Spinal and Supraspinal Control in Chronic Ankle Instability

NCT06898554 | Recruiting

• 1 other identifier: YeditepeU23
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 2

Brief Summary

Ankle sprains are common sports injuries that often lead to chronic ankle instability (CAI). Patients with CAI experience deficits in neuromuscular control (NMC), including proprioception and strength. It is believed that damage to the ankle's ligament mechanoreceptors and the peroneal nerve after the initial ankle sprain can cause alterations in NMC, resulting in postural control and dynamic joint stability dysfunction. Inflammation related to recurrent ankle sprains may also contribute to neuromuscular impairments. Evidence suggests that bilateral postural control deficits occur after an ankle sprain, suggesting alterations in the central nervous system (CNS). Rehabilitation for CAI has been shown to lead to bilateral improvements in NMC, potentially due to neural alterations at both the spinal and supraspinal levels. Cross-education, which refers to the muscular crossed effect of unilateral training, has also been proposed as a mechanism for improving contralateral strength in neurologically healthy individuals. While the exact mechanisms underlying cross-education are not yet fully understood, evidence suggests that it involves neural adaptations at both spinal and supraspinal levels. This study aims to investigate the cross-education effect of a 6-week, unilateral balance training on corticomotor excitability, motor neuron pool excitability, and static and dynamic balance in athletes with chronic ankle instability.

Conditions

Ankle Injuries; Ankle Sprains

Keywords

ankle, joint instability, cross-education, rehabilitation

Outcome Measures

Primary Outcomes (3)

• Proprioceptive-Stabilometric Assessment

  The Prokin PK 252 will be used for proprioceptive-stabilometric assessment of the lower extremities, incorporating static and dynamic evaluations. The sensorimotor assessment will include the monopodal controlled-load proprioceptive control test and its variant with total load. Participants will perform movements with one foot on the platform, with angular displacements converted into electrical impulses for data acquisition. Static balance will be assessed on a stable platform for 30 seconds per ankle under eyes-open and eyes-closed conditions. Dynamic balance will be measured on an unstable platform under the same conditions. Proprioception will be evaluated on an unstable platform for 90 seconds, guiding the platform through horizontal, diagonal, and circular patterns as per the test program.

  at the baseline and end of the intervention, 8 weeks

• Transcranial Magnetic Stimulation

  Transcranial Magnetic Stimulation (TMS), a non-invasive neurophysiological technique, will be used to assess motor cortical function. Corticomotor excitability will be evaluated using dual-cone coil TMS to examine adaptations following cross-training after unilateral training. TMS will induce corticospinal volleys of direct (D) and indirect (I) waves. The resting motor threshold (rMT), a biomarker of upper motor neuron function, will be recorded. EMG recordings will assess corticomotor excitability, with Ag/AgCl electrodes placed on the tibialis anterior, peroneus longus, and gastrocnemius medialis muscles, following SENIAM guidelines. Participants will be seated in a TMS chair, and the hotspot in the left primary motor cortex will be identified. The MEP amplitude will be assessed at 120% rMT with 10 repetitions, and latency will be recorded. A 15-minute rest will be observed between muscle tests.

  at the baseline and end of the intervention, 8 weeks

• Hoffman Reflex

  The H-reflex will be measured to assess motor neuron pool excitability within the spinal loop, aiming to explain the mechanism underlying bilateral adaptations. As a valuable tool for evaluating neurological function in athletes, the H-reflex will provide insights into neurophysiological changes. EMG signals will be pre-amplified and bandpass filtered between 30-300 Hz and recorded from the peroneus longus, tibialis anterior, and gastrocnemius medialis muscles. The tibial nerve will be stimulated using single 1 ms square-wave pulses applied over the popliteal fossa. The test sequence will be randomized between stable and unstable ankles, ensuring balanced measurements. H-reflex excitability will be assessed for both ankles before and after the protocol to determine neuromuscular adaptations.

  at the baseline and end of the intervention, 8 weeks

Secondary Outcomes (2)

• Cumberland Ankle Instability Tool

  at the baseline and end of the intervention, 8 weeks

• Foot and Ankle Ability Measure (FAAM)

  at the baseline and end of the intervention, 8 weeks

Study Arms (3)

Stable Group

EXPERIMENTAL

The intervention will be applied to only the stable ankle of the athletes with unilateral chronic ankle instability.

Other: The structured balance training protocol

Unstable Group

EXPERIMENTAL

The intervention will be applied to only the unstable ankle of the athletes with unilateral chronic ankle instability.

Other: The structured balance training protocol

Control Group

NO INTERVENTION

No intervention will be applied.

Interventions

The structured balance training protocol OTHER

The structured balance training protocol consists of 7 exercises including balance and hop stabilization exercises for athletes with chronic ankle instability.

Stable Group; Unstable Group

Eligibility Criteria

• Age: 18 Years - 25 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Volunteering to participate in the study,
• Being an athlete between the ages of 18-25,
• Being a player in a field team sport such as basketball, volleyball, and handball,
• Having a history of at least 2 significant grade II LAS diagnosed by a physician,
• Related inflammatory symptoms, "giving away" sensation, obtaining a score ≤25 from the Cumberland Ankle Instability Tool (CAIT),
• A score \<90% for the activities of daily living subscale and \<80% for the sport subscale from the Foot and Ankle Ability Measure,
• Recurrent episodes of LAS of the injured ankle which occurred within at least 12 months.

You may not qualify if:

• Acute injury of lower extremity musculoskeletal structures in the last three months,
• Orthopedic surgery in any of the lower extremities,
• Bilateral ankle instability,
• Vestibular or balance disorder

Sponsors & Collaborators

• Ayca Yagcioglu: lead
• Yeditepe University: collaborator
• Yeditepe University Hospital: collaborator

Study Sites (2)

Yeditepe University Koşuyolu Hospital

Istanbul, 34718, Turkey (Türkiye)

RECRUITING

Yeditepe University

Istanbul, 34755, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Ankle Injuries; Joint Instability

Condition Hierarchy (Ancestors)

Leg Injuries; Wounds and Injuries; Joint Diseases; Musculoskeletal Diseases

Study Officials

• Berrin Aktekin, MD, Professor

  Yeditepe University Hospital

  PRINCIPAL INVESTIGATOR

• Feyza Şule Hantal, PHd

  Yeditepe University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ayca Yagcioglu, MSc

CONTACT

+905432800692; ayca.yagcioglu@yeditepe.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: MSc

Study Record Dates

• First Submitted: March 21, 2025
• First Posted: March 27, 2025
• Study Start: November 15, 2024
• Primary Completion: June 30, 2025
• Study Completion: July 31, 2025
• Last Updated: March 27, 2025

Record last verified: 2024-11

Locations

TU (2)