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Objective: To observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI)., Design: Four-arm randomized controlled trial., Setting: A college rehabilitation center., Participants: Individuals with CAI (N=73)., Interventions: Participants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks., Main Outcome Measures: Cumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion., Results: The UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone., Conclusions: A 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The shoulder complex, which has the highest prevalence of instability, is currently, the subject of considerable debate regarding the methodologies used to assess shoulder stability during dynamic exercises., Research Question: The primary aim is to summarize evidence on various methodologies used to evaluate shoulder stability during dynamic exercises., Methods: This scoping review included cross-sectional studies focusing on various evaluation techniques to assess shoulder forces, kinetics, and stability during dynamic movements. In analyzing each study, the selected data included population profile, sample size, exercise type, and evaluation methodology used., Results: Twenty-seven studies with a total of 1187 subjects were included. Among the studies, various dynamic exercises were evaluated, including throwing exercises, movements with dumbbells or elastic bands, push-ups, and functional tasks. Most evaluation techniques were combined, with eleven studies using surface electromyography; seven used dynamometers to obtain direct strength measurements; two used six-force axis sensors; one utilized force platforms; and one was focused on the loss of speed using linear velocity transducers. Furthermore, motion capture systems such as high-speed cameras were used in fourteen studies. In conclusion, surface electromyography and high-speed cameras are the primary techniques for measuring muscle activity and kinetic and kinematic data. However, they do not directly measure glenohumeral stability, meaning further research is needed to develop reliable methodologies for this purpose., Significance: This study holds significant relevance in the field of shoulder instability and has clear clinical implications, as it establishes the primary tools for estimating glenohumeral stability, which could enable patient stratification and the design of optimal intervention programs based on these measurements., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This study investigated the effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with Functional Ankle Instability (FAI). Forty-three athletes with FAI were randomly assigned to either a Tai Chi group ( n  = 21) or a control group ( n  = 22). The Tai Chi group followed a tailored exercise protocol addressing ankle instability through a three-phase progression, while the control group had no intervention but continued their usual activities. Measurements, including Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT), Tampa Scale for Kinesiophobia (TSK), Short Form-12 (SF-12), figure-8 hop test, and perceived treatment effect were assessed before and after the intervention. The Tai Chi group showed significant improvements in CAIT score and SEBT reach distance compared to the control group ( p  < 0.001). Tai Chi exercises also reduced TSK, improved figure-8 hop score, and enhanced the physical component of SF-12 ( p  < 0.005), with no significant effect on the mental component of SF-12 ( p  = 0.7). The findings imply that Tai Chi may be a valuable consideration for athletic trainers and sports medicine professionals working with athletes with FAI.

OBJECTIVE: To evaluate the relative efficacy of various physical therapy interventions for chronic ankle instability (CAI). DESIGN: A network meta-analysis of randomized controlled trials. LITERATURE SEARCH: PubMed, Cochrane Library, Embase, Scopus, and CINAHL bibliographic databases were searched up to December 2023. STUDY SELECTION CRITERIA: Randomized controlled trials examining nonsurgical treatments for CAI. DATA SYNTHESIS: We used frequentist network meta-analysis to assess 8 outcomes across 44 trials, including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scale or Sport scale, Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) in 3 directions (anterior [A], posteromedial [PM], and posterolateral [PL]), dorsiflexion range of motion, and pain. Surface under the cumulative ranking curve (SUCRA) values identified the most effective interventions. RESULTS : Based on SUCRA rankings, a regimen combining balance and strengthening exercises, augmented with either manual therapy or dry needling, was identified as the most effective in enhancing function (SUCRA: FAAM ADL = 95.2% [manual]/83.9% [dry needling]; FAAM Sport = 87.9% [manual]/80.1% [dry needling]), improving dynamic balance (SUCRA [manual]: SEBT-A = 92.1%; SEBT-PM = 98.0%; SEBT-PL = 90.8%), and significantly relieving pain (SUCRA: 99.9%). A multimodal exercise approach combined with manual therapy showed superior efficacy in increasing dorsiflexion (SUCRA: 61.6%). Tai chi emerged as the most promising intervention for improving stability (SUCRA: 99.9%). CONCLUSION: Interventions that emphasized strengthening and balance exercises were the most effective strategy for achieving best function and pain relief for patients with CAI. Multimodal exercises and tai chi might improve ankle range of motion and instability, respectively. J Orthop Sports Phys Ther 2025;55(1):26-44. Epub 20 December 2024. doi:10.2519/jospt.2024.12601 .

Objective: To investigate the effectiveness of wrist stabilisation exercises compared to conventional intervention, whether it reduces pain and/or paraesthesia in the hand, as well as how the interventions affected activity ability, health-related quality of life and effects on hand function and grip strength in people with Hypermobility Diagnosis., Design: A randomised controlled trial. Setting : Units of Occupational therapy in Primary Care, Kalmar County Council, SwedenParticipants: The study included 169 participants' data randomised to the Exercise group (n = 83) or the Control group (n = 86). The samples consisted of adults in diagnosed Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome with symptoms of pain and/or paraesthesia in the hands in the last three years. Interventions : The Exercise group trained according to structured progressive exercises and weights programme. The Control group used the hand orthosis during selected activities. Both groups performed randomised intervention for 12 weeks. Main measures : The primary outcome was the Disabilities of Arm, Shoulder, and Hand questionnaire. Secondary outcomes were the Grip Ability Test, the Jamar dynamometer and the EuroQol EQ-5D., Results: There were 116 subjects who completed the intervention. There were no statistically significant difference between the wrist stabilisation exercise and the conventional intervention in terms of activity ability, health-related quality of life, hand function, grip strength, pain or paraesthesia in people with Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome., Conclusion: There is no statistically significant difference between the Exercise group and the Control group regarding activity ability after 12 weeks intervention period.

The study aimed to determine if virtual reality (VR) games could enhance neuromuscular control and improve anticipatory and compensatory strategies in ball-kicking for soccer players. It was a single-blind randomized clinical trial involving 32 male soccer players with chronic ankle instability. Participants were divided into two groups: VR games and balance training. The primary outcomes measured were the amplitude and onset time of muscle activities in the peroneus longus (PL), tibialis anterior (TA), soleus (SOL), rectus femoris (RF), biceps femoris (BF), and gluteus medius (GM) in three phases: anticipatory (APA), compensatory 1 (CPA1), and compensatory 2 (CPA2). Secondary outcomes included the Y-balance test and perceived ankle instability. Evaluations were done before and after treatment. Both groups underwent 12 sessions, three times a week, each lasting 60 min. In the VR games group, there was a significant decrease in SOL muscle activity amplitude during CPA2 after treatment (P = 0.033), and the BF muscle activated earlier (P = 0.043). The balance training group showed a significant increase in GM muscle activity amplitude during APA (P = 0.037) and earlier activation of the GM muscle post-treatment (P = 0.050). Additionally, this group demonstrated significant decreases in RF activity during CPA1 and PL activity in CPA1 and CPA2 (P = 0.048, P = 0.030, and P = 0.050, respectively). Between-group comparisons indicated a significant increase in GM muscle activity amplitude during APA and a reduction during CPA1 for the balance training group compared to the VR games group (P = 0.050 and P = 0.012, respectively). Both groups showed significant reductions in perceived ankle instability (VR group: P = 0.002, balance training group: P < 0.001) and improvements on the Y-balance test (VR group: P < 0.021, balance training group: P < 0.033), although neither group showed significant improvement in the anterior direction. Overall, both VR games and balance training effectively enhanced perceived ankle stability and dynamic postural control, with neither approach showing clear superiority. Both groups exhibited improvements in muscle activation timing, though neither outperformed the other. While both interventions led to increased muscle activity amplitude during the anticipatory and compensatory phases, the balance training group achieved somewhat greater improvements. These results suggest that both VR games and balance training are effective rehabilitation approaches for chronic ankle instability, providing comparable benefits for enhancing ankle stability and neuromuscular control, without a distinct advantage of one over the other.RCT Registration: On the Iranian Registry of Clinical Trials (IRCT20230124057197N1). Registration date: 30/06/2023., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: This study involves human participants. All protocols of this research adhered to the ethical principles outlined in the Declaration of Helsinki and received approval from the Tehran University of Medical Sciences Ethics Committee (IR.TUMS.FNM.REC.1401.149). Participants gave informed consent to participate in the study before taking part. Patient consent for publication: The two individuals depicted in Fig. 2 have provided written informed consent for the publication of their images in this online open-access publication., (© 2024. The Author(s).)

