Efficacy of Neuromodulation in the Treatment of Lateral Ankle Sprain and Chronic Ankle Instability

Background/Objectives: Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries, and a large proportion of patients go on to develop chronic ankle instability (CAI). Neuromodulation, ranging from transcutaneous to percutaneous techniques, has been proposed as a conservative adjunct for both conditions. This review examined its efficacy in LAS and CAI and compared the available modalities. Methods: We carried out a narrative review with a structured search of PubMed, Scopus, Web of Science and Embase (January–March 2026), reported following PRISMA 2020. Studies published between 2015 and 2026 with levels of evidence 1 to 3 were eligible. Of 511 records identified, 19 studies were included: three systematic reviews, eleven randomized trials, two non-randomized controlled studies, one cohort study and two case series or case-control studies. Results: In LAS (nine studies), results were heterogeneous. Low-frequency stimulation combined with proprioceptive training improved pain, range of motion, strength and joint position sense in one cohort and one randomized trial, and a trial of non-invasive neurostimulation reported less pain and faster return to sport. Two reviews, however, found no added benefit of electrical stimulation in acute sprains. Neuromuscular electrical stimulation (NMES) reduced edema in one pilot trial but not in another study. In CAI (ten studies), six-week NMES programs combined with exercise improved balance, muscle morphology, frontal-plane motor control and patient-reported outcomes, whereas single sessions and two-week programs did not. Percutaneous techniques showed rapid effects in one non-randomized LAS report but only limited acute effects on postural control in CAI. Conclusions: Neuromodulation appears useful as an adjunct to exercise-based rehabilitation rather than as a stand-alone treatment. The evidence is most consistent for NMES combined with exercise in CAI. Standardized protocols and more rigorous trials are required.