by Lisa Jerry, SPT


Lateral ankle sprains are one of the most common injuries for physically active individuals, occurring when the ankle rolls or gives out during activity. An ankle sprain can involve tearing of some or much of the ligament fibers of the ankle. Chronic Ankle Instability (CAI) happens when the ankle is repeatedly sprained, occurring around 30-40% of the time. One theory behind the prevalence of CAI is the change in balance and position receptors input and output, altering the ankle’s neuromuscular control. This study examined if balance training on the stable ankle would have any effect on the unstable ankle.


27 individuals between the age 13-35 volunteered for this study; 13 were in the treatment group, and 14 were in the control group. Both groups participated in pre-training and post-training testing, which consisted of an ankle and foot outcome measure, a dynamic balance test of both legs, and a static balance test of both legs.


The treatment group participated in a 30-minute physical therapy session twice per week for four weeks. Each individual’s program consisted of the same 8 balance activities, which were modified and progressed in difficulty as appropriate by a Physical Therapist. Activities included: single leg standing on different surfaces, single leg hopping in different directions, tossing and catching a ball while on one leg, and hip hikes. The individuals were training their stable ankle only; if their left ankle had CAI, all of these activities were performed on their right ankle. The control group were instructed to continue their normal activities, and to not work on any ankle or balance specific exercises.

Results and PTF Implications

Following the 4 weeks of balance training on the stable ankle, the rehabilitation group showed statistically significant improvements in all three testing measures compared to the control group, including static and dynamic balance. This study showed that training the stable ankle increased the neuromuscular control of the unstable ankle, which in turn could decrease the risk of future ankle sprains. Here at Physical Therapy First, we will use this information to help an individual who may be experiencing CAI and balance limitations. We can apply the results of this study to improve your balance and stability in your affected ankle using both lower extremities. Our licensed Physical Therapists have the knowledge and expertise to get you safely back on both feet, even if that means training only one foot at a time.


Hale SA, Fergus A, Axmacher R, Kiser K. Bilateral improvements in lower extremity function after unilateral balance training in individuals with chronic ankle instability. Journal of Athletic Training. Volume 49, Number 2, pages 181-191.