Loudon, Janice K; Santos, Marcio J; Franks, Leah; Liu, Wen

Functional ankle instability (FAI) describes a condition where the ankle `gives way’ easily during activity. The cause of FAI is not clear but may be due to proprioceptive deficiency, muscular weakness, balance control deficits, or delayed muscle reaction time.

This lack of clarity over the cause makes treatment and rehabilitation difficult. This article reviews clinical trials which have used conservative exercise protocols in FAI and looks at the changes brought about by the exercise regimen. Sixteen articles detailing the exercise treatment of FAI were reviewed and examined outcome and scientific validity.

The review concludes that conservative rehabilitation programs which include balance, proprioceptive and muscle strengthening exercises are effective in reducing the incidence of giving-way, improving balance stability, and improving function in individuals with FAI.

Sports Medicine, Volume 38, Number 7, 2008 , pp. 553-563(11)

Walter Bily, Lukas Trimmel, Michaela Mödlin, Alexandra Kaider, Helmut Kern

To aim of this study was to evaluate the effect of a training program in patients with patellofemoral pain syndrome (PFPS) and the additional influence of electric muscle stimulation (EMS) to the quadricep muscles.

8 patients with bilateral PFPS were divided into two groups. Group 1 received supervised physiotherapy (PT) training. Group 2 received the same physiotherapy program but also received home-based EMS. This consisted of 20 minute sessions, twice daily, 5 days a week over a twelve week period. The settings used were: 40Hz; pulse duration 0.26 ms; 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.

Assessment of pain was by the visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment. Measures were also repeated at a one year follow-up.

Results demonstrated a statistically significant reduction of pain in both groups and significant improvement of the Kujala score in both groups after 12 weeks of treatment. Improvement of function and reduction of pain were also noted at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant and there was no significant increase in isometric strength.

The study concludes that PT programs can reduce pain and improve function in patients with PFPS. EMS does not appear to produce additional positive effects.

Archives of Physical Medicine and Rehabilitation, Volume 89, Issue 7, Pages 1230-1236 (July 2008)