NMES With PNF for Ankle Sprain Rehabilitation

Effects of Neuromuscular Electrical Stimulation Combined With Proprioceptive Neuromuscular Facilitation in Adults With a History of Ankle Sprain

Ankle sprains are one of the most common sports injuries. In some people, they can lead to chronic ankle problems that affect daily life and sports performance. In this study, we want to see if combining neuromuscular electrical stimulation (NMES) with proprioceptive neuromuscular facilitation (PNF) can help improve these problems. We plan to recruit 60 participants, with 30 in the experimental group and 30 in the control group. The experimental group will receive PNF stretching with NMES, while the control group will only do PNF stretching. Both groups will have training three times a week for four weeks (12 sessions in total). We will test participants before and after the program, looking at pain, balance, range of motion, proprioception, strength, joint mobility, and functional limitations. We expect that 12 sessions will help improve chronic ankle problems, and that NMES combined with PNF will be more effective than PNF alone.

Study Overview

• Status: Recruiting
• Conditions: Ankle Sprain
• Intervention / Treatment: Behavioral: Proprioceptive neuromuscular facilitation (PNF) with neuromuscular electrical stimulation (NMES); Behavioral: Proprioceptive neuromuscular facilitation (PNF) only

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: I-Hsuan Chen; Phone Number: 886-7-7811151 #7043; Email: Y0894@fy.edu.tw

Study Locations

• Taiwan
  • No. 151, Jinxue Road, Daliao District
    • Kaohsiung City, No. 151, Jinxue Road, Daliao District, Taiwan
      • Recruiting
      • Fooyin University
      • Contact: I-Hsuan Chen; Phone Number: +886-7-781-1151#7043; Email: Y0894@fy.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 18-30 years
• Adults with a history of ankle sprain

Exclusion Criteria:

• Participants with ankle fractures, dislocations, grade III ankle sprains, bony restrictions, swelling, neuropathy, or any other neuromuscular disorders are excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: NMES with PNF; The experimental group will receive proprioceptive neuromuscular facilitation (PNF) stretching combined with neuromuscular electrical stimulation (NMES)	Behavioral: Proprioceptive neuromuscular facilitation (PNF) with neuromuscular electrical stimulation (NMES); The NMES was applied during the plantarflexor contraction phase of the PNF stretching (described as below). Two electrodes (4 × 8 cm) were used for stimulation, placed on the triceps surae of the affected side: one positioned 5 cm below the popliteal fossa, and the other placed 5 cm below the first electrode, directly over the triceps surae. The hold-relax technique of proprioceptive neuromuscular facilitation (PNF) will be applied to stretch the triceps surae muscle. It will be performed ten times on the affected limb during each treatment session, lasting approximately 10 minutes in total. Participants will receive interventions three times per week for four weeks, for a total of twelve sessions.
Active Comparator: PNF only; The control group will receive PNF stretching only.	Behavioral: Proprioceptive neuromuscular facilitation (PNF) only; The hold-relax technique will be applied to stretch the triceps surae muscle. It will be performed ten times on the affected limb during each treatment session, lasting approximately 10 minutes in total. Participants will receive interventions three times per week for four weeks, for a total of twelve sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Star Excursion Balance Test, SEBT	Balance ability will be assessed using the Star Excursion Balance Test (SEBT). Participants stand barefoot at the center of a grid with eight lines extending at 45° angles. They are instructed to reach with the distal part of the foot to touch the farthest point along each line while maintaining a standing position. The examiner recorded the reached distance in centimeters, measured from the center of the grid to the point touched by the participant's big toe.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Proprioception - ankle dorsiflexion (degrees)	Proprioception of the affected ankle will be measured using the Micro FET3 inclinometer. The examiner moves the foot to a target angle (hold for 10 seconds), and then returned to the starting position. Participants then actively reproduces the angle. The difference between the target and reproduced angles represented proprioceptive accuracy.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Proprioception - ankle plantarflexion (degrees)	Proprioception of the affected ankle will be measured using the Micro FET3 inclinometer. The examiner moves the foot to a target angle (hold for 10 seconds), and then returned to the starting position. Participants then actively reproduces the angle. The difference between the target and reproduced angles represented proprioceptive accuracy.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Muscle strength - ankle dorsiflexors (kg)	A dynamometer (Micro FET3) will be placed on the dorsal surfaces of the metatarsals to measure strength of dorsiflexors.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Muscle strength - ankle plantarflexors (kg)	A dynamometer (Micro FET3) will be placed on the plantar surfaces of the metatarsals to measure strength of plantarflexors.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Range of motion - Ankle dorsiflexion (degrees)	The axis of the goniometer was placed at the lateral malleolus, the stationary arm aligned with the lateral fibula, and the moving arm aligned with the fifth metatarsal. Participants will be instructed to actively move the ankle from 0° starting position to maximal dorsiflexion.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Range of motion - Ankle plantarflexion (degrees)	The axis of the goniometer was placed at the lateral malleolus, the stationary arm aligned with the lateral fibula, and the moving arm aligned with the fifth metatarsal. Participants will be instructed to actively move the ankle from 0° starting position to maximal plantarflexion	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Foot and Ankle Disability Index (FADI)	Functional limitations will be assessed using the Foot and Ankle Disability Index (FADI). The FADI includes 22 questions related to functional activities and 4 questions related to pain. Each item is scored from 0 (unable to do) to 4 (no difficulty), with a maximum total score of 104, which is then converted to a percentage. A score of 100% indicates no functional limitation.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Knee to wall test	Participants stand facing a wall with their toes about 10 cm away. The non-affected foot steps back, and the affected knee bends forward to touch the wall while keeping the heel on the ground. If the knee cannot reach the wall, the front foot moves closer. The distance from the affected big toe to the wall is then measured. The distance (cm) from the participant's big toe of the affected foot to the wall was measured and recorded.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)
Visual analog scale (VAS)	Participants mark their pain level on a 10-cm line, with the left end representing 'no pain' and the right end representing 'unbearable pain.' The mark indicates the intensity of their pain.	1. Baseline (Day 1, prior to intervention) 2. Post-intervention (after 12 sessions, Week 4)

Collaborators and Investigators

• Sponsor: Fooyin University

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): March 31, 2026
• Study Completion (Estimated): July 31, 2026

Study Registration Dates

• First Submitted: September 17, 2025
• First Submitted That Met QC Criteria: September 17, 2025
• First Posted (Estimated): September 24, 2025

Study Record Updates

• Last Update Posted (Actual): November 17, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Balance; Pain; Strength; Proprioception; Range of motion; Ankle sprain
• Additional Relevant MeSH Terms: Neurologic Manifestations; Wounds and Injuries; Leg Injuries; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Ankle Injuries; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Physical Therapy Modalities; Patient Care; Socioeconomic Factors; Population Characteristics; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Demography; Exercise; Family Characteristics; Marital Status; Muscle Stretching Exercises; Single Person
• Other Study ID Numbers: NCKU HREC-E-114-0093-2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No