The effectiveness of strain counterstrain in the treatment of patients with chronic ankle instability: A randomized clinical trial

Abstract

Study design: Randomized clinical trial.

Objective: To determine the effect of strain counterstrain (SCS) on dynamic balance and subjective sense of instability in individuals with chronic ankle instability (CAI). Although many studies have been published on CAI, the cause for this common clinical dysfunction remains inconclusive. No studies have assessed the effectiveness of SCS on CAI.

Methods: At baseline all participants completed a demographic questionnaire, the star excursion balance test (SEBT), and the foot and ankle ability measure (FAAM). Following the baseline evaluation, participants were randomized into the SCS experimental group (EG) (n = 13) or the sham SCS group (SG) (n = 14). All participants received the assigned treatment once a week for 4 weeks and participated in a prescribed exercise program. At week 4, all participants repeated the outcome measures and completed a global rating of change (GROC) form. The primary aim was examined with a two-way analysis of variance (ANOVA).

Results: A significant group-by-time interaction was found for seven directions in the SEBT (P<0.031). For subjective measures, no significant group-by-time interaction was found for the FAAM (P>0.548), but the GROC revealed a significant difference (P = 0.014) in the mean score for the EG (3.92±1.66) when compared to the SG (2.43±1.66).

Discussion: Although SCS may not have an effect on subjective ankle function in individuals with CAI, preliminary evidence suggests that SCS may lead to an improvement in dynamic ankle stability and the subjective sense of ankle instability.

Level of evidence: Therapy, Level 1b.

Keywords: Chronic ankle instability; Lateral ankle sprain; Manual therapy; Star excursion balance test; Strain counterstrain.

Figures

Figure 1

Flow chart of participants through the study. SCS: strain counterstrain.

Figure 2

Home exercise program (HEP).

Figure 3

Star excursion balance test (SEBT) – eight directions referenced from the stance leg.

Figure 4

Star excursion balance test (SEBT) in the posteromedial direction.