{"id":4564,"date":"2023-01-18T15:57:19","date_gmt":"2023-01-18T15:57:19","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/management-of-chronic-ankle-instability-it\/"},"modified":"2023-01-30T10:11:28","modified_gmt":"2023-01-30T10:11:28","slug":"management-of-chronic-ankle-instability-it","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/it\/management-of-chronic-ankle-instability-it\/","title":{"rendered":"Gestione dell&#8217;instabilit\u00e0 cronica della caviglia"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"><b>Redattrice principale <\/b>&#8211; <a title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\">Ewa Jaraczewska<\/a> sulla base del corso di <a class=\"external text\" href=\"https:\/\/members.physio-pedia.com\/instructor\/helene-simpson\/\" rel=\"nofollow\">Helene Simpson<\/a><br \/>\n<b>Principali collaboratori<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a> e <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenuti<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Definition_of_Chronic_Ankle_Instability_.28CAI.29\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Definizione di instabilit\u00e0 cronica della caviglia<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-2\"><a href=\"#Long-term_Outcomes\"><span class=\"tocnumber\">1.1<\/span> <span class=\"toctext\">Outcome a lungo termine<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-3\"><a href=\"#Mechanical_and_Functional_Instability\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Instabilit\u00e0 meccanica e funzionale<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Mechanical_Instability\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Instabilit\u00e0 meccanica<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Functional_Instability\"><span class=\"tocnumber\">2.2<\/span> <span class=\"toctext\">Instabilit\u00e0 funzionale<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-6\"><a href=\"#Diagnostic_Procedures\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Procedure diagnostiche<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-7\"><a href=\"#Physiotherapy_Management\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Gestione fisioterapica<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-8\"><a href=\"#Neuromuscular_Training\"><span class=\"tocnumber\">4.1<\/span> <span class=\"toctext\">Allenamento neuromuscolare<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-9\"><a href=\"#Guide_to_Neuromuscular_Training\"><span class=\"tocnumber\">4.1.1<\/span> <span class=\"toctext\">Guida all&#8217;allenamento neuromuscolare<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-10\"><a href=\"#Exercises\"><span class=\"tocnumber\">4.1.1.1<\/span> <span class=\"toctext\">Esercizi<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-11\"><a href=\"#Balance_Training\"><span class=\"tocnumber\">4.2<\/span> <span class=\"toctext\">Allenamento dell&#8217;equilibrio<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-12\"><a href=\"#Guide_to_Balance_Training\"><span class=\"tocnumber\">4.2.1<\/span> <span class=\"toctext\">Guida all&#8217;allenamento dell&#8217;equilibrio<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-13\"><a href=\"#Proprioception\"><span class=\"tocnumber\">4.2.1.1<\/span> <span class=\"toctext\">Propriocezione<\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-14\"><a href=\"#Therapeutic_Interventions\"><span class=\"tocnumber\">4.2.1.2<\/span> <span class=\"toctext\"><b>Interventi terapeutici<\/b><\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Mobilisation\"><span class=\"tocnumber\">4.3<\/span> <span class=\"toctext\">Mobilizzazione<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-16\"><a href=\"#Therapeutic_Interventions_2\"><span class=\"tocnumber\">4.3.1<\/span> <span class=\"toctext\">Interventi terapeutici<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-17\"><a href=\"#Braces_and_Taping\"><span class=\"tocnumber\">4.4<\/span> <span class=\"toctext\">Tutori e taping<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-18\"><a href=\"#Taping\"><span class=\"tocnumber\">4.4.1<\/span> <span class=\"toctext\">Taping<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-19\"><a href=\"#Therapeutic_Intervention\"><span class=\"tocnumber\">4.4.1.1<\/span> <span class=\"toctext\">Intervento terapeutico<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-3 tocsection-20\"><a href=\"#Braces\"><span class=\"tocnumber\">4.4.2<\/span> <span class=\"toctext\">Tutori<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-21\"><a href=\"#Therapeutic_intervention_2\"><span class=\"tocnumber\">4.4.2.1<\/span> <span class=\"toctext\">Intervento terapeutico<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-22\"><a href=\"#Flexibility_and_Strength_Training\"><span class=\"tocnumber\">4.5<\/span> <span class=\"toctext\">Allenamento della flessibilit\u00e0 e della forza<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-23\"><a href=\"#Example_Treatment_Protocol\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Esempio di protocollo di trattamento<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-24\"><a href=\"#General_Principles\"><span class=\"tocnumber\">5.1<\/span> <span class=\"toctext\">Principi generali<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-25\"><a href=\"#Phase_1\"><span class=\"tocnumber\">5.2<\/span> <span class=\"toctext\">Fase 1<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-26\"><a href=\"#Phase_2\"><span class=\"tocnumber\">5.3<\/span> <span class=\"toctext\">Fase 2<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-27\"><a href=\"#Phase_3\"><span class=\"tocnumber\">5.4<\/span> <span class=\"toctext\">Fase 3<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-28\"><a href=\"#References\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Citazioni<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Definition_of_Chronic_Ankle_Instability_(CAI)\"><\/span><span id=\"Definition_of_Chronic_Ankle_Instability_.28CAI.29\" class=\"mw-headline\">Definizione di instabilit\u00e0 cronica della caviglia<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Definition of Chronic Ankle Instability (CAI)\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=1\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Definition of Chronic Ankle Instability (CAI)\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=1\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>L&#8217;instabilit\u00e0 cronica della caviglia \u00e8 stata definita come &#8220;episodi ripetitivi di instabilit\u00e0 della caviglia laterale che causano numerose distorsioni della caviglia&#8221;.<sup id=\"cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\">(1)<\/a><\/sup> L&#8217;instabilit\u00e0 cronica si riferisce a una sensazione di apprensione della caviglia, &#8220;cedimento&#8221; e distorsioni ricorrenti della caviglia, che persistono per un minimo di sei mesi dopo la distorsione iniziale.<sup id=\"cite_ref-:1_2-0\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> I sintomi includono:<sup id=\"cite_ref-:1_2-1\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li>Dolore alla caviglia laterale<\/li>\n<li>Gonfiore cronico<\/li>\n<li>Difficolt\u00e0 a camminare su terreni irregolari<\/li>\n<\/ul>\n<p>In base del modello della Classificazione Internazionale della Funzione, della Salute e della Disabilit\u00e0 (ICF), gli effetti dell&#8217;instabilit\u00e0 cronica della caviglia sulla funzione e sulla salute includono:<\/p>\n<ul>\n<li>In termini di <i>menomazioni<\/i>:<sup id=\"cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup>\n<ul>\n<li>Aumento della lassit\u00e0 legamentosa<\/li>\n<li>Deficit propriocettivi<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>In termini di <i>limitazioni dell&#8217;attivit\u00e0:<\/i><sup id=\"cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup>\n<ul>\n<li>Incapacit\u00e0 di camminare<\/li>\n<li>Incapacit\u00e0 di saltare<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>In termini di <i>partecipazione<\/i>:<sup id=\"cite_ref-:0_3-2\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup>\n<ul>\n<li>Interruzione dell&#8217;attivit\u00e0 sportiva<\/li>\n<li>Ritiro da o diminuzione del coinvolgimento professionale<\/li>\n<li>Diminuzione dei livelli di esercizio fisico<\/li>\n<li>Cambiamento nel tipo di sport<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><span id=\"Long-term_Outcomes\" class=\"mw-headline\">Outcome a lungo termine<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Long-term Outcomes\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=2\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Long-term Outcomes\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=2\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>I pazienti con instabilit\u00e0 cronica della caviglia vivono una riduzione della qualit\u00e0 della vita fisica. I trattamenti possono migliorare la stabilit\u00e0, ma richiedono molto tempo e potrebbero necessitare di attrezzature specializzate.<sup id=\"cite_ref-:1_2-2\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> Konradsen et al.<sup id=\"cite_ref-:19_4-0\" class=\"reference\"><a href=\"#cite_note-:19-4\">(4)<\/a><\/sup> hanno condotto uno studio in cui il follow-up dei pazienti era sette anni dopo il trauma in inversione della caviglia. Hanno riscontrato quanto segue:<sup id=\"cite_ref-:19_4-1\" class=\"reference\"><a href=\"#cite_note-:19-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>il 32% dei pazienti ha riportato disturbi cronici di dolore, gonfiore o distorsioni ricorrenti<\/li>\n<li>il 72% dei soggetti con disabilit\u00e0 residua ha riferito di essere funzionalmente compromesso dalla caviglia<\/li>\n<li>il 4% dei pazienti accusava dolore a riposo ed \u00e8 rimasto gravemente disabile<\/li>\n<li>il 19% ha avuto ripetuti infortuni in inversione<\/li>\n<li>il 43% di questi soggetti riteneva di poter compensare utilizzando un supporto esterno per la caviglia<\/li>\n<li>l&#8217;85% delle persone che hanno sviluppato un&#8217;instabilit\u00e0 cronica della caviglia dopo una distorsione unilaterale riportava problemi alla caviglia controlaterale<\/li>\n<\/ul>\n<p>Secondo Hertel,<sup id=\"cite_ref-:2_5-0\" class=\"reference\"><a href=\"#cite_note-:2-5\">(5)<\/a><\/sup> una distorsione ne garantisce un&#8217;altra.<sup id=\"cite_ref-:1_2-3\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> E Struijs e Kerkhoffs<sup id=\"cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\">(6)<\/a><\/sup> hanno riscontrato che c&#8217;era un 30% di recidiva di distorsioni entro un anno dall&#8217;infortunio.<sup id=\"cite_ref-:1_2-4\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<p>Sono stati riportati altri outcome nel lungo termine, inclusi:<\/p>\n<ul>\n<li>Difetti della cartilagine articolare sul lato mediale dell&#8217;articolazione dovuti a:<sup id=\"cite_ref-:1_2-5\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Strappo del legamento peroneo-astragalico anteriore e del legamento peroneo-calcaneare<\/li>\n<li>Alterazione e aumento del picco di deformazione della cartilagine<\/li>\n<li>Con conseguente degenerazione della cartilagine dell&#8217;articolazione tibio-tarsica<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Difetto di posizione dell&#8217;astragalo anteriore<sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup><\/li>\n<li>Schemi di movimento alterati nelle caviglie instabili:<sup id=\"cite_ref-:1_2-6\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Atterraggio in maggior flessione dorsale nel tentativo di ridurre al minimo la dipendenza dai legamenti laterali e di aumentare la stabilit\u00e0 ossea<\/li>\n<li>Nel drop jump: maggior eversione massima del calcagno e spostamento frontale del corpo<\/li>\n<li>Tempi pi\u00f9 brevi per raggiungere il picco di forza di reazione al suolo nell&#8217;atterraggio dalla caduta<\/li>\n<li>Maggior forza di reazione al suolo mediale<\/li>\n<li>L&#8217;altezza del metatarso \u00e8 inferiore durante l&#8217;oscillazione terminale del passo<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li class=\"mw-empty-elt\"><\/li>\n<\/ul>\n<h2><span id=\"Mechanical_and_Functional_Instability\" class=\"mw-headline\">Instabilit\u00e0 meccanica e funzionale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mechanical and Functional Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=3\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Mechanical and Functional Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=3\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Esistono due sottogruppi comunemente accettati di instabilit\u00e0 cronica della caviglia: instabilit\u00e0 meccanica e instabilit\u00e0 funzionale.<sup id=\"cite_ref-:1_2-7\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><sup id=\"cite_ref-:0_3-3\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Nel modello di Hertel sulla stabilit\u00e0 della caviglia<sup id=\"cite_ref-:3_8-0\" class=\"reference\"><a href=\"#cite_note-:3-8\">(8)<\/a><\/sup>, l&#8217;instabilit\u00e0 meccanica e funzionale sono parte di un continuum. Si verificano distorsioni ricorrenti quando sono presenti entrambe le condizioni.<sup id=\"cite_ref-:3_8-1\" class=\"reference\"><a href=\"#cite_note-:3-8\">(8)<\/a><\/sup><\/p>\n<h3><span id=\"Mechanical_Instability\" class=\"mw-headline\">Instabilit\u00e0 meccanica<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mechanical Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=4\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Mechanical Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=4\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>L&#8217;instabilit\u00e0 meccanica viene definita lassit\u00e0 legamentosa patologica del complesso articolare della caviglia.<sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup> L&#8217;instabilit\u00e0 meccanica potrebbe essere causata da varie alterazioni anatomiche presenti isolatamente o in combinazione. Possono portare a patologie responsabili dell&#8217;instabilit\u00e0 della caviglia.<sup id=\"cite_ref-:0_3-4\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h3><span id=\"Functional_Instability\" class=\"mw-headline\">Instabilit\u00e0 funzionale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Functional Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=5\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Functional Instability\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=5\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Non esiste una definizione universalmente approvata di instabilit\u00e0 funzionale della caviglia.<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup> Sulla base della definizione stabilita da Evans et al.,<sup id=\"cite_ref-:4_11-0\" class=\"reference\"><a href=\"#cite_note-:4-11\">(11)<\/a><\/sup> l&#8217;instabilit\u00e0 funzionale \u00e8 un disburbo soggettivo di debolezza. Lentell et al.<sup id=\"cite_ref-:5_12-0\" class=\"reference\"><a href=\"#cite_note-:5-12\">(12)<\/a><\/sup> descrivono l&#8217;instabilit\u00e0 funzionale come dolore alla caviglia e la percezione che la caviglia infortunata sia meno funzionale dell&#8217;altra o che sia meno funzionale di quanto fosse prima dell&#8217;infortunio.<sup id=\"cite_ref-:5_12-1\" class=\"reference\"><a href=\"#cite_note-:5-12\">(12)<\/a><\/sup> Tropp et al.<sup id=\"cite_ref-:6_13-0\" class=\"reference\"><a href=\"#cite_note-:6-13\">(13)<\/a><\/sup> hanno concluso che l&#8217;instabilit\u00e0 funzionale pu\u00f2 essere definita come un movimento articolare che non supera i normali limiti fisiologici, ma che non viene pi\u00f9 controllato volontariamente.