Background: Glenohumeral instability is a highly prevalent pathology; however, there are problems in defining it. Traditionally, structural problems such as labral injury or bone loss in the glenoid cavity and/or humeral side were considered the main causes; but recently, it has been seen that motor control plays a very relevant role. This means that currently, there is a disparity of action protocols, and the treatment of this pathology is a great challenge., Aim: The primary aim of this study is to evaluate the effectiveness of a supervised multicomponent therapeutic exercise program in reducing multivariable fatigue in patients with instability of the glenohumeral joint., Methods: A single-blind randomized controlled trial will be carried out, in which 108 adult patients who have suffered at least one episode of glenohumeral instability in the last year will be recruited by the Department of Traumatology and Rehabilitation of Axarquia Hospital (Málaga). Patients will be randomized to the intervention group, which will carry out a multicomponent therapeutic exercise program supervised by physiotherapists (MoveUS Program); or to the control group, which will receive the usual care. All subjects will be evaluated at baseline, mid-treatment, after the intervention, and three months later at the follow-up. In these evaluations, range of movement, maximum peak of isometric force, kinematic, physiological, and psychometric fatigue, return to activity, motor control, and number of recurrences will be assessed; as well as the quality of life measured through the Western Ontario Shoulder Instability Index, which will be the main outcome variable. A multivariate analysis will be performed through a statistical program to better determine the factors that could influence the results., Discussion: This study aims to determine if therapeutic exercise supervised by physiotherapists is capable of reducing multivariable fatigue, reducing the number of recurrences, and improving quality of life; to be able to implement it in the future in public and private clinics since materials are available and physiotherapist have enough skills in the field of therapeutic exercise, so it is expected to be a quality tool in the approach to glenohumeral instability., Registration: Registry: ClinicalTrials.gov. Number: NCT05443295. Date: 01/07/2022., Competing Interests: Declarations. Ethical approval and consent to participate: The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía and Malaga Ethics Committee (1311-N-22). The principles of the Declaration of Helsinki and the standard of Good Clinical Practice are respected. Likewise, participants are given an information sheet and informed consent in which all the potential risks and benefits are specified. Also, consent is requested to include the data obtained in scientific publications or other knowledge dissemination activities. The data provided by the patients will be kept by the main researcher of the project to ensure confidentiality. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Trial status: This study is open for participant recruitment at the time of submission., (© 2024. The Author(s).)

Objective: This study aimed to investigate the effects of 6 wks of peroneal longus neuromuscular electrical stimulation on the balance control ability in young adults with chronic ankle instability., Design: This study is a double-blind randomized controlled trial. Six weeks of neuromuscular electrical stimulation and placebo intervention were conducted in the neuromuscular electrical stimulation and control groups for 20 mins, three times a week, respectively. Thirty-eight participants successfully completed the whole intervention and single-leg standing tests. The kinetics data of the center of pressure trajectory during static single-leg stance were measured using a Kistler force platform. Two-way repeated measures analysis of variance was used to analyze the electrical stimulation effects., Results: Significant interactions were detected in Cumberland Ankle Instability Tool scores and all balance parameters including displacement X, displacement Y, 95% confidence ellipse area, root-mean-square, and center of pressure mean displacement velocity ( P < 0.05, 0.103 ≤ η 2 ≤ 0.201). Significant between-group differences were found in Cumberland Ankle Instability Tool scores ( P = 0.003, Cohen's d = 0.215), displacement X ( P = 0.045, Cohen's d = 0.107), root-mean-square ml ( P = 0.019, Cohen's d = 0.143), and 95% confidence ellipse area ( P = 0.031, Cohen's d = 0.123) after the 6-wk interventions., Conclusions: Six weeks of neuromuscular electrical stimulation on the peroneus longus can improve static balance control ability in young adults with chronic ankle instability, especially the stability of ankle frontal plane., Competing Interests: Conflict of Interest: The authors declare no conflicts of interest, including financial, consultant, institutional, and other relationships. The results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: People with chronic ankle instability (CAI) have insufficient ankle dorsiflexion range of motion (DFROM) and decreases proprioception and muscle strength. Foam roller with and without vibration as a warm-up intervention may have benefits for healthy populations, but the effect on applied to injured individuals is still lacking, especially in CAI. Therefore, we aimed to compare the acute effects of three warm-up interventions, including vibration foam rolling (VR), foam rolling (FR), and static stretching (SS) in adults with CAI., Methods: This study was a randomized, counterbalanced crossover trial. Eligible sixteen adults with CAI received all three interventions (VR, FR, and SS) in unilateral CAI leg in a randomized order. Each intervention included 6 sets, 30 s each, targeting the ankle dorsiflexors and plantarflexors, with a 30-s rest time in between. Ankle dorsiflexion range of motion (DFROM), muscle strength, and ankle proprioception were measured before and immediately after each intervention., Results: VR significantly improved ankle DFROM and muscle strength by over 30% compared to the pre-intervention, whereas FR improved DFROM by 23.68%, and SS did not improve DFROM. Additionally, VR was more significantly effective than SS in improving ankle DFROM and maximal strength. The ankle joint repositioning error angle did not have significantly different., Conclusions: Our results suggest that VR and FR interventions may be incorporated into warm-ups for adults with CAI to improve ankle DFROM. Furthermore, VR offers additional benefits in increasing muscle strength, especially compared to SS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Hypermobile Ehlers-Danlos syndrome (EDS) is an inherited condition marked by joint hypermobility, instability, chronic pain and fatigue, significantly impacting quality of life and autonomy. Management focuses solely on symptom alleviation. After experiencing a rapid decline in functional abilities, a patient in late adolescence with hypermobile EDS underwent hippotherapy rehabilitation (30 hours). She saw substantial improvements in fatigue, chronic pain and regained walking abilities. Hippotherapy played a crucial role in refining her postural balance, motor skills, proprioception, muscle function and endurance. It also positively affected her cognitive and emotional regulation by stimulating sensory inputs that activate neural pathways, providing relief from pain and fatigue. Notably, the patient transitioned from wheelchair reliance to walking with crutches, and then greatly enhanced both gait quality and speed. These findings demonstrate the relevance of hippotherapy for the rehabilitation of hypermobile EDS, reducing the need for pharmacological interventions and fostering a proactive approach to future challenges., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Researchers have shown that patients with chronic ankle instability (CAI) have deficits in memory and attention allocation. This functional deficit affects lower extremity performance. Motor-cognitive dual-task training may improve lower limb dysfunction caused by central nervous system injury. Further study is needed to determine whether dual-task training is more favorable than single-task training for improving neuromuscular control in patients with CAI., Objective: To compare the effects of balance-cognition dual-task training and balance single-task training on lower limb function and electroencephalography changes during static postural control in patients with CAI., Design: Randomized clinical trial (Chinese Clinical Trial Registry: ChiCTR2300073875)., Setting: Rehabilitation training room., Patients or Other Participants: A total of 24 patients with CAI (age = 22.33 ± 2.43 years, height = 175.62 ± 7.7 cm, mass = 70.63 ± 14.59 kg) were block randomized into 2 groups., Intervention(s): Protocols were performed 3 times per week for 6 weeks. The single-task group underwent 1-legged static balance training with eyes open and closed and hopping balance training. The dual-task group underwent balance and cognitive training (backward-counting task)., Main Outcome Measure(s): Cortical activity, proprioception, muscle onset time (difference between the muscle activation time and touchdown time), and dynamic balance were assessed before and after the interventions. We performed multivariate analyses of variance to identify main effects and interactions across groups and time. A post hoc Bonferroni test was performed for pairwise comparisons when interactions were present., Results: All participants successfully completed the 6-week interventions. Proprioception, peroneus longus (PL) muscle onset time, and dynamic postural control improved after the interventions in both groups (P < .05). Dual-task training was superior to single-task training in improving joint position sense in plantar flexion, shortening PL muscle onset time, and altering cortical activity (P < .05)., Conclusions: A 6-week program of balance training or balance combined with cognitive training could improve the functional deficits associated with CAI. The dual-task training could also improve joint position sense in plantar flexion, PL muscle onset time, and cortical activity., (© by the National Athletic Trainers’ Association, Inc.)

