Effects Of Mulligan Combined With PNF Pattern Muscle Strength Training On Postural Stability And Proprioception In Patients With Unilateral Functional Ankle Instability

PurposeFunctional ankle instability（FAI）is a functional disorder associated with repeated ankle sprains.Its pathological mechanism is unclear,and its treatment and exercise prescription have not been unified.In this study,Pro-kin dynamic balance instrument was used to observe the effects of Mulligan’s mobilisations with movement（MWM）combined with PNF pattern muscle strength training on static and dynamic postural stability and proprioception ability in unilateral FAI patients.In order to provides theoretical and practical reference for clinical rehabilitation of the patients with functional ankle instability.Material and MethodA total of 64 FAI patients who met the inclusion criteria were recruited and randomly stratified into control group,PNF group,MWM group and combined group.Each group included 9 male students（4 on the left and 5 on the right）and 7 female students（4 on the left and 3 on the right）.All subjects received therapeutic intervention 3 times a week for 4weeks.The static and dynamic postural stability and proprioception ability of the affected side of the ankle were quantitatively evaluated by Pro-kin dynamic balance instrument of Tecnobody Company in Italy before and after intervention.The test indexes included:the Luo Bo test value（including closed/open eyes area ratio and closed/open eyes length ratio）and total standard deviation of trunk with eyes closed and eyes open;total stability index,anterior and posterior axis stability index,left and right axis stability index when the affected side stood on one foot on the unstable test plate;average trajectory error（A.T.E）and average freeweight variance ratio（A.F.V）.SPSS23.0 was used for statistical analysis of the test results,and the intervention effects of four groups of rehabilitation training programs on postural stability and proprioception ability of FAI patients were compared.Results（1）Static postural stability（1）Intra-group comparison:after 4 weeks of treatment,the ratio of closed/open eyes area,closed/open eyes length,total standard deviation of trunk with eyes closed and eyes open had extremely significant differences compared with baseline（P<0.001）.（2）Pairwise comparison of the difference between groups after 4 weeks:the difference of the ratio of closed/open eyes area in PNF group was significantly better than that in control group（P<0.05）,and that in combined group was significantly better than that in control group（P<0.01）;the difference of closed/open eyes length ratio in PNF group and MWM group was significantly better than that in control group（P<0.01）,and that in combined group was extremely significant than that in control group（P<0.001）;the difference of total standard deviation of trunk with eyes closed in combined group was significantly better than that in control group（P<0.01）,and combined group was better than MWM group（P<0.05）;the difference of total standard deviation of trunk with eyes open in combined group was significantly better than that in control group（P<0.01）.（2）Dynamic postural stability（1）Intra-group comparison:after 4 weeks of treatment,the total stability index,anterior and posterior axis stability index,left and right axis stability index had extremely significant differences compared with baseline（P<0.001）.（2）Pairwise comparison of the difference between groups after 4 weeks:the total stability index difference of MWM group was significantly better than that of control group（P<0.05）,combined group was significantly better than control group（P<0.01）,combined group was significantly better than PNF group（P<0.05）;the anterior and posterior axis stability index difference of combined group was significantly better than that of control group（P<0.05）;the difference of left and right axis stability index in MWM group was significantly better than that in control group（P<0.05）,combined group was significantly better than control group（P<0.01）,and combined group was significantly better than PNF group（P<0.05）.（3）Proprioceptive ability（1）Intra-group comparison:after 4 weeks of treatment,the average trajectory error and average freeweight variance ratio had extremely significant differences compared with baseline（P<0.001）.（2）Pairwise comparison of the difference between groups after 4 weeks:the difference of average trajectory error in PNF group,MWM group and combined group was extremely significant better than that in control group（P<0.001）,combined group was significantly better than MWM group（P<0.01）,and the difference of average freeweight variance ratio in combined group was significantly better than that in control group and MWM group（P<0.01）.Conclusions（1）For FAI patients,Mulligan’s mobilisation with movement technique combined with PNF pattern muscle strength training showed the best performance in improving static and dynamic postural stability and proprioception ability;Mulligan’s mobilisation with movement or PNF pattern muscle strength training effect was the second;simple routine muscle function training is generally effective.（2）After 4 weeks of phased intervention,Mulligan’s mobilisations with movement combined with PNF pattern muscle strength training significantly improve the FAI patients neuromuscular control ability,the sensory ability of plantar muscle group of movement,position and muscle force,reduced compensatory involvement of the trunk in maintaining body balance,improve the stability of the ankle,reconstruction of human motion pattern.And then prevent sports injury.