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Context: Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI. Objective: To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI. Design: Cross-Sectional Study Setting: Anonymous online survey Patients or Other Participants: A total of 259 people, recruited via e-mail and social media, with a history of ankle sprain completed the survey; of those, 126 participants (age=32.69±4.38, female=84.92%, highly active=73.81%) were identified to have CAI and were included in the analysis. Main Outcome Measure(s): Demographics included gender identity, age, and physical activity level. Assessments encompassed the Identification of Functional Ankle Instability (instability), the Pain Catastrophizing Scale (pain catastrophizing), the Tampa Scale of Kinesiophobia-11 (injury-related fear), a numeric pain rating scale and activity-based question (pain presence), the Quick-FAAM (ankle function), and the modified Disablement in the Physically Active Scale (disability). Relationships between variables were explored through correlation and regression analyses. Results: After controlling for instability and pain, pain catastrophizing and injury-related fear were significantly related to function and disability ratings in individuals with CAI. Together, the variables predicted 48.7% (P<.001) variance in function and 44.2% (P<.001) variance in disability. Conclusions: Greater instability, pain, greater pain catastrophizing, and greater injury-related fear were predictive of decreased function and greater disability in those with CAI. This is consistent with the hypothesized relationships in the Fear-Avoidance Model, although further investigation is needed to determine causality of these factors in the development of CAI.

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.

BackgroundChronic ankle instability (CAI) results in hip neuromuscular impairments that can perpetuate dysfunction through reduced lumbopelvic stability and subsequent malpositioning of the lower body during functional movement. Lumbopelvic stability might be further impaired through changes in trunk muscular contractility. However, lumbopelvic stability and trunk muscle morphology have not been compared between individuals with and without CAI. PurposeTo compare lumbopelvic stability and trunk muscle contractility between individuals with and without chronic ankle instability (CAI) and determine if lumbopelvic stability and trunk muscle contractility are associated with self-reported function. Study DesignCase-control study. MethodsTen individuals with CAI, 10 ankle sprain copers (COP), and 10 healthy controls (CON) participated. Diagnostic ultrasound imaging was used to assess transversus abdominis (TrA) and lumbar multifidus (LM) muscle contractility. A percent change in contraction thickness from rested to contracted conditions was calculated for each muscle. Lumbopelvic stability was assessed using unilateral hip bridge, trunk flexion endurance, Biering-Sorensen, and side plank tests. Self-reported function was measured with the Foot and Ankle Ability Measure Activity of Daily Living (FAAM-ADL) and Sport (FAAM-S) subscales. One-way ANOVAs and Cohen's d effect sizes compared scores on clinician and patient-reported outcomes between groups. Pearson product moment correlations analyzed associations between self-reported function and trunk muscle contractility and lumbopelvic stability. Significance was set a priori at P<0.05 ResultsCOP had significantly greater TrA contractility than CAI (P<0. 01, d=2.65[1.45,3.85]) and CON (P=0. 03, d=1.05[0.08,1.94]). Although not statistically significant, a large effect size suggest that CAI had lower TrA contractility than CON (P=0.12, d=0.92 [-0.03,1.80]). No differences existed for LM contractility or lumbopelvic stability tests. A moderate direct correlation (r=0.65, P=0.04) existed between CON's TrA contractility and FAAM-ADL scores. ConclusionDeficits in TrA contractility are a novel finding among individuals with CAI. While LM contractility and lumbopelvic stability did not differ between groups, future research should continue to examine their relevance to CAI.