Ankle Sprains
Conditions
Brief summary
The purpose of this study was to determine the effects of supervised balance and proprioceptive neuromuscular facilitation (PNF) training for the rehabilitation of ankle sprains
Detailed description
Supervised proprioceptive training has been recommended by recently published guidelines for the rehabilitation of ankle sprains. However, research evidence on the efficacy of this type of training is still weak, mainly owing to the methodological limitations of relevant studies. In addition, there is paucity of evidence concerning the effects of such training for the outcomes of functional performance, pain, ankle range of motion, and contradictory results have been reported for postural control. This study aimed to substantiate the benefits of supervised training for the rehabilitation of ankle sprains, and elucidate the effects of two different proprioceptive protocols on the above-mentioned outcomes.
Interventions
OTHERPNF training
Ten individual PNF sessions, supervised by a physical therapist, with 50-60 min duration per session, within a maximal five-week period
OTHERBalance training
Ten individual balance sessions, supervised by a physical therapist, with 50-60 min duration per session, within a maximal five-week period
Sponsors
Lazaros Lazarou
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Individuals with a symptomatic, conventionally treated, post acute (after 14 days) lateral ankle sprain, Grade I-II
Exclusion criteria
* Individuals with lateral ankle sprains Grade III * Individuals with ankle sprain to the medial ligaments * Individuals with ankle sprain to the interosseous (syndesmotic) ligament * Individuals with concurrent fracture * Individuals with chronic ankle instability * Individuals with history of surgery to the ankles * Individuals with history of lower limb nerve injuries * Individuals with history of further ankle injuries, after the sprain * Individuals with any injuries that hindered training participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Participants hopped, using the sprained leg, as far forward as possible, and remained in the landing position for 2sec. Three trials were performed, and the mean hopping distance was used for analysis. |
| Ankle Functional Stability, Via the Single-leg Hops for Time Test | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Participants hopped, using the sprained leg, as fast as possible, a six-meter distance. Three trials were performed, and the mean hopping time was used for analysis. |
| Endurance of Ankle Dorsiflexor Muscles | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The rising on heel test was used, and participants rose on the heel of the sprained leg, as many times as possible. Scoring:10 points for \>40 rises, 5 points for 30-39 rises, 0 points for \<30 rises. |
| Endurance of Ankle Plantar Flexor Muscles | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The rising on toes test was used, and participants rose on the toes of the sprained leg, as many times as possible. Scoring:10 points for \>40 rises, 5 points for 30-39 rises, 0 points for \<30 rises. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Sensation | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The main component of the Greek version of the short form of McGill Pain Questionnaire (GR-SFMPQ) was used for the assessment of pain sensation of the sprained ankle. This consists of 15 descriptive adjectives for the pain sensation (11 sensory and 4 affective), which are self-rated according to their intensity level on a 4-point rating scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). The total rating score (minimum = 0, maximum = 45) of the main component of the GR-SFMPQ was used for data analysis, with higher values representing a worse pain sensation. |
| Pain Intensity During the Week Before Testing | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The second component of the Greek version of the short form of McGill Pain Questionnaire, which is a visual analogue scale (VAS), was used for the assessment. The VAS is a horizontal 10-cm line with clearly defined boundaries: 0 cm = 'No pain' and 10.0 cm = 'worst possible pain'. partipants made a mark on the line at the point that better described the average pain intensity for their sprained ankle, during the week before testing. The distance marked from the 'no pain' point was measured in mm and was used for data analysis. |
| Present Pain | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The third component of the Greek version of the short form of McGill Pain Questionnaire, which is a 6-point verbal rating scale, was used for the assessment. Participants noted what word at the time completing the questionnaire would best describe their pain sensation for the sprained ankle (scoring: no pain = 0, mild = 1, discomforting = 2, distressing = 3, horrible = 4, excruciating = 5). The score corresponding to the noted word was used for data analysis, with higher values representing a worse pain sensation. |