Context: Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI., Methods: Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants' involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions., Results: A significant group × time interaction existed for psychosocial outcomes (P = .008), but not for balance (P = .159), strength (P = .492), or ankle function and disability (P = .128). Time main effects existed for balance (P = .003), strength (P < .001), function and disability (P < .001), and psychosocial outcomes (P = .006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS., Conclusions: Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians.

Introduction: Patients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group., Methods and Analysis: In this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VAS NA , 0-100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power., Ethics and Dissemination: This study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024., Trial Registration Number: NCT06277401., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study is to investigate the clinical efficacy of early accelerated motion rehabilitation in treating wrist joint instability with Geissler IV scapholunate instability (SLI) using arthroscopic palmaris longus tendon transplantation in conjunction with scapholunate ligament reconstruction., Methods: From June 2019 to January 2022, seven patients with Geissler Type IV SLI underwent arthroscopic ligament reconstruction and repair surgery of the wrist joint, followed by early accelerated motion rehabilitation. Postoperative follow-up indicators included visual analogue scale (VAS) for pain assessment, DASH-CHINESE upper limb function score, Mayo wrist joint score, wrist joint range of motion, and grip strength. Surgical efficacy was evaluated based on these indicators., Results: All patients were followed up postoperatively, with a follow-up duration ranging from 6 to 20 months (mean: 15.3 months). No postoperative complications occurred, and significant improvements were observed in all measured parameters. Postoperative MRI results at one year indicated restoration of the anatomical structure of the scapholunate joint with good healing. Both VAS and DASH-CHINESE scores significantly decreased, and the differences between pre- and postoperative scores were statistically significant (P < .001). The preoperative Mayo wrist joint score was (47.857±21.380) points, with 2 cases rated as fair and 5 cases as poor. At the latest follow-up, the score was (84.286±6.726) points, with 2 cases rated as excellent, 2 cases as good, and 3 cases as fair. Wrist joint flexion-extension range, rotation range, and grip strength all significantly improved compared to the preoperative values, with statistically significant differences (P < .001)., Conclusion: The combined approach of arthroscopic transplantation of the palmaris longus tendon and early accelerated motion rehabilitation shows satisfactory clinical outcomes in treating Geissler Type IV scapholunate instability of the wrist joint. This combined approach is of great significance in improving the patient's quality of life and wrist function and helps reduce pain symptoms. Furthermore, in future research, it is recommended to increase the sample size and prolong the observation period to further validate the efficacy.

