The Effects of Vestibulo-Ocular Reflex Exercises Added to Postural Stabilization Training in Amateur Athletes With Chronic Ankle Instability

NCT07760233 | Recruiting DMC

• 1 other identifier: MFP-CAI-VOR-2027
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

Chronic ankle instability (CAI) is a common condition after lateral ankle sprain. CAI is characterized by mechanical and/or functional instability, or recurrent episodes of "giving way," persisting for at least 12 months after the initial injury, and is associated with limitations in activity and and participation. Contemporary theoretical models emphasize that CAI should not be explained solely by biomechanical or neuromuscular deficits, but rather as a dynamic condition shaped by the interaction of motor-behavioral, sensory-perceptual, psychological, and environmental factors. Postural stabilization training is commonly used to improve balance and neuromuscular control in individuals with CAI. However, individuals with CAI may show increased reliance on visual information and altered visual-vestibular sensory reweighting during postural control tasks. The vestibulo-ocular reflex (VOR) contributes to gaze stability and visual clarity during head movements and may also be related to neurocognitive processes such as attention and processing speed. This study is designed as a randomized controlled, prospective, parallel-group, pretest-posttest design trial to investigate whether VOR exercises added to postural stabilization training improve visuo-motor reaction performance, fear avoidance behavior related to sports injuries and kinesiophobia in amateur athletes with CAI.

Conditions

Ankle Sprain; Ankle Sprain Strain; Ankle Inversion Sprain

Keywords

sprain; sensory reweighting; injury-related anxiety; psychological readiness; gaze stabilization

Outcome Measures

Primary Outcomes (1)

• Reactive Balance Test

  This test will be used to assess visuo-motor reaction performance during dynamic postural control. The test will combine the Y-Balance Test setup with a smartphone-controlled LED light system (BlazePod). LED targets will be placed at 80% of each participant's maximum reach distance in the anterior, posteromedial, and posterolateral directions. Participants will stand in the standard Y-Balance Test position and will be instructed to touch the target LED stimulus as quickly as possible without losing balance. A total of 45 randomized visual stimuli will be presented, with inter-stimulus intervals ranging from 0.5 to 2.5 seconds. Visuo-motor reaction time will be recorded in milliseconds, and accuracy will be calculated based on missed stimuli, multiple attempts, and decision errors. The test will be performed twice on the limb with a history of instability; the first trial will be used for familiarization, and the second trial will be used for analysis.

  baseline, 6 weeks after baseline, and 10-week after baseline

Secondary Outcomes (2)

• The Athlete Fear Avoidance Questionnaire - Turkish Version (AFAQ-TR)

  baseline, 6 weeks after baseline, and 10-week after baseline

• The Tampa Scale for Kinesiophobia - Turkish Version (TSK-TR)

  baseline, 6 weeks after baseline, and 10-week after baseline

Other Outcomes (4)

• Foot and Ankle Ability Measure Turkish Version (FAAM-T)

  baseline, 6 weeks after baseline, and 10-week after baseline

• Cumberland Ankle Instability Tool - Turkish Version

  baseline, 6 weeks after baseline, and 10-week after baseline

• Weight-Bearing Lunge Test

  baseline, 6 weeks after baseline, and 10-week after baseline

Study Arms (2)

Postural Stabilization Training Group

ACTIVE COMPARATOR

Participants in this group will receive ankle joint mobilization followed by a structured postural stabilization training program. The program will include single-leg stance progression, hop stabilization tasks, and number-sequence hop tasks. Exercises will be progressed according to the participant's ability to complete each task without errors. Ankle joint mobilization will include talocrural anteroposterior mobilization and distal fibular mobilization with movement, applied before the exercise session for approximately 5 minutes.

Other: Postural Stabilization Training

Vestibulo-Ocular Reflex Exercise in addition to Postural Stabilization Training Group

EXPERIMENTAL

Participants in this group will receive the same ankle joint mobilization and postural stabilization training program as the Postural Stabilization Training Group. In addition, vestibulo-ocular reflex (VOR) exercises involving fixation on a visual target during head movements will be implemented. VOR exercises will be structured to progressively increase postural demands and will include sitting, standing, walking, and single-leg stance positions.