| Ankle Joint Sense for 10° Dorsiflexion | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 10° dorsiflexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis. |
| Ankle Joint Sense for 15° Plantar Flexion | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 15° plantar flexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis. |
| Ankle Joint Sense for 30° Plantar Flexion | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 30° plantar flexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis. |
| Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Anterior-posterior Stability Index | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The anterior-posterior stability index corresponded to the variance of foot platform displacement in the sagittal plane, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis. |
| Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle dorsiflexor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization. |
| Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle dorsiflexor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization. |
| Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle plantar flexor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization. |
| Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle plantar flexor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization. |
| Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot evertor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization. |
| Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot evertor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization. |
| Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot invertor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization. |
| Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot invertor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization. |
| Participants With Recurrent Ankle Sprain | Twelve months after the completion of training | — |
| Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis. |
| Medial-lateral Stability Index | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The medial-lateral stability index corresponded to the variance of foot platform displacement in the frontal plane, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis. |
| Overall Stability Index | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The overall stability index corresponded to the variance of foot platform overall displacement, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis. |
| Ankle Dorsiflexion Range of Motion | Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2) | Assessement was performed with a goniometer. Participants actively dorsiflexed the sprained ankle, while being in long sitting, on a physical therapy table. The mean score of three measurements was used for analysis. |
Countries
Greece
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) PNF training
proprioceptive neuromuscular facilitation exercise program: Ten individual sessions (50-60min per session) of PNF training, supervised by a physical therapist | 10 |
| Balance Balance training
balance exercise program: Ten individual sessions (50-60min per session) of balance training, supervised by a physical therapist | 10 |
| Total | 20 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 1 | 1 |
Baseline characteristics
| Characteristic | Proprioceptive Neuromuscular Facilitation (PNF) | Balance | Total |
|---|---|---|---|
| Age, Continuous | 21.8 years STANDARD_DEVIATION 3.8 | 21.5 years STANDARD_DEVIATION 1.8 | 21.7 years STANDARD_DEVIATION 2.9 |
| Sex: Female, Male Female | 7 Participants | 7 Participants | 14 Participants |
| Sex: Female, Male Male | 3 Participants | 3 Participants | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 11 | 0 / 11 |
| other Total, other adverse events | 0 / 11 | 0 / 11 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Ankle Functional Stability, Via the Single-leg Hop for Distance Test
Participants hopped, using the sprained leg, as far forward as possible, and remained in the landing position for 2sec. Three trials were performed, and the mean hopping distance was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Baseline | 65.6 Centimeters | Standard Deviation 17 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Follow-up 1 | 100.3 Centimeters | Standard Deviation 17 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Follow-up 2 | 77.0 Centimeters | Standard Deviation 17.6 |
| Balance | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Baseline | 82.8 Centimeters | Standard Deviation 19.5 |
| Balance | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Follow-up 1 | 101.4 Centimeters | Standard Deviation 29.8 |
| Balance | Ankle Functional Stability, Via the Single-leg Hop for Distance Test | Follow-up 2 | 110.0 Centimeters | Standard Deviation 30.5 |
Primary
Ankle Functional Stability, Via the Single-leg Hops for Time Test