<sup id=\"cite_ref-:6_13-1\" class=\"reference\"><a href=\"#cite_note-:6-13\">(13)<\/a><\/sup><\/p>\n<p>La compromissione del controllo propriocettivo e neuromuscolare pu\u00f2 essere responsabile dell&#8217;instabilit\u00e0 funzionale.<sup id=\"cite_ref-:3_8-2\" class=\"reference\"><a href=\"#cite_note-:3-8\">(8)<\/a><\/sup><\/p>\n<p>L&#8217;instabilit\u00e0 meccanica tipicamente si presenta come eccessiva inversione, lassit\u00e0 del retropiede ed eccessiva lassit\u00e0 anteriore dell&#8217;articolazione tibio-tarsica. Pu\u00f2 essere causata dall&#8217;instabilit\u00e0 dei legamenti o da un processo infiammatorio degenerativo e cronico. Nell&#8217;instabilit\u00e0 funzionale, invece, i pazienti riportano di avere una sensazione di cedimento della caviglia. Il ritardo nella risposta neuromuscolare, i deficit propriocettivi o la compromissione dell&#8217;equilibrio possono causare questo sintomo.<\/p>\n<p>La Tabella 1 riassume le cause e i risultati dell&#8217;instabilit\u00e0 meccanica e funzionale della caviglia:<sup id=\"cite_ref-:1_2-8\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<div class=\"center\">\n<div class=\"floatnone\"><a class=\"image\" href=\"\/File:CAI-2.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/CAI-2.png\/650px-CAI-2.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/CAI-2.png\/975px-CAI-2.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/7\/75\/CAI-2.png\/1300px-CAI-2.png 2x\" alt=\"\" width=\"650\" height=\"413\"><\/a><\/div>\n<\/div>\n<h2><span id=\"Diagnostic_Procedures\" class=\"mw-headline\">Procedure diagnostiche<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=6\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=6\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le procedure diagnostiche possono aiutare i professionisti clinici a confermare la presenza di vari deficit della caviglia, tra cui la riduzione del range di movimento e la disabilit\u00e0 percepita. Questo pu\u00f2 aiutare a definire\/diagnosticare una condizione specifica. I clinici dovrebbero considerare se i risultati della ricerca suggeriscono una &#8220;utilit\u00e0 positiva coerente&#8221; prima di decidere quale strumento diagnostico utilizzare:<sup id=\"cite_ref-:7_14-0\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup><\/p>\n<ul>\n<li><b>Test del cassetto anteriore<\/b>: eseguito in leggera flessione del ginocchio per rilassare il gastrocnemio. Tuttavia, Kovaleski et al.<sup id=\"cite_ref-:8_15-0\" class=\"reference\"><a href=\"#cite_note-:8-15\">(15)<\/a><\/sup> suggeriscono di eseguire il test con il ginocchio flesso a 90\u00b0 e la caviglia a 10\u00b0 di flessione plantare per isolare il legamento peroneo-astragalico anteriore.<sup id=\"cite_ref-:8_15-1\" class=\"reference\"><a href=\"#cite_note-:8-15\">(15)<\/a><\/sup> Si raccomanda un confronto bilaterale.<sup id=\"cite_ref-:7_14-1\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup> Un&#8217;eccessiva traslazione anteriore e la mancanza di una sensazione di fine range solido indicano un risultato positivo del test.<\/li>\n<li><b>Radiografia sotto stress<\/b>: utilizzata per quantificare l&#8217;entit\u00e0 della lassit\u00e0 articolare della caviglia. Mostra la separazione delle strutture ossee articolari quando viene applicata una forza. Dal punto di vista clinico, aiuta a identificare un tensione eccessiva delle strutture legamentose. Una traslazione anteriore totale superiore a 9 mm o una traslazione superiore a 5 mm (o entrambe) rispetto al lato controlaterale indica una significativa lassit\u00e0 del legamento peroneo-astragalico anteriore. La lassit\u00e0 patologica del legamento peroneo-calcaneare \u00e8 dimostrata da un angolo di inclinazione dell&#8217;astragalo superiore a 10\u00b0 o da un angolo superiore di oltre 5\u00b0 rispetto all&#8217;arto controlaterale.<sup id=\"cite_ref-:7_14-2\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup><\/li>\n<li><a title=\"MRI Scans\" href=\"\/MRI_Scans\"><b>RISONANZA MAGNETICA<\/b><\/a>: non considerata conclusiva. Risultati negativi della RM devono essere considerati con cautela in un paziente sintomatico e si dovrebbe prendere in considerazione l&#8217;artroscopia.<sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><\/li>\n<li><b>Ecografia diagnostica<\/b>: l&#8217;evidenza suggerisce che l&#8217;ecografia diagnostica offre una conferma da moderata a forte della lesione dei legamenti laterali.<sup id=\"cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\">(17)<\/a><\/sup> Mostra un aumento della lunghezza dei legamenti laterali durante il test del cassetto anteriore e il test di inclinazione dell&#8217;astragalo in soggetti con una storia di instabilit\u00e0 cronica della caviglia.<sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/li>\n<li><b>Pedane di forza stabili<\/b>: suggerite per la valutazione della stabilit\u00e0 del passo e del salto:<sup id=\"cite_ref-:12_19-0\" class=\"reference\"><a href=\"#cite_note-:12-19\">(19)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/D6JMr-ZPbjQ?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup><\/p>\n<ul>\n<li><b>Infiltrazioni di cortisone ecoguidate<\/b> come strumento diagnostico clinico. Il consenso basato su Delphi degli esperti della European Society of Musculoskeletal Radiology ha rilevato che le infiltrazioni anestetiche intraarticolari di caviglia e piede eseguite sotto la guida della diagnostica per immagini forniscono informazioni precise sulla fonte del dolore<b>.<\/b><sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"Physiotherapy_Management\" class=\"mw-headline\">Gestione fisioterapica<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Physiotherapy Management\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=7\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Physiotherapy Management\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=7\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La gestione conservativa \u00e8 il trattamento di scelta per le lesioni acute della caviglia laterale. L&#8217;approccio chirurgico per queste lesioni \u00e8 riservato a casi particolari.<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup> Le modalit\u00e0 conservative attualmente disponibili comprendono:<sup id=\"cite_ref-:1_2-9\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li>Allenamento neuromuscolare<\/li>\n<li>Allenamento dell&#8217;equilibrio<\/li>\n<li>Mobilizzazione<\/li>\n<li>Controllo neuromuscolare da parte dei peronei (l&#8217;allenamento con il theraband e l&#8217;isocinetica non influiscono sulla forza degli eversori della caviglia)<sup id=\"cite_ref-:1_2-10\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Tutori e taping<\/li>\n<li>Allenamento della flessibilit\u00e0 e della forza<\/li>\n<\/ul>\n<h3><span id=\"Neuromuscular_Training\" class=\"mw-headline\">Allenamento neuromuscolare<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Neuromuscular Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=8\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Neuromuscular Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=8\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>De Vries et al.<sup id=\"cite_ref-:9_23-0\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup> hanno riscontrato che l&#8217;allenamento neuromuscolare da solo ha un outcome positivo a breve termine e che i pazienti hanno una migliore funzionalit\u00e0.<sup id=\"cite_ref-:9_23-1\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup> Questo tipo di allenamento \u00e8 una caratteristica fondamentale della maggior parte dei regimi di trattamento conservativo.<sup id=\"cite_ref-:9_23-2\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup><sup id=\"cite_ref-:1_2-11\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Uno studio di Kim et al.