CAI Rehab & Treatment Tips
You need to assess joint range, laxity, strength & swelling
Neuromuscular deficits may be manifested as:
Reduced joint position sense (JPS)
Strength deficits (any mm group)
Decreased ROM (esp DF)
Slower firing of peroneals to inversion perturbation
Slowed nerve conduction velocity
Impaired cutaneous sensation
Treatment & rehabilitation must not only address mechanical stability
Restoration of neuromuscular function
Good evidence for:
1. Both MAI & FAI contribute to CAI.
2. Often still deficits in Dynamic Postural Control (DPC) at 6 months - they need long term rehab! Patients can benefit from the Ankle Rehab App to increase compliance.
3. CAI patients have a more ‘laterally based foot’ in gait & Functional activities. Try to retrain normal foot placement/position and feedback to land jumps and hops with a flat foot.
4. Delayed peroneal reaction time (feedforward system disrupted, ie, not just the feedback systems) – activation & timing issues – not just strength.
5. BAREFOOT REHAB HELPS TO STIMULATE FOOT SENSORY AREAS
6.Train the whole functional range – not just around neutral position – as the JPS & proprioception is especially poor in the inverted position...their area of danger where they need the best recovery of all.
7. Ax & Rehab multi-directional (not uni-planar). Specificity to the activities they need to return to. Variety of movements and challenges.
8. Postural control is definitely reduced at the ankle - central deficits theorised.
Riemann, B.L., and Lephart, S.M(2002) The Sensorimotor System, Part I: The Physiologic Basis of Functional Joint Stability, J AthlTrain. 37(1), p71-79.
Riemann, B.L., and Lephart, S.M(2002) The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional JointStability, J Athl Train. 37(1), p80-84.
9. Maximise ankle input & output by minimising hip & knee compensatory movements.
10.Train both sides – central 'spillover'
11. Challenge all variables when training proprioception
The main situations when CAI get giving way are:
1. When they are distracted, eg looking up at a sign, crossing the road, etc. Their eyes (which are usually compensating heavily for the poor proprioception) are looking elsewhere.
2. Over uneven surfaces such as a field, or over cobblestones.
3. In unmet challenges.
Thus, in rehabilitation:
- look all different directions, not just straight ahead - changes in head position will also change vestibular input.
- train at various body positions (eg, knee bent at different angles, or in lunges/tackle positions, etc).
- incorporate dynamic not just static training,
- various surfaces (eg, mini tramploline, air balance cushion or x2 cushions)