CRITICAL RESEARCH APPRAISAL AND

PRESENTATION:

EFFECT OF PLYOMETRIC TRAINING ON FUNCTIONAL

ANKLE INSTABILITY

UCC- I
CENTER PHYSIOTHERAPY AND REHABILITATION SCIENCES
. CPRS
JAMIA MILLIA ISLAMIA
SUBMITTED BY: MOIN RASHID,MPT IST SEM(Sports).
 ARTICLES INCLUDE
1. Lower Extremity biomechanics in Athletes with Ankle instability after a 6 Week integrated
training program.
Pi-yin Huang, Ms,PT; Wen-Ling Chen,PhD; Cheng-Feng Lin,PhD,PT
2. Effect of plyometric versus Ankle stability Exercises on lower limb biomechanics in
Taekwondo demonstration Athletes with Functional Ankle Instability.
Ha Min Lee, Seunghue Oh, And Jung Won Kwon.
3. Effect of balance and plyometric training on balance control among individuals with Functional
Ankle Instability
Aileen Surakhamhaeng, Sunee Bovonsunthonchai, Roongtiwa Vachalathiti
4. Effects of Plyometric and Balance Training on Neuromuscular Control of Recreational Athletes with
Functional Ankle Instability: A Randomized Controlled Laboratory Study.
Pi-Yin Huang 1, Amornthep Jankaew 2 and Cheng-Feng Lin.
5. Effectiveness of Plyometric Training Program Versus Conventional Program on Pain and
Ankle Instability Among Football Player Randomized-Controlled Trial (RCT)
Muralisankar K.S.I.1, Aarthi S.2, Abinaya S.3* and Dhivyadharshini V.4
 PROCESS OF CRITICAL APPRAISAL
• Database searches- for the purpose of the articles search research, various
databases like pubmed, google scholar, PEDro database, Scopus and web of
science.

• Scales used for scoring the quality of Randomized Trials: PEDro scale, and
CONSORT checklist