Participants hopped, using the sprained leg, as fast as possible, a six-meter distance. Three trials were performed, and the mean hopping time was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Baseline | 2.9 Seconds | Standard Deviation 0.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Follow-up 1 | 2.1 Seconds | Standard Deviation 0.2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Follow-up 2 | 2.1 Seconds | Standard Deviation 0.3 |
| Balance | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Baseline | 3.3 Seconds | Standard Deviation 0.4 |
| Balance | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Follow-up 1 | 2.7 Seconds | Standard Deviation 0.4 |
| Balance | Ankle Functional Stability, Via the Single-leg Hops for Time Test | Follow-up 2 | 2.2 Seconds | Standard Deviation 0.4 |
Primary
Endurance of Ankle Dorsiflexor Muscles
The rising on heel test was used, and participants rose on the heel of the sprained leg, as many times as possible. Scoring:10 points for \>40 rises, 5 points for 30-39 rises, 0 points for \<30 rises.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Dorsiflexor Muscles | Baseline | 0 points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Dorsiflexor Muscles | Follow-up 1 | 10 points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Dorsiflexor Muscles | Follow-up 2 | 7.5 points on a scale |
| Balance | Endurance of Ankle Dorsiflexor Muscles | Baseline | 5 points on a scale |
| Balance | Endurance of Ankle Dorsiflexor Muscles | Follow-up 1 | 10 points on a scale |
| Balance | Endurance of Ankle Dorsiflexor Muscles | Follow-up 2 | 10 points on a scale |
Primary
Endurance of Ankle Plantar Flexor Muscles
The rising on toes test was used, and participants rose on the toes of the sprained leg, as many times as possible. Scoring:10 points for \>40 rises, 5 points for 30-39 rises, 0 points for \<30 rises.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Plantar Flexor Muscles | Baseline | 0 points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Plantar Flexor Muscles | Follow-up 1 | 5 points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Endurance of Ankle Plantar Flexor Muscles | Follow-up 2 | 7.5 points on a scale |
| Balance | Endurance of Ankle Plantar Flexor Muscles | Follow-up 1 | 7.5 points on a scale |
| Balance | Endurance of Ankle Plantar Flexor Muscles | Baseline | 0 points on a scale |
| Balance | Endurance of Ankle Plantar Flexor Muscles | Follow-up 2 | 7.5 points on a scale |
Secondary
Ankle Dorsiflexion Range of Motion
Assessement was performed with a goniometer. Participants actively dorsiflexed the sprained ankle, while being in long sitting, on a physical therapy table. The mean score of three measurements was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Dorsiflexion Range of Motion | Baseline | 7 Degrees | Standard Deviation 3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Dorsiflexion Range of Motion | Follow-up 1 | 13 Degrees | Standard Deviation 3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Dorsiflexion Range of Motion | Follow-up 2 | 15 Degrees | Standard Deviation 2 |
| Balance | Ankle Dorsiflexion Range of Motion | Baseline | 8 Degrees | Standard Deviation 2 |
| Balance | Ankle Dorsiflexion Range of Motion | Follow-up 1 | 15 Degrees | Standard Deviation 2 |
| Balance | Ankle Dorsiflexion Range of Motion | Follow-up 2 | 15 Degrees | Standard Deviation 1 |
Secondary
Ankle Joint Sense for 10° Dorsiflexion
The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 10° dorsiflexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 10° Dorsiflexion | Baseline | 4 Degrees | Standard Deviation 2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 10° Dorsiflexion | Follow-up 1 | 1 Degrees | Standard Deviation 1 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 10° Dorsiflexion | Follow-up 2 | 5 Degrees | Standard Deviation 3 |
| Balance | Ankle Joint Sense for 10° Dorsiflexion | Follow-up 2 | 4 Degrees | Standard Deviation 2 |
| Balance | Ankle Joint Sense for 10° Dorsiflexion | Baseline | 6 Degrees | Standard Deviation 4 |
| Balance | Ankle Joint Sense for 10° Dorsiflexion | Follow-up 1 | 3 Degrees | Standard Deviation 3 |
Secondary
Ankle Joint Sense for 15° Plantar Flexion
The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 15° plantar flexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 15° Plantar Flexion | Baseline | 10 Degrees | Standard Deviation 4 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 15° Plantar Flexion | Follow-up 1 | 7 Degrees | Standard Deviation 3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 15° Plantar Flexion | Follow-up 2 | 8 Degrees | Standard Deviation 3 |
| Balance | Ankle Joint Sense for 15° Plantar Flexion | Baseline | 9 Degrees | Standard Deviation 4 |
| Balance | Ankle Joint Sense for 15° Plantar Flexion | Follow-up 1 | 5 Degrees | Standard Deviation 1 |
| Balance | Ankle Joint Sense for 15° Plantar Flexion | Follow-up 2 | 5 Degrees | Standard Deviation 1 |
Secondary
Ankle Joint Sense for 30° Plantar Flexion
