Effects of Cervical and Oculomotor Exercises on Functional Status, Balance, and Proprioception in Chronic Ankle Instability

Effects of Cervical and Oculomotor Exercises Added to Conventional Treatment on Ankle Functional Status, Balance, and Proprioception in Individuals with Chronic Ankle Instability: A Randomized Controlled Trial

• Exercise (Other): Participants in the experimental group will receive a conventional rehabilitation program including mobility, strengthening, balance, and proprioceptive exercises targeting the ankle joint. In addition, they will perform cervical stabilization and oculomotor exercises.
• Exercise (Other): Participants in the control group will receive a conventional rehabilitation program including mobility, strengthening, balance, and proprioceptive exercises targeting the ankle joint.

Primary outcomes

• Y-Balance Test [Baseline and post-intervention (after 4 weeks)]: Dynamic balance performance assessed using balance tests (Y-Balance Test)
• Foot and Ankle Ability Measure (FAAM) [Baseline and post-intervention (after 4 weeks)]: Functional status assessed using the Foot and Ankle Ability Measure (FAAM) The daily living activities subscale contains 21 items; the minimum score is 0 and the maximum score is 84. The sports subscale consists of 8 items; the minimum score is 0 and the maximum score is 32. A higher score represents a higher level of physical function.

Secondary outcomes

• Ankle Joint Position Error Test [Baseline and post-intervention (after 4 weeks)]: Ankle proprioception assessed using laser beam device joint position error (JPE) tests
• Weight Bearing Lunge Test [Baseline and post-intervention (after 4 weeks)]: Ankle dorsiflexion range of motion will be assessed with the weight bearing lunge test
• Computerized balance assessment [Baseline and post-intervention (after 4 weeks)]: Postural stability will be assessed using the Prokin Tecnobody balance assessment system.
• Side Hop Test [Baseline and post-intervention (after 4 weeks)]: Side hop test will be used to assess the dynamic postural control capacity around the ankle.
• Ankle Pain [Baseline and post-intervention (after 4 weeks)]: Ankle pain will be assessed using a visual analog scale (VAS). The VAS is a scale ranging from 0 (no pain) to 10 (most severe pain), with higher scores indicating greater pain.
• Cervical Joint Position Error Test [Baseline and post-intervention (after 4 weeks)]: Cervical proprioception will be assessed using the Cervical Joint Position Error Test.

Sex: All, ages: 18 Years to 45 Years

Inclusion Criteria:

* Diagnosed with unilateral chronic ankle instability (CAI) in accordance with the International Ankle Consortium recommendations
* A history of at least one significant lateral ankle sprain that occurred at least 12 months prior to participation, resulting in inflammatory symptoms such as pain and swelling and causing at least one day of interruption in physical activity
* A history of "giving way" and/or recurrent ankle sprains and/or a feeling of instability in the affected ankle within the past 6 months
* A Cumberland Ankle Instability Tool (CAIT) score of ≤ 25

Exclusion Criteria:

* History of surgery or fracture in the lower extremities or spine
* Acute musculoskeletal injury affecting other joints of the lower extremity within the past 3 months (e.g., sprains, fractures) that impaired joint integrity and function and caused at least one day of interruption in physical activity
* History of injection in the affected ankle
* History of ankle sprain in the affected extremity within the past 4 weeks
* Presence of systemic musculoskeletal disorders, neurological disorders, vestibular disorders, or any other condition that may affect balance or sensory function
* Previous participation in any rehabilitation program for the ankle or cervical region
* History of head or neck trauma or diagnosed pathology within the past 12 months
* History of neck pain greater than 3/10 in severity within the past 12 months

• Damla KARABAY, Assistant Professor, Study chair, Izmir Katip Çelebi University
• Simge N UNGAN, Physiotherapist (Bachelor), Principal investigator, Izmir Katip Çelebi University
• Sercan Çapkın, Associate Professor, Study director, Izmir Bakırçay University