title: Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability.
abstract: BACKGROUND
  A dynamic-balance-training (DBT) program supplemented with the Graston instrument-assisted soft-tissue mobilization (GISTM) technique has not been evaluated collectively as a treatment in subjects with chronic ankle instability (CAI).
  
  
  OBJECTIVE
  To examine the effects of GISTM in conjunction with a DBT program on outcomes associated with CAI, including pain and disability, range of motion (ROM), and dynamic postural control.
  
  
  METHODS
  Pretest/posttest, repeated measures.
  
  
  METHODS
  High school and a Division I mid-Atlantic university.
  
  
  METHODS
  Thirty-six healthy, physically active individuals (5 female, 31 male; age 17.7 ± 1.9 y; height 175.3 ± 14.6 cm) with a history of CAI as determined by an ankle-instability questionnaire volunteered to be in this study.
  
  
  METHODS
  Subjects were randomly assigned to 1 of 3 intervention groups: both treatments (DBT/GISTM, n = 13), DBT and a sham GISTM treatment (DBT/GISTM-S, n = 12), or DBT and control-no GISTM (DBT/C, n = 11). All groups participated in a 4-wk DBT program consisting of low-impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 min before performing the DBT program. Pretest and posttest measurements included the Foot and Ankle Ability Measure (FAAM), FAAM Sport, the visual analog scale (VAS), ankle ROM in 4 directions, and the Star Excursion Balance Test (SEBT) in 3 directions.
  
  
  METHODS
  FAAM and FAAM-Sport scores, VAS, goniometric ROM (plantar flexion, dorsiflexion, inversion, eversion), and SEBT (anterior, posteromedial, posterolateral).
  
  
  RESULTS
  Subjects in all groups posttest demonstrated an increase in FAAM, FAAM Sport, ROM, and SEBT in all directions but not in VAS, which decreased. No other results were significant.
  
  
  CONCLUSIONS
  For subjects with CAI, dynamic postural control, ROM, pain and disability improved pretest to posttest regardless of group membership, with the largest effects found in most measures in the DBT/GISTM group.
authors.affiliation: Missouri Orthopaedic Institute/University of Missouri, Columbia, MO, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Schaefer
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Sandrey
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D004856:Postural Balance / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology; D011795:Surveys and Questionnaires; D055815:Young Adult