Study Design Double-blind, randomised controlled.

Objectives To evaluate the effect of internal focus (IF) and external focus (EF) feedback instructions on balance training in those with CAI.

Background CAI has been linked to many different causative factors including deficits in postural control. Balance training has been used as an effective ankle injury rehabilitation program for patients suffering from CAI and repeated ankle sprains. However, there has been no study investigating the effect of attentional focus with four weeks of balance training on ankle kinematics in CAI patients on postural control.

Methods and Measures A total of 20 subjects with CAI were recruited. Subjects were randomly assigned to two different groups (IF and EF). Two groups completed a four-week progressive balance training described by Mckeon et al. Before and after training, subjects performed 10 s single-leg stance balance test with their eyes open and closed. The Acusway force plate was used to analyse time to boundary (TTB) measures. A 2 (Type of feedback)×2 (time) mixed model two-way repeated measures of ANOVA was used to analyse the differences between the group and time.

Results There were no significant interactions or main effects for TTB measures in the eyes open condition. In eyes closed condition, there was significant time main effect in the absolute minimum TTB mediolateral (ML) [F_1,18=7.44; p=0.01], absolute minimum TTB anteroposterior (AP) [F_1,18=22.94; p=0.00], and mean of the TTB minima AP [F_1,18=17.13; p=0.00]. In addition, there were significant interactions in SD of TTB ML [F_1,18=6.48; p=0.02]. Post hoc comparisons revealed that there was a significant improvement of balance in EF [pre: 0.57±0.16, post: 0.65±0.17].

Conclusion EF feedback improved the postural control as compared to IF. Providing specific target to the patient with CAI when they perform dynamic balance training may be an effective way to improve postural control.