Effect of neurocognitive training on pain, proprioception, injury anxiety, with functional and neurocognitive performance in athletes with chronic ankle instability

Aim: This study aimed to investigate the effects of neurocognitive training (NT) on pain, proprioception, injury-related fear, functional, and neurocognitive performance in athletes with chronic ankle instability (CAI). Materials and Methods: A total of 30 athletes residing in Balıkesir province, with a mean age of 11.10 ± 1.06 years and diagnosed with chronic ankle instability (CAI), were included in the study. The athletes were randomly assigned using simple randomization into a study group (n=15) and a control group (n=13). The study group underwent a NT program for four weeks, consisting of two sessions per week following an initial familiarization week. The control group continued their regular training without any additional intervention. Both groups were assessed at baseline and after four weeks using the Identification of Functional Ankle Instability (IdFAI), Cumberland Ankle Instability Tool (CAIT), pain intensity, proprioception, and injury-related fear evaluations. In addition, the Postural Stability Test, Y Balance Test (YBT), Side Hop Test, Reactive Balance Test (RBT), and Upper Extremity Choice Reaction Time Test were administered. Results: When the results were analyzed, the study group showed a decrease in IdFAI scores (p<0,001), an increase in CAIT scores (p=0,004), improvement in ankle proprioception for dorsiflexion (p=0,003) and plantarflexion (p=0,018), a reduction in injury-related anxiety (p=0,013), a decrease in the anterior component of the Y-Balance Test (YBT) (p=0,048), a decrease in anterior sway in the postural stability assessment (p=0,054), a decrease in lower extremity reaction time in the outcome measures of the RBT (p=0,030), and an increase in accuracy percentage as an indicator of dynamic balance (p=0,003). In the control group, improvement was found only in ankle proprioception for plantarflexion (p=0,028), while the level of pain after training increased (p=0,030). Conclusion: In conclusion, it was found that neurocognitive training reduced ankle instability symptoms, improved proprioception, decreased injury-related anxiety, and enhanced both functional and neurocognitive performance. NT is thought to enhance functional adaptation by simulating multitasking demands that may be encountered during sports activities. Keywords: Ankle Instability; Cognitive Load; Reactive Balance Test