• Reliability of the scales used for quality scoring

• Consort
• PEDro: Maher et al.(2003)
 Article - 1
Title: Lower Extremity biomechanics in Athletes with Ankle instability after a 6 Week
integrated training program
Authors: Pi-yin Huang, Ms,PT; Wen-Ling Chen,PhD; Cheng-Feng Lin,PhD,PT
Year of publication: 2014.
Journal: Journal of Athletics Training.
Impact factor: 3.84
H Index: 124
SJR score: 1.427
Jadad score: 1
Pedro scale: 5/11
 Objective : To investigate the effect of integrated plyometric and balance
training in participants with FAI during a single-
legged drop landing and single-legged standing position.
Design Randomized controlled clinical trial.
Participants Inclusion criteria were (1) membership in a sport team (eg,
basketball, rugby, soccer, volleyball) and performance of
regular exercise; (2) at least 1 acute ankle-inversion sprain (3)
recurrent ankle sprains or ankle ‘‘giving way’’ in the past 12
months; (4) clinically negative anterior drawer and talar tilt
tests. Total 30 Athletes.Age: 18 to 30 years
Exclusion criteria: any neurologic disorder, severe lower
extremity injury that affected equilibrium, or an ankle sprain
within the past month .
Intervention A 6-week plyometric-training program versus a 6-
week integrated-training program.
Main outcome measures Postural sway during single-legged standing with eyes open and
closed was measured before and after training
Results Reduced postural sway in the medial-lateral
direction and reduced sway area occurred in the plyometric-and
integrated-training groups.
Conclusions Plyometric training improved static and dynamic postural control
and should be incorporated into rehabilitation programs for
those with FAI.
Title
• Describes the population , intervention.
• It is specific and descriptive and doesn’t include outcome measures.
Abstract
• Mentioned in the structured pattern With inclusion of purpose ,intervention,
outcome measures, Results and conclusions
Introduction
• The introduction has sufficiently given all details regarding FAI
• 6 weeks of plyometric isolated and combined plyometric and balance traning
mentioned
• Why particularly plyometric combined with balance is used in this study was
also made clear.
Method
Study Design: Randomised controlled clinical trail
Sample size: 30 participants
Method of sample size mentioned properly.
Inclusion and Exclusion criteria:
Detailed inclusion and Exclusion criteria were mentioned And the participants were
screened on the basis of mentioned criteria.
Randomization:
Randomisation Process was not explained
Intervention:
Detailed intervention protocol about all groups were mentioned.
Outcome measures:
All the outcome measures used were relaible for the assessment
Statistical Analysis:
• Calculation of sample size was mentioned
• Reason for choosing all tests were also mentioned and explained
Result:
• All the outcome measures have been described in the result section and
in table.
• There was no reporting bias found in the result .
Discussion:
• Comprehensive discussion.
• Physiological reason between the effect of Plyometric and balance
Also discussed .
Limitations:
• Men and women sex are not separated during group allocation
• Did not investigate retention of training effect.
• COM location assumed at centre of pelvis
• Low sample size
Conclusions:
They found that the plyometric training improved static and dynamic
posural control and should be incorporated into rehabilitation programs for
those with FAI.
 ARTICLE - 2
Title: Effect of plyometric versus Ankle stability Exercises on lower limb
biomechanics in Taekwondo demonstration Athletes with Functional Ankle
Instability.
Authors: Ha Min Lee, Seunghue Oh, And Jung Won Kwon
Year of publication: 2020
Journal: International journal of environmental Research and Public health.
Impact factor: 4.614
H index: 167
SJR score : 0.828
Jadad score: 2
Pedro score: 6/11
Objective This study aimed to compare the effects of plyometric and
ankle stability exercises on the dynamic balance and lower
limb kinematic and kinetic parameters of Taekwondo
demonstration athletes with functional ankle instability
Design Randomised control
Participants Inclusion criteria: No History of a congenital orthopaedic
deformity in the lower limbs, no orthopaedic surgery during
the previous 6 months, and no vestibular or balance disorder.
Total : 14 and divided into two groups i.e plyometric group
and Stability Exercise group
Intervention 8 week training program of plyometric and Ankle stability
Exercises twice a week for 1 hour including warm up and cool
down exercises for 10 minutes
Outcome measures Y balance test measures dynamic balance, flexibility, and
proprioception
3D motion analysis used to record kinematics and kinetics of
lower limb during single leg drop landing
Results In both groups, exercise increased dynamic balance and
shock absorption and reduced postural sway on the
anteroposterior displacement
Conclusions This study suggests that the application of plyometric
exercises in ankle rehabilitation would improve stability and
shock absorption and help prevent injuries during Taekwondo
• Title
• Describes the population , intervention.
• It is specific and descriptive and doesn’t include outcome measures.
• Abstract
• Mentioned in the structured pattern With inclusion of purpose ,intervention,
