Wobble-Board Balance Intervention to Decrease Symptoms and Prevent Reinjury in Athletes With Chronic Ankle Instability: An Exploration Case Series

Ankle sprains are the most common injury in physically active populations and are especially prevalent in sports such as basketball and soccer.^1,2 Short-term sequelae of ankle sprains include time lost from sport participation, pain, and loss of function. Long term, approximately 34% of individuals who sustain an acute lateral ankle sprain develop chronic ankle instability (CAI).³ Chronic ankle instability is characterized by ongoing instability and recurrent sprains after an acute lateral ankle sprain⁴ and can persist for years postinitial injury, resulting in decreased physical activity,⁵ disability,⁶ and posttraumatic osteoarthritis.⁷

Researchers^8–15 have detailed multiple interventions for decreasing symptoms, increasing function, and decreasing recurrent sprains in individuals with CAI. One such intervention, a wobble-board balance-training protocol, has shown promising results in multiple studies.^8–10 Given the high patient volume and time constraints of providing clinical care in an athletic setting, this protocol has the advantage of being a simple, single-exercise intervention that can be completed independently by the patient in approximately 5 minutes using 1 piece of equipment.⁹ Investigators^8–10,16 have shown improvement in patient-reported outcomes, clinical balance tests, and functional tests after completion of the 4-week intervention.

Typically, clinical trials have excluded participants who have acute ankle symptoms, have recently completed other ankle rehabilitation protocols, or are concurrently undergoing treatment for other injuries.^8,9,14 These exclusion criteria attempt to control for the influence of potentially confounding variables and were appropriate for past study designs. However, they create a controlled laboratory setting that does not necessarily mimic the variability of real-life clinical situations. Clinicians do not have the option of selecting and treating only patients with isolated, uncomplicated injuries. Thus, an exploration of the effectiveness of this wobble-board protocol when applied in a live clinical setting is needed.

Ankle injury-prevention programs have been most effective in high-risk individuals (eg, those with a history of sprains).¹⁷ Therefore, we proposed to screen a population of university soccer and basketball athletes for a history of recurrent ankle sprains or instability (or both) and proactively assign those with CAI to the wobble-board protocol as a prophylactic treatment. However, to explore the intervention's effectiveness in a clinically realistic (and ethical) manner, no one would be assigned to a no-treatment group, nor would...