Background: Chronic ankle instability (CAI) is frequently seen in basketball, where ankle sprains are common due to repetitive movements such as jumping, landing, deceleration and acceleration., Objective: This study investigated the effects of CAI on core stabilization, dynamic balance, and agility in university-level basketball players., Materials and Methods: The study included 22 basketball players with CAI (8F, 3M; 20.09 ± 1.04 years) and without CAI (8F, 3M; 21.27 ± 2.24 years), registered as team players in the Yeditepe University basketball teams. Participants divided into two groups: the chronic ankle instability group (CAIG) and the control group (CG). The participants' core stabilization was evaluated using the McGill Core Endurance Test, dynamic balance was evaluated with the Y Balance Test and the T Test was used to evaluate agility., Results: According to the results of an independent t-test, significant differences were observed between groups including posteromedial (p = 0.03) and posterolateral (p = 0.03) reach distances, trunk flexion (p = 0.04) and trunk extension (p = 0.03) tests. According to the logistic regression analysis, Y Balance Test posteromedial and posterolateral reach distances, trunk flexion and trunk extension tests in the McGill Core Endurance Test were found to be statistically significant on the presence of CAI (p < 0.05)., Conclusion: Including core stabilization and dynamic balance exercises in the training program may be beneficial to improve core stabilization and dynamic balance parameters and prevention of CAI in university-level basketball players with CAI., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Individuals with chronic ankle instability (CAI) often experience deficits in balance, hip strength, and lumbopelvic stability. Unilateral balance training can lead to improved balance in the contralateral limb, but it is unknown if similar cross-education effects occur for hip strength and lumbopelvic stability. Our purpose was to determine if unilateral balance training improved balance, hip strength, and lumbopelvic stability of the contralateral limbs in individuals with CAI., Methods: Using a randomized-controlled trial, 30 individuals with CAI were separated into control (CON) and balance (BAL). Uninvolved limbs underwent testing at baseline and post-intervention. We tested balance with the star excursion balance test in anterior (SEBT-ANT), posterolateral (SEBT-PL), and posteromedial (SEBT-PM) directions. We tested hip strength with a handheld dynamometer in extension (EXT), abduction (ABD), and external rotation (ER). We tested lumbopelvic stability with a unilateral hip bridge. After baseline, BAL completed an 8-week balance training program on the involved limb. CON did not participate in the intervention. Two-way repeated measures ANOVAs analyzed effects of group and time on each outcome. Cohen's d effect sizes analyzed each group's changes from baseline to post-intervention., Results: Eleven participants discontinued the study (5 CON, 6 BAL) before completion. There were significant group-by-time interactions for SEBT-PL (P = 0.03) and hip bridge (P = 0.03). BAL had moderate to large effect sizes for SEBT-PM (d = 0.69 [-0.06,1.41]), SEBT-PL (d = 0.87 [0.10,1.60]), EXT (d = 0.73 [-0.02,1.45]), ABD (d = 0.79 [0.03,1.51]), and hip bridge (d = 0.83 [0.07,1.55])., Conclusion: A balance training program for limbs with CAI led to contralateral improvements in balance, hip strength, and lumbopelvic stability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing., Design: This was a randomized, controlled, double-blind trial. Thirty-six individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week 0 and week 6 . A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week 6 , with the outcome variables at week 0 as covariates., Results: Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (-16.05, -78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week 6 ., Conclusions: Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future., Competing Interests: Disclosure A. Lin: Stryker/Tornier: Paid Consultant/IP, Arthrex: Paid Consultant/IP, American Shoulder and Elbow Surgeon: Committee or board member, American Orthopedic Society for Sports Medicine: Committee or board member, ISAKOS: Committee or board member, Rotator Cuff Study Group: Committee or board member, Knee Surgery, Sports Traumatology, Arthroscopy: Editorial or governing board, JBJS Case Connector: Associate Editor, Arthroscopy: Editorial or governing board, JISAKOS: Editorial or governing board, American Journal of Sports Medicine: Reviewer, Journal of American Academy of Orthopedic Surgeons: Reviewer, Knee Surgery, Sports Traumatology, Arthroscopy: Reviewer, Journal of Shoulder and Elbow Surgery: Reviewer, Journal of Bone and Joint Surgery: Reviewer. No other authors have anything to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: High ankle motion smoothness involves small acceleration or deceleration, which is related to ankle stability. Interventions for ankle motion smoothness are important to reduce the progression of chronic ankle instability (CAI) symptoms and prevent recurrent ankle sprains. Training using whole-body vibration (WBV) may easily and effectively improve ankle motion smoothness; however, its effects have not yet been investigated., Objectives: We aimed to clarify the acute effects of WBV training on ankle motion smoothness in patients with CAI., Design: Randomized controlled trials., Method: Overall, 31 university students from a basketball team with CAI were included. Training was performed using a WBV device in both groups. The WBV group was administered with WBV using the device, whereas the NWBV group was not administered with WBV. Only one training session was performed in each group immediately after the premeasurements. The main outcome measure was the mean angular jerk cost of the ankle joint in plantar/dorsal flexion and in inversion/eversion during the star excursion balance test (SEBT), which were measured using accelerometers., Results/findings: No significant group × time interaction was noted for the mean angular jerk cost of the ankle joint in any direction (anterior, posterolateral, or posteromedial) during ankle inversion/eversion or plantar/dorsal flexion. Pre and postintervention comparisons of each group showed no significant differences in any of the SEBT directions in both ankle inversion/eversion and plantar/dorsal flexion in the NWBV and WBV groups., Conclusions: Using WBV training on individuals with chronic ankle instability did not acutely improve ankle motion smoothness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: To assess the impact of a Physiotherapist-led Pilates Intervention for school aged children with Generalised Joint Hypermobility (GJH) on pain, physical function and Health Related Quality of Life (HRQoL)., Methods: Three children aged 8-12 years with GJH participated in an 8 week Physiotherapist-led Pilates Intervention within a single-case experimental design (multiple baseline design). Repeated measures were collected during baseline, intervention, withdrawal and follow-up, for: (i) pain, (ii) physical function as measured by muscle strength, postural control, fatigue and activity levels and (iii) HRQoL., Results: Within the intervention phase, two children showed reduced fatigue and one child improved in muscle group strength of hip abduction (gluteus medius) and scapula adduction/rotation (rhomboideus major/minor) and HRQoL. No improvements were seen in pain or postural control. Within the early withdrawal phase all children showed improved strength for at least two muscle groups and one child showed reduced fatigue, pain (worst in last week) and improved postural control (functional reach lateral)., Conclusions: Pilates may provide an effective intervention for children with GJH to reduce fatigue and improve muscle strength and HRQoL. Limited conclusions can be made regarding pain and postural control. Further research with a longer Pilates duration is needed to confirm the dose and benefits for this population., Competing Interests: Declaration of competing interest The authors state that they had no interests that could be perceived as posing as a conflict or bias., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: There appears to be no consensus on the usefulness of kinesiological tape in athletes with chronic ankle instability, therefore the aim of this study was to examine the effects of kinesiological tape on dynamic balance in football players with chronic ankle instability., Design, Setting and Participants: Football players who were eligible for this randomized controlled study were randomly assigned (allocation ratio 1:1:1) to one of three groups: experimental group, placebo group or control., Interventions: The experimental group received kinesiological tape bands applied to the peroneal and tibialis anterior muscles. The tape was applied for 48 h. The placebo group received a sham kinesiological tape application for the same duration, while the control group did not receive any tape., Outcome Measures: Balance was assessed using the Y-Balance Test at baseline and 48 h later, with the kinesiological tape still in place, either sham or control., Results: A total of 69 (23 per group) semi-professional, male, players (22.1 ± 4.3 years) completed the study. There was a significant change in test performance over time (F 1,66  = 9.425; P = 0.003; η p 2  = 0.125), with a significant interaction for group × time (F 2,66  = 11.154; P < 0.001; η p 2  = 0.253). The kinesiological tape group improved the overall performance in the Y-balance test (85.2 ± 8.7% to 90.3 ± 8.4%, P < 0.001), while no differences were observed for the placebo and control groups., Conclusion: The application of kinesiological tape for 48 h improved overall dynamic balance performance on the Y-balance test. These findings suggest that kinesiological tape could be a beneficial strategy for addressing the consequences of chronic ankle instability., Competing Interests: Declaration of competing interest The authors report there are no competing interests to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Individuals with chronic ankle instability (CAI) have problems in function. The purpose of this study was to systematically investigate the short- or long-term effects of various orthoses on function of these people., Methods: Randomized controlled trial (RCT) studies reporting on the short- or long-term effects of orthotic intervention on functional performance in individuals with CAI were identified through PubMed, Cochrane Library, PEDro, MEDLINE via Ovid, and Scopus databases from inception to July 2022. Two reviewers independently extracted data and assessed the risk of bias and quality of the studies using ROB tool and PEDro scale, respectively., Results: Eleven RCTs published from 2012 to 2022 were included in this review. The studies were of a fair or good quality. The risk of bias was low in 50 percent and high in 16.7 percent of the studies. The mSEBT in the posterolateral and posteromedial directions were improved both in the short- and long-term application of orthoses. Single leg hop did not change but single leg stance was improved more in the experimental group who used orthoses for 4 weeks., Conclusion: Various tapes can improve dynamic balance immediately after application and their effects would last up to 2 months. Therefore, they can be used during training. Athletes with CAI who want to perform better should use the tape at least two weeks before competing to take advantage of its long-term effects. The timing of application of orthotic appliances, needs to be adjusted according to the relevant function., Competing Interests: Declaration of competing interest The authors of the current manuscript declare that there is no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Functional ankle instability (FAI) patients often experience restricted ankle dorsiflexion, increased inversion angle, and elevated ground reaction forces during walking, all related to altered kinematics of the talocrural and subtalar joints. This study aimed to investigate the potential positive impact of joint mobilization on FAI patients from a biomechanical perspective. The experimental group (EG, n = 17; Age: 20.06 ± 1.34 years; Height: 1.74 ± 0.07 m; Weight: 69.79 ± 11.20 kg; BMI:22.88 ± 2.63 kg/m 2 ; CAIT:15.59 ± 2.58; M/F: 15/2) received joint mobilization + routine rehabilitation training, while the control group (CG, n = 16; Age: 20.50 ± 0.73 years; Height: 1.73 ± 0.09 m; Weight: 64.59 ± 7.21 kg; BMI: 21.65 ± 2.47 kg/m 2 ; CAIT: 16.75 ± 2.21; M/F: 14/2) only received regular rehabilitation training. Biomechanical tests were performed in both groups after the 4-week intervention. The spatial parameters during walking (including step length, stride length, step width, step time, cadence, step speed, support time, and swing time), ankle flexion and dorsiflexion angle, inversion, and eversion angles, internal and external rotation angles, ankle torque, as well as the vertical ground reaction force were measured before and after the intervention. The results of the two-way ANOVA showed that the main effect of time was significant for step length (P < 0.001), stride length (P = 0.008), step speed (P < 0.001), the sagittal plane angle at touchdown (P < 0.001), maximum dorsiflexion angle (P = 0.005), sagittal plane toe off-ground angle (P < 0.001), peak flexion-dorsiflexion torque (P = 0.033), the first peak vGRF (P = 0.013), and second peak vGRF (P = 0.011). The main effect of Time * Group was significant for step speed (P = 0.044). The EG demonstrated significant improvements in step speed (P = 0.047), maximum dorsiflexion angle (P = 0.047), and the first peak vGRF (P = 0.028) compared to the CG. This study reveals that joint mobilization intervention enhances gait spatiotemporal parameters, kinematics, and kinetics, particularly in step speed, maximum dorsiflexion angle, and the first vGRF peak for the EG compared to the CG. Therefore, the rehabilitation strategy for patients with functional ankle instability should appropriately increase the use of joint movement to promote the functional recovery of FAI patients., (© 2024. The Author(s).)