<sup id=\"cite_ref-:10_24-0\" class=\"reference\"><a href=\"#cite_note-:10-24\">(24)<\/a><\/sup> ha rilevato che gli atleti con caviglie instabili presentano uno schema del passo alterato, ossia una posizione relativamente in inversione della caviglia durante il contatto iniziale e la fase intermedia di appoggio (mid-stance). La partecipazione a sei settimane di allenamento neuromuscolare ha immediatamente modificato l&#8217;orientamento della caviglia dell&#8217;atleta in una direzione relativamente maggiormente in inversione durante l&#8217;atterraggio dal salto. Tuttavia, non c&#8217;\u00e8 stato alcun effetto sulla camminata e sulla corsa.<sup id=\"cite_ref-:10_24-1\" class=\"reference\"><a href=\"#cite_note-:10-24\">(24)<\/a><\/sup><\/li>\n<li>Secondo Guzm\u00e1n-Mu\u00f1oz et al.,<sup id=\"cite_ref-:11_25-0\" class=\"reference\"><a href=\"#cite_note-:11-25\">(25)<\/a><\/sup> quattro settimane di allenamento neuromuscolare hanno migliorato il controllo posturale in giocatrici di pallavolo universitarie con instabilit\u00e0 funzionale della caviglia.<sup id=\"cite_ref-:11_25-1\" class=\"reference\"><a href=\"#cite_note-:11-25\">(25)<\/a><\/sup>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Neuromuscular_reeducation_step_1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/65\/Neuromuscular_reeducation_step_1.jpg\/150px-Neuromuscular_reeducation_step_1.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/65\/Neuromuscular_reeducation_step_1.jpg\/225px-Neuromuscular_reeducation_step_1.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/6\/65\/Neuromuscular_reeducation_step_1.jpg\/300px-Neuromuscular_reeducation_step_1.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Passo 1<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Neuromuscular_reeducation_step_2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Neuromuscular_reeducation_step_2.jpg\/150px-Neuromuscular_reeducation_step_2.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Neuromuscular_reeducation_step_2.jpg\/225px-Neuromuscular_reeducation_step_2.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/0\/0e\/Neuromuscular_reeducation_step_2.jpg\/300px-Neuromuscular_reeducation_step_2.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Passo 2<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Neuromuscular_reeducation_step_3.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Neuromuscular_reeducation_step_3.jpg\/150px-Neuromuscular_reeducation_step_3.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Neuromuscular_reeducation_step_3.jpg\/225px-Neuromuscular_reeducation_step_3.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/8\/8e\/Neuromuscular_reeducation_step_3.jpg\/300px-Neuromuscular_reeducation_step_3.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Passo 3<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Guide_to_Neuromuscular_Training\" class=\"mw-headline\">Guida all&#8217;allenamento neuromuscolare<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Guide to Neuromuscular Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=9\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Guide to Neuromuscular Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=9\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>L&#8217;allenamento neuromuscolare \u00e8 una &#8220;attivazione inconsapevole dei freni dinamici in preparazione e in risposta al movimento e ai carichi articolari per mantenere e ripristinare la stabilit\u00e0 funzionale dell&#8217;articolazione&#8221;.<sup id=\"cite_ref-:1_2-12\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<p>Obiettivi dell&#8217;allenamento neuromuscolare:<\/p>\n<ol>\n<li>Ottimizzare il controllo posturale degli arti inferiori<sup id=\"cite_ref-:1_2-13\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Ripristinare la stabilit\u00e0 attiva con l&#8217;allenamento<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/li>\n<\/ol>\n<h5><span id=\"Exercises\" class=\"mw-headline\">Esercizi<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Exercises\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=10\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Exercises\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=10\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Gli esercizi vengono eseguiti in catena chiusa e in posizioni funzionali:<\/p>\n<ul>\n<li>In piedi su una gamba sola su Wobble board o Balance mat<\/li>\n<li>Lancio della palla con un solo arto<\/li>\n<li>Kicks (calci) a una gamba sola con Theraband e Step down a una gamba sola (si vedano le figure dei Passi 1-3)<\/li>\n<\/ul>\n<h3><span id=\"Balance_Training\" class=\"mw-headline\">Allenamento dell&#8217;equilibrio<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Balance Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=11\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Balance Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=11\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>Studiando l&#8217;instabilit\u00e0 funzionale della caviglia e la qualit\u00e0 della vita correlata alla salute, Arnold et al.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup> hanno concluso che l&#8217;allenamento dell&#8217;equilibrio pu\u00f2 interessare pi\u00f9 articolazioni e produrre miglioramenti complessivi.<sup id=\"cite_ref-:1_2-14\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>McKeon et al.<sup id=\"cite_ref-:12_19-1\" class=\"reference\"><a href=\"#cite_note-:12-19\">(19)<\/a><\/sup> hanno dimostrato che l&#8217;allenamento dell&#8217;equilibrio migliora significativamente il controllo posturale statico e il controllo posturale dinamico.<sup id=\"cite_ref-:1_2-15\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Uno studio prospettico di coorte di Sefton et al.<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\">(28)<\/a><\/sup> ha rilevato che la riabilitazione influisce sulla funzione del sistema sensomotorio.<sup id=\"cite_ref-:1_2-16\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Sulla base di una revisione di studi randomizzati controllati, Moll\u00e0 Casanova et al.<sup id=\"cite_ref-:13_29-0\" class=\"reference\"><a href=\"#cite_note-:13-29\">(29)<\/a><\/sup> hanno concluso che l&#8217;allenamento dell&#8217;equilibrio migliora significativamente gli outcome di funzionalit\u00e0, instabilit\u00e0 ed equilibrio dinamico nelle persone con instabilit\u00e0 cronica della caviglia.<sup id=\"cite_ref-:13_29-1\" class=\"reference\"><a href=\"#cite_note-:13-29\">(29)<\/a><\/sup><\/li>\n<\/ul>\n<h4><span id=\"Guide_to_Balance_Training\" class=\"mw-headline\">Guida all&#8217;allenamento dell&#8217;equilibrio<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Guide to Balance Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=12\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Guide to Balance Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=12\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>La letteratura indica che le seguenti misure di equilibrio dovrebbero guidare la pratica clinica. Tuttavia, De Vries et al.<sup id=\"cite_ref-:9_23-3\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup> non hanno trovato una correlazione con la funzione:<\/p>\n<ul>\n<li>Escursione del centre-of-pressure (COP)<sup id=\"cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\">(30)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Time-to-boundary (TTB) dopo l&#8217;atterraggio<sup id=\"cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\">(31)<\/a><\/sup><\/li>\n<li>Analisi del picco plantare<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\">(32)<\/a><\/sup><\/li>\n<li><a title=\"Star Excursion Balance Test\" href=\"\/Star_Excursion_Balance_Test\">Star Excursion Balance Test (SEBT)<\/a><\/li>\n<\/ul>\n<h5><span id=\"Proprioception\" class=\"mw-headline\">Propriocezione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Proprioception\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Proprioception\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=13\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>La cinestesia e il senso di posizione articolare sono solitamente compromessi nei pazienti con instabilit\u00e0 cronica della caviglia.