Impact of dynamic balance and hip abductor strength on chronic ankle instability


  • Alejandro López-Valenciano Universidad Miguel Hernandez de Elche
  • Francisco Ayala Rodríguez
  • José Luis López-Elvira
  • David Barbado Murillo
  • Francisco José Vera-García


Introduction: Ankle sprains are injuries that commonly occur during physical activity. They constitute between 15-75% of all sport injuries, and they can develop into chronic ankle instability (CAI) and functional disability. Subjects with CAI have exhibited diminished dynamic balance and weakness in the hip abductor muscles. Therefore, the purpose of this study was to investigate whether dynamic balance and hip abduction strength measures were related to the level of severity in CAI. Material y Methods: 40 students with Cumberland ankle instability tool (CAIT), defined by the CAIT, were divided into two groups: severe instability and mild instability group. Participants were assessed in dynamic balance and hip abduction strength. Results: No significant correlations were found between CAIT, Y-Balance and abduction strength variables in any group. Y-Balance test explained 24.7% of the CAI variance in the regression analysis, being statistically significant in the predictive model (p < 0.01). Hip abductor strength was rejected from the model. Discussion: This study reinforces the necessity of the inclusion of balance exercises for the lower extremity as a key content when designing rehabilitation programs for athletes with CAI. However, hip abductor strength exercises are still remains controversial. This knowledge would allow sports therapists to design more effective rehabilitation programs.

Author Biography

Alejandro López-Valenciano, Universidad Miguel Hernandez de Elche

Licenciado en Ciencias de la Actividad Física y del deporte. Becarios FPU del Centro de Investigación del deporte de la Universidad Miguel Hernandez de Elche.


Ambegaonkar, J.P., Mettinger, L.M., Caswell, S.V., Burtt, A., & Cortes, N. (2014). Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther, 9(5), 604-616.

Bosien, W.R., Staples, O.S., & Russell, S.W. (1955). Residual disability following acute ankle sprains. J Bone Joint Surg Am, 37, 1237–1243.

Boyle, J., & Negus, V. (1998). Joint position sense in the recurrently sprained ankle. Aust J Physiother, 44, 159–63.

Bullocksaxton, J.E., Janda, V., Bullock, M. (1994). The influence of ankle sprain injury on muscle activation during hip extension. International Journal of Sports Medicine, 15(6), 330-334.

Clanton, T.O. (1989). Instability of the subtalar joint. Orthop Clin North Am, 20, 583–592.

De Noronha, M., Refshauge, K.M., Crosbie, J., & Kilbreath, S.L. (2008). Relationship between functional ankle instability and postural control. Journal of orthopaedic & sports physical therapy, 38(12), 782-789.

De Noronha, M.D., Franca, L.C., Haupenthal, A., & Nunes, G.S. (2013). Intrinsic predictive factors for ankle sprain in active university students: a prospective study. Scandinavian journal of medicine & science in sports, 23(5), 541-547.

De Noronha, M., Refshauge, K.M., & Kilbreath, S.L., & Crosbie J. (2007). Loss of proprioception or motor control is not related to functional ankle instability: an observational study. Aust J Physiother, 53, 193–8.

Delahunt, E., Coughlan, G.F., Caulfield, B., Nightingale, E. J., Lin, C.W. & Hiller, C.E. (2010). Inclusion criteria when investigating insufficiencies in chronic ankle instability. Medicine and Science in Sports and Exercise, 42(11), 2106-2121.

Fernandez, W.G., Yard, E.E. & Comstock, R.D. (2007). Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med, 14(7), 641-5.

Filipa, A., Byrnes, R., Paterno, M.V., Myer, G.D., & Hewett, T.E. (2010). Neuromuscular training improves performance on the Star Excursion Balance Test in young female athletes. J Orthop Sports Phys Ther, 40(9), 551–558.

Fong, D.T.P., Hong, Y., Chan, L.K., Yung, P.S.H., & Chan, K.M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1), 73-94.

Fousekis, K., Tsepis, E., & Vagenas, G. (2012). Intrinsic risk factors of noncontact ankle sprains in soccer a prospective study on 100 professional players. The American journal of sports medicine, 40(8), 1842-1850.

Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train, 41, 74-8.

Gauffin, H. (1991). Knee and ankle kinesiology and joint instability [dissertation]. Linkoping University: Linkoping.

Gribble, P.A., Hertel, J., & Denegar, C.R. (2007). Chronic ankle instability and fatigue create proximal joint alterations during performance of the Star Excursion Balance Test. Int J Sports Med, 28(3), 236-42.

Gribble, PA., Hertel, J., & Plisky, P. (2012) Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. Journal of Athletic Training, 47, 339-357.

Gribble, P.A., & Robinson, R.H. (2009). An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability. J Strength Cond Res, 23, 395.

Gross, M.T. (1987). Effects of recurrent lateral ankle sprains on active and passive judgements of joint position. Phys Ther, 67, 1505-1509.

Hertel J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train, 37, 364–375.

Hertel, J., Braham, R.A., Hale, S.A., & Olmsted-Kramer, L.C. (2006). Simplifying the Star Excursion Balance Test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther, 36(3), 131–137.

Hiller, C.E., Refshauge, K.M., Bundy, A.C., Herbert, R.D., & Kilbreath, S.L. (2006). The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil, 87, 1235-41.

