Hip work helps wobbly ankles only alongside ankle rehab

Chronic ankle instability is the long tail of a bad sprain: an ankle that keeps rolling, feels unreliable and often never returns to its old confidence. Rehabilitation has traditionally been aimed at the ankle itself, with balance drills and local strengthening. Over the past decade attention has shifted upstream to the hip, on the reasoning that the muscles controlling the pelvis and thigh influence how the whole leg lands and stabilises. Trials testing hip strengthening in this group have produced conflicting results, which left clinicians and patients unsure whether adding it is worth the time.

The reviewers searched five databases from inception to 6 November 2025 following PRISMA guidelines, and pooled results using a random-effects model. Nine randomised controlled trials in people with chronic ankle instability were included. Outcomes were postural control, measured mainly by reach distances on the Star excursion balance test, self-reported instability on the Cumberland ankle instability tool, and hip muscle strength. Crucially, they also ran a subgroup analysis by comparison type, separating trials where hip strengthening was added to ankle rehabilitation from those where it stood alone against no training or against ankle rehab.

Overall, hip strengthening significantly improved reach distance in the posteromedial and posterolateral directions, raised Cumberland ankle instability tool scores by about 1.54 points, and increased hip abductor strength. The subgroup analysis is where the story changes: combining hip strengthening with ankle rehabilitation significantly improved balance reach distances, while isolated hip strengthening showed no superiority over either a control group or ankle rehabilitation alone. So the headline benefit appears to depend on hip work being an addition rather than a replacement. The reviewers flag the limited number of trials, their small samples and the low quality of the evidence.

This helps explain why previous trials disagreed: whether hip strengthening looks effective depends heavily on what it is being compared against and whether ankle-specific work sits alongside it. It supports the idea that hip strength contributes to how a leg controls landing and balance, without supporting the stronger claim that the hip is the missing key to unstable ankles. With nine small, low quality trials, the pooled estimates could move substantially with better studies. Open questions include how much hip work is needed, whether the improvements translate into fewer repeat sprains, and whether the same holds in athletes at high sprain risk.

For anyone dealing with an ankle that repeatedly gives way, the practical reading is that hip strengthening looks like a reasonable complement to ankle rehabilitation rather than a shortcut around it. The improvements reported here are in balance reach, self-reported stability and hip strength, which are the measures rehab tends to track, not in future injury rates. Because the evidence base is small and rated low quality, the honest expectation is a modest and uncertain gain. It is also worth noting that everyone studied already had instability, so none of this is a prevention finding.