<sup id=\"cite_ref-:14_33-0\" class=\"reference\"><a href=\"#cite_note-:14-33\">(33)<\/a><\/sup> La metodologia dei test per la propriocezione comprende:<\/p>\n<ul>\n<li>Cinestesia: valutata utilizzando la soglia di rilevamento del movimento passivo<sup id=\"cite_ref-:1_2-17\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<li>Senso di posizione articolare: valutato con la riproduzione del posizionamento attivo e passivo dell&#8217;articolazione<sup id=\"cite_ref-:1_2-18\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<h5><span id=\"Therapeutic_Interventions\" class=\"mw-headline\"><b>Interventi terapeutici<\/b><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Therapeutic Interventions\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=14\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Therapeutic Interventions\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=14\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<ul>\n<li>Regime di esercizi su pi\u00f9 stazioni una volta alla settimana<sup id=\"cite_ref-:1_2-19\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Allenamento con disco per la caviglia, Balance pad<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Esercizi di perturbazione con tubi elastici<sup id=\"cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\">(34)<\/a><\/sup><sup id=\"cite_ref-:1_2-20\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Quattro esercizi, tra cui trazione anteriore, trazione posteriore, crossover e crossover inverso, eseguiti 3 volte alla settimana. Il protocollo standard prevede 3 serie da 15 ripetizioni con una fascia elastica di resistenza stando in piedi sulla gamba interessata<\/li>\n<li>Obiettivo: mantenere l&#8217;allineamento e la stabilit\u00e0<\/li>\n<li>Outcome: l&#8217;equilibrio \u00e8 migliorato in 4 settimane<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><span id=\"Mobilisation\" class=\"mw-headline\">Mobilizzazione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mobilisation\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Mobilisation\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=15\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>La limitata flessione dorsale della caviglia durante la corsa e la camminata \u00e8 considerata un fattore di rischio per le distorsioni ricorrenti a causa di quanto segue:<sup id=\"cite_ref-:1_2-21\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Incapacit\u00e0 di raggiungere la posizione di close-packed dell&#8217;articolazione (posizione di massima congruenza articolare) della caviglia durante la fase di appoggio (stance)<\/li>\n<li>Tendenza a bloccare il mesopiede in supinazione<\/li>\n<li>Il baricentro si sposta lateralmente, quindi l&#8217;articolazione della caviglia diventa vulnerabile alla supinazione e alla distorsione<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Secondo Westad et al.,<sup id=\"cite_ref-:15_35-0\" class=\"reference\"><a href=\"#cite_note-:15-35\">(35)<\/a><\/sup> le tecniche di mobilizzazione con movimento (MWM) utilizzate per trattare le articolazioni periferiche sono risultate superiori a un placebo, ma non ad altri interventi medici o fisioterapici.<sup id=\"cite_ref-:15_35-1\" class=\"reference\"><a href=\"#cite_note-:15-35\">(35)<\/a><\/sup><\/li>\n<li>I risultati di una revisione sistematica e meta-analisi di Weerasekara et al.<sup id=\"cite_ref-:16_36-0\" class=\"reference\"><a href=\"#cite_note-:16-36\">(36)<\/a><\/sup> suggeriscono che un intervento di mobilizzazione con movimento ha portato immediatamente benefici ai pazienti con instabilit\u00e0 cronica della caviglia, aumentando il range di movimento in flessione dorsale.<sup id=\"cite_ref-:16_36-1\" class=\"reference\"><a href=\"#cite_note-:16-36\">(36)<\/a><\/sup><\/li>\n<\/ul>\n<h5><span id=\"Therapeutic_Interventions_2\" class=\"mw-headline\">Interventi terapeutici<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Therapeutic Interventions\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=16\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Therapeutic Interventions\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=16\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Una tecnica di <a title=\"Mulligan Manual Therapy\" href=\"\/Mulligan_Manual_Therapy\">mobilizzazione con movimento (MWM) di Mulligan<\/a> dovrebbe comprendere quanto segue:<\/p>\n<ul>\n<li>Glide del perone in corrispondenza dell&#8217;articolazione tibio-peroneale distale e prossimale<\/li>\n<\/ul>\n<ul>\n<li>Glide dell&#8217;astragalo<\/li>\n<\/ul>\n<p>Helene Simpson raccomanda anche di utilizzare una tecnica MWM che includa la mobilit\u00e0 del mesopiede in corrispondenza del navicolare.<sup id=\"cite_ref-:1_2-22\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<h3><span id=\"Braces_and_Taping\" class=\"mw-headline\">Tutori e taping<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Braces and Taping\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=17\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Braces and Taping\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=17\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<h4><span id=\"Taping\" class=\"mw-headline\">Taping<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Taping\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Taping\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Hubbard e Cordova<sup id=\"cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\">(37)<\/a><\/sup> hanno riscontrato che la lassit\u00e0 meccanica \u00e8 diminuita dopo l&#8217;applicazione del tape.<sup id=\"cite_ref-:1_2-23\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Delahunt et al.<sup id=\"cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\">(38)<\/a><\/sup> non hanno rilevato alcun cambiamento nella stabilit\u00e0 &#8220;effettiva&#8221;, ma la percezione della stabilit\u00e0 da parte dei pazienti \u00e8 migliorata in modo significativo (56%).<sup id=\"cite_ref-:1_2-24\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Hopper et al.<sup id=\"cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\">(39)<\/a><\/sup> hanno riscontrato che il taping di Mulligan non aveva alcun impatto sul controllo neuromuscolare durante l&#8217;equilibrio statico e dinamico.<sup id=\"cite_ref-:1_2-25\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<h5><span id=\"Therapeutic_Intervention\" class=\"mw-headline\">Intervento terapeutico<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Therapeutic Intervention\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=19\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Therapeutic Intervention\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=19\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Sono state valutate clinicamente le seguenti tecniche di taping:<sup id=\"cite_ref-:1_2-26\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<ul>\n<li>Fasciatura sotto-astragalica laterale (finalizzata a contrastare l&#8217;inversione dell&#8217;articolazione tibio-tarsica)<\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/hTQjt7vGNCw?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\">(40)<\/a><\/sup><\/p>\n<ul>\n<li>Riposizionamento del perone,<sup id=\"cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\">(41)<\/a><\/sup> ma non si conosce l&#8217;esatto meccanismo per ridurre l&#8217;incidenza delle distorsioni<\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/CRuWvtMmPKw?