# Exercise Therapy for Chronic Ankle Instability: Which Modality for Which Deficit? A Systematic Review and Meta‐Analysis

## TL;DR

This study reviews which exercise therapies best address specific sensorimotor issues in chronic ankle instability, aiming to improve personalized rehabilitation.

## Contribution

The paper provides an evidence-based framework for selecting exercise modalities based on specific sensorimotor deficits in chronic ankle instability.

## Key findings

- Balance training improves multiple sensorimotor outcomes including function, balance, and strength.
- Strength training enhances patient-reported function and dynamic balance but not force sense or eccentric strength.
- Stroboscopic training benefits joint position sense in addition to function and balance.

## Abstract

Chronic ankle instability (CAI) involves heterogeneous sensorimotor deficits. Evidence comparing exercise modalities for specific deficits is limited, impeding personalised rehabilitation. To determine the relative efficacy of exercise interventions and create an evidence‐based framework for deficit‐specific prescription in CAI.

Systematic review and meta‐analysis.

Searches of 9 electronic databases from inception to 1 September 2025.

Randomised controlled trials comparing exercise interventions against no intervention for sensorimotor outcomes in CAI individuals.

Two reviewers independently conducted the screening, and will independently extract the data into an Excel spreadsheet. Methodological quality was assessed using PEDro criteria, and bias analysis was conducted using the Cochrane Risk of Bias tool 2. Sensitivity analysis and I
2 statistics evaluated heterogeneity. Meta‐analysis summarised standard mean difference for sensorimotor indicators.

Fifty‐eight studies (n = 2097) were included. Of the included studies, 28 were rated as low risk of bias, 19 as unclear risk and 11 as high risk. Balance training provided comprehensive benefits, improving patient‐reported function, dynamic balance, joint position sense, concentric strength and functional performance. Strength training enhanced patient‐reported function, dynamic balance and concentric strength. 3D, stroboscopic and neuromuscular training improved patient‐reported function and dynamic balance; stroboscopic training also benefited joint position sense. Vibration training improved only dynamic balance. No interventions significantly improved force sense or eccentric strength.

Exercise modalities have distinct efficacy profiles in CAI. Balance training is foundational, but therapy can be personalised by framework optimises management.

This systematic review was registered in the PROSPERO database (CRD42024606683)