Background: There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice., Method: Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement., Results: 11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined "safe zone." Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks. Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient's confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score., Conclusion: This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS. CONTRIBUTION OF THE PAPER., (Copyright © 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Background: Neurofeedback training (NFT) can aid in the treatment of the abnormal patterns of the brain brought on by physical injury, enhancing cognitive and behavioral abilities. The present study aimed to compare the effectiveness of combining neuromuscular training (NMT) and NFT (NMT+NFT) with NMT alone in rehabilitating athletes with chronic ankle instability (CAI)., Hypothesis: NMT+NFT will be more effective than NMT alone., Study Design: A 3-arm, single-blind randomized controlled trial., Level of Evidence: Level 2., Methods: A total number of 62 athletes, aged 18 to 25 years, with CAI, participated in this study. The study subjects were allocated randomly to 3 groups: 21 cases in the control group, 21 cases in the combination group (CG) receiving NMT+NFT, and 20 cases in the neuromuscular group (NG) practicing NMT alone, undergoing exercises related to their groups for 8 weeks. Data were recorded and analyzed before and after the 8-week training program. The primary outcome measures were postural sway indices; secondary outcomes included ankle proprioception and biopsychosocial indices., Results: NMT+NFT was more effective than NMT alone in terms of improving postural control during single- and 2-legged standing positions under the conditions of eyes closed and eyes open, proprioception at 20° of plantar flexion, as well as anxiety and depression in athletes with CAI. However, the findings revealed that NMT+NFT and NMT alone could both improve such indices., Conclusion: NMT+NFT as a treatment protocol improved postural control, ankle proprioception, anxiety, and depression greater than NMT alone., Clinical Relevance: A combined protocol of NFT and NMT led to greater improvement compared with NMT alone. NFT was recommended as an adjunct therapy in the rehabilitation of athletes suffering from CAI., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Objective: To explore and compare the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability (CAI)., Methods: The PubMed, Embase, Web of Science, Medline, and Cochrane databases were searched up to December 2023. Quality assessment was carried out using the risk-of-bias guidelines of the Cochrane Collaboration, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were compute., Results: Among 20 eligible studies, including 682 participants were analyzed in this meta-analysis. The results of the meta-analysis demonstrated that balance training was effective in enhancing ankle function with self-functional scores (SMD = 1.02; 95% CI, 0.61 to 1.43; p < 0.00001; I 2  = 72%) and variables associated with the ability of dynamic balance such as SEBT-A (MD = 5.88; 95% CI, 3.37 to 8.40; p < 0.00001; I 2  = 84%), SEBT-PM (MD = 5.47; 95% CI, 3.40 to 7.54; p < 0.00001; I 2  = 61%), and SEBT-PL (MD = 6.04; 95% CI, 3.30 to 8.79; p < 0.0001; I 2  = 79%) of CAI patients. Meta-regression indicated that the intervention time might be the principal cause of heterogeneity (p = 0.046) in self-functional scores. In subgroup analyses of self-functional score across intervention types, among the intervention time, more than 20 min and less than 30 min had the most favorable effect (MD = 1.21, 95% CI: 0.96 to 1.46, p < 0.00001, I 2  = 55%); among the intervention period, 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, p < 0.00001, I 2  = 78%) and 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, p < 0.00001, I 2  = 71%) had significant effects; among the intervention frequency, 3 times (MD = 1.14, 95% CI: 0.89 to 1.38), p < 0.00001, I 2  = 57%) had significant effects. Secondly, in subgroup analyses of SEBT across intervention types, a 4-week and 6-week intervention with balance training 3 times a week for 20-30 min is the optimal combination of interventions to improve SEBT (dynamic balance) in patients with chronic ankle instability., Conclusion: Balance training proves beneficial for ankle function in patients with CAI. Intervention time constitutes a major factor influencing self-function in patients with CAI. It is recommended that the optimal dosage of balance training for CAI involves intervention three times a week, lasting for 20 to 30 min over a period of 4 to 6 weeks for superior rehabilitation., (© 2024. The Author(s).)

Background: The aim of study was to observe the therapeutic effect of joint mobilization of Maitland on subjects with chronic ankle instability (CAI)., Methods: 76 subjects with CAI were recruited for this randomized, single-blinded trial and randomized divided into experimental group (EG) and control group (CG). The CG was received conventional rehabilitation, and the EG added 8-weeks treatment of Maitland technology based on the CG. The visual analogue scale, ankle range of motion, Y-balance test, and Foot and Ankle Ability Measure scores (the daily living part of Foot and Ankle Ability Measure scores and the sport part of Foot and Ankle Ability Measure scores) were measured before and 8 weeks after the intervention respectively., Results: There was no significant difference on outcomes between the 2 groups before treatment (P > .05). After 8 weeks of intervention, the visual analogue scale, ankle range of motion (dorsiflexion, plantar flexion, and varus), the value of Y-balance test (forward extension distance, inner extension distance, and posterior extension distance), the daily living part of Foot and Ankle Ability Measure scores, and the sport part of Foot and Ankle Ability Measure scores of the 2 groups were significantly improved (P < .01), and the improvement of the EG showed remarkable than CG (P < .01)., Conclusion: Maitland therapy is effective in the treatment of CAI. Conventional rehabilitation assisted by Maitland therapy were beneficial to improve pain and functional state in patients with CAI than only routine rehabilitation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Joint instability is a common finding of clinical importance in patients with knee disease. This literature review aimed to examine the evidence regarding the effect of orthosis management on joint instability in knee joint disease., Methods: The detailed protocol for this study was published in the International Prospective Register of Systematic Reviews in the field of health and social welfare (CRD 42022335360). A literature search was conducted on May 2023, using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Physiotherapy Evidence Database (PEDro), and Institute of Electrical and Electronics Engineers (IEEE) Xplore. A secondary search was manually conducted using Google Scholar to address publication bias. Each database search strategy was described, and the search was conducted by independent reviewers., Results: A total of 281 studies were retrieved, 11 articles were included in the systematic review. Of the 11 articles selected, the number of included diseases was 2 for osteoarthritis, 7 for anterior cruciate ligament injuries, and 3 for posterior cruciate ligament injuries. In result, orthosis management may improve self-reported instability and functional assessment in patients with osteoarthritis, anterior cruciate ligament injury, and posterior cruciate ligament injury. However, an objective evaluation of anatomical instability did not indicate an improvement in joint instability., Conclusion: The effects of orthosis management on knee instability might improve physical function and self-reported instability., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI ( n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus ( p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG ( p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.

Clinical Scenario: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted., Focused Clinical Question: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI?, Summary of Key Findings: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies., Clinical Bottom Line: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone., Strength of Recommendation: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI.