Other: Vestibulo-Ocular Reflex Exercise in addition to Postural Stabilization Training

Interventions

Postural Stabilization Training OTHER

Participants in this group will receive ankle joint mobilization followed by a structured postural stabilization training program. The program will include single-leg stance progression, hop stabilization tasks and number-sequence hop tasks. Exercises will be progressed according to the participant's ability to complete each task without errors. Ankle joint mobilization will include talocrural anteroposterior mobilization and distal fibular mobilization with movement, applied before the exercise session for approximately 5 minutes. The total session will last approximately 45 minutes and will be performed 3 times per week for 6 weeks.

Also known as: Talocrural joint mobilization

Postural Stabilization Training Group

Vestibulo-Ocular Reflex Exercise in addition to Postural Stabilization Training OTHER

Participants in this group will receive the same ankle joint mobilization and postural stabilization training program as the Postural Stabilization Training Group. In addition, vestibulo-ocular reflex (VOR) exercises involving fixation on a visual target during head movements will be implemented. VOR exercises will be structured to progressively increase postural demands and will include sitting, standing, walking, and single-leg stance positions. The total session will last approximately 45 minutes and will be performed 3 times per week for 6 weeks.

Also known as: Talocrural joint mobilization

Vestibulo-Ocular Reflex Exercise in addition to Postural Stabilization Training Group

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Being between 18 and 35 years of age.
• Being classified as a Tier 2 athlete according to the McKay et al. Participant Classification Framework (trained/developmental level).
• Having a history of at least one lateral ankle sprain (LAS) occurring at least 12 months before enrollment, resulting in swelling, pain, and functional impairment, and followed by persistent instability.
• Having the most recent ankle sprain at least 3 months before study enrollment.
• Having a history of recurrent ankle sprains or episodes of "giving way."
• Having a diagnosis of unilateral chronic ankle instability (CAI).
• Having a Cumberland Ankle Instability Tool - Turkish Version (CAIT-T) score of ≤24.
• Having a Foot and Ankle Ability Measure (FAAM) score of \<90%.
• Having a Foot and Ankle Ability Measure Sports subscale (FAAM-S) score of \<80%.
• A side-to-side difference of ≥2.5 cm in Weight-Bearing Lunge Test distance, with the affected side demonstrating less dorsiflexion than the unaffected side.

You may not qualify if:

• History of acute lateral ankle sprain within the last 3 months.
• History of lower extremity surgery.
• History of acute injury to other musculoskeletal structures of the lower extremity joints within the last 3 months that affected joint integrity and function and caused interruption of desired physical activity for at least one day.
• History of balance or vestibular disorders, including cerebellar, vestibular, cochlear, or inner ear dysfunction.
• Visual problems that may affect the administration or interpretation of the Dynamic Visual Acuity Test, including a history of amblyopia, diplopia, or significant visual loss.
• Persistent symptoms related to a previous concussion or traumatic brain injury.

Sponsors & Collaborators

• Bahçeşehir University: lead

Study Sites (1)

Reset Fizyoterapi

Istanbul, Turkey, 34728, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Ankle Injuries; Sprains and Strains

Condition Hierarchy (Ancestors)

Leg Injuries; Wounds and Injuries

Study Officials

• Mustafa Fatih Çetintaş, PT, PhD (c)

  Bahçeşehir University

  PRINCIPAL INVESTIGATOR

• Pelin Pişirici, PT, PhD

  Bahçeşehir University

  STUDY CHAIR

• Gamze Kılıç, PT, PhD

  Istanbul Nisantasi University

  STUDY DIRECTOR

• Barış Kocaoğlu Kocaoğlu, MD

  Acibadem University

  STUDY DIRECTOR

Central Study Contacts

Mustafa Fatih Çetintaş, PT, PhD (c)

CONTACT

+905336654580; mfcetintas@gmail.com

Pelin Pişirici, PT, PhD

CONTACT

+905055016076; pelin.pisirici@bau.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PT, PhD (c)

Model Details: Participants who meet the inclusion criteria will be randomized into Participants will be randomly allocated to one of two groups two parallel groups: Postural Stabilization Training Group and Postural Stabilization Training plus Vestibulo-Ocular Reflex Exercises Group. Both groups will receive the ankle joint mobilization by the same physiotherapist. Assessments will be performed at baseline, at the end of week 6, and at 4-week follow-up.

Study Record Dates

• First Submitted: August 7, 2026
• First Posted: August 12, 2026
• Study Start: July 25, 2026
• Primary Completion (Estimated): July 25, 2027
• Study Completion (Estimated): July 25, 2027
• Last Updated: August 12, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)