EFFECTS OF WHOLE BODY VIBRATION AND BALANCE TRAINING ON ATHLETES WITH CHRONIC ANKLE INSTABILITY A RANDOMIZED CONTROL TRIAL

INTRODUCTION

• Lateral ankle sprains are one of the most common sports injuries and often result in a decrease in neuromuscular control and loss of proprioception.
• Neuromuscular control helps maintain the functional stability of the ankle, whereas proprioception influences ankle joint position and sense of movement. Impairments in these functions cause reduced dynamic balance and reaction time of the ankle joint during exercise.
• An ankle sprain resulting in damage to the lateral ankle capsuloligamentous complex can cause sequelae, such as recurring ankle sprains. It decreases ankle function and causes a loose feeling, and this post-injury symptom is classified as chronic ankle instability (CAI).
• Athletes with CAI may experience limited functionality in their lower extremities, which can impact their sports performance. Therefore, specific balance exercises for athletes with CAI are critical in rehabilitation and training programs and could effectively reduce the risk of ankle sprain during sports activities.
• Balance training is a progressive type of exercise performed on an unstable surface, and the resultant efferent output causes changes in α motor neuron excitability. Balance training was used to improve muscle excitability in the ankle joint and increase motor control for CAI.
• Whole-body vibration (WBV) training is another popular method used in CAI rehabilitation. WBV training was performed on an oscillating vibration platform, which activates muscle spindles to facilitate the tonic vibration reflex. This training also enhances motor neuron excitability and the synchronization of motor units to increase motor control in the ankle. To the best of our knowledge, there have only been a few studies comparing the effects of WBC and traditional balance training on CAI. Therefore, WBV and balance training programs were designed and used for athletes with CAI in the current study.
• For basketball and volleyball players, ankle stability and motor control are crucial for ground impact during jumping and landing. The dominant leg is a commonly discussed factor in these types of actions by injured athletes because it plays a critical role in object manipulation and lead-out movements. However, the nondominant leg performs a stabilizing and supporting role in sports activities.
• Therefore, the dominant leg is highly susceptible to sports injuries such as ankle sprain and may suddenly become injured during jumping and landing on an unstable surface.
• A systematic review revealed that female athletes sustained ankle sprains more often than male athletes. Sex-related differences in the epidemiology of ankle injuries were noted in sports injury protection.

NEED FOR THE STUDY:

The burden of these lower extremities injuries, especially ankle sprain, will always make the players or coaches experience physiological and psychological stress.

This is because the lack of awareness of the importance of balance training as their normal training routine will increase the risks of ankle sprain among the athletes and thus affect the performance.

Therefore, this research is intended to study the sports-specific balance training program for Pravara Institute of Medical Sciences (PIMS) basketball players in reducing their risk of ankle sprain.

 RESEARCH QUESTION

What are the effects of whole body vibration and balance training in increasing ankle stability?

 AIM AND OBJECTIVES

AIM:

To study the effects of Whole-Body Vibration Versus Balance Training on Athletes with Chronic Ankle Instability.

OBJECTIVES:

To assess the Whole Body Vibration (WBV) effects on athletes.

To assess the balance training effects on athletes.

To compare WBV and balance training in athletes.

Hypotheses:

Null Hypothesis (H0):

There will be noeffects of whole-body vibration and balance training on athletes with chronic ankle instability.

Alternative Hypothesis (H1):

There will be effects of whole-body vibration and balance training on athletes with chronic ankle instability.

MATERIAL AND METHODOLOGY:

 Source of Data: Pravara Institute of Medical Sciences, Loni

Study setting:  The study will be conducted at PMT Sports Ground, Loni BK

Study Duration: 2 years

Study Design: Randomized controlled  trial

Type of Data: Quantitative

Sample size: 45

Sampling Method: Randomized sampling

Equipment to be used:

1.    BOSU ball

2.    Whole body vibrator

Materials to be used:

1.    Informed consent forms

  ELIGIBILITY CRITERIA**:**

Inclusion criteria:

Participants included will be:

Athletes should have a history of at least one ankle sprain.

