{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:43:26Z","timestamp":1790963006178,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy.<\/jats:p>","DOI":"10.3390\/medicina61071267","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T07:54:23Z","timestamp":1752479663000},"page":"1267","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Targeting Arthrogenic Muscle Inhibition in Chronic Ankle Instability: A Narrative Review of Neural and Functional Rehabilitation Strategies"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9037-4767","authenticated-orcid":false,"given":"Roberto","family":"Tedeschi","sequence":"first","affiliation":[{"name":"Independent Researcher, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, 40139 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Donati","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy"},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.semarthrit.2009.10.001","article-title":"Quadriceps Arthrogenic Muscle Inhibition: Neural Mechanisms and Treatment Perspectives","volume":"40","author":"Rice","year":"2010","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.jelekin.2012.06.002","article-title":"Altered Postural Modulation of Hoffmann Reflex in the Soleus and Fibularis Longus Associated with Chronic Ankle Instability","volume":"22","author":"Kim","year":"2012","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1177\/107110070502601210","article-title":"Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability","volume":"26","author":"McVey","year":"2005","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.jshs.2024.02.005","article-title":"Soleus Arthrogenic Muscle Inhibition Following Acute Lateral Ankle Sprain Correlates with Symptoms and Ankle Disability but Not with Postural Control","volume":"13","author":"Kim","year":"2024","journal-title":"J. Sport Health Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1123\/jsr.2022-0200","article-title":"Arthrogenic Muscle Inhibition: 20 Years On","volume":"31","author":"Hopkins","year":"2022","journal-title":"J. Sport Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1123\/jsr.2021-0128","article-title":"Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury","volume":"31","author":"Pietrosimone","year":"2022","journal-title":"J. Sport Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1080\/17461391.2021.1881620","article-title":"Arthrogenic Muscle Inhibition and Return to Sport after Arthrofibrosis Complicating Anterior Cruciate Ligament Surgery","volume":"22","author":"Dauty","year":"2022","journal-title":"Eur. J. Sport Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3810\/psm.2009.06.1715","article-title":"Ankle Instability in Sports","volume":"37","author":"Murawski","year":"2009","journal-title":"Phys. Sportsmed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1302\/0301-620X.47B4.678","article-title":"The Etiology and Prevention of Functional Instability of the Foot","volume":"47","author":"Freeman","year":"1965","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_10","first-page":"447","article-title":"The Sprained Ankle. Diagnosis and Management of Lateral Ligament Injuries","volume":"21","author":"Litt","year":"1992","journal-title":"Aust. Fam. Physician"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1054\/math.1997.0281","article-title":"The Effects of Joint Damage on Muscle Function, Proprioception and Rehabilitation","volume":"2","author":"Hurley","year":"1997","journal-title":"Man. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.jpain.2019.03.005","article-title":"Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions","volume":"20","author":"Rice","year":"2019","journal-title":"J. Pain"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1136\/bjsports-2017-098401","article-title":"Arthrogenic Muscle Inhibition after ACL Reconstruction: A Scoping Review of the Efficacy of Interventions","volume":"53","author":"Saithna","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1136\/bjsports-2015-095596","article-title":"Critical Components of Neuromuscular Training to Reduce ACL Injury Risk in Female Athletes: Meta-Regression Analysis","volume":"50","author":"Sugimoto","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1177\/0363546508330147","article-title":"Peroneal Activation Deficits in Persons with Functional Ankle Instability","volume":"37","author":"Hopkins","year":"2009","journal-title":"Am. J. Sports Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1177\/03635465241232090","article-title":"Individuals With Chronic Ankle Instability Show Abnormalities in Maximal and Submaximal Isometric Strength of the Knee Extensor and Flexor Muscles","volume":"52","author":"Labanca","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4085\/1062-6050-46.3.263","article-title":"Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain","volume":"46","author":"Klykken","year":"2011","journal-title":"J. Athl. Train."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.math.2012.11.004","article-title":"Lower Leg Neuromuscular Changes Following Fibular Reposition Taping in Individuals with Chronic Ankle Instability","volume":"18","author":"Chou","year":"2013","journal-title":"Man. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1136\/bjsm.2010.077404","article-title":"Characteristics of People with Recurrent Ankle Sprains: A Systematic Review with Meta-Analysis","volume":"45","author":"Hiller","year":"2011","journal-title":"Br. J. Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"CPG1","DOI":"10.2519\/jospt.2021.0302","article-title":"Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021","volume":"51","author":"Martin","year":"2021","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1177\/00315125241277250","article-title":"Assessment of Balance During a Single-Limb Stance Task in Healthy Adults: A Cross-Sectional Study","volume":"131","author":"Tedeschi","year":"2024","journal-title":"Percept. Mot. Skills"},{"key":"ref_22","first-page":"92","article-title":"The Reliability of an Instrumented Device for Measuring Components of the Star Excursion Balance Test","volume":"4","author":"Plisky","year":"2009","journal-title":"N. Am. J. Sports Phys. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.math.2016.08.006","article-title":"Manual Therapy in Joint and Nerve Structures Combined with Exercises in the Treatment of Recurrent Ankle Sprains: A Randomized, Controlled Trial","volume":"26","year":"2016","journal-title":"Man. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1037\/0021-9010.84.5.795","article-title":"A Meta-Analytic Review of the Distribution of Practice Effect: Now You See It, Now You Don\u2019t","volume":"84","author":"Donovan","year":"1999","journal-title":"J. Appl. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"355","DOI":"10.4085\/1062-6050-547-16","article-title":"Whole-Body-Vibration Training and Balance in Recreational Athletes with Chronic Ankle Instability","volume":"53","author":"Esteban","year":"2018","journal-title":"J. Athl. Train."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1249\/MSS.0000000000002129","article-title":"The Effects of Transcranial Direct Current Stimulation on Chronic Ankle Instability","volume":"52","author":"Bruce","year":"2020","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1123\/jsr.2021-0232","article-title":"Gamma Loop Dysfunction as a Possible Neurophysiological Mechanism of Arthrogenic Muscle Inhibition: A Narrative Review of the Literature","volume":"31","author":"Konishi","year":"2022","journal-title":"J. Sport Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1177\/03635465231209987","article-title":"Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group","volume":"52","author":"Hopper","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"i3","DOI":"10.1136\/qshc.2008.029066","article-title":"Publication Guidelines for Quality Improvement in Health Care: Evolution of the SQUIRE Project","volume":"17","author":"Davidoff","year":"2008","journal-title":"Qual. Saf. Health Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4085\/1062-6050-51.3.09","article-title":"Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial","volume":"51","author":"Donovan","year":"2016","journal-title":"J. Athl. Train."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jelekin.2015.01.009","article-title":"Fibular Taping Does Not Alter Lower Extremity Spinal Reflex Excitability in Individuals with Chronic Ankle Instability","volume":"25","author":"Grindstaff","year":"2015","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1177\/19417381241253248","article-title":"Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-Analysis","volume":"17","author":"Lin","year":"2025","journal-title":"Sports Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1007\/s00221-024-06874-z","article-title":"Metaplastic Neuromodulation via Transcranial Direct Current Stimulation Has No Effect on Corticospinal Excitability and Neuromuscular Fatigue","volume":"242","author":"Boda","year":"2024","journal-title":"Exp. Brain Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"134597","DOI":"10.1016\/j.neulet.2019.134597","article-title":"Preconditioning Cathodal Transcranial Direct Current Stimulation Facilitates the Neuroplastic Effect of Subsequent Anodal Transcranial Direct Current Stimulation Applied during Cycling in Young Adults","volume":"714","author":"Pourmajidian","year":"2020","journal-title":"Neurosci. Lett."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Janssen, K.W., van Mechelen, W., and Verhagen, E.A. (2011). Ankles Back in Randomized Controlled Trial (ABrCt): Braces versus Neuromuscular Exercises for the Secondary Prevention of Ankle Sprains. Design of a Randomised Controlled Trial. BMC Musculoskelet. Disord., 12.","DOI":"10.1186\/1471-2474-12-210"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hupperets, M.D.W., Verhagen, E.A.L.M., and van Mechelen, W. (2008). The 2BFit Study: Is an Unsupervised Proprioceptive Balance Board Training Programme, given in Addition to Usual Care, Effective in Preventing Ankle Sprain Recurrences? Design of a Randomized Controlled Trial. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-71"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Coelho-Oliveira, A.C., Taiar, R., Pessanha-Freitas, J., Reis-Silva, A., Ferreira-Souza, L.F., Jaques-Albuquerque, L.T., Lennertz, A., Moura-Fernandes, M.C., Rodrigues Lacerda, A.C., and Mendon\u00e7a, V.A. (2023). Effects of Whole-Body Vibration Exercise on Athletes with Ankle Instability: A Systematic Review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054522"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Biz, C., Nicoletti, P., Tomasin, M., Bragazzi, N.L., Di Rubbo, G., and Ruggieri, P. (2022). Is Kinesio Taping Effective for Sport Performance and Ankle Function of Athletes with Chronic Ankle Instability (CAI)? A Systematic Review and Meta-Analysis. Medicina, 58.","DOI":"10.3390\/medicina58050620"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1123\/jsr.22.2.150","article-title":"Effect of Eccentric Strengthening after Anterior Cruciate Ligament Reconstruction on Quadriceps Strength","volume":"22","author":"Lepley","year":"2013","journal-title":"J. Sport Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/1941738115578112","article-title":"Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction: A Review of the Current Literature","volume":"7","author":"Lepley","year":"2015","journal-title":"Sports Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"329","DOI":"10.2165\/00007256-200434050-00005","article-title":"Effects of Resistance Training on Older Adults","volume":"34","author":"Hunter","year":"2004","journal-title":"Sports Med."},{"key":"ref_43","first-page":"71","article-title":"The Sensorimotor System, Part I: The Physiologic Basis of Functional Joint Stability","volume":"37","author":"Riemann","year":"2002","journal-title":"J. Athl. Train."},{"key":"ref_44","first-page":"351","article-title":"The Role of the Sensorimotor System in the Athletic Shoulder","volume":"35","author":"Myers","year":"2000","journal-title":"J. Athl. Train."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ptsp.2018.08.010","article-title":"Eccentric Cross-Exercise after Anterior Cruciate Ligament Reconstruction: Novel Case Series to Enhance Neuroplasticity","volume":"34","author":"Lepley","year":"2018","journal-title":"Phys. Ther. Sports"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"155","DOI":"10.25259\/JMSR_133_2023","article-title":"The Need for Standardization in Foot and Ankle Outcome Measures: Implications for Evidence-Based Medicine in Orthopedics","volume":"7","author":"Rathod","year":"2023","journal-title":"J. Musculoskelet. Surg. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1267\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:20Z","timestamp":1760033360000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,13]]},"references-count":46,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["medicina61071267"],"URL":"https:\/\/doi.org\/10.3390\/medicina61071267","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,13]]}}}