Neuromuscular characteristics of individuals with chronic ankle instability during unilateral landing tasks: a meta-analysis of electromyographic studies.

BACKGROUND

Chronic ankle instability (CAI) is a prevalent consequence of lateral ankle sprain. Electromyographic (EMG) investigations examining neuromuscular control during unilateral landing tasks have produced inconsistent findings, particularly during the critical post-initialcontact (post-IC) phase. This systematic review and meta-analysis aimed to synthesize current evidence on post-IC muscle activation patterns in individuals with CAI during unilateral landing tasks.

METHODS

This PRISMA-compliant review (PROSPERO: CRD420261415793) searched PubMed, Scopus, and Web of Science from inception to June 2026. Cross-sectional studies comparing EMG activity between individuals with CAI and healthy controls during unilateral landing tasks were included. Study quality was assessed using Joanna Briggs Institute checklists; random-effects meta-analysis was performed with Comprehensive Meta-Analysis software, evaluating heterogeneity (I2, Q-test) and publication bias (Egger's test).

RESULTS

Seventeen studies involving 757 participants met the inclusion criteria. Compared with healthy controls, individuals with CAI demonstrated significantly lower post-IC activation of the peroneus longus (p = 0.005), gluteus medius (p = 0.027), and biceps femoris (p = 0.010), alongside significantly greater activation of the soleus (p = 0.036) and rectus femoris (p = 0.013). No significant differences were observed for the tibialis anterior (p = 0.453), medial gastrocnemius (p = 0.552), or lateral gastrocnemius (p = 0.845). Substantial heterogeneity was identified for several muscles, particularly the peroneus longus, tibialis anterior, soleus, and rectus femoris (I2 = 76-90%). Subgroup analyses suggested potential sex-related differences in peroneus longus activation patterns.

CONCLUSIONS

Individuals with CAI exhibit distinct neuromuscular alterations during the post-IC phase of unilateral landing tasks, characterized by reduced activation of key lateral ankle and proximal stabilizing muscles and increased activation of muscles associated with joint stiffening and impact attenuation. Rehabilitation strategies should extend beyond the ankle to target proximal muscle function and landing mechanics to optimize dynamic stability and reduce recurrent injury risk.