outcome measures, Results and conclusions
• Introduction
• The introduction has sufficiently given all details regarding FAI
• 8 weeks of plyometric combined with Ankle stability Exercises mentioned
• Why particularly plyometric combined with ASE is used in this study was also
made clear
• Hypothesis: plyometric exercise can promote ankle stability by changing
landing strategies.
• Method
• Study Design: Randomised controlled clinical trail
• Sample size: 14 participants
• Method of sample size mentioned properly.
• Inclusion and Exclusion criteria:
• Detailed inclusion were mentioned And the participants were screened on
the basis of mentioned criteria.
• Randomization:
• Randomisation Process was not explained
• Intervention:
• Detailed intervention protocol about all groups were mentioned.
• Outcome measures:
• All the outcome measures used were relaible for the assessment
• Statistical Analysis:
• Calculation of sample size was mentioned
• Reason for choosing all tests were also mentioned and explained
• Result:
• All the outcome measures have been described in the result section and in table.
• There was no reporting bias found in the result .
• Discussion:
• Comprehensive discussion.
• Physiological reason between the effect of Plyometric and ASE Also discussed .
• Limitations:
• number of young male Taekwondo demonstration athletes. Thus, our results cannot
be applied to female athletes due to biomechanical differences, and a future study
must be conducted on a larger sample size. Second,this study was conducted during
the regular season, and exercises other than the intervention weren't controlled.
We recommend that future studies be conducted during the preseason to limit
other exercises. Finally, the present study did not address the persistence of the
effects of ASE and PE.
• Conclusions:
• They found that the plyometric training and ASE improve STABILITY and shock
absorber and alter landing strategies to control ankle instability at landing
control
 Article - 3
• Title: Effect of balance and plyometric training on balance control among
individuals with Functional Ankle Instability
• Authors: Aileen Surakhamhaeng, Sunee Bovonsunthonchai, Roongtiwa
Vachalathiti
• Year of publication: 2020
• Journal: Physiotherapy Quarterly .
• Impact factor:
• H index: 9
• SJR score : 0.206
• Jadad score: 2
• Pedro score: 6/11
Objective Study aimed to compare the effects of balance and
plyometric training on balance control among individuals
with functional ankle instability (FAI).
Design Randomised
Participants Inclusion criteria: (1.history of unilateral or bilateral ankle
sprain (2.Recent ankle sprain (3.able to perform one leg stand
with full weight bearing on injured side 4.Experincing no pain
on walking and running (5.Age between 18 to 45.
Exclusion criteria; history of fracture or surgery, BMI > 30
kg/m2 ,VAS >3/10
Total 20 individuals comprising 7 male and 13 females
Intervention 5 to 6 Week training program of plyometric and balance for
each two groups that is plyometric group (n= 10) and balance
group( n= 10) for 3 days per week for 20 minutes including
warm up and cool down
Outcome measures SD of COP(in mm) in all directions were collected by using a
force plate,stood their single leg for 20 sec.
TTS ( in sec.) of GRF in all directions were collected during step
down test from a box 30 cm in height
Results Plyometric group showed significant improvement in all testing
variables whereas balance training group presented
improvement only in the reach distances
Conclusions Plyometric training provided benefits in both static and
• Title
• Describes the population , intervention.
• It is specific and includes outcome measures.
• Abstract
• Mentioned in the structured pattern With inclusion of purpose
,intervention, outcome measures, Results and conclusions
• Introduction
• The introduction has sufficiently given all details regarding FAI
• 5 to 6 weeks of plyometric combined with balance training mentioned
• Why particularly plyometric combined with balance is used in this study
was also made clear
• Hypothesis: plyometric exercise can promote more benefits for improving
postural balance and ankle stability than balance training.
• Method
• Study Design: Randomised
• Sample size: 20 participants
• Method of sample size mentioned properly.
• Inclusion Criteria:
• Brief inclusion and exclusion criteria were mentioned And the participants
were screened on the basis of mentioned criteria.
• Randomization:
• Randomisation Process was not explained but concealment was done by
using envelope.
• Intervention:
• Detailed intervention protocol about all groups were mentioned.
• Outcome measures:
• All the outcome measures used were reliable for the assessment
• Statistical Analysis:
• Calculation of sample size was mentioned
• Reason for choosing all tests were also mentioned and explained
• Result:
• All the outcome measures have been described in the result section and
in table.
• There was no reporting bias found in the result .
• Discussion:
• Comprehensive discussion.
• Physiological reason between the effect of Plyometric and balance
Also discussed .
• Limitations:
• The study may have been limited by a long-term effect of training that was not
evaluated. Additionally, the functional assessment conducted in the study
