Dynamic neuromuscular stabilization, balance, and conventional training for chronic ankle instability in amateur athletes: a randomised controlled trial.

Objectives: The aim of this study was to compare the effects of three distinct rehabilitation approaches, namely Dynamic Neuromuscular Stabilization (DNS) training, balance training and conventional physiotherapy, on neuromuscular control and functional performance in amateur athletes with chronic ankle instability (CAI).

Trial design and framework: A single-blind, parallel-group randomized controlled trial with a superiority framework was conducted.

Methods: Amateur athletes with chronic ankle instability were recruited from sports clinics in Istanbul. A total of 40 participants (18 males, 22 females) from football, gymnastics, rowing, taekwondo, tennis, volleyball, and swimming were randomly assigned (1:1:1) using a computer-generated permuted block design to DNS training (DNSG) (n = 13), balance training (BTG) (n = 14), or conventional training (CTG) (n = 13). Interventions were delivered three times per week for six weeks. DNS involved breathing-centered stabilization exercises; balance training included structured proprioceptive and vestibular tasks; and conventional training used standard strength and posture control exercises. Outcome assessors were blinded, while participants and therapist were not.

Results: A total of thirty-six participants completed the trial, with the following group distributions: DNSG (n = 12), BTG (n = 13), and CTG (n = 11). Both DNSG and BTG showed significantly greater improvements than the CTG across all outcome measures (p < 0.001), with large effect sizes (FAAM-ADL η²=0.97; YBT-A η²=0.92; SHT η²=0.95). DNS was significant in postural control (p = 0.01), while balance training showed greater improvements in reaction time (RT) (p = 0.02). No significant between-group differences were observed in CAIT scores, though DNSG and BTG demonstrated large within-group improvements. No serious harms or adverse events were reported in any of the groups.

Conclusions: DNS and balance training are more effective than conventional physiotherapy in improving neuromuscular function, postural control, and performance in amateur athletes with CAI. These interventions offer complementary benefits and may be integrated into targeted rehabilitation protocols to optimize outcomes and support return-to-sport strategies.

Trial registration: Clinical trial approval was obtained at https://www.

Clinicaltrials: gov/ , and the registration status was made publicly available with the number of NCT06296537 on February 29, 2024. The registry record can be accessed at https://clinicaltrials.gov/study/NCT06296537 . As of the time of writing, the results have not yet been published on the registry.