The Biodex isokinetic dynamometer was used for assessment. During testing, participants were blindfolded, in the seated position, with footwear on.The internal goniometer of Biodex recorded the degrees of error for the active repositioning of 30° plantar flexion (non-weight-bearing) for the sprained ankle, and the mean of three trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 30° Plantar Flexion | Baseline | 7 Degrees | Standard Deviation 6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 30° Plantar Flexion | Follow-up 1 | 4 Degrees | Standard Deviation 2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Ankle Joint Sense for 30° Plantar Flexion | Follow-up 2 | 5 Degrees | Standard Deviation 2 |
| Balance | Ankle Joint Sense for 30° Plantar Flexion | Baseline | 4 Degrees | Standard Deviation 3 |
| Balance | Ankle Joint Sense for 30° Plantar Flexion | Follow-up 1 | 3 Degrees | Standard Deviation 1 |
| Balance | Ankle Joint Sense for 30° Plantar Flexion | Follow-up 2 | 3 Degrees | Standard Deviation 2 |
Secondary
Anterior-posterior Stability Index
The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The anterior-posterior stability index corresponded to the variance of foot platform displacement in the sagittal plane, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Anterior-posterior Stability Index | Baseline | 2.6 Degrees | Standard Deviation 0.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Anterior-posterior Stability Index | Follow-up 1 | 2.6 Degrees | Standard Deviation 0.3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Anterior-posterior Stability Index | Follow-up 2 | 2.5 Degrees | Standard Deviation 0.4 |
| Balance | Anterior-posterior Stability Index | Baseline | 3.1 Degrees | Standard Deviation 0.6 |
| Balance | Anterior-posterior Stability Index | Follow-up 1 | 3.0 Degrees | Standard Deviation 0.7 |
| Balance | Anterior-posterior Stability Index | Follow-up 2 | 3.1 Degrees | Standard Deviation 0.7 |
Secondary
Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle dorsiflexor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Baseline | 0.99 Proportion | Standard Deviation 0.13 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Follow up 1 | 0.98 Proportion | Standard Deviation 0.17 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Follow up 2 | 1.02 Proportion | Standard Deviation 0.21 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Baseline | 0.88 Proportion | Standard Deviation 0.23 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Follow up 1 | 0.85 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 120°/Sec Speed | Follow up 2 | 0.83 Proportion | Standard Deviation 0.13 |
Secondary
Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle dorsiflexor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Baseline | 1.02 Proportion | Standard Deviation 0.25 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Follow up 1 | 0.90 Proportion | Standard Deviation 0.24 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Follow up 2 | 1.02 Proportion | Standard Deviation 0.27 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Baseline | 0.88 Proportion | Standard Deviation 0.1 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Follow up 1 | 1.03 Proportion | Standard Deviation 0.1 |
| Balance | Electromyographic Activity of Anterior Tibialis Muscle During Ankle Dorsiflexion at 30°/Sec Speed | Follow up 2 | 0.92 Proportion | Standard Deviation 0.13 |
Secondary
Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle plantar flexor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Baseline | 0.82 Proportion | Standard Deviation 0.28 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Follow up 1 | 0.68 Proportion | Standard Deviation 0.21 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Follow up 2 | 0.71 Proportion | Standard Deviation 0.16 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Baseline | 0.61 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Follow up 1 | 0.71 Proportion | Standard Deviation 0.1 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 120°/Sec Speed | Follow up 2 | 0.83 Proportion | Standard Deviation 0.12 |
Secondary
Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the ankle plantar flexor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Baseline | 0.78 Proportion | Standard Deviation 0.21 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Follow up 1 | 0.60 Proportion | Standard Deviation 0.16 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Follow up 2 | 0.61 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Baseline | 0.64 Proportion | Standard Deviation 0.09 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Follow up 1 | 0.76 Proportion | Standard Deviation 0.12 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Ankle Plantar Flexion at 30°/Sec Speed | Follow up 2 | 0.68 Proportion | Standard Deviation 0.14 |
Secondary
Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot evertor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Baseline | 0.95 Proportion | Standard Deviation 0.34 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Follow up 1 | 0.67 Proportion | Standard Deviation 0.26 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Follow up 2 | 0.87 Proportion | Standard Deviation 0.43 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Baseline | 0.75 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Follow up 1 | 0.70 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 120°/Sec Speed | Follow up 2 | 0.74 Proportion | Standard Deviation 0.16 |