should also monitor other factors, such as injury recurrence, pain, and quality
of life, which are also important for this population. Furthermore, other types
of exercises should be investigated in future studies for proper selection
concerning various circumstances
• Conclusions: plyometric training provided benefits in both static and
dynamic balances for individuals with FAI.
 ARTICLE- 4
Title: Effects of Plyometric and Balance Training on Neuromuscular Control of
Recreational Athletes with Functional Ankle Instability: A Randomized
Controlled Laboratory Study.
Authors: Pi-Yin Huang 1, Amornthep Jankaew 2 and Cheng-Feng Lin.
Year of Publication: 2021.
Journal: International journal of environmental research and public Health
Impact factor: 4.614
H index:167
SJR score : 0.828
Jadad score: 2
Pedro score: 7/11
Objective Investigate the change of joint position sense, neuromuscular
activity of the unstable ankle after six-week integrated
balance/plyometric training and six-week plyometric training.
Design Randomised controlled study
Participants Inclusion criteria: participate regularly in sports activities (b)
have experienced at least one prior ankle inversion sprain over
the past 12 months;(c) have experience a ankle “giving way”
events over the past 12 months;(d) clinically test negative in
anterior drawer and talar tilt tests.Exlusion Criteria: Applicants
with any form of neurological disorder or lower extremity
injuries that would affect balance or an ankle sprain within a
month were excluded.
Total 30 individuals comprising 23 males And 7 females
Intervention 6 Week plyometric training and balance training for each
group that is, PG (n=10), BPG (n=10) and CG(n=10), 3 sessions
per week
Outcome measures Ankle joint position,EMG and balance adjusting time during
medial single leg drop landings.
Results Plyometric group exhibited a higher integrated EMG of TA
muscle and shorter adjusting time of plantar flexors
Conclusions Both programs improved ankle joint position sense and muscle
activation of plantar flexors.plyometric group showed a
reduced adjusting time of ankle plantar flexors
• Title
• Describes the population , intervention and Design of study
• It is specific and includes outcome measures.
• Abstract
• Mentioned in the structured pattern With inclusion of purpose ,intervention,
outcome measures, Results and conclusions
• Introduction
• The introduction has sufficiently given all details regarding FAI
• 6 weeks of plyometric combined with balance training mentioned
• Why particularly plyometric combined with balance training on
Neuromuscular control is used in this study was also made clear
• Hypothesis: plyometric training improves the ability of individuals with FAI to
regain stability following landing.
• Method
• Study Design: Randomised
• Sample size: 30 participants
• Method of sample size mentioned properly.
• Inclusion Criteria:
• Brief inclusion and exclusion criteria were mentioned And the participants were screened on
the basis of mentioned criteria.
• Randomization:
• Randomisation Process was explained and concealment was done by using envelope.
• Intervention:
• Detailed intervention protocol about all groups were mentioned.
• Outcome measures:
• All the outcome measures used were reliable for the assessment
• Statistical Analysis:
• Calculation of sample size was mentioned
• Reason for choosing all tests were also mentioned and explained
• Result:
• All the outcome measures have been described in the result section and in table.
• There was no reporting bias found in the result .
• Discussion:
• Comprehensive discussion.
• Physiological reason between the effect of Plyometric and balance Also discussed .
• Limitations:
• First, participants with bilateral ankle instability were not excluded, and testing was
simply performed on the ankle joint with the lower CAIT score. Second, specific onset
time of each ankle sprain was not documented and this may possibly affect their
performance. Third, the number of plyometric sets and repetitions was not standardized
as these were modified depending upon participants’ feedback and progress. Future
studies should evaluate the effect of the plyometric training volume (number of
plyometric sets and repetitions) on the ankle joint performance and prevention of ankle
injury. In addition, combination between plyometric programs and other types of training
such as power, strength, or endurance exercise need to be explored.
• Conclusions:
• Isolated plyometric training leads to a more rapid stabilization in the ankle plantar flexor
during a medial single-leg drop-landing task. Even though the plyometric training may be
a better training type based on the present findings.
 ARTICLE- 5
• Title: Effectiveness of Plyometric Training Program Versus Conventional
Program on Pain and Ankle Instability Among Football Player Randomized-
Controlled Trial (RCT)
• Authors: Muralisankar K.S.I.1, Aarthi S.2, Abinaya S.3* and Dhivyadharshini
V.4
• Year of Publication: 2023
• Journal: Biological Forum – An International Journal
• Impact factor: 5.11
• Jadad score: 2
• Pedro score: 5/11
Objective Aim of this study is to investigate how well plyometric training
enhances ankle stability in football players with ankle
instability.
Design Randomised control Trail

