Effects of hip strengthening on postural control and muscle strength in individuals with chronic ankle instability: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Despite encouraging findings, research on the therapeutic efficacy of hip strengthening in individuals with chronic ankle instability (CAI) continues to yield conflicting results. PURPOSE: This study aims to systematically evaluate the effects of hip strengthening on postural control and muscle strength in individuals with CAI. METHODS: A comprehensive search of five databases was conducted from inception to November 6, 2025 following the guidelines defined by the PRISMA statement. We conducted a meta-analysis using a random-effects model via the metafor package in R software. Subgroup analysis was performed based on comparison types. RESULTS: Nine randomized controlled trials were included. Hip strengthening significantly improved the posteromedial distance (SMD=0.60, 95% CI: 0.22-0.97) and posterolateral distance (SMD=0.55, 95% CI: 0.15-0.96) in the Star excursion balance test (SEBT), Cumberland ankle instability tool scores (MD=1.54, 95% CI: 0.86-2.24), and hip abductor muscle strength (SMD=0.72, 95% CI: 0.17-1.26). Subgroup analysis results demonstrated that combining hip strengthening with ankle rehabilitation significantly improved SEBT distances, whereas isolated hip strengthening showed no superior effect to either the blank control group or ankle rehabilitation training alone. CONCLUSION: Hip strengthening improves postural control and muscle strength in individuals with CAI. Notably, the application of hip strengthening combined with ankle rehabilitation training is beneficial for postural control, whereas standalone hip strengthening yields no additional benefits. However, these findings should be interpreted with caution due to the limited number of studies, small sample sizes, and low quality of the evidence.