Secondary
Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot evertor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the peroneus longus muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Baseline | 0.89 Proportion | Standard Deviation 0.24 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Follow up 1 | 0.78 Proportion | Standard Deviation 0.22 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Follow up 2 | 0.92 Proportion | Standard Deviation 0.17 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Baseline | 0.70 Proportion | Standard Deviation 0.22 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Follow up 1 | 0.68 Proportion | Standard Deviation 0.12 |
| Balance | Electromyographic Activity of Peroneus Longus Muscle During Foot Eversion at 30°/Sec Speed | Follow up 2 | 0.63 Proportion | Standard Deviation 0.16 |
Secondary
Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot invertor muscles, at 120°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Baseline | 0.43 Proportion | Standard Deviation 0.12 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Follow up 1 | 0.45 Proportion | Standard Deviation 0.16 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Follow up 2 | 0.38 Proportion | Standard Deviation 0.14 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Baseline | 0.44 Proportion | Standard Deviation 0.15 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Follow up 1 | 0.36 Proportion | Standard Deviation 0.14 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 120°/Sec Speed | Follow up 2 | 0.32 Proportion | Standard Deviation 0.17 |
Secondary
Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed
Two surface electrodes and a ground electrode were used for assessment. Measurements were taken for the sprained leg, during isokinetic testing of the foot invertor muscles, at 30°/sec speed, with the Biodex dynamometer. Normalized values of the electromyographic (EMG) signals were used for analysis, and EMG activity during maximal voluntary isometric contraction of the anterior tibialis muscle was used as the reference value for normalization.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Baseline | 0.40 Proportion | Standard Deviation 0.11 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Follow up 1 | 0.32 Proportion | Standard Deviation 0.13 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Follow up 2 | 0.54 Proportion | Standard Deviation 0.16 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Baseline | 0.39 Proportion | Standard Deviation 0.1 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Follow up 1 | 0.40 Proportion | Standard Deviation 0.18 |
| Balance | Electromyographic Activity of Tibialis Anterior Muscle During Foot Inversion at 30°/Sec Speed | Follow up 2 | 0.31 Proportion | Standard Deviation 0.15 |
Secondary
Medial-lateral Stability Index
The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The medial-lateral stability index corresponded to the variance of foot platform displacement in the frontal plane, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Medial-lateral Stability Index | Baseline | 1.9 Degrees | Standard Deviation 0.5 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Medial-lateral Stability Index | Follow-up 1 | 1.7 Degrees | Standard Deviation 0.5 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Medial-lateral Stability Index | Follow-up 2 | 1.6 Degrees | Standard Deviation 0.4 |
| Balance | Medial-lateral Stability Index | Baseline | 1.9 Degrees | Standard Deviation 0.4 |
| Balance | Medial-lateral Stability Index | Follow-up 1 | 2.0 Degrees | Standard Deviation 0.5 |
| Balance | Medial-lateral Stability Index | Follow-up 2 | 1.5 Degrees | Standard Deviation 0.3 |
Secondary
Overall Stability Index
The Biodex Stability System, which is a dynamic tilting platform, was used for assessment. The overall stability index corresponded to the variance of foot platform overall displacement, and it was measured in single-leg stance, for the sprained leg, without footwear. Three 20-sec trials were performed, with open eyes, and the mean score was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Overall Stability Index | Baseline | 3.1 Degrees | Standard Deviation 0.7 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Overall Stability Index | Follow-up 1 | 3.0 Degrees | Standard Deviation 0.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Overall Stability Index | Follow-up 2 | 2.9 Degrees | Standard Deviation 0.6 |
| Balance | Overall Stability Index | Baseline | 3.6 Degrees | Standard Deviation 0.8 |
| Balance | Overall Stability Index | Follow-up 1 | 3.4 Degrees | Standard Deviation 0.5 |
| Balance | Overall Stability Index | Follow-up 2 | 3.4 Degrees | Standard Deviation 0.6 |
Secondary
Pain Intensity During the Week Before Testing
