Optimal Exercise Therapy for Chronic Ankle Instability: Insights from a Systematic Review and Meta-Analysis

A recent systematic review and meta-analysis of randomized trials shows exercise therapy improves patient-oriented function in chronic ankle instability (CAI), making targeted dosing decisions directly relevant to sports-medicine practice. This high-confidence evidence confirms a clear functional benefit for patients with CAI.

Pooled data from 26 randomized controlled trials (1,032 participants) found statistically significant mean differences: CAIT MD = 4.59 (95% CI 4.16–5.03, p < 0.001), FAAM-A MD = 7.71 (95% CI 6.36–9.05, p < 0.001), and FAAM-S MD = 11.86 (95% CI 7.86–15.85, p < 0.001). These pooled changes approach commonly cited MCIDs for FAAM subscales (~8 points): FAAM-A is near this threshold and FAAM-S exceeds it; a widely accepted MCID for the CAIT is less consistently defined, limiting direct interpretation of the CAIT MD against a single benchmark.

Subgroup analyses clarify actionable dosage and modality patterns. Short-course manual therapy 1–2×/week for up to 4 weeks produced the largest short-term CAIT gains, while multimodal programs that combined proprioception, balance, and strength training (1–2×/week for ≈5–8 weeks) yielded greater FAAM-A and FAAM-S improvements. The multimodal benefit likely reflects cumulative sensorimotor and strength adaptations, with supervised, mixed-component protocols driving the most robust activity- and sport-related score increases.

Higher per-week session intensity in brief manual-therapy courses drove short-term symptom relief and rapid CAIT improvement, whereas sustained multimodal frequency over several weeks produced larger FAAM-A and FAAM-S gains—reflecting improved daily and sport function. This dose–response pattern suggests matching frequency and program length to whether the immediate goal is early symptom relief or longer-term functional return.

Collectively, these implications inform outcome-focused CAI rehabilitation planning: prioritize manual therapy for rapid symptom relief and multimodal supervised programs for sustained functional return.