Rhythmic Auditory Cueing Optimizes Pre-landing Movement and Ankle Function in Athletes with Chronic Ankle Instability: A Randomized Controlled Trial

Abstract Background People with chronic ankle instability (CAI) have poor lower limb control during landing that contributes to recurrent ankle injury. Training combined with metronome has shown better motor performance than training alone. The aim of this study was to investigate the effects of an exercise program with and without auditory cues on lower limb biomechanics during single-leg jump-landing and self-reported ankle function in athletes with CAI. Methods Twenty-six participants were allocated to experimental and control groups. Both groups received a functional exercise program at home for 4 weeks with an experimental group performing exercises with metronome synchronization. The motion analysis system synchronized with force platform was used to determine lower limb biomechanics during a single-leg jump-landing test. Foot and Ankle Ability Measure (FAAM) was used as the self-reported ankle ability. Mixed model ANOVA (2 × 2; group × time) were used to compare the within-group, between-group, and interaction effects. Results There was a significant interaction of ankle plantarflexion excursion in pre-landing phase ( p = 0.028 ). Post hoc comparisons showed ankle plantarflexion excursion (degrees) was significantly greater in the experimental group (32.5 ± 12.2) compared with the control group (18.8 ± 4.1) post-intervention ( p = 0.023 ). Increased sagittal excursion of the hip and knee was observed ( p < 0.05 ) in pre-landing phase but not in the landing phase in both groups. Wilcoxon Signed Rank tests showed significantly increased scores of FAAM in ADL and sport domains from pre- (ADL, 86.5 ± 6.5; Sport, 67.5 ± 11.1) to post-intervention (ADL, 93.9 ± 4.3; Sport, 85.6 ± 13.9) in the experimental group (ADL, p = 0.007 ; Sport, p = 0.018 ), but no differences were seem between groups. Conclusions The functional exercise program helped to improve self-reported ankle function in athletes with CAI. The use of rhythmic auditory cueing seems to demonstrate a superior benefit in ankle movement during pre-landing in athletes with CAI. Trial registration: Thai Clinical Trials Registry on April 3, 2023 (TCTR20230412001).