Participants Football players were randomly recruited for this study (n=32 in
each group – Group A&B). .Total 64 participants

Intervention 6 Week Plyometric and conventional therapy, 3 days per week.

Group A received plyometric training program. Group B
received conventional therapy.
Outcome measures VAS and CAIT were recorded before and after intervention of 6
weeks.

Results Result shows that the VAS and CAIT scores are improved
significantly in both groups, but the difference of improvement
is higher in group A, who received plyometric training
program. Plyometric training program is much better than the
conventional therapy for the management of ankle instability.
Conclusions Plyometric training programmes help athlete’s ankle stability
while also enhancing their neuromuscular, neuro-motor, and
Title
Describes the population , intervention and Design of study
It is specific and includes outcome measures.
Abstract
Mentioned in the structured pattern With inclusion of purpose ,intervention,
outcome measures, Results and conclusions
Introduction
The introduction has sufficiently given all details regarding FAI
6 weeks of plyometric and conventional therapy used in this study was also
made clear
Why particularly Plyometric training is used in this study also mentioned
Hypotheses: plyometric activities may have a higher effect on variables
linked to an increase in ankle stability.
• Method
• Study Design: Randomised
• Sample size: 64 participants
• Method of sample size mentioned properly.
• Inclusion Criteria:
• Brief inclusion and exclusion criteria were not mentioned.
• Randomization:
• Randomisation Process was not explained
• Intervention:
• Detailed intervention protocol about all groups were mentioned.
• Outcome measures:
• All the outcome measures used were reliable for the assessment
• Statistical Analysis:
• Calculation of sample size was mentioned
• Reason for choosing all tests were also mentioned and explained
• Result:
• All the outcome measures have been described in the result section and in
table.
• There was no reporting bias found in the result .
• Discussion:
• Comprehensive discussion.
• Physiological reason between the effect of Plyometric and conventional
therapy Also discussed .
• Limitations:
• only the variables of pain severity and ankle instability were studied, and
females were not included in the study due to its limited sample size.
• Conclusions:
• Plyometric training program is much better than the conventional therapy
for the management of ankle instability.
 IN CONCLUSION
• Database search – for the purpose of the articles search research,
various databases like PubMed, google scholar, PEDro database, Scopus
and web of science.
• The Methodological quality of the article was assessed through PEDro
scale and the score of scale was 3 out of 5 articles were of good quality,-
Article 2 (Ha Min lee.et.al),Article 3(Aileen Surakhamhaeng.et .al) and
Article 4(Pi-Yin Huang.et al).
• The appraisal of articles suggested that Plyometric training can be used
as a treatment approach in Functional Ankle Instability patients because
it enhances neuromuscular, euro motor and sensory motor system,
improving static and dynamic balance and reducing the risk of injury
recurrence in patients with Ankle injuries. Also It will be highly beneficial
treatment option for sports person who has sprained their ankle
• Evidence based practice:
• Plyometric training can be used in Functional ankle Instability in a clinical
settings For 40 to 60 minutes including warm up and cool down phase for
10 minutes each, 3 to 4 sessions per week for 5 to 6 weeks
Future research Purpose:
• More studies with large sample size
• Females patients should include in the future study.
• Retention of the training effect should be investigate.
• Combination between plyometric programs and other types of training
such as power, strength, or endurance exercise need to be explored.
THANK YOU