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\">(42)<\/a><\/sup><\/p>\n<ul>\n<li>L&#8217;applicazione del metodo Kinesio Taping nella prevenzione delle distorsioni della caviglia non ha avuto alcun effetto sull&#8217;attivazione muscolare del peroneo lungo<sup id=\"cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\">(43)<\/a><\/sup><\/li>\n<\/ul>\n<h4><span id=\"Braces\" class=\"mw-headline\">Tutori<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Braces\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Braces\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=20\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Non \u00e8 stato riscontrato alcun effetto significativo sulla funzione e sull&#8217;equilibrio quando sono stati applicati dei tutori.<sup id=\"cite_ref-:1_2-27\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> I seguenti risultati sono interessanti:<\/p>\n<ul>\n<li>Barlow et al.<sup id=\"cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\">(44)<\/a><\/sup> hanno riscontrato che i tutori influenzano l&#8217;attivit\u00e0 neuromuscolare durante la deambulazione, il che pu\u00f2 contribuire a ridurre le distorsioni.<\/li>\n<li>Feger et al.<sup id=\"cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\">(45)<\/a><\/sup> hanno studiato l&#8217;effetto dei tutori per la caviglia sulle attivit\u00e0 muscolari dell&#8217;arto inferiore durante gli esercizi funzionali:\n<ul>\n<li>Affondo in avanti: riduzione dell&#8217;attivit\u00e0 muscolare durante il contatto pre-iniziale nel gastrocnemio laterale e durante il contatto post-iniziale nel peroneo lungo.<\/li>\n<li>Star Excursion Balance Test: minore attivit\u00e0 muscolare del peroneo lungo, del gastrocnemio laterale, del retto femorale e del gluteo medio durante il raggiungimento anteriore in equilibrio.<\/li>\n<li>Raggiungimento anteriore: riduzione significativa dei muscoli della coscia e dell&#8217;attivit\u00e0 muscolare totale.<\/li>\n<li>Raggiungimento postero-laterale: notevole riduzione dell&#8217;attivit\u00e0 del gluteo medio.<\/li>\n<li>Equilibrio su un solo arto ad occhi chiusi, raggiungimento postero-mediale nello Star Excursion Balance Test o in esercizi di saltello laterale: nessuna differenza tra condizioni con e senza tutore.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Janssen et al.<sup id=\"cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\">(46)<\/a><\/sup> hanno presentato un protocollo per valutare l&#8217;effetto dei tutori rispetto agli esercizi neuromuscolari.<sup id=\"cite_ref-:1_2-28\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>Secondo la loro pubblicazione del 2014<sup id=\"cite_ref-:20_47-0\" class=\"reference\"><a href=\"#cite_note-:20-47\">(47)<\/a><\/sup>: &#8220;Il tutore \u00e8 risultato superiore all&#8217;allenamento neuromuscolare nel ridurre l&#8217;incidenza ma non la gravit\u00e0 delle distorsioni ricorrenti della caviglia auto-riferite dopo le cure tradizionali&#8221;.<sup id=\"cite_ref-:20_47-1\" class=\"reference\"><a href=\"#cite_note-:20-47\">(47)<\/a><\/sup><\/li>\n<li>Fuerst et al.<sup id=\"cite_ref-:17_48-0\" class=\"reference\"><a href=\"#cite_note-:17-48\">(48)<\/a><\/sup> hanno sostenuto che i soggetti con instabilit\u00e0 della caviglia potrebbero trarre beneficio da un tutore semirigido per la caviglia per mantenere gli angoli di inversione della caviglia &#8220;in un range paragonabile ai valori delle persone sane&#8221;.<sup id=\"cite_ref-:17_48-1\" class=\"reference\"><a href=\"#cite_note-:17-48\">(48)<\/a><\/sup><\/li>\n<\/ul>\n<h5><span id=\"Therapeutic_intervention_2\" class=\"mw-headline\">Intervento terapeutico<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Therapeutic intervention\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=21\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Therapeutic intervention\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=21\">fonte di modifica<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<ul>\n<li>Le misurazioni per valutare l&#8217;efficacia dell&#8217;uso dei tutori nei pazienti con instabilit\u00e0 cronica della caviglia non sono sufficientemente sensibili per valutare la stabilit\u00e0 dinamica.<sup id=\"cite_ref-:1_2-29\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Helene Simpson suggerisce di continuare a usare i tutori:<sup id=\"cite_ref-:1_2-30\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup>\n<ul>\n<li>Sulla base dei dati relativi alle distorsioni acute della caviglia e alla prevenzione delle distorsioni ricorrenti per un anno dopo l&#8217;infortunio<\/li>\n<li>Efficienza in termini di costi e di tempo<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><span id=\"Flexibility_and_Strength_Training\" class=\"mw-headline\">Allenamento della flessibilit\u00e0 e della forza<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Flexibility and Strength Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=22\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Flexibility and Strength Training\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=22\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p><i>Flessibilit\u00e0:<\/i><\/p>\n<p>I concetti tradizionali degli esercizi di flessibilit\u00e0 nell&#8217;instabilit\u00e0 cronica della caviglia includono allungamenti del soleo e del gastrocnemio, eseguiti 3 volte per 30 secondi.<sup id=\"cite_ref-:1_2-31\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup> Un nuovo protocollo suggerisce di includere gli allungamenti della fascia plantare e la camminata all&#8217;indietro.<sup id=\"cite_ref-:18_49-0\" class=\"reference\"><a href=\"#cite_note-:18-49\">(49)<\/a><\/sup> Helene Simpson consiglia i roll-down neurali e gli allungamenti in estensione delle dita dei piedi (flessore lungo dell&#8217;alluce ed estensione dell&#8217;alluce).<sup id=\"cite_ref-:1_2-32\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<p><i>Forza:<\/i><\/p>\n<p>Una meta-analisi di Arnold et al.<sup id=\"cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\">(50)<\/a><\/sup> sui deficit di forza concentrica degli eversori ha riscontrato che:<\/p>\n<ul>\n<li>Non c&#8217;\u00e8 causa ed effetto tra i deficit e la perdita di stabilit\u00e0 funzionale<\/li>\n<li>Non \u00e8 facile individuare la debolezza degli eversori<\/li>\n<li>I test isocinetici a basse velocit\u00e0 potrebbero massimizzare le differenze<\/li>\n<\/ul>\n<ul>\n<li>Debolezza degli inversori<\/li>\n<\/ul>\n<p>Durante gli esercizi di rinforzo, la co-contrazione muscolare \u00e8 essenziale. I protocolli di trattamento dovrebbero includere:<\/p>\n<ul>\n<li>Sollevamenti bilaterali dei polpacci<\/li>\n<\/ul>\n<ul>\n<li>Esercizi del piede corto<sup id=\"cite_ref-:18_49-1\" class=\"reference\"><a href=\"#cite_note-:18-49\">(49)<\/a><\/sup><\/li>\n<\/ul>\n<p>La forza \u00e8 importante e dovrebbe essere inclusa nella riabilitazione.<\/p>\n<h2><span id=\"Example_Treatment_Protocol\" class=\"mw-headline\">Esempio di protocollo di trattamento<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Example Treatment Protocol\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=23\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Example Treatment Protocol\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=23\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Helene Simpson fornisce un esempio del suo protocollo di trattamento per la gestione dell&#8217;instabilit\u00e0 cronica della caviglia.