This randomized controlled trial investigates the comparative effect of combined strength and balance training versus balance and core training on kinesiophobia (fear of movement), ankle instability, functional outcomes, and athletic performance in adolescent table tennis players with functional ankle instability (FAI). Participants will be randomly allocated into two groups over a 6-week intervention (3 sessions/week). The Experimental Group will receive combined strength and balance training, while the Control Group will receive balance and core training. Outcomes will be measured using validated tools: TSK-17, CAIT, FAAM, Y-Balance Test, Single-Leg Hop Test, T-Test, and Illinois Agility Test.
Male/female table tennis players aged 15-30 years
Experienced at least one ankle sprain with swelling/pain that interrupted training for >1 day within the last 6 months
Reported sensation of instability of the ankle
Scored ≤25 points on the Cumberland Ankle Instability Tool (CAIT), indicating functional ankle instability
History of ankle fracture or surgery
Any fracture of lower limb history
Any neurological or vestibular disorders
Other injuries of lower limb affecting performance
Parallel
Experimental : Combined Strength and Balance Training
Other interventionA structured 6-week exercise program combining ankle strengthening exercises (Theraband resistance training, heel raises, lunges) with dynamic balance training (single-leg stance, wobble board, Y-balance drills). Sessions last 40-45 minutes and are conducted 3 times per week. Warm-up: 5-7 min light jogging/dynamic mobility. Main Training: 30 min combined strength and balance work. Cool-down: 5 min static stretching.
Control : Balance and Core Training
Other interventionA structured 6-week program combining balance training (single-leg stance on firm and foam surfaces, tandem walking, Y-balance drills) with core stabilization exercises (plank, side plank, dead bug). Sessions last 40-45 minutes, 3 times per week with the same warm-up and cool-down structure as the experimental group
Kinesiophobia - Tampa Scale for Kinesiophobia (TSK-17)
17-item self-report questionnaire measuring fear of movement and re-injury. Good internal consistency (Cronbach's α = 0.70-0.86) and test-retest reliability (ICC = 0.72-0.90). Reduced scores indicate decreased kinesiophobia.
Ankle Instability - Cumberland Ankle Instability Tool (CAIT)
Validated questionnaire assessing functional ankle instability severity. Excellent test-retest reliability (ICC = 0.96) and internal consistency (Cronbach's α = 0.83). Increased post-intervention scores indicate improved perceived ankle stability
Functional Ability - Foot and Ankle Ability Measure (FAAM)
Self-reported tool assessing functional limitations in foot and ankle disorders. Excellent internal consistency (α = 0.89-0.98) and reliability (ICC = 0.84-0.92) for ADL and Sports subscales. Increased scores indicate improved functional ability
Dynamic Balance - Y Balance Test (YBT)
Measures dynamic balance and lower limb neuromuscular control. Excellent test-retest reliability (ICC = 0.85-0.91). Reach distances normalized to limb length. Increased post-intervention reach distance indicates improved ankle stability.
Functional Performance - Single-Leg Hop Test
Reliable measure of lower limb strength, dynamic stability, and functional performance (ICC = 0.85-0.95). Increased hop distance and improved landing control indicate enhanced neuromuscular function.
Agility and Performance - T-Test and Illinois Agility Test
Valid and reliable measures of agility and change-of-direction speed. T-Test (ICC = 0.90-0.98), Illinois Agility Test (ICC = 0.88-0.96). Reduced completion time indicates improved dynamic stability and neuromuscular control.
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