Lateral ankle instability of any one leg with a severity score of 24 measured using theCumberland Ankle Instability Tool.

Both Genders.

Age group 19 to 25years.

 E****xclusion criteria:

Participants excluded will be:

• Acute ankle sprain.
• Participants who are currently undergoing or have recently undergone specific interventions or treatments for ankle instability.
• Individuals who have experienced recent trauma or undergone surgery on the affected ankle.
• Individuals with significant cognitive impairments or conditions affecting decision-making abilities

Those with systemic disorders or medical conditions that could impact joint stability or neuromuscular function (e.g., rheumatoid arthritis, peripheral neuropathy).

 **OUTCOME MEASURES:**Outcome measures used for this study will be:

• Dynamic balance - Star excursion balance test.
• Whole body balance - Stork balance stand test.

PROCEDURE:

• The protocol is prepared, and Ethical Clearance will be obtained from the IEC at Dr. APJ Abdul Kalam College of Physiotherapy.
• Participants will be selected on the basis of eligibility criteria.
• Informed consent will be obtained from the participants, and demographic data will be recorded.
• Participants will be allocated into 3 groups - Group B[(Allocation to WBV  training group (n= 15)], Group A [Allocation to balance  training ( n=15)], and Group C [Allocation to control group (n=15)]
• Prior assessment of the participants will be done using the Star Excursion Balance Test (SEBT) and the Stork Balance Stand Test for dynamic and whole body balance.
• For 6 weeks, participants will be given the intervention three times a week.
• Statistical analysis will be done, and results will be calculated.

Protocol:

The participants were randomly divided into three groups:

Group A will complete a 6-week  balance training program using a BOSU ball.

Group B will complete a 6-week WBV training program.

Group C will continue the previous training program.

All participants will continue their normal daily activity and were instructed not to receive any treatments or therapy for CAI. Participants will be assessed before and after the study.

The participants underwent three assessments, including the Star Excursion Balance Test (SEBT).

The participants and researchers are not blinded to the study process.

Group A will use a balance ball (BOSU ball) for balance training.

Group B will perform the WBV exercises during the 6-week training programs and will use a Whole-Body Vibrator platform.

Group A will perform the exercises on the balance ball. Participants in both groups will be asked to maintain balance on either leg or the affected leg while having their eyes closed.

Group B participants will perform the exercises while standing on the vibration platform, which is operated at a frequency and amplitude of 5 Hz and 3 mm, respectively.

Both training programs will be conducted three times per week for 6 weeks and will consist of a 5-minute warm-up exercise, a 45-minute main exercise, and a 5-minute cool-down exercise.

REFERENCES

Sierra-Guzmán, R.; Jiménez, F.; Abián-Vicén, J. Predictors of chronic ankle instability: Analysis of peroneal reaction time, dynamic balance and isokinetic strength. Clin. Biomech. 2018, 54, 28–33.

Echarte, C.; Vaes, P.; Duquette, W. The dynamic postural control is impaired in patients with chronic ankle instability: Reliability and validity of the multiple hop test. Clin. J. Sport Med. 2009, 19, 107–114.

Delahunt, E.; Coughlan, G.F.; Caulfield, B.; Nightingale, E.J.; Lin, C.W.; Hiller, C.E. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med. Sci. Sports Exerc. 2010, 42, 2106–2121.

Schiffman, G.S.; Ross, L.A.; Hahne, A.J. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. J. Sci. Med. Sport. 2015, 18, 238–244.

De Ridder, R.; Willems, T.; Vanrenterghem, J.; Roosen, P. Influence of balance surface on ankle stabilizing muscle activity in subjects with chronic ankle instability. J. Rehabil. Med. 2015, 47, 632–638.