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Balance Capabilities after Lateral Ankle Trauma and Intervention: A Meta-analysis


Medicine & Science in Sports & Exercise: June 2009 - Volume 41 - Issue 6 - p 1287-1295
doi: 10.1249/MSS.0b013e318196cbc6
Applied Sciences

Despite the high incidence of lateral ankle sprains, the issue about whether postural control is impaired after acute or chronic injury is still unresolved. In addition, the literature is unclear if balance training, a commonly prescribed intervention, improves postural control after a history of lateral ankle trauma.

Purpose: To conduct a meta-analysis on studies reporting the effects of lateral ankle trauma on postural control and how balance training affects postural control after acute and chronic lateral ankle trauma cumulatively and separately as moderating variables.

Methods: Thirty-seven postural control studies qualified for inclusion in the meta-analysis. Twenty-five studies investigated postural control independent of an intervention, and 15 studies administered balance-training interventions. Separate analyses on the two types of studies calculated Hedges' g individual effect sizes (ES). Further, we explored moderating variables for both the postural stability and the intervention studies.

Results: A significant cumulative effect size (ES) indicated that postural stability is impaired after a history of ankle injury (ES = 0.492, P < 0.0001). Moderator analysis revealed that both acute and chronic lateral ankle trauma negatively affected balance: a) acute: ES = 0.419, P < 0.0001, and b chronic, ES = 0.570, P < 0.0001. A third meta-analysis showed that balance training improves postural control (ES = −0.857, P < 0.0001). In addition, moderator variables indicated large ES for both types of ankle trauma.

Conclusions: Postural control impairments are present in patients with a history of lateral ankle trauma. However, clinicians should exercise caution when using the uninjured contralateral limb as a reference of normal postural control. In addition, balance training improves postural control scores after both acute and lateral ankle trauma. However, further research should determine the optimal dosage, intensity, type of training, and a risk reduction/preventative effect associated with balance training after both acute and chronic ankle trauma.

1Biodynamics Research Laboratory, Kinesiology Department, University of North Carolina at Charlotte, Charlotte, NC; and 2Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL

Address for correspondence: Erik A. Wikstrom, Ph.D., ATC, Department of Kinesiology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223; E-mail:

Submitted for publication July 2008.

Accepted for publication November 2008.

©2009The American College of Sports Medicine