A Comparison between Two Methods of Exercise in Water and Land to Improve Pain, Function, Static and Dynamic Balance in Patients with Chronic Ankle Sprain

Document Type : Research Paper


1 Associate Professor, Sport Injury and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran

2 M.Sc. Student, Sport Injury and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran

3 Ph.D. Student, Sport Injury and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran


Ankle sprain is one of the most common injuries of the ankle joint. Recurrent and chronic ankle sprain can cause balance impairment. Recurrent injury is a consequence of inadequate rehabilitation and instability of ankle joint will follow. In this quasi-experimental study, 30 women with chronic ankle sprain participated and were randomly assigned to three groups: exercise therapy in water, land and control. Pain, motor function, static and dynamic balance were measured before and after the exercise program. Data analysis was performed using SPSS-21 software (P=0.05). Findings demonstrated a significant difference in pain, motor function, static and dynamic balance in each training group after 8 weeks of exercise therapy (P˂0.05). There were no significant differences between the two training groups in pain, motor function, static and dynamic balance (P>0.05). Although there were no statistically significant differences between the two exercise groups, the difference between the two groups in the mean percentage of changes can indicate that the clinical effects of aquatic therapy are higher than exercise in land.


1. ایل بیگی، سعید. حیدری، مرضیه. ثاقب‌جو، مرضیه. (1393)."تأثیر 6 هفته تمرین پیلاتس بر تعادل و میزان درد افراد مبتلا به اسپرین مچ پا ".پژوهش در توانبخشی ورزشی،2(3)، ص:49-41.
2. بابایی، حمید. طاهری، حمیدرضا. قره، محمدعلی. بهرامی، مصطفی. (1387). " بررسی نقص‌های فانکشنال در ورزشکاران دارای سابقۀ اسپرین مچ پا ".پژوهش در علوم ورزشی، 10(1)، ص:46-37.
3. صمدی،‌ هادی.رجبی، رضا. علیزاده، محمدحسین. جمشیدی، علی‌اشرف. (1392)." تأثیر شش هفته تمرینات عصبی-عضلانی بر کنترل وضعیتی پویا و عملکرد اندام تحتانی ورزشکاران پسر مبتلا به بی‌ثباتی عملکردی مچ پا ". مطالعات طب ورزشی، 5(14)، ص:90-73.
4. فرجی، الهه. ابراهیمی عطری، احمد. دانشمندی، حسن. عنوانی، وحید. (1391). " تأثیر ارتزهای پیش‌ساختۀ مچ پا بر تعادل ورزشکاران مبتلا به بی‌ثباتی مزمن مچ پا در زمان خستگی"، پژوهش در علوم توانبخشی، 8 (4)، ص: 8-1.
5. Asimenia G, Paraskevi M, Polina S, Anastasia B, Kyriakos T, Georgios G. (2013)" .Aquatic Training for Ankle Instability ". Journal of Foot Ankle Spec,5, PP: 346-350.
6. Ben Moussa Zouita A, Majdoub O, Ferchichi H, Grandy K, Dziri C, Ben Salah F.Z. (2013)." The effect of 8-weeks proprioceptive exercise program in postural sway and isokinetic strength of ankle sprains of Tunisian athletes". Journal of Ann Phys Rehabil Med. Dec, 56(9-10), PP: 634-43.
7. De Vries J.S., R. Krips, I.N. Sierevelt, L. Blankevoort, and C. van Dijk. (2011). "Interventions for treating chronic ankle instability". Journal of Cochrane Database Syst Rev, 8, P: CD004124.
8. Docherty, Carrie L. (2005). "Functional-performancedeficits in volunteers with functional ankleinstability" . Journal of Athletic Training; 40(1), PP:30-34.
9. El Sayed MMA. (2012). "Balance Exercises and its Role in the Treatment of Chronic Ankle Instability". World Journal of Sport Sciences, 6 (2), PP: 95-101.
10. Ferran, NA., Francesco O; Maffulli, N. (2009)" .Ankle Instability ". Journal of FRCS Sports Medicine & Arthroscopy Review, June 17(2), PP: 139-145.
11. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. (2007). "A systematic review on ankle injury and ankle sprain in sports" . Journal of Sports Medicine,37(1), PP:73-94.
12. Freeman MA. (1965)." Instability of the foot after injuries to the lateral ligament of the ankle". Journal Bone Joint Surg Br,47(4), PP:669-77.
13. Giza, E., Fuller, C., Junge, A., Dvorak, J.(2003)."Mechanisms of foot and ankle injuries in soccer". The American Journal of sports medicine, 31(4), PP: 550-554.
14. Gribble PA, Robinson RH. (2009)." Alterations in knee kinematics and dynamic stability associated with chronic ankle instability". Journal of Athl Train,44(4), PP:350-5.
15. Guskiewicz KM, Perrin DH. (1996)." Effect of orthotics on postural sway following inversion ankle sprain" . Journal of Orthop Sports Phys Ther, 23, PP:326-31.
16. Hertel J. (2002). "Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability". Journal of Athl Train, 37(4), PP:364-75.
17. Hrysomallis C. (2007)." Relationship Between Balance Ability Training and Sports Injury Risk ".Journal of Sports Med , 37(6), PP:547-556.
18. Huang, P., Lin, C. )2010(."Effects of Balance Training Combined with Plyometric Exercise in Postural Control: Application in Individuals with Functional Ankle Instability". Paper presented at the 6th World Congress of Biomechanics (WCB 2010), August 1-6, Singapore.