Background: Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice., Purpose: This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity., Study Design: This was a case series study., Methods: This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test., Results: A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P < .001; d = 2.9) and visual analog scale (P < .001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately., Conclusions: Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol., Competing Interests: Declaration of competing interest The authors have no conflict of interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Lateral ankle sprains (LAS) often lead to chronic ankle instability (CAI). The Ebbets foot drills were created to strengthen the lower leg muscles and reduce the risk of LAS. The current study aimed to explore the activation of the lower leg muscles during the Ebbets foot drills. Twenty-two (22) college students without LAS participated in the study. Surface electromyography (sEMG) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) was collected during each of the Ebbets foot drills and a normal walking trial. The sEMG mean root mean square (RMS) was calculated for each walking and Ebbets foot drill trial duration. The mean RMS was higher during the Ebbets foot drills compared to normal walking for all muscles. The TA sEMG mean RMS was greater (4.0-68.3%, P = 0.001-0.023) during all the Ebbets foot drills than during the walking trial. The TP had greater mean RMS during the toe-in (50.4%, P < 0.001), toe-out (55.0%, P < 0.001), and backward walking (47.3%, P < 0.001) drills, than during the walking trial. The PL had greater mean RMS during all Ebbets foot drills (19.4-53.7%, P < 0.001) except for the heel walking and inversion drills. Ebbets foot drills higher muscle activity than regular walking, suggesting that the Ebbets foot drills could aid in the strengthening of the TA, TP, and PL muscles. These results build evidence on Ebbets' theory and indicate that these drills may be used to rehabilitate LAS and CAI., Competing Interests: Declaration of competing interest No authors have any commercial relationships that would lead to a conflict of interest and have no financial conflicts of interest associated with this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Studies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose of this study was to evaluate the feasibility of a planned cross-over study to assess efficacy of manual therapy techniques applications in patients with chronic ankle instability., Methods: This feasibility study used a randomized controlled, blinded assessor cross-over design. Criteria of success under evaluation were adherence and attrition rates and adverse events. while preliminary treatment effects of manual therapy techniques on muscular activity (measured by surface electromyography) and on dynamic balance (measured by time to stabilization test) were secondary aims., Results: Thirteen participants (mean age: 24.4 ± 3.8 years) with chronic ankle instability volunteered in this feasibility study. Success criteria showed a high adherence (98.7%) and low attrition (0%). No missing data were reported but four out of 26 data sets could not be used for statistical analysis because of non-readability of the recorded data. Preliminary treatment effect showed divergent results for surface electromyography and time to stabilization. One significant result (p = 0.03, ES = 1.48) in peroneus longus muscle activity after jump landing between 30 and 60 ms could be determined., Conclusions: This study showed that the study protocol is feasible but should be modified by offering participants the opportunity to familiarize to the jumps and to the test repetitions. This study generates better understanding of manual therapy techniques for patients with chronic ankle instability., Competing Interests: Declaration of competing interest The authors declare no potential conflict of interest with respect to the authorship and/or publication of this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Context: Therapeutic interventions for individuals with chronic ankle instability (CAI) are recommended to improve muscle strength, postural control, and range of motion. However, their effects on neuromechanics during a drop landing remain unclear. In addition, even though therapeutic interventions with stroboscopic glasses appear to effectively improve postural control, how they affect landing neuromechanics remains unclear., Objective: To identify the effect of balance training with stroboscopic glasses on neuromechanics during a single-legged drop landing in patients with CAI., Design: Randomized controlled clinical trial., Setting: Laboratory., Patients or Other Participants: A total of 50 participants with CAI were randomly assigned to 1 of 2 groups: strobe (n = 25; age = 22 ± 3 years, height = 174.7 ± 8.2 cm, mass = 71.8 ± 12.2 kg) or control (n = 25; age = 21 ± 2 years, height = 173.1 ± 8.3 cm, mass = 71.1 ± 13.5 kg)., Intervention(s): The 4-week rehabilitation (3 sessions per week) included hop-based tasks and single-legged stance. The strobe group wore stroboscopic glasses during the training, whereas the control group did not., Main Outcome Measure(s): Ankle-, knee-, and hip-joint kinematics and 4 lower extremity muscle activations 150 milliseconds before and after initial contact during a single-legged drop landing in the 2 groups., Results: The strobe group showed greater eversion (from 150 milliseconds before to 30 milliseconds after initial contact) and dorsiflexion (from 30 to 96 milliseconds after initial contact) angles and peroneal longus (from 35 milliseconds before to 5 milliseconds after initial contact) and tibialis anterior (from 0 to 120 milliseconds after initial contact) activation in the posttest than the pretest., Conclusions: Patients with CAI who underwent a 4-week rehabilitation with stroboscopic glasses demonstrated changes in neuromechanics, including increased ankle-dorsiflexion and -eversion angles and tibialis anterior and peroneus longus activation, during a single-legged drop landing. This finding suggests that use of stroboscopic glasses during rehabilitation could help patients with CAI develop safe landing mechanics., (© by the National Athletic Trainers' Association, Inc.)

Background: Anterior cruciate ligament injury of the knee is common and leads to decreased activity and risk of secondary osteoarthritis of the knee. Management of patients with a non-acute anterior cruciate ligament injury can be non-surgical (rehabilitation) or surgical (reconstruction). However, insufficient evidence exists to guide treatment., Objective(s): To determine in patients with non-acute anterior cruciate ligament injury and symptoms of instability whether a strategy of surgical management (reconstruction) without prior rehabilitation was more clinically and cost-effective than non-surgical management (rehabilitation)., Design: A pragmatic, multicentre, superiority, randomised controlled trial with two-arm parallel groups and 1:1 allocation. Due to the nature of the interventions, no blinding could be carried out., Setting: Twenty-nine NHS orthopaedic units in the United Kingdom., Participants: Participants with a symptomatic (instability) non-acute anterior cruciate ligament-injured knee., Interventions: Patients in the surgical management arm underwent surgical anterior cruciate ligament reconstruction as soon as possible and without any further rehabilitation. Patients in the rehabilitation arm attended physiotherapy sessions and only were listed for reconstructive surgery on continued instability following rehabilitation. Surgery following initial rehabilitation was an expected outcome for many patients and within protocol., Main Outcome Measures: The primary outcome was the Knee Injury and Osteoarthritis Outcome Score 4 at 18 months post randomisation. Secondary outcomes included return to sport/activity, intervention-related complications, patient satisfaction, expectations of activity, generic health quality of life, knee-specific quality of life and resource usage., Results: Three hundred and sixteen participants were recruited between February 2017 and April 2020 with 156 randomised to surgical management and 160 to rehabilitation. Forty-one per cent ( n  = 65) of those allocated to rehabilitation underwent subsequent reconstruction within 18 months with 38% ( n  = 61) completing rehabilitation and not undergoing surgery. Seventy-two per cent ( n  = 113) of those allocated to surgery underwent reconstruction within 18 months. Follow-up at the primary outcome time point was 78% ( n  = 248; surgical, n  = 128; rehabilitation, n  = 120). Both groups improved over time. Adjusted mean Knee Injury and Osteoarthritis Outcome Score 4 scores at 18 months had increased to 73.0 in the surgical arm and to 64.6 in the rehabilitation arm. The adjusted mean difference was 7.9 (95% confidence interval 2.5 to 13.2; p  = 0.005) in favour of surgical management. The per-protocol analyses supported the intention-to-treat results, with all treatment effects favouring surgical management at a level reaching statistical significance. There was a significant difference in Tegner Activity Score at 18 months. Sixty-eight per cent ( n  = 65) of surgery patients did not reach their expected activity level compared to 73% ( n  = 63) in the rehabilitation arm. There were no differences between groups in surgical complications ( n  = 1 surgery, n  = 2 rehab) or clinical events ( n  = 11 surgery, n  = 12 rehab). Of surgery patients, 82.9% were satisfied compared to 68.1% of rehabilitation patients. Health economic analysis found that surgical management led to improved health-related quality of life compared to non-surgical management (0.052 quality-adjusted life-years, p  = 0.177), but with higher NHS healthcare costs (£1107, p  < 0.001). The incremental cost-effectiveness ratio for the surgical management programme versus rehabilitation was £19,346 per quality-adjusted life-year gained. Using £20,000-30,000 per quality-adjusted life-year thresholds, surgical management is cost-effective in the UK setting with a probability of being the most cost-effective option at 51% and 72%, respectively., Limitations: Not all surgical patients underwent reconstruction, but this did not affect trial interpretation. The adherence to physiotherapy was patchy, but the trial was designed as pragmatic., Conclusions: Surgical management (reconstruction) for non-acute anterior cruciate ligament-injured patients was superior to non-surgical management (rehabilitation). Although physiotherapy can still provide benefit, later-presenting non-acute anterior cruciate ligament-injured patients benefit more from surgical reconstruction without delaying for a prior period of rehabilitation., Future Work: Confirmatory studies and those to explore the influence of fidelity and compliance will be useful., Trial Registration: This trial is registered as Current Controlled Trials ISRCTN10110685; ClinicalTrials.gov Identifier: NCT02980367., Funding: This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/140/63) and is published in full in Health Technology Assessment ; Vol. 28, No. 27. See the NIHR Funding and Awards website for further award information.

