The studies
Chronic ankle instability, or CAI, is the problem patients quietly accept as just how their ankle is now. Two recent papers looked at how much rehab actually helps, and they are more useful read side by side.
The first is a systematic review and meta-analysis. It pulled together 26 randomised controlled trials covering 1,032 people with CAI and asked a straightforward question: does exercise therapy genuinely improve these ankles, and does the type or length of program matter? The authors sorted the trials by the kind of exercise used and tracked how patients scored on three standard questionnaires.
Those three questionnaires come up constantly in ankle research, so they are worth knowing:
The CAIT, or Cumberland Ankle Instability Tool, measures how unstable the ankle feels to the patient. A higher score means a steadier, more confident ankle.
The FAAM, or Foot and Ankle Ability Measure, rates how well the foot and ankle perform in everyday activity and in sport.
The FADI, or Foot and Ankle Disability Index, is a similar measure of day to day function and disability.
The second paper is a smaller pilot trial that tested something less conventional: a 12 week program of simplified Tai Chi. One group did the Tai Chi, the other received advice and education only, and the researchers compared their CAIT scores, their AOFAS scores (the American Orthopaedic Foot and Ankle Society scale, a common measure of pain, function and alignment), and how well each group controlled the ankle and the joints above it while walking.
What they found
In the meta-analysis, exercise therapy clearly came out ahead. Across the pooled trials, patients improved on all three questionnaires, so their ankles both felt more stable and worked better in daily life and sport. Two patterns stood out when the authors compared how the programs were built. Short blocks of hands-on manual therapy seemed to help the felt-stability scores, the CAIT, in the early stages. Longer programs of around five to eight weeks that combined strength, balance and functional work did more for the activity and sport scores, the FAAM.
The Tai Chi trial was small, but it pointed the same way. After 12 weeks, the Tai Chi group improved their CAIT and AOFAS scores more than the education-only group, and they showed better control of the ankle and the joints above it while walking. That last finding matters, because a lot of ongoing instability is really a control problem rather than a simple lack of strength.
Read together, the two papers tell a consistent story. Structured, progressive exercise changes the outcomes that actually matter to people with unstable ankles, and a short hands-on phase at the start can help confidence and movement before the harder strength and balance work takes over.
What it means for your practice
When a patient tells you their ankle is just the way it is, you have good grounds to push back, because these ankles respond to the right rehab.
Build a proper program rather than a one-off treatment. That means balance, strength, mobility, and retraining the way the person walks and moves, and it means re-measuring as you go with something like the CAIT or FAAM. A short course of hands-on work early can help them feel more confident and move more freely, and then the main work is several weeks, roughly five to eight, of progressive strength, balance and functional loading. That later phase is usually where the improvements in sport and activity show up.
Tai Chi is worth keeping in mind as a real option rather than a novelty. The slow, controlled, single-leg balance and flowing movement it involves is close to what good ankle rehab looks like anyway, and it suits the patient who is never going to enjoy a traditional gym program. For those people it can be the difference between sticking with rehab and quietly dropping off.
I would also re-score the CAIT or FAAM every few weeks rather than only at the start and finish. It shows the patient how far they have come, it keeps them engaged in the plan, and it gives you something concrete to point to if a referrer or funder ever asks why treatment is continuing.
Bottom line
These ankles improve with structured, progressive rehab carried out over several weeks, not with a couple of passive sessions and a hope that things settle. And for the patients who will not go near a gym, Tai Chi style work is a genuinely useful way to get them moving.