Hiller, C.E., Refshauge, K.M., Herbert, R.D, & Kilbreath, S.L. (2007). Balance and recovery from a perturbation are impaired in people with functional ankle instability. Clin J Sport Med, 17, 269–75.

Hootman, J.M., Dick R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train, 42(2), 311-9.

Hubbard, T.J., & Hertel, J. (2006). Mechanical contributions to chronic ankle instability. Sports Med, 36, 263–277

Hubbard, T.J., Kramer, L.C., Denegar, C.R., & Hertel, J. (2007a). Correlations among multiple measures of functional and mechanical instability in subjects with chronic ankle instability. Journal of Athletic Training. 42(3), 361-366.

Hubbard, T.J., Kramer, L.C., Denegar, C.R., & Hertel J. (2007b). Contributing factors to chronic ankle instability. Foot Ankle Int, 28(3), 343–354.

Karlsson, J., Bergsten, T., Peterson, L., & Zachrisson, B.E. (1991). Radiographic evaluation of ankle joint stability. Clin J Sport Med, 1, 166–175.

Kumar-Jain, T. (2014). Objective evaluation of functional ankle instability and balance exercise treatment (Doctoral thesis, University of Kansas, EE.UU.). Retrieved from

Larsen, E., & Angermann, P. (1990). Association of ankle instability and foot deformity. Acta Orthop Scand, 61, 136–139.

Lentell, G.B., Baas, B., Lopez, D., McGuire, L., Sarrels, M., & Synder, P. (1995). The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther, 21, 206–215.

McHugh, M.P., Tyler, T.F., Tetro, D.T., Mullaney, M.J., & Nicholas, S.J. (2006). Risk factors for noncontact ankle sprains in high school athletes -The role of hip strength and balance ability. American Journal of Sports Medicine, 34(3), 464-470.

McKeon, P.O., & Hertel, J. (2008). Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing?. Journal of athletic training, 43(3), 293-304.

Mulloy Forkin, D.M., Koczur, C., Battle, R., & Newton, R.A. (1996). Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther, 23, 245–50.

Nakasa, T., Fukuhara, K., Adachi, N., & Ochi, M. (2008). The deficit of joint position sense in the chronic unstable ankle as measured by inversion angle replication error. Arch Orthop Trauma Surg,128, 445–9.

Negahban, H., Moradi-Bousari, A., Naghibi, S., Sarrafzadez, J., Shaterzadeh-Yazdil, M., Goharpey, S. et al. (2013). The eccentric torque production capacity of the ankle, knee, and hip muscle groups in patients with unilateral chronic ankle instability. Asian J Sports Med, 4, 144–152.

Nicholas, J.A., Strizak, A.M., & Veras, G. (1976). A study of thigh muscle weakness in different pathological states of the lower extremity. Am J Sports Med, 4, 241–248

Olmsted, L.C, Carcia, C.R., Hertel, J., & Shultz, S.J. (2002): Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train, 37(4), 501–6.

Pisani, G., Pisani, P.C., & Parino, E. (2005). Sinus tarsi syndrome and subtalar joint instability. Clin Podiatr Med Surg, 22(1), 63-77, vii.

Plisky, P.J., Rauh, M.J., Kaminski, T.W., & Underwood, F.B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther, 36(12), 911-919.

Read, P.J., Oliver, J.L., De Ste Croix, M.B., Myer, G.D., & Lloyd, R.S. (2016). Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med.

Ross, S.E., & Guskiewicz, K.M. (2004). Examination of static and dynamic postural stability in individuals with functionally stable and unstable ankles. Clinical Journal of Sport Medicine, 14(6), 332-338.

Santos, M.J., & Liu, W. (2008). Possible factors related to functional ankle instability. J Orthop Sports Phys Ther, 38(3), 150-7.

Shaffer, S.W., Teyhen, D.S., Lorenson, C.L., Warren, R.L., Koreerat, C.M., Straseske, C.A., & Childs, J.D. (2013). Y-balance test: A reliability study involving multiple raters. Military Medicine, 178(11), 1264-1270.

Staples, O.S. (1975). Ruptures of the fibular collateral ligaments of the ankle: result study of immediate surgical treatment. J Bone Joint Surg Am, 57, 101–107.

Tol, J.L., Struijs, P.A.A., Bossuyt, P.M.M., Verhagen, R.A.W., & Van Dijk, C. N. (2000). Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot & Ankle International, 21(2), 119-126.

Thorborg, K., Petersen, J., Magnusson, S.P., & Hölmich, P. (2010). Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports, 20, 493–501. doi: 10.1111/j.1600-0838.2009.00958.x

Valderrabano, V., Hintermann, B., Horisberger, M., & Fung, T.S. (2006). Ligamentous posttraumatic ankle osteoarthritis. The American journal of sports medicine, 34(4), 612-620.

Verhagen, R.A., de Keizer, G., & van Dijk, C.N. (1995). Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg, 114(2), 92-96.

Wikstrom, E.A., Tillman, M.D., & Borsa, P.A. (2005). Detection of dynamic stability deficits in subjects with functional ankle instability. Med Sci Sports Ex erc, 37, 169-175.






European Journal of Human Movement