Purpose: Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI)., Materials and Methods: This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results., Results: PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36-30, p  < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months ( p  < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery., Conclusions: We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.

Purpose: Physical therapy (PT) plays a central role in treating individuals with Generalized Hypermobility Spectrum Disorder (G-HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). However, there is limited research describing these individuals' PT management. This review aims to systematically map the evidence on PT interventions to treat this patient population., Methods: A systematic literature search of PubMed, CINAHL, and Embase from January 2000 to April 2023 was performed. After the screening process, studies were appraised and classified based on the type of PT interventions used. Five reviewers independently assessed the articles., Results: The search produced 757 articles. Twenty-eight met the inclusion criteria. The studies included 630 participants, mostly female, with a mean age of 26.2 (ranging from 2 to 69). The PT interventions used were therapeutic exercise, patient instruction, motor function training, adaptive equipment, manual therapy, and functional training., Conclusions: The evidence indicates that therapeutic exercise and motor function training are efficacious methods to treat individuals with G-HSD and hEDS. There is also weak evidence for using adaptive equipment, patient instruction, manual therapy, and functional training. Recent studies emphasize multidisciplinary care and understanding of the psychological impact of G-HSD/hEDS. Additional research is needed to determine the effectiveness and dosage of PT interventions.

Background: After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that people with chronic ankle instability (CAI) commonly have deficits in joint position sense and reinjury risks. Joint position sense plays an important role in ankle control, thereby reducing the risk of injury. Therefore, this study aims to compare the effects of balance and strength training on ankle proprioception in people with CAI., Methods: This single-blind randomized controlled study included 29 volunteer participants (21 women and eight men) aged 18 to 30 years. Participants with a Cumberland ankle instability scale score less than or equal to 24 were randomly divided into two treatment groups: strength training (n = 14) and balance training (n = 15). Y balance test, joint position, and vibration sense were evaluated at the beginning and end of the treatment. "Hop to stabilization" exercises were applied to the balance group and resistive bands exercises to the strength group, which were performed for 6 weeks, 35 minutes per day, two times per week., Results: There was no significant difference between the two groups in the anterior, posterolateral, and posteromedial directions of the Y balance test (P = .89, P = .50, and P = .34, respectively), but the strength training group showed significant improvement in ankle proprioception (140°) and vibration sense (fifth finger) (P < .001), and the post hoc Cohen's d effect size values were medium (.52) and small (.25), respectively., Conclusions: The findings of this study show that strengthening and balance exercises have similar effects on dynamic balance, but strengthening exercises are more effective in improving joint position and vibration sense. Given the positive effects of both exercise programs, it is recommended to implement the two interventions separately or together for CAI rehabilitation.

Background: This study focuses on the relationship between forearm muscles, carpal ligaments, and their impact on scapholunate joint stability across varying forearm rotations. This is crucial for optimizing pre and postoperative rehabilitation strategies for scapholunate joint dysfunction., Purpose: Our study aims to understand the kinetic influence of forearm muscles on scapholunate joint instability. We emphasize the significance of forearm rotation to enhance treatment efficacy., Study Design: We conducted an experimental study to understand how forearm muscles contribute to the stability of the scapholunate joint during different degrees of forearm rotation and we focused on the joint effect of muscle groups rather than individual muscles for treatment protocols., Results: Our findings shed light on the conservative treatment of dynamic scapholunate instability and the postoperative rehabilitation of scapholunate ligament repair. We found that the effect of forearm muscles significantly contributes to preserve stability in the scapholunate joint across various forearm rotational positions. These insights have practical implications for hand therapists, offering innovative strategies to enhance clinical practice., Conclusions: This research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability and provides a valuable perspective in line with current rehabilitation principles., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia. It may occur in isolation, but frequently co-exists in individuals with hypermobile variants of Ehlers-Danlos Syndrome (EDS) and related conditions (chronic fatigue syndrome [CFS] and fibromyalgia). Exercise is recommended for non-pharmacological POTS management but needs to be individualised. This scoping review explores the current literature on use and effectiveness of exercise-based management for POTS, with specific focus on individuals with joint hypermobility and related conditions who experience hypermobility, and/or pain, and/or fatigue., Methods: A systematic search, to January 2023, of Medline, EMBASE, AMED, CINAHL and the Cochrane library was conducted. Studies that reported on adolescents and adults who had been diagnosed with POTS using standard criteria and underwent an exercise-based training intervention were included., Results: Following full-text screening, 10 articles were identified (2 randomised control trials, 4 comparative studies and 4 case reports). One comparative study reported a small subset of participants with EDS and one case report included an individual diagnosed with CFS; the remainder investigated a wider POTS population. Overall, 3 months of endurance followed by resistance exercise, graduating from the horizontal-to-upright position reduced POTS symptoms and improved quality-of-life., Conclusion: The findings highlight a paucity of higher-level studies documenting exercise for POTS management in people with joint hypermobility and related conditions. Results from the wider POTS population demonstrate exercise is safe and effective. Large, well-designed clinical studies exploring exercise for POTS management adapting to meet the complex musculoskeletal and non-musculoskeletal features of symptomatic joint hypermobility are needed., Competing Interests: Declaration of competing interest No conflicts of interest, financial or otherwise are declared by the authors., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The aim of this study is to review the implementation of the Frequency, Etiology, Direction, and Severity (FEDS) classification for shoulder instability by the physical therapy scientific community since its publication in 2011., Methods: A systematic search was conducted on January 10, 2024 in the MEDLINE, EMBASE, SPORTDiscus, Scopus, Web of Science, Cochrane, and SciELO databases, as well as Google Scholar. Studies investigating physical therapy interventions in people with shoulder instability, and reporting selection criteria for shoulder instability were considered eligible. A narrative synthesis was conducted., Results: Twenty-six studies were included. None reported using the FEDS classification as eligibility criteria for shoulder instability. Only 42% of the studies provided data of all four criteria of the FEDS classification. The most reported criterion was direction (92%), followed by etiology (85%), severity (65%), and frequency (58%). The most common reported descriptor for profiling shoulder instability was "dislocation" (83.3%), followed by "first-time" (66.7%), "anterior" (62.5%), and "traumatic" (59.1%). Regarding other instability classifications, only one study (4%) used the Thomas & Matsen classification, and two (8%) the Stanmore classification., Conclusions: The FEDS classification system has not been embraced enough by the physical therapy scientific community since its publication in 2011., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. Marcus Bateman is the author of the Derby Shoulder Instability Rehabilitation Programme but does not receive any financial benefits from its use., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3, and 6 months after anterior cruciate ligament reconstruction (ACLR)., Design: Retrospective study., Methods: Two groups (n = 53) of ACLR patients (combination of OKC and CKC exercises group compared to a CKC exercise group) were recruited. OKC protocol was introduced at 2 weeks post-operatively without external resistance and progressed at 4 weeks with load. Comparative ACL graft laxity measurement and isokinetic strength testing were prospectively performed up to 6 months in both groups., Results: No significant differences were observed in the knee laxity at 1 (p = 0.263), 3 (p = 0.263), and 6 months (p = 0.256) follow up between the groups. Similarly, no significant results were observed in within-group knee laxity between 1 and 6 months after ACLR in the intervention (p = 0.155) and control group (p = 0.690)., Conclusion: The early initiation of OKC along with CKC exercises doesn't seem to increase the ACLR graft laxity as compared to a rehabilitation program with only CKC exercises., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders., Data Sources: A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases., Study Selection: Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included., Data Extraction: CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into "recommended," "may be recommended," or "not recommended." Disagreements were resolved by discussion until reviewers reached consensus., Data Synthesis: Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it., Conclusions: Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Patients with chronic ankle instability (CAI) often experience injury-related fear following ankle injuries, a condition known as kinesiophobia. Little research has investigated the impact of kinesiophobia in patients with CAI., Research Question: How does kinesiophobia impact the static and dynamic balance of individuals with CAI?, Methods: Fifty patients with CAI were divided into 2 subgroups based on their responses to the Tampa Scale of Kinesiophobia: 25 with kinesiophobia (CAI-K) and 25 without kinesiophobia (CAI-N). These groups were compared to 20 control participants. All participants performed a single-leg balance test with eyes open (EO) and eyes closed (EC). They also performed the Y-balance test (YBT) with EO. Romberg ratios were calculated as EC/EO and used for statistical analysis., Results: No differences in static balance with EO and EC were found among three groups. However, the CAI-K group displayed a higher Romberg ratio in the mediolateral direction during static balance than both CAI-N and control groups. Additionally, both CAI-K and CAI-N groups displayed higher Romberg ratio in the anterior-posterior than controls. During YBT, the CAI-K group showed reduced reach distance in the anterior direction than CAI-N and control groups., Significance: The CAI-K group relies more on visual feedback during static balance in the mediolateral direction than CAI-N and control groups. Furthermore, the CAI-K group displayed less anterior reach distance during YBT compared to the CAI-N and control groups. Clinicians should consider both psychological and physical factors when designing rehabilitation programs., Competing Interests: Declaration of Competing Interest The authors declare that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Individuals with chronic ankle instability (CAI) present muscular weakness and potential changes in the activation of the peroneus longus muscle, which likely explains the high recurrence of ankle sprains in this population. However, there is conflicting evidence regarding the role of the peroneus longus activity in CAI, possibly due to the limited spatial resolution of the surface electromyography (sEMG) methods (i.e., bipolar sEMG). Recent studies employing high-density sEMG (HD-sEMG) have shown that the peroneus longus presents differences in regional activation, however, it is unknown whether this regional activation is maintained under pathological conditions such as CAI. This study aimed to compare the myoelectric activity, using HD-sEMG, of each peroneus longus compartment (anterior and posterior) between individuals with and without CAI. Eighteen healthy individuals (No-CAI group) and 18 individuals with CAI were recruited. In both groups, the center of mass (COM) and the sEMG amplitude at each compartment were recorded during ankle eversion at different force levels. For the posterior compartment, the sEMG amplitude of CAI group was significantly lower than the No-CAI group (mean difference = 5.6% RMS; 95% CI = 3.4-7.6; p = 0.0001). In addition, it was observed a significant main effect for group (F 1,32  = 9.608; p = 0.0040) with an anterior displacement of COM for the CAI group. These findings suggest that CAI alters the regional distribution of muscle activity of the peroneus longus during ankle eversion. In practice, altered regional activation may impact strengthening programs, prevention, and rehabilitation of CAI., (© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Background: Whole-body vibration (WBV) is being used in rehabilitation and sport. Studies confirm its positive impact on muscle strength and power or regulating muscle hypertension. However, there are some uncertainties regarding its influence on postural stability. This issue seems particularly interesting in the case of individuals with generalized joint hypermobility (GJH), for whom proprioceptive training and muscle strengthening exercises are recommended while techniques that decrease muscle tension are not advised., Objective: The aim of the study was to evaluate the acute effect of WBV on postural stability in adults with GJH., Methods: 60 participants were categorized into the groups: 1) hypermobility with vibration (GJH+WBV), 2) hypermobility without vibration (GJH-WBV), 3) control group with vibration (CTRL+WBV), 4) control group without vibration (CTRL-WBV). The first and the third group completed WBV (frequency: 15 Hz and 30 Hz, amplitude 3 mm, 3 × 3 min). The second and fourth groups participated only in measurement sessions. GJH was assessed using the Beighton test. Postural stability was measured as the overall stability index (OSI) on the Biodex Balance System on the stable and unstable platform with open and closed eyes. Measurements were taken before and after WBV for two weeks., Results: At a frequency of 15 Hz, a significant time effect was observed for measurements Before and After in CTRL-WBV on the stable platform with open eyes (p= 0.012) and on the unstable platform with closed eyes (p= 0.000) for the GJH+WBV and CTRL+WBV groups. There were no significant interactions (p> 0.05) between factors. At a frequency of 30 Hz, there was a significant time effect Before and After (p= 0.047) on the stable platform with open eyes, but no interaction was found between factors (p= 0.835)., Conclusion: There is no positive acute effect of WBV on postural stability in adults with and without GJH.

