External Versus Internal Feedback in Patients With Chronic Ankle Instability

External Versus Internal Feedback on Biomechanics and Self-reported Function in Patients With Chronic Ankle Instability

Although altered biomechanics has been well documented as an impairment associated with chronic ankle instability (CAI), effective interventions targeting biomechanics with long-term outcomes measuring patient-reported outcomes (PROs) are absent. Evidence suggests that external focus of attention (ExFOCUS), internal focus of attention (InFOCUS) feedback, and auditory feedback during movement training can alter biomechanics in other patient populations, with ExFOCUS and auditory enhancing retention of learned biomechanics. Therefore, this randomized controlled trial will determine if a 4-week (12 session) impairment-based rehabilitation program that includes feedback (ExFOCUS or InFOCUS or Auditory) can (1) decrease ankle inversion kinematics and lateral plantar pressure during walking and (2) improve self-reported function.

Inclusion Criteria:

• Characterized as having chronic ankle instability (CAI) by reporting a history of recurrent ankle sprains, with the first sprain occurring longer than 12 months ago. Participants will have lingering symptoms, and disability, but have not actively sought treatment for their CAI.
• All participants will be physically active: Participating in some form of physical activity for at least 20 min per day, three times per week.

Exclusion Criteria:

• Neurological or vestibular disorders affecting balance
• Currently seeking medical care for CAI
• History of ankle surgery
• History of ankle sprain within the past 6 weeks
• History of other musculoskeletal injuries within the past 6 weeks
• Current/previous self-reported disability due to lower extremity pathology that may adversely affect neuromuscular function