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Randomized trialThe Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2026

Comparative Effects of Platelet-Rich Plasma, Exercise Therapy, and Myofascial Superficial Back Line Manual Therapy on Balance, Posture, and Function in Chronic Ankle Instability: A Three Arm Randomized Controlled Trial.

İlayda Çakıcı, Nilüfer Cerbezer, Elif Tuğçe Çil

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Physical Medicine & RehabilitationRandomized trial

Combined platelet-rich plasma with exercise improved foot and ankle function in chronic ankle instability.

Comparative Effects of Platelet-Rich Plasma, Exercise Therapy, and Myofascial Superficial Back Line Manual Therapy on Balance, Posture, and Function in Chronic Ankle Instability: A Three Arm Randomized Controlled Trial.

İlayda Çakıcı et al. · The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2026

Background

Chronic ankle instability is a musculoskeletal disorder involving repeated ankle sprains, reduced joint position sense, and postural imbalance.

Purpose

This randomized controlled study compared platelet-rich plasma injection, platelet-rich plasma combined with a structured exercise program, and manual therapy focusing on the myofascial superficial back line in terms of pain, proprioception, posture, balance, and function.

Methods

A Three-Arm Forty-seven participants were randomly divided into three groups: platelet-rich plasma injection (three ultrasound-guided intra-articular applications at two-week intervals), platelet-rich plasma with exercise (the same injections plus an eight-week supervised exercise program), and manual therapy (an eight-week fascial-based intervention).

Δ=+20.58

Results

foot and ankle function improved by this amount with combined platelet-rich plasma and exercise

More results

All groups showed significant improvements after treatment (p<0.05).

Platelet-rich plasma injection produced the greatest pain reduction (Visual Analog Scale Δ=-6.94).

Dynamic balance improved significantly, particularly in the platelet-rich plasma with exercise group.

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Conclusion · 1 of 2

While platelet-rich plasma provides strong analgesic benefits, its combination with exercise or fascial-based manual therapy yields broader gains in posture, proprioception, and function, supporting multimodal rehabilitation in chronic ankle instability.

Conclusion · 2 of 2

LEVEL OF CLINICAL EVIDENCE: 2 or 3.

Comparative Effects of Platelet-Rich Plasma, Exercise Therapy, and Myofascial Superficial Back Line Manual Therapy on Balance, Posture, and Function in Chronic Ankle Instability: A Three Arm Randomized Controlled Trial.

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