Objectives: To investigate the immediate effects of local muscle vibration (LMV) on static and dynamic balance control in individuals with and without chronic ankle instability (CAI)., Design: Quasi-experimental study., Setting: Research laboratory., Participants: Twenty-six individuals with CAI and 26 healthy controls., Main Outcome Measures: Center of pressure variables (mean total velocity and displacement in anteroposterior (AP) and mediolateral (ML) directions) during single-leg standing with eyes open and eyes closed and also reach distances in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions of the modified star excursion balance test (MSEBT) were assessed before and after LMV., Results: Statistical analyses showed a significant decrease in mean total velocity and displacement in AP direction from before to after LMV in eyes open condition for both individuals with CAI (p = 0.025, p = 0.041, respectively) and healthy controls (p = 0.001, p = 0.003, respectively). Similar results were observed in eyes closed condition for both individuals with CAI (p < 0.001, p < 0.001, respectively) and healthy controls (p = 0.040, p = 0.014, respectively). The results also showed increased reach distances in ANT (p < 0.001), PM (p < 0.001), and PL directions (p < 0.001) in all participants after LMV., Conclusion: Our results suggest that LMV may be a useful tool in rehabilitation of static and dynamic balance deficits in individuals with CAI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure., Objective: Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain., Design: Randomized clinical trial; assessor-blind; before and after comparison., Setting: Treatment of patients referred to the institutional rehabilitation clinics., Main Outcome Measure(s): Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool., Methods: Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment., Results: Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05)., Conclusion: The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability., Competing Interests: Declaration of competing interest There were no conflicts of interest in this study., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Although chronic ankle instability (CAI) patients display altered reactive joint kinematics after inversion perturbation, little is known about the effects of anticipation on reactive joint kinematics among CAI, coper, and control groups., Objective: To assess changes in reactive joint kinematics after different inverted landing situations including planned- and unplanned-condition among groups of CAI, coper, and control., Methods: Sixty-six volunteers participated (22 per group). Participants completed three trials of both planned and unplanned single-leg landing onto an inverted force platform while reactive joint kinematic data were collected from initial-contact to 200 ms after initial-contact. Two-way repeated measures ANOVAs were used to examine the differences between condition (planned-, unplanned-conditions) and group (CAI, coper, control)., Results: There were significant group by condition interactions for total ankle displacement in the frontal plane (p < 0.01) and maximum ankle inversion velocity (p = 0.01). CAI patients displayed increased ankle displacement (p < 0.01) and maximum inversion velocity (p < 0.01) under the unplanned condition compared to the planned condition. However, copers did not show any differences in ankle displacement and maximum inversion velocity between the two conditions., Conclusions: CAI patients displayed greater changes in ankle joint displacement and maximum ankle inversion velocity occurred after inversion perturbation under unplanned condition compared with copers and controls. Current data suggest that altered reactive joint kinematics under the unanticipated condition in CAI patients may contribute to the condition of CAI after ankle sprains. Clinicians should focus on rehabilitation programs to recover and/or develop feedback control for CAI patients during functional movements under unanticipated condition to prevent further injuries., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)