<sup id=\"cite_ref-:1_2-33\" class=\"reference\"><a href=\"#cite_note-:1-2\">(2)<\/a><\/sup><\/p>\n<h3><span id=\"General_Principles\" class=\"mw-headline\">Principi generali<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: General Principles\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=24\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: General Principles\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=24\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ol>\n<li>La definizione degli obiettivi \u00e8 fondamentale\n<ul>\n<li>Lavoro di squadra<\/li>\n<li>L&#8217;atleta si assume la responsabilit\u00e0<\/li>\n<\/ul>\n<\/li>\n<li>Lavorare sulla stabilit\u00e0 posturale<\/li>\n<li>Includere la stabilit\u00e0 prossimale, in particolare delle articolazioni dell&#8217;anca e del ginocchio<\/li>\n<li>Focus sugli stabilizzatori locali di caviglia e piede<\/li>\n<li>Il recupero del range di movimento in flessione dorsale \u00e8 una priorit\u00e0<\/li>\n<li>Includere il fitness cardio-vascolare<\/li>\n<li>Integrare gli esercizi in palestra per migliorare la compliance<\/li>\n<li>Valutare la calzatura e la tecnica specifica per lo sport<\/li>\n<\/ol>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Retraining_MLA.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3e\/Retraining_MLA.jpg\/150px-Retraining_MLA.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3e\/Retraining_MLA.jpg\/225px-Retraining_MLA.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3e\/Retraining_MLA.jpg\/300px-Retraining_MLA.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Riallenamento dei legamenti della caviglia mediale<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Phase_1\" class=\"mw-headline\">Fase 1<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Phase 1\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=25\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Phase 1\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=25\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p><b>Fitness cardiovascolare<\/b> che include:<\/p>\n<ul>\n<li>Andare in bicicletta<\/li>\n<li>Idroterapia o nuoto<\/li>\n<li>Camminare\n<ul>\n<li>Avanti e indietro<\/li>\n<li>Scala: lunghezza della falcata, &#8220;Pantera Rosa&#8221;, tacco-punta, alluce, posizionamento del piede<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Esercizi per il <b>controllo posturale\/equilibrio<\/b> che comprendono:<\/p>\n<ul>\n<li>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Tibialis_posterior_training.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/2\/28\/Tibialis_posterior_training.png\/150px-Tibialis_posterior_training.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/2\/28\/Tibialis_posterior_training.png\/225px-Tibialis_posterior_training.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/2\/28\/Tibialis_posterior_training.png\/300px-Tibialis_posterior_training.png 2x\" alt=\"\" width=\"150\" height=\"100\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Riallenamento del tibiale posteriore<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Pilates<\/li>\n<li>Esercizi del piede corto<\/li>\n<li>Riallenamento del tibiale posteriore<\/li>\n<\/ul>\n<p>Esercizi di <b>rinforzo<\/b> che includono:<\/p>\n<ul>\n<li>Leg press<\/li>\n<li>Sollevamenti dei polpacci, esercizi con theraband<\/li>\n<li>Hamstring curls<\/li>\n<li>Ponte (glutei)<\/li>\n<li>Addominali<\/li>\n<\/ul>\n<ul>\n<li>Neurodinamica e flessibilit\u00e0<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Lounges.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/34\/Lounges.jpg\/150px-Lounges.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/34\/Lounges.jpg\/225px-Lounges.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/3\/34\/Lounges.jpg\/300px-Lounges.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Affondi<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 152px;\"><a class=\"image\" href=\"\/File:Balance_and_proximal_control.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/e\/ee\/Balance_and_proximal_control.jpg\/150px-Balance_and_proximal_control.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/e\/ee\/Balance_and_proximal_control.jpg\/225px-Balance_and_proximal_control.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/e\/ee\/Balance_and_proximal_control.jpg\/300px-Balance_and_proximal_control.jpg 2x\" alt=\"\" width=\"150\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Equilibrio e controllo prossimale<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Phase_2\" class=\"mw-headline\">Fase 2<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Phase 2\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=26\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Phase 2\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=26\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p><b>Fitness cardiovascolare<\/b><\/p>\n<ul>\n<li>Corsa<\/li>\n<li>Ellittica<\/li>\n<li>Stepper<\/li>\n<li>Vogatore<\/li>\n<\/ul>\n<p><b>Forza funzionale<\/b><\/p>\n<ul>\n<li>Affondi modificati<\/li>\n<li>Squat: bilaterali, su una gamba sola<\/li>\n<li>Attivit\u00e0 su una sola gamba<\/li>\n<\/ul>\n<p><b>Allenamento dell&#8217;equilibrio<\/b><\/p>\n<ul>\n<li>Aeroplane, Star Excursion Balance Test<\/li>\n<li>Bosu ball, Balance pad, Wobble board<\/li>\n<\/ul>\n<p><b>Valutazione delle scarpe<\/b><\/p>\n<h3><span id=\"Phase_3\" class=\"mw-headline\">Fase 3<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Phase 3\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=27\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Phase 3\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=27\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p><b>Cardiovascolare<\/b><\/p>\n<ul>\n<li>Esercitazioni e abilit\u00e0 specifiche per lo sport<\/li>\n<li>Resistenza<\/li>\n<li>Terreno<\/li>\n<\/ul>\n<p><b>Equilibrio \/ funzione \/ agilit\u00e0<\/b><\/p>\n<ul>\n<li>Saltare, fare skipping, atterrare<\/li>\n<li>Molteplici saltelli<\/li>\n<li>Salti verticali<\/li>\n<\/ul>\n<p><b>Integrazione di attivit\u00e0 specifiche per lo sport<\/b>, ma senza compromettere la qualit\u00e0 del movimento.<\/p>\n<p><b>Monitoraggio del dolore<\/b><\/p>\n<h2><span id=\"References\" class=\"mw-headline\">Citazioni<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;veaction=edit&amp;section=28\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Management_of_Chronic_Ankle_Instability&amp;action=edit&amp;section=28\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1\">\u2191<\/a><\/span> <span class=\"reference-text\">Hertel J. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC164367\/\" rel=\"nofollow\">Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability.<\/a> J Athl Train. 2002 Dec;37(4):364-375.<\/span><\/li>\n<li id=\"cite_note-:1-2\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_2-0\">2.00<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-1\">2.01<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-2\">2.02<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-3\">2.03<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-4\">2.04<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-5\">2.05<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-6\">2.06<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-7\">2.07<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-8\">2.08<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-9\">2.09<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-10\">2.10<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-11\">2.11<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-12\">2.12<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-13\">2.13<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-14\">2.14<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-15\">2.15<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-16\">2.16<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-17\">2.17<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-18\">2.18<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-19\">2.19<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-20\">2.20<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-21\">2.21<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-22\">2.22<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-23\">2.23<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-24\">2.24<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-25\">2.25<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-26\">2.26<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-27\">2.27<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-28\">2.28<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-29\">2.29<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-30\">2.30<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-31\">2.31<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-32\">2.32<\/a><\/sup> <sup><a