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.

Abstract

Chronic ankle instability is a musculoskeletal disorder involving repeated ankle sprains, reduced joint position sense, and postural imbalance. Although exercise-based rehabilitation is essential, variations in program design and a focus on local stabilization limit overall effectiveness. 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. A Three-Arm Randomized Controlled Trial Methods: 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). 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). The platelet-rich plasma with exercise and manual therapy groups showed superior improvements in posture and functional outcomes, including Foot and Ankle Ability Measure (Δ=+20.58), Cumberland Ankle Instability Tool (Δ=+9.94), and posture score (Δ=-5.93). Dynamic balance improved significantly, particularly in the platelet-rich plasma with exercise group. 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. 2 or 3.