The second component of the Greek version of the short form of McGill Pain Questionnaire, which is a visual analogue scale (VAS), was used for the assessment. The VAS is a horizontal 10-cm line with clearly defined boundaries: 0 cm = 'No pain' and 10.0 cm = 'worst possible pain'. partipants made a mark on the line at the point that better described the average pain intensity for their sprained ankle, during the week before testing. The distance marked from the 'no pain' point was measured in mm and was used for data analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Intensity During the Week Before Testing | Baseline | 2.0 Points on a scale | Standard Deviation 1.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Intensity During the Week Before Testing | Follow-up 1 | 0.4 Points on a scale | Standard Deviation 0.4 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Intensity During the Week Before Testing | Follow-up 2 | 1.3 Points on a scale | Standard Deviation 1 |
| Balance | Pain Intensity During the Week Before Testing | Baseline | 2.8 Points on a scale | Standard Deviation 2.1 |
| Balance | Pain Intensity During the Week Before Testing | Follow-up 1 | 1.1 Points on a scale | Standard Deviation 1.3 |
| Balance | Pain Intensity During the Week Before Testing | Follow-up 2 | 0.5 Points on a scale | Standard Deviation 0.7 |
Secondary
Pain Sensation
The main component of the Greek version of the short form of McGill Pain Questionnaire (GR-SFMPQ) was used for the assessment of pain sensation of the sprained ankle. This consists of 15 descriptive adjectives for the pain sensation (11 sensory and 4 affective), which are self-rated according to their intensity level on a 4-point rating scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). The total rating score (minimum = 0, maximum = 45) of the main component of the GR-SFMPQ was used for data analysis, with higher values representing a worse pain sensation.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Sensation | Baseline | 7 Total score of scales |
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Sensation | Follow-up 1 | 0 Total score of scales |
| Proprioceptive Neuromuscular Facilitation (PNF) | Pain Sensation | Follow-up 2 | 3.5 Total score of scales |
| Balance | Pain Sensation | Baseline | 6 Total score of scales |
| Balance | Pain Sensation | Follow-up 1 | 0 Total score of scales |
| Balance | Pain Sensation | Follow-up 2 | 0.5 Total score of scales |
Secondary
Participants With Recurrent Ankle Sprain
Time frame: Twelve months after the completion of training
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Participants With Recurrent Ankle Sprain | 2 Participants |
| Balance | Participants With Recurrent Ankle Sprain | 0 Participants |
Secondary
Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Baseline | 20.3 Newton metres | Standard Deviation 4.2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Follow-up 1 | 19.0 Newton metres | Standard Deviation 5.4 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Follow-up 2 | 19.4 Newton metres | Standard Deviation 4.1 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Baseline | 22.7 Newton metres | Standard Deviation 5.9 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Follow-up 1 | 21.4 Newton metres | Standard Deviation 5.5 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 120°/Sec Speed | Follow-up 2 | 22.1 Newton metres | Standard Deviation 5.5 |
Secondary
Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Baseline | 35.8 Newton metres | Standard Deviation 8.2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Follow-up 1 | 30.7 Newton metres | Standard Deviation 7.3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Follow-up 2 | 30.8 Newton metres | Standard Deviation 5.8 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Baseline | 31.7 Newton metres | Standard Deviation 6.8 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Follow-up 1 | 32.3 Newton metres | Standard Deviation 8.6 |
| Balance | Peak Torque of Ankle Dorsiflexor Muscles at 30°/Sec Speed | Follow-up 2 | 30.3 Newton metres | Standard Deviation 7.3 |
Secondary
Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Baseline | 17.4 Newton metres | Standard Deviation 4.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Follow up 1 | 25.0 Newton metres | Standard Deviation 13.4 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Follow up 2 | 25.0 Newton metres | Standard Deviation 8.6 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Baseline | 26.0 Newton metres | Standard Deviation 15.5 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Follow up 1 | 40.2 Newton metres | Standard Deviation 12.1 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 120°/Sec Speed | Follow up 2 | 38.1 Newton metres | Standard Deviation 12.4 |
Secondary
Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the ankle joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Baseline | 31.5 Newton metres | Standard Deviation 13.8 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Follow-up 1 | 46.1 Newton metres | Standard Deviation 11.3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Follow-up 2 | 53.5 Newton metres | Standard Deviation 14.7 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Baseline | 47.8 Newton metres | Standard Deviation 23.6 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Follow-up 1 | 80.6 Newton metres | Standard Deviation 31.4 |
| Balance | Peak Torque of Ankle Plantar Flexor Muscles at 30°/Sec Speed | Follow-up 2 | 65.5 Newton metres | Standard Deviation 25.5 |
Secondary
Peak Torque of Foot Evertor Muscles at 120°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Baseline | 8.0 Newton metres | Standard Deviation 1.4 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Follow up 1 | 10.5 Newton metres | Standard Deviation 2.3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Follow up 2 | 10.5 Newton metres | Standard Deviation 3.1 |
| Balance | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Baseline | 9.1 Newton metres | Standard Deviation 1.5 |
| Balance | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Follow up 1 | 8.6 Newton metres | Standard Deviation 2.2 |
| Balance | Peak Torque of Foot Evertor Muscles at 120°/Sec Speed | Follow up 2 | 13.0 Newton metres | Standard Deviation 3 |
Secondary
Peak Torque of Foot Evertor Muscles at 30°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Baseline | 11.9 Newton metres | Standard Deviation 1.8 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Follow up 1 | 13.0 Newton metres | Standard Deviation 3.8 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Follow up 2 | 13.9 Newton metres | Standard Deviation 4 |
| Balance | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Baseline | 13.6 Newton metres | Standard Deviation 2.5 |
| Balance | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Follow up 1 | 14.5 Newton metres | Standard Deviation 2 |
| Balance | Peak Torque of Foot Evertor Muscles at 30°/Sec Speed | Follow up 2 | 18.8 Newton metres | Standard Deviation 2.3 |
Secondary
Peak Torque of Foot Invertor Muscles at 120°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Baseline | 6.7 Newton metres | Standard Deviation 2.3 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Follow up 1 | 9.5 Newton metres | Standard Deviation 3.2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Follow up 2 | 21.6 Newton metres | Standard Deviation 5.7 |
| Balance | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Baseline | 9.3 Newton metres | Standard Deviation 3.5 |
| Balance | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Follow up 1 | 12.0 Newton metres | Standard Deviation 3.7 |
| Balance | Peak Torque of Foot Invertor Muscles at 120°/Sec Speed | Follow up 2 | 27.7 Newton metres | Standard Deviation 8.9 |
Secondary
Peak Torque of Foot Invertor Muscles at 30°/Sec Speed
The Biodex isokinetic dynamometer was used for assessment. During isokinetic testing of the subtalar joint, participants were in the seated position, with footwear on. Measurements were taken for the sprained leg, and the mean of five maximal trials was used for analysis.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Baseline | 10.1 Newton metres | Standard Deviation 3.2 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Follow up 1 | 12.6 Newton metres | Standard Deviation 5.6 |
| Proprioceptive Neuromuscular Facilitation (PNF) | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Follow up 2 | 26.2 Newton metres | Standard Deviation 6.5 |
| Balance | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Follow up 2 | 29.6 Newton metres | Standard Deviation 9.9 |
| Balance | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Baseline | 12.2 Newton metres | Standard Deviation 3.8 |
| Balance | Peak Torque of Foot Invertor Muscles at 30°/Sec Speed | Follow up 1 | 18.6 Newton metres | Standard Deviation 3.7 |
Secondary
Present Pain
The third component of the Greek version of the short form of McGill Pain Questionnaire, which is a 6-point verbal rating scale, was used for the assessment. Participants noted what word at the time completing the questionnaire would best describe their pain sensation for the sprained ankle (scoring: no pain = 0, mild = 1, discomforting = 2, distressing = 3, horrible = 4, excruciating = 5). The score corresponding to the noted word was used for data analysis, with higher values representing a worse pain sensation.
Time frame: Baseline, after the completion of training (follow-up 1), and eight weeks after the completion of training (follow-up 2)
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Proprioceptive Neuromuscular Facilitation (PNF) | Present Pain | Baseline | 1 Points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Present Pain | Follow-up 1 | 0 Points on a scale |
| Proprioceptive Neuromuscular Facilitation (PNF) | Present Pain | Follow-up 2 | 1 Points on a scale |
| Balance | Present Pain | Baseline | 1 Points on a scale |
| Balance | Present Pain | Follow-up 1 | 0 Points on a scale |
| Balance | Present Pain | Follow-up 2 | 0 Points on a scale |