href=\"#cite_ref-:1_2-33\">2.33<\/a><\/sup><\/span> <span class=\"reference-text\">Simpson H. Chronic Ankle Instability Course. Physiopedia 2022<\/span><\/li>\n<li id=\"cite_note-:0-3\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_3-0\">3.0<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-1\">3.1<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-2\">3.2<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-3\">3.3<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-4\">3.4<\/a><\/sup><\/span> <span class=\"reference-text\">Hiller CE, Kilbreath SL, Refshauge KM. <a class=\"external text\" href=\"https:\/\/meridian.allenpress.com\/jat\/article\/46\/2\/133\/191250\/Chronic-Ankle-Instability-Evolution-of-the-Model\" rel=\"nofollow\">Chronic ankle instability: evolution of the model<\/a>. Journal of athletic training. 2011 Mar;46(2):133-41.<\/span><\/li>\n<li id=\"cite_note-:19-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:19_4-0\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-:19_4-1\">4.1<\/a><\/sup><\/span> <span class=\"reference-text\">Konradsen L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports. 2002 Jun;12(3):129-35.<\/span><\/li>\n<li id=\"cite_note-:2-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:2_5-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Hertel J. Immobilisation for acute severe ankle sprain. Lancet. 2009 Feb 14;373(9663):524-6. <\/span><\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-6\">\u2191<\/a><\/span> <span class=\"reference-text\">Struijs PA, Kerkhoffs GM. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2907605\/\">Ankle sprain<\/a>. BMJ Clin Evid. 2010 May 13;2010:1115.<\/span><\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-7\">\u2191<\/a><\/span> <span class=\"reference-text\">Wikstrom EA, Hubbard TJ. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.archives-pmr.org\/article\/S0003-9993(10)00253-4\/fulltext\">Talar positional fault in persons with chronic ankle instability<\/a>. Arch Phys Med Rehabil. 2010 Aug;91(8):1267-71.<\/span><\/li>\n<li id=\"cite_note-:3-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_8-0\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_8-1\">8.1<\/a><\/sup> <sup><a href=\"#cite_ref-:3_8-2\">8.2<\/a><\/sup><\/span> <span class=\"reference-text\">Hertel J. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC164367\/\">Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability.<\/a> J Athl Train. 2002 Dec;37(4):364-375<\/span><\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-9\">\u2191<\/a><\/span> <span class=\"reference-text\">Tropp H. Commentary: <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC164386\/\">Functional Ankle Instability Revisited<\/a>. J Athl Train. 2002 Dec;37(4):512-515.<\/span><\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-10\">\u2191<\/a><\/span> <span class=\"reference-text\">Konradsen L. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC164369\/\">Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense<\/a>. J Athl Train. 2002 Dec;37(4):381-385. <\/span><\/li>\n<li id=\"cite_note-:4-11\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:4_11-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Evans GA, Hardcastle P, Frenyo AD. Acute rupture of the lateral ligament of the ankle. To suture or not to suture? J Bone Joint Surg Br. 1984 Mar;66(2):209-12<\/span><\/li>\n<li id=\"cite_note-:5-12\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_12-0\">12.0<\/a><\/sup> <sup><a href=\"#cite_ref-:5_12-1\">12.1<\/a><\/sup><\/span> <span class=\"reference-text\">Lentell G, Katzman LL, Walters MR. The Relationship between Muscle Function and Ankle Stability. J Orthop Sports Phys Ther. 1990;11(12):605-11.<\/span><\/li>\n<li id=\"cite_note-:6-13\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:6_13-0\">13.0<\/a><\/sup> <sup><a href=\"#cite_ref-:6_13-1\">13.1<\/a><\/sup><\/span> <span class=\"reference-text\">Tropp H, Odenrick P, Gillquist J. Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med. 1985 Jun;6(3):180-2.<\/span><\/li>\n<li id=\"cite_note-:7-14\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:7_14-0\">14.0<\/a><\/sup> <sup><a href=\"#cite_ref-:7_14-1\">14.1<\/a><\/sup> <sup><a href=\"#cite_ref-:7_14-2\">14.2<\/a><\/sup><\/span> <span class=\"reference-text\">Gribble PA. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/meridian.allenpress.com\/jat\/article\/54\/6\/617\/420891\/Evaluating-and-Differentiating-Ankle-Instability\">Evaluating and differentiating ankle instability<\/a>. Journal of athletic training. 2019 Jun;54(6):617-27.<\/span><\/li>\n<li id=\"cite_note-:8-15\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:8_15-0\">15.0<\/a><\/sup> <sup><a href=\"#cite_ref-:8_15-1\">15.1<\/a><\/sup><\/span> <span class=\"reference-text\">Kovaleski JE, Norrell PM, Heitman RJ, Hollis JM, Pearsall AW. <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2386430\/\">Knee and ankle position, anterior drawer laxity, and stiffness of the ankle complex<\/a>. J Athl Train. 2008 May-Jun;43(3):242-8.<\/span><\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-16\">\u2191<\/a><\/span> <span class=\"reference-text\">Joshy S, Abdulkadir U, Chaganti S, Sullivan B, Hariharan K. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle. 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J Athl Train. 2009 Nov-Dec;44(6):653-62. <\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20230109192135 Cache expiry: 0 Dynamic content: true Complications: () CPU time usage: 0.236 seconds Real time usage: 0.250 seconds Preprocessor visited node count: 955\/1000000 Post\u2010expand include size: 146\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/40 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 33489\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 13.128 1 Special:Contributors\/Management_of_Chronic_Ankle_Instability 100.00% 13.128 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Redattrice principale &#8211; Ewa Jaraczewska sulla base del corso di Helene Simpson Principali collaboratori &#8211; Ewa Jaraczewska, Jess Bell e Kim Jackson Contenuti 1 Definizione di instabilit\u00e0 cronica della caviglia 1.1 Outcome a lungo termine 2 Instabilit\u00e0 meccanica e funzionale 2.1 Instabilit\u00e0 meccanica 2.2 Instabilit\u00e0 funzionale 3 Procedure diagnostiche 4 Gestione fisioterapica 4.1 Allenamento neuromuscolare [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4564","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4564","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/comments?post=4564"}],"version-history":[{"count":5,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4564\/revisions"}],"predecessor-version":[{"id":4733,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4564\/revisions\/4733"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/media?parent=4564"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}