Chronic ankle instability refers to a combination of persistent mechanical and functional instability symptoms following an ankle sprain. Along with these symptoms, decreased proprioception, reduced neuromuscular control, poor postural control, limited dorsiflexion range of motion, decreased ankle strength, and altered lower-extremity biomechanics during functional activities are also observed. In addition, individuals with chronic ankle instability have been shown to exhibit limitations in energy transfer across the lower extremity. These symptoms may hinder patients' physical activity levels and athletic performance and negatively affect their quality of life. Since the lower extremity functions as a unit, changes in adaptive strategies at the ankle can lead to kinematic alterations in proximal joints. Although the instability originates at the ankle, higher-level joints are also affected, and it has even been reported that in this population, lower-extremity stability is primarily achieved through the hip joint. While the effectiveness of hip-focused exercises has begun to be investigated in the literature, the superiority of different muscle groups has not yet been compared.
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Parallel
Gluteus Medius
Other interventionParticipants with chronic ankle instability will undergo a 6-week hip-focused strengthening exercise program specifically targeting the gluteus medius muscle. The intervention aims to improve hip muscle strength and lower extremity stability.
Gluteus Maximus
Other interventionParticipants with chronic ankle instability will participate in a 6-week hip-focused strengthening exercise program targeting the gluteus maximus muscle. The program aims to enhance hip extension strength and overall lower extremity stability.
Control
Other interventionParticipants with chronic ankle instability will perform a 6-week standard strengthening exercise program commonly used in the rehabilitation of ankle instability, without specific emphasis on targeted hip muscle strengthening.
Cumberland Ankle Instability Tool (CAIT)
The Cumberland Ankle Instability Tool (CAIT) is a self-reported questionnaire designed to assess the severity of chronic ankle instability. It consists of 9 items evaluating ankle stability during daily and sports-related activities. Scores range from 0 to 30, with lower scores indicating greater perceived ankle instability. An increase in the CAIT score reflects clinical improvement in ankle stability.
Functional Ankle Instability Questionnaire
Self-reported functional ankle instability will be evaluated using the Functional Ankle Instability Questionnaire. The questionnaire will be administered face-to-face by a trained physiotherapist to assess perceived ankle instability during daily and sports-related activities.
Hip Muscle Strength
Isometric hip abduction and hip extension muscle strength will be assessed using a handheld dynamometer (KForce Muscle Controller, KInvent, USA). Hip abduction strength will be measured in a side-lying position at 25° of hip abduction with the knee extended, targeting the gluteus medius muscle. Hip extension strength will be measured in a prone position with the knee flexed at 90°, targeting the gluteus maximus muscle. Three trials will be performed bilaterally, and the mean value will be used for analysis.
Side Hop Test
Functional performance will be assessed using the Side Hop Test. Participants will be instructed to perform repeated lateral hops on one leg over a single reference line as quickly as possible for 30 seconds. The total number of successful hops will be recorded. The test will be performed three times, and the highest value will be used for analysis.
Step-Down Test
Postural stability and lower extremity kinematics will be evaluated using the Step-Down Test. Participants will stand on a raised platform on the test limb with hands placed on the waist and perform a controlled step-down by lowering the contralateral heel toward the ground and returning to the starting position. The movement will be performed at a standardized pace. The movement quality will be evaluated based on trunk, pelvis, and knee alignment.
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