Ankle Instability, Chronic Ankle Instability
Conditions
Keywords
Tissue Flossing, Floss Band, Chronic Ankle Instability, Ankle Rehabilitation, Exercise Therapy
Brief summary
This study will evaluate whether tissue flossing with different pressure levels, when combined with exercise training, improves ankle function in young adults with chronic ankle instability. Forty-eight participants will be randomly assigned to one of three groups: a control exercise group, a 150 mmHg tissue flossing plus exercise group, or a 200 mmHg tissue flossing plus exercise group. All groups will complete the same 6-week rehabilitation program, three times per week. Outcomes will be assessed at baseline and after the intervention, and long-term follow-up data will also be collected.
Detailed description
Chronic ankle instability is characterized by recurrent ankle sprains, a feeling of giving way, pain, swelling, reduced function, and impaired balance control. Exercise-based rehabilitation is a cornerstone of nonoperative management, but adjunctive strategies that may enhance recovery remain of interest. Tissue flossing is a compression-based intervention in which an elastic band is wrapped around the target joint or limb segment during exercise. It may influence mobility, neuromuscular control, proprioception, and symptom perception. However, the optimal pressure level for long-term rehabilitation in chronic ankle instability remains unclear. This single-center, assessor-blinded, three-arm parallel randomized controlled trial will be conducted at Chengdu Sport University. A total of 48 young adults with chronic ankle instability will be allocated in a 1:1:1 ratio to a control exercise group, a 150 mmHg tissue flossing plus exercise group, or a 200 mmHg tissue flossing plus exercise group. All participants will complete the same 6-week rehabilitation program, with 3 sessions per week and 18 sessions in total. The two tissue flossing groups will receive pressure-calibrated flossing during the main training phase, while the control group will perform the same exercises without compression. The primary outcome will be the change in Foot and Ankle Ability Measure Activities of Daily Living score from baseline to 6 weeks. Secondary outcomes will include sport-related foot and ankle function, functional movement screening, ankle range of motion, ankle isometric strength, Biodex balance-related measures, pain, long-term follow-up outcomes, adherence, and adverse events.
Interventions
BEHAVIORALExercise Training
All groups will perform the same supervised ankle rehabilitation program for 6 weeks, 3 sessions per week, 18 sessions in total, approximately 30 minutes per session. The program will include warm-up, forward lunge ankle mobility training, resistance exercises for dorsiflexion, plantarflexion, inversion, and eversion using an elastic band, double-leg vertical jumping, single-leg balance training, and cool-down. From week 4 onward, the balance task will be progressed to eyes-closed single-leg stance.
DEVICETissue Flossing at 150 mmHg
During the main exercise phase, tissue flossing will be applied to the affected ankle using an elastic floss band calibrated with a pressure gauge to 150 mmHg. Wrapping will start distally over the dorsum of the foot and follow a figure-of-eight pattern covering the ankle joint region and extending to the distal lower leg. The floss band will be removed immediately after training. If numbness, severe pain, or pallor occur, the compression will be removed immediately.
DEVICETissue Flossing at 200 mmHg
During the main exercise phase, tissue flossing will be applied to the affected ankle using an elastic floss band calibrated with a pressure gauge to 200 mmHg. Wrapping will start distally over the dorsum of the foot and follow a figure-of-eight pattern covering the ankle joint region and extending to the distal lower leg. The floss band will be removed immediately after training. If numbness, severe pain, or pallor occur, the compression will be removed immediately.
Sponsors
Chengdu Sport University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessments will be performed by an assessor blinded to group allocation. Because the pressure intervention is perceptible, participants and the treating therapist will not be blinded.
Intervention model description
Participants will be randomly assigned to one of three parallel groups: a control exercise group, a 150 mmHg tissue flossing plus exercise group, or a 200 mmHg tissue flossing plus exercise group.
Eligibility
Sex/Gender
ALL
Age
18 Years to 30 Years
Healthy volunteers
No
Inclusion criteria
* Young adults aged 18 to 30 years. * History of at least one recurrent ankle sprain or repeated episodes of ankle giving way in the affected limb. * Subjective ankle instability, with or without pain, swelling, or activity limitation. * Reduced balance ability, movement ability, or foot and ankle function on screening assessment. * Symptoms lasting at least 6 months. * No recent structured ankle rehabilitation before enrollment. * No plan for vigorous additional exercise during the intervention period. * Willing to participate and able to provide informed consent.
Exclusion criteria
* Latex allergy or intolerance to floss band material. * Previous ankle dislocation, fracture, complete ligament rupture, or other severe structural injury. * Most recent ankle sprain within 1 month before enrollment. * Recent ankle surgery or acute ankle injury. * Receipt of other ankle-related treatment, rehabilitation, or additional training during the study period. * Diabetes, hyperlipidemia, or other conditions that may affect vascular status. * Neurological disease, major musculoskeletal disease, vestibular disorder, visual disorder, or other lower-limb conditions that could affect assessment. * Determined by the study physician or investigator to be unsuitable for participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Biodex Limits of Stability Overall Directional Control Score | Baseline and 6 weeks | Dynamic postural control will be assessed using the Biodex Balance System SD Limits of Stability Test. Higher overall directional control scores indicate better balance control. Change is calculated as the Week 6 score minus the baseline score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Biodex Postural Stability Test Overall Stability Index | Baseline and 6 weeks | Static postural stability will be assessed using the Biodex Balance System SD Postural Stability Test under eyes-open and stable-platform conditions. Lower Overall Stability Index scores indicate better postural stability. Change is calculated as the Week 6 score minus the baseline score. |
| Biodex Fall Risk Test Overall Stability Index | Baseline and 6 weeks | Dynamic postural stability will be assessed using the Biodex Balance System SD Fall Risk Test. Lower Overall Stability Index scores indicate better stability and lower fall-related balance risk. Change is calculated as the Week 6 score minus the baseline score. |
| Biodex Athlete Single-Leg Stability Test Overall Stability Index | Baseline and 6 weeks | Dynamic single-leg postural stability will be assessed using the Biodex Balance System SD Athlete Single-Leg Stability Test. Lower Overall Stability Index scores indicate better single-leg stability. Change is calculated as the Week 6 score minus the baseline score. |
| Active Ankle Dorsiflexion Range of Motion | Baseline and 6 weeks | Active dorsiflexion range of motion of the involved ankle will be measured three times using a joint goniometer, and the mean value will be recorded in degrees. Change is calculated as the Week 6 value minus the baseline value. |
| Maximum Isometric Ankle Eversion Strength | Baseline and 6 weeks | Maximum isometric eversion strength of the involved ankle will be measured three times using a microFET3 handheld dynamometer, and the maximum value will be recorded in newtons. Higher values indicate greater muscle strength. Change is calculated as the Week 6 value minus the baseline value. |
| FAAM Activities of Daily Living Subscale Score | Baseline and 6 weeks | Daily foot and ankle function will be assessed using the Foot and Ankle Ability Measure Activities of Daily Living subscale. Scores are converted to a scale from 0 to 100, with higher scores indicating better function. Change is calculated as the Week 6 score minus the baseline score. |
| FAAM Sports Subscale Score | Baseline and 6 weeks | Sports-related foot and ankle function will be assessed using the Foot and Ankle Ability Measure Sports subscale. Scores are converted to a scale from 0 to 100, with higher scores indicating better sports function. Change is calculated as the Week 6 score minus the baseline score. |
Countries
China
Contacts
CONTACTWeiyang Zhang
Outcome results
None listed