19. Hupperets MD et al. (2009)."Proprioceptive training reduces the risk of ankle sprain recurrence in athletes". Journal of BMJ , 339, P: b2684.
20. Janice k, heather l. (2002). "Intrarater reliability of functional- performance tests for subjects with patellafemoral pain syndrome". Journal of Athletic Training, 37(3), PP:256-261.
21. Kerry M, Sandra J. (2002)." Chronic Ankle Instability Does Not Affect Lower Extremity Functional Performance".Journal Athl Train, 37(4), PP:507–511.
22. Kim E, Kim T, Kang H, Lee J, Childers MK.(2010). "Aquatic Versus Land-based Exercises as Early Functional Rehabilitation for Elite Athletes with Acute Lower Extremity Ligament Injury ": A Pilot Study.Journal of PM R,2,PP:703-712.
23. Konradsen L. (2002)."Sensori-motor control of the uninjured and injured human ankle". Journal of Electromyogr Kinesiol, 12, PP:199-203.
24. Kynsburg, A., Halasi, T., Tallay, A., Berkes, I. (2006)."Changes in joint position sense after conservatively treated chronic lateral ankle instability". Journal of Knee Surgery, Sports Traumatology, Arthroscopy, 14(12), PP:1299-1306.
25. Lauren C, Christopher R . (2002)."Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability". Journal of Athlethic Training , 37(4), PP:501–506.
26. Lederman E. (2005)."The science and practice of manual therapy". 2nd ed. Edinburgh, New York: Elsevier Churchill & Livingstone, PP:89-224.
27. Mickel T, Bottoni C, Tsuji G,Chang K, Baum L, Tokushige K. (2006)."Prophylactic bracing versus taping for the prevention of ankle sprains in high school athletes : a prospective‘ randomized trail".Journal of Foot Ankle Surg , 45(6), PP:360-5.
28. Mitchell A, Dyson R, Hale T, Abraham C. ( 2008)."Biomechanics of ankle instability" . Part 1,reaction time to simulated ankle sprain, Journal of Med Sci Sports Exerc, 40, PP:1515–21.
29. Munn J, Beard D, Refshauge K, Lee RJ. (2002)."Do functionalperformance tests detect impairment in subjects with ankle instability?"Journal of Sport Rehabilition, 11, PP:40–50.
30. Nadler SF, Malanga GA. (2002)."Functional performance deficits in athletes with previous lower extremity injury".Clin Journal of Sport Medicine 12(2),PP:73-8.
31. Peterson C. (2001)."Exercise in 94 degrees F water for a patient with multiple sclerosis. "Journal ofPhys Ther, 81(4), PP:1049-58.
32. Prentice. William E. (2011)."Rehabilitation Techniques for Sports Medicine and Athletic Training" .McGraw-Hill Humanities, PP: 318-336.
33. Resende SM, Rassi CM, Viana FP. (2008)." Effect of hydrotherapy in balance and prevention of falls among elderly women". Journal of Rev Bras fisioter, 12(1), PP:57-63.
34. Richard S, Scott B. (2002). "Rehabilitating Ankle Sprains". Journal of the Physician And Sports Medicine,30(8), PP:48-50.
35. Ross, S. E., & Guskiewicz, K. M. (2006)."Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects withfunctional ankle instability and subjects with stable ankles". Clinical Journal of Sport Medicine, 16(4), PP:323-328.
36. Sadeghi, H., Alirezaei F.(2008). "Effect of a training exercise on the water balance in elderlywomen". Iranian Journal of Aging ,2(6),PP: 402-9.
37. Sekir U, Yildiz Y, Hazneci B, Ors F, Aydin T. (2007)." Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instabilitySurgery, Sports Traumatology Knee ".Journal of sport Med, PP: 654-664.
38. Sheth P, Yu B, Laskowski ER, An KN. (1997)." Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain". Am Journal of Sports Med, 25, PP:538-43.
39. Smith BA, Docherty CL, Simon J, Klossner J, Schrader J. (2012). "Ankle Strength and Force Sense After a Progressive, 6-Week Strength-Training Program in People With Functional Ankle Instability". Journal of Athletic Training;47(3), PP:282–288.
40. Tanaka H, Mason L. (2011)." chronic ankle instability". Journal of orthopaedics and trauma ,25(4), PP: 269-278.
41. Tarang KJ, Clayton NW, Wen Liu.(2014). "The effect of balance training on ankle proprioception in patients with functional ankle instability". Journal of Foot and Ankle Research,7 (Suppl 1), A37, PP:1-2.
42. Thacker SB, Stroup DF, Branche CM, Gilchrist J, Goodman RA, Weitman EA. (1999)."The prevention of ankle sprains in sports A systematic review of the literature" . The American Journal of sports medicine, 27(6), PP:753-760.
43. Twist, C., Gleeson, N., &Eston, R.(2008)".The effects of plyometric exercise on unilateral balance performance."Journal of sports sciences, 26(10), PP:1073-1080.
44. Verhagen E, Van der beek A,Twisk j,Boutre L,Bahr R,Van Mechelen W. (2004)."The effect of a poroprioseptive balance board training program for the prevention of ankle sprain : a prospective controlled Trial" . Am Journal of sports Med, 32(6), PP:1385-93.
45. Yang C-H , B.Vicenzino. (2002)." Proprioceptive , Balance , And Functional Deficits Across Acute , Subacute And Chronik Ankle Sprain Subjects". Journal of Adv Exp Med Biol, 508, PP: 95-101.