Dynamic neuromuscular stabilization training for chronic ankle instability: A randomized controlled trial in amateur athletes

Abstract

Background

Chronic ankle instability (CAI) is a widespread condition in athletes, characterized by recurrent episodes of ankle “giving way,” diminished neuromuscular control and balance deficits. Traditional rehabilitation programmes typically emphasize strength and posture control, while more effective strategies incorporate balance training, including open chain exercises, vestibular training and multi-planar movements. In addition, novel approaches such as Dynamic Neuromuscular Stabilization (DNS) present an innovative method that aims to restore functional stability by activating the brain's natural movement control mechanisms.

Objective

This study aimed to determine and compare the impacts of balance and DNS training on functionality, instability severity, stabilization, balance, reaction time and performance in amateur athletes with CAI.

Methods

This single-blind randomized controlled trial was conducted with 36 amateur athletes (DNS training group: n = 12, balance training group: n = 12, conventional training group: n = 12) over a 6-week period. The DNS training group participated in exercises based on DNS principles, while the balance training group focused on training to enhance postural stability and vestibular function, and the conventional training group underwent conventional rehabilitation. The primary outcomes were measured using the Cumberland Ankle Instability Tool (CAIT) and Y Balance Test (YBT). Secondary measures were assessed through the Foot and Ankle Ability Measure (FAAM), Foot Lift Test (FLT), Balance Error Scoring System (BESS) and BlazePod™ Reaction Time (RT) Test. Assessments were carried out at three distinct time points: at baseline (pre-test), following 6 weeks of training (post-test), and at 12 weeks (follow-up test).

Results

DNS and balance training significantly improved all measures compared to conventional therapy (p < 0.05). DNS training showed significant superiority in FLT score, while balance training demonstrated significant performance increase in foam surface single-leg stance and foam surface tandem stance subscales of the BESS, with the high effect sizes (ranging from 0.95 to 1.00).

Conclusion

Innovative and effective interventions, such as DNS and balance training, play a crucial role in the rehabilitation processes of amateur athletes with CAI, with these effects being sustained in the long term.