Comparative Effect of Combined Strength, Core and Balance Training on Kinesiophobia, Ankle Instability, Functional Outcomes, and Performance in Table Tennis Players With Functional Ankle Instability

This randomized controlled trial investigates the comparative effect of combined strength and balance training versus balance and core training on kinesiophobia (fear of movement), ankle instability, functional outcomes, and athletic performance in adolescent table tennis players with functional ankle instability (FAI). Participants will be randomly allocated into two groups over a 6-week intervention (3 sessions/week). The Experimental Group will receive combined strength and balance training, while the Control Group will receive balance and core training. Outcomes will be measured using validated tools: TSK-17, CAIT, FAAM, Y-Balance Test, Single-Leg Hop Test, T-Test, and Illinois Agility Test.

Study Overview

• Status: Not yet recruiting
• Conditions: Kinesiophobia; Functional Ankle Instability; Neuromuscular Control; Sports Rehabilitation
• Intervention / Treatment: Other: Experimental : Combined Strength and Balance Training; Other: Control : Balance and Core Training

• Study Type: Interventional
• Enrollment (Estimated): 51
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmad Zia, MS-PT Sports; Phone Number: +92 340 9270376; Email: khanxia961@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Male/female table tennis players aged 15-30 years
2. Experienced at least one ankle sprain with swelling/pain that interrupted training for >1 day within the last 6 months
3. Reported sensation of instability of the ankle
4. Scored ≤25 points on the Cumberland Ankle Instability Tool (CAIT), indicating functional ankle instability

Exclusion Criteria:

1. History of ankle fracture or surgery
2. Any fracture of lower limb history
3. Any neurological or vestibular disorders
4. Other injuries of lower limb affecting performance

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental: Combined Strength and Balance Training; Participants will receive a 6-week combined strength and balance training program (3 sessions/week, 40-45 min). Strength Component: Theraband Dorsiflexion (3×12), Theraband Eversion (3×12), Heel Raises progressing to single-leg (3×12), Forward Lunges (3×10 each leg). Balance Component: Single-Leg Stance Eyes Open→Closed (3×30 sec), Wobble Board Standing (3×30 sec), Y-Balance Reach (3 trials each direction). Weekly progression: Week 1-2 basic stable surface exercises, Week 3-4 increased repetitions, Week 5-6 single-leg variations introduced.	Other: Experimental : Combined Strength and Balance Training; A structured 6-week exercise program combining ankle strengthening exercises (Theraband resistance training, heel raises, lunges) with dynamic balance training (single-leg stance, wobble board, Y-balance drills). Sessions last 40-45 minutes and are conducted 3 times per week. Warm-up: 5-7 min light jogging/dynamic mobility. Main Training: 30 min combined strength and balance work. Cool-down: 5 min static stretching.
Active Comparator: Control Group: Balance and Core Training; Participants will receive a 6-week balance and core training program (3 sessions/week, 40-45 min). Balance Component: Single-Leg Stance Firm→Foam (3×30 sec), Tandem Walking (3×10 m), Y-Balance Drill (3 trials each direction). Core Component: Plank Hold (3×20 sec), Side Plank each side (3×15 sec), Dead Bug Exercise (3×10 reps). Weekly progression: Week 1-2 basic level, Week 3-4 increased repetitions, Week 5-6 maintained progression.	Other: Control : Balance and Core Training; A structured 6-week program combining balance training (single-leg stance on firm and foam surfaces, tandem walking, Y-balance drills) with core stabilization exercises (plank, side plank, dead bug). Sessions last 40-45 minutes, 3 times per week with the same warm-up and cool-down structure as the experimental group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinesiophobia - Tampa Scale for Kinesiophobia (TSK-17)	17-item self-report questionnaire measuring fear of movement and re-injury. Good internal consistency (Cronbach's α = 0.70-0.86) and test-retest reliability (ICC = 0.72-0.90). Reduced scores indicate decreased kinesiophobia.	Baseline (Week 0) and Post-intervention (Week 6)
Ankle Instability - Cumberland Ankle Instability Tool (CAIT)	Validated questionnaire assessing functional ankle instability severity. Excellent test-retest reliability (ICC = 0.96) and internal consistency (Cronbach's α = 0.83). Increased post-intervention scores indicate improved perceived ankle stability	Baseline (Week 0) and Post-intervention (Week 6)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional Ability - Foot and Ankle Ability Measure (FAAM)	Self-reported tool assessing functional limitations in foot and ankle disorders. Excellent internal consistency (α = 0.89-0.98) and reliability (ICC = 0.84-0.92) for ADL and Sports subscales. Increased scores indicate improved functional ability	Baseline (Week 0) and Post-intervention (Week 6)
Dynamic Balance - Y Balance Test (YBT)	Measures dynamic balance and lower limb neuromuscular control. Excellent test-retest reliability (ICC = 0.85-0.91). Reach distances normalized to limb length. Increased post-intervention reach distance indicates improved ankle stability.	Baseline (Week 0) and Post-intervention (Week 6)
Functional Performance - Single-Leg Hop Test	Reliable measure of lower limb strength, dynamic stability, and functional performance (ICC = 0.85-0.95). Increased hop distance and improved landing control indicate enhanced neuromuscular function.	Baseline (Week 0) and Post-intervention (Week 6)
Agility and Performance - T-Test and Illinois Agility Test	Valid and reliable measures of agility and change-of-direction speed. T-Test (ICC = 0.90-0.98), Illinois Agility Test (ICC = 0.88-0.96). Reduced completion time indicates improved dynamic stability and neuromuscular control.	Baseline (Week 0) and Post-intervention (Week 6)

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad
• Investigators: Principal Investigator: Hafsah Gul Khattak, DPT, MSNMPT, Ibadat International University, Islamabad (Iiui)

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: June 22, 2026
• First Submitted That Met QC Criteria: June 22, 2026
• First Posted (Actual): June 26, 2026

Study Record Updates

• Last Update Posted (Actual): June 26, 2026
• Last Update Submitted That Met QC Criteria: June 22, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Athletes; Strength Training; Balance Training; Table Tennis; Functional Ankle Instability
• Additional Relevant MeSH Terms: Mental Disorders; Phobic Disorders; Anxiety Disorders; Kinesiophobia
• Other Study ID Numbers: IIUI/RERC/ADT/2026/05/261

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