Exercise Therapy for Chronic Ankle Instability: Which Modality for Which Deficit? A Systematic Review and Meta‐Analysis

OBJECTIVE: Chronic ankle instability (CAI) involves heterogeneous sensorimotor deficits. Evidence comparing exercise modalities for specific deficits is limited, impeding personalised rehabilitation. To determine the relative efficacy of exercise interventions and create an evidence-based framework for deficit-specific prescription in CAI. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Searches of 9 electronic databases from inception to 1 September 2025. STUDY SELECTION: Randomised controlled trials comparing exercise interventions against no intervention for sensorimotor outcomes in CAI individuals. DATA EXTRACTION AND SYNTHESIS: statistics evaluated heterogeneity. Meta-analysis summarised standard mean difference for sensorimotor indicators. RESULTS: Fifty-eight studies (n = 2097) were included. Of the included studies, 28 were rated as low risk of bias, 19 as unclear risk and 11 as high risk. Balance training provided comprehensive benefits, improving patient-reported function, dynamic balance, joint position sense, concentric strength and functional performance. Strength training enhanced patient-reported function, dynamic balance and concentric strength. 3D, stroboscopic and neuromuscular training improved patient-reported function and dynamic balance; stroboscopic training also benefited joint position sense. Vibration training improved only dynamic balance. No interventions significantly improved force sense or eccentric strength. CONCLUSION: Exercise modalities have distinct efficacy profiles in CAI. Balance training is foundational, but therapy can be personalised by framework optimises management. TRIAL REGISTRATION: This systematic review was registered in the PROSPERO database (CRD42024606683).