particular, although exercises that To assess the static balance ability in the standing position, all
strengthen ankle muscles, proprioceptive exercises, and exercises participants took off their shoes and stood on the Wii comfortably
that improve balance account for a large part of ankle damage re- with their arms put down on both sides when the static balance
habilitation, systematic exercise programs for ankle instability ability was measured. The measurement was conducted for 30 sec
have not yet been concretely presented. Therefore, the present with both eyes open and was repeated three times and the average
study aimed to investigate whether ankle strengthening exercise value was used (Clark et al., 2010). Balancia software ver 2.0
programs applied to adults with FAI on unstable supporting sur- (Mintosys, Seoul, Korea) was used for analysis.
faces affect the improvement of the proprioceptive sense and bal-
ance ability of the ankle joints. Dynamic balance
The functional reach test (FRT) is used to measure dynamic
METERIALS AND METHODS balance ability. This method was used to measure a subject to in-
structed to stand a flat floor at a 5-cm distance from a wall, spread
Participants the legs shoulder width apart, stand comfortably, extend the el-
The subjects of the present study were 20 male and female bows, bend the shoulder at 90°, move the body forward as maxi-
adults recruited using social network service after explaining the mally as possible using only the ankle joint, and extend the body
purpose and method of the study. The study subjects sufficiently parallel as maximally as possible. Then the distance to the tip of
understood the purpose of the present study and voluntarily agreed the middle finger (3th metacarpal bone) was measured (In et al.,
to participate in the study. The subject selection criterion was those 2016).
with the score of the Cumberland Ankle Instability Tool (CAIT)
not higher than 24 points, which corresponds to FAI and 30 sub- Ankle exercise program
jects were selected. The selected subjects were randomly divided The ankle exercise for experimental group was applied for 40
into an experimental group (ankle exercise applied on unstable min as shown in Table 1.
supporting surface) and a control group (general exercise).
Functional ankle instability Table 1. Ankle exercise program applied on unstable bearing surfaces
FAI was measured using the CAIT scale (Hiller et al., 2006). Step Program Time (min)
The evaluation tool consists of nine items that assess subjective Warm up Stretching around the ankle joint 5
feelings such as ankle pain, whether the ankles are instable in dai- Exercise 30
ly activities, and recovery time after ankle spraining and defines Bare floor & aerostep Ankle dorsiflexion and plantarflexion in
standing
24 or lower points out of the full score of 30 points as FAI (Dona-
One leg standing
hue et al., 2011).
Ankle plantarflexion in one leg standing
Wobble board Circle a clockwise and counterclockwise
Proprioceptive sense direction in double support standing
The proprioceptive sense of the ankles was measured through One leg standing
ankle’s active joint position sense tests. A digital dual inclinome- Cool down Standing wall pushing, stretching 5
Table 3. Comparison of dorsiflexion and plantar flexion before and after ankle Pre 10.64± 5.39 8.68± 2.74 0.22
exercises (°) Post 9.03± 4.20 10.13± 4.25 0.48
Post-pre -1.61± 2.74 1.45± 2.75 0.00*
Proprioception Experimental Control P-value
P-value 0.04* 0.06
Dorsiflexion
Values are presented as mean± standard deviation.
Pre 4.03± 1.88 3.49± 1.77 0.43
*P< 0.05.
Post 1.84± 0.87 4.01± 1.62 0.00*
Post-Pre -2.19± 1.68 0.52± 1.25 0.00*
Table 5. Comparison of dynamic balance before and after ankle exercises (cm)
P-value 0.00* 0.13
Plantarflexion Functional reach test Experimental Control P-value
Pre 4.74± 1.93 4.43± 1.67 0.65 Pre 35.56± 6.38 35.61± 4.48 0.97
Post 2.03± 0.95 5.28± 1.44 0.00* Post 36.91± 7.63 35.05± 4.78 0.42
Post-Pre -2.71± 1.68 0.85± 2.30 0.00* Post-pre 1.35± 2.17 -0.57± 1.53 0.00*
P-value 0.00* 0.18 P-value 0.03* 0.18
Values are presented as mean± standard deviation. Values are presented as mean± standard deviation.
*P< 0.05. *P< 0.05.
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