The Effects of Vestibulo-Ocular Reflex Exercises Added to Postural Stabilization Training in Amateur Athletes With Chronic Ankle Instability

Summary

Chronic ankle instability (CAI) is a common condition after lateral ankle sprain. CAI is characterized by mechanical and/or functional instability, or recurrent episodes of "giving way," persisting for at least 12 months after the initial injury, and is associated with limitations in activity and and participation. Contemporary theoretical models emphasize that CAI should not be explained solely by biomechanical or neuromuscular deficits, but rather as a dynamic condition shaped by the interaction of motor-behavioral, sensory-perceptual, psychological, and environmental factors. Postural stabilization training is commonly used to improve balance and neuromuscular control in individuals with CAI. However, individuals with CAI may show increased reliance on visual information and altered visual-vestibular sensory reweighting during postural control tasks. The vestibulo-ocular reflex (VOR) contributes to gaze stability and visual clarity during head movements and may also be related to neurocognitive processes such as attention and processing speed. This study is designed as a randomized controlled, prospective, parallel-group, pretest-posttest design trial to investigate whether VOR exercises added to postural stabilization training improve visuo-motor reaction performance, fear avoidance behavior related to sports injuries and kinesiophobia in amateur athletes with CAI.

Eligibility

Inclusion Criteria:

* Being between 18 and 35 years of age.
* Being classified as a Tier 2 athlete according to the McKay et al. Participant Classification Framework (trained/developmental level).
* Having a history of at least one lateral ankle sprain (LAS) occurring at least 12 months before enrollment, resulting in swelling, pain, and functional impairment, and followed by persistent instability.
* Having the most recent ankle sprain at least 3 months before study enrollment.
* Having a history of recurrent ankle sprains or episodes of "giving way."
* Having a diagnosis of unilateral chronic ankle instability (CAI).
* Having a Cumberland Ankle Instability Tool - Turkish Version (CAIT-T) score of ≤24.
* Having a Foot and Ankle Ability Measure (FAAM) score of \<90%.
* Having a Foot and Ankle Ability Measure Sports subscale (FAAM-S) score of \<80%.
* A side-to-side difference of ≥2.5 cm in Weight-Bearing Lunge Test distance, with the affected side demonstrating less dorsiflexion than the unaffected side.

Exclusion Criteria:

* History of acute lateral ankle sprain within the last 3 months.
* History of lower extremity surgery.
* History of acute injury to other musculoskeletal structures of the lower extremity joints within the last 3 months that affected joint integrity and function and caused interruption of desired physical activity for at least one day.
* History of balance or vestibular disorders, including cerebellar, vestibular, cochlear, or inner ear dysfunction.
* Visual problems that may affect the administration or interpretation of the Dynamic Visual Acuity Test, including a history of amblyopia, diplopia, or significant visual loss.
* Persistent symptoms related to a previous concussion or traumatic brain injury.

Conditions4

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