Return to Preinjured Function Following Ankle Injury

in International Journal of Athletic Therapy and Training
Aaron D. Sciascia PhD, ATC, PES, SMTC * , 1 , Arthur J. Nitz PhD, PT * , 2 , Patrick O. McKeon PhD, ATC, CSCS * , 3 , Jennifer Havens PhD * , 2 , and Timothy L. Uhl PhD, ATC, PT, FNATA * , 2
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  • 1 Eastern Kentucky University
  • 2 University of Kentucky
  • 3 Ithaca College
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Athletic preinjury function is typically determined via subjective recall; however, obtaining preinjury function before injury occurs should be attempted in order to establish an individual baseline for postinjury comparison. The purpose of this study was to obtain preinjury baseline values for the Foot and Ankle Disability Index (FADI) and Foot and Ankle Disability Index sport version (FADISP), single-leg hop for distance, and Star Excursion Balance Test anterior reach and determine if athletes returned to those values following ankle injury. Out of 41 qualifying injuries, FADI/FADISP scores were significantly reduced at initial injury compared with baseline and all other time points (p < .001) but recovered by discharge. Single-leg hop and Star Excursion Balance Test recovered to baseline values by the discharge time point (p ≥ .98). Subjective and objective preinjury function can be reestablished by discharge from supervised treatment following low-grade ankle injury and maintained for at least 6 months following the cessation of treatment. However, testing metrics should be reviewed on an individual athlete basis, because group data may mask individual patient needs.

Sciascia is with the Eastern Kentucky University, Richmond, KY, USA. Nitz, Havens, and Uhl are with the University of Kentucky, Lexington, KY, USA. McKeon is with the Ithaca College, Ithaca, NY, USA.

Sciascia (aaron.sciascia@eku.edu) is corresponding author.
  • 1.

    Sauers EL, Snyder AR. A team approach: demonstrating sport rehabilitation’s effectiveness and enhancing patient care through clinical outcomes assessment. J Sport Rehabil. 2011;20(1):37. PubMed ID: 21411818 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Davidson M, Keating J. Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? A practical guide for clinicians and researchers who are not biostatisticians. Br J Sports Med. 2014;48(9):792796. PubMed ID: 23258849 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Reiman MP, Manske RC. The assessment of function: how is it measured? A clinical perspective. J Man Manip Ther. 2011;19(2):9199. PubMed ID: 22547919 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Michener LA. Patient- and clinician-rated outcome measures for clinical decision making in rehabilitation. J Sport Rehabil. 2011;20(1):3745. PubMed ID: 21411821 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Evans TA, Lam KC. Clinical outcomes assessment in sport rehabilitation. J Sport Rehabil. 2011;20(1):816. PubMed ID: 21411819 doi:

  • 6.

    Sciascia AD. A basic construct for improving outcomes in rehabilitation. Int J Athl Ther Train. 2013;18(3):1419. doi:

  • 7.

    Sciascia AD, Myers N, Kibler WB, Uhl TL. Return to pre-injury levels of play following superior labral repair in overhead athletes: a systematic review. J Athl Train. 2015;50(7):767777. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Smith FW, Rosenlund EA, Aune AK, MacLean JA, Hillis SW. Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med. 2004;38(3):279284. PubMed ID: 15155426 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Kovacic J, Bergfeld J. Return to play issues in upper extremity injuries. Clin J Sports Med. 2005;15(6):448452. doi:

  • 10.

    Creighton DW, Shrier I, Schultz R, Meeuwisse WH, Matheson GO. Return-to-play in sport: a decision-based model. Clin J Sports Med. 2010;20(5):379385. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Clover J, Wall J. Return-to-play criteria following sports injury. Clin Sports Med. 2010;29(1):169175. PubMed ID: 19945592 doi:

  • 12.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596606. PubMed ID: 21398310 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Matheson GO, Shultz R, Bido J, Mitten MJ, Meeuwisse WH, Shrier I. Return-to-play decisions: are they the team physician’s responsibility? Clin J Sports Med. 2011;21(1):2530. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39(3):538543. PubMed ID: 21098818 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Myers JB, Wassinger CA, Lephart SM. Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation. Man Ther. 2006;11(3):197201. PubMed ID: 16777465 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Ardern CL, Taylor NF, Feller JA, Webster KE. Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J Sci Med Sport. 2012;15(6):488495. PubMed ID: 22695136 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853864. PubMed ID: 27226389 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Sciascia A, Haegele LE, Lucas J, Uhl TL. Preseason perceived physical capability and previous injury. J Athl Train. 2015;50(9):937943. doi:

  • 19.

    Cameron KL, Thompson BS, Peck KY, Owens BD, Marshall SW, Svoboda SJ. Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med. 2013;41(3):582589. PubMed ID: 23328737 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Wymore L, Fronek J. Shoulder functional performance status of National Collegiate Athletic Association swimmers. Am J Sports Med. 2015;43(6):15131517. PubMed ID: 25790836 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Martin RL, Burdett RG, Irrgang JJ. Development of the foot and ankle disability index (FADI). J Orthop Sports Phys Ther. 1999;29(1):A32A33.

    • Search Google Scholar
    • Export Citation
  • 22.

    Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function. Arthritis Care Res. 2011;63(suppl):S208S228. doi:

  • 23.

    Ingelsrud LH, Granan LP, Terwee CB, Engebretsen L, Roos EM. Proportion of patients reporting acceptable symptoms or treatment failure and their associated KOOS values at 6 to 24 months after anterior cruciate ligament reconstruction: a study from the norwegian knee ligament registry. Am J Sports Med. 2015;43(8):19021907. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Hale SA, Hertel J. Reliability and sensitivity of the foot andankle disability index in subjects with chronic ankle instability. J Athl Train. 2005;40(1):3540.

    • Search Google Scholar
    • Export Citation
  • 25.

    Eechaute C, Vaes P, Van Aerschot L, Asman S, Duquet W. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review. BMC Musculoskel Dis. 2007;8(1):6. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Kockum B, Heijne AI-LM. Hop performance and leg muscle power in athletes: reliability of a test battery. Phys Ther Sport. 2015;16(3):222227. PubMed ID: 25891995 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Gribble PA, Hertel J, Plisky P. Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47(3):339357. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Witchalls JB, Newman P, Waddington G, Adams R, Blanch P. Functional performance deficits associated with ligamentous instability at the ankle. J Sci Med Sport. 2013;16(2):8993. PubMed ID: 22743237 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Hegedus EJ, McDonough S, Bleakley C, Baxter D, Cook CE. Clinician-friendly lower extremity physical performance tests in athletes: a systematic review of measurement properties and correlation with injury. Part 2—the tests for the hip, thigh, foot and ankle including the star excursion balance test. Br J Sports Med. 2015;49(10):649656. PubMed ID: 25614536 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Stiffler MR, Bell DR, Sanfilippo JL, Hetzel SJ, Pickett KA, Heiderscheit BC. Star excursion balance test anterior asymmetry is associated with injury status in division I collegiate athletes. J Orthop Sports Phys Ther. 2017;47(5):339346. PubMed ID: 28355980 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Clarsen B, Bahr R. Matching the choice of injury/illness definition to study setting, purpose, and design: one size does not fit all! Br J Sports Med. 2014;48(7):510512. PubMed ID: 24620038 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Jacobsson J, Timpka T, Kowalski J, et al. Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Br J Sports Med. 2013;47(15):941952. PubMed ID: 23543425 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

  • 34.

    Dunlop W, Cortina J, Vaslow J, Burke M. Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods. 1996;1(2):170177.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Fuller CW, Bahr R, Dick RW, Meeuwisse WH. A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance. Clin J Sports Med. 2007;17(3):197200. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46(2):124130. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    De Vos RJ, Reurink G, Goudswaard GJ, Moen MH, Weir A, Tol JL. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br J Sports Med. 2014;48(18):13771384. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501506.

    • Search Google Scholar
    • Export Citation
  • 39.

    McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):18101819. PubMed ID: 18799992 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA. Discriminating between copers and people with chronic ankle instability. J Athl Train. 2012;47(2):136142. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Peters JW, Trevino SG, Renstrom PA. Chronic lateral ankle instability. Foot Ankle. 1991;12(3):182191. PubMed ID: 1791012 doi:

  • 42.

    Lofvenberg R, Karrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995;23(4):414417. PubMed ID: 7573649

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Forkin DM, Koczur C, Battle R, Newton RA. Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther. 1996;23(4):245250. PubMed ID: 8775369 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Becker H, Rosenbaum D, Claes L, Gerngro H. Measurement of plantar pressure distribution during gait for diagnosis of functional lateral ankle instability. Clin Biomech. 1997;12(3):S19. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Isakov E, Mizrahi J. Is balance impaired by recurrent sprained ankle? Br J Sports Med. 1997;31(1):6567. PubMed ID: 9132216 doi:

  • 46.

    Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653660. PubMed ID: 9801078 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sport Sci. 2014;32(13):12291236.

  • 48.

    Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004;32(1 suppl):516. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Hagglund M, Walden M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767772. PubMed ID: 16855067 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25(3):298304. PubMed ID: 19245994 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med. 2009;37(9):17501754. PubMed ID: 19556471 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Owens BD, Dickens JF, Kilcoyne KG, Rue JPH. Management of mid-season traumatic anterior shoulder instability in athletes. J Am Acad Orthop Surg. 2012;20(8):518526. PubMed ID: 22855854 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Cameron KL, Mountcastle SB, Nelson BJ, et al. History of shoulder instability and subsequent injury during four years of follow-up: a survival analysis. J Bone Joint Surg. 2013;95(5):439445. PubMed ID: 23467867 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Monk PA, Roberts PG, Logishetty K, et al. Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med. 2013;49(5):307311. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Ward JP, Bradley JP. Decision making in the in-season athlete with shoulder instability. Clin Sports Med. 2013;32(4):685696. PubMed ID: 24079428 doi:

  • 56.

    Augustsson J, Thomee R, Karlsson J. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2004;12(5):350356. PubMed ID: 15138668 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Haneuse S, Bartell S. Designs for the combination of group- and individual-level data. Epidemiology. 2011;22(3):382389. PubMed ID: 21490533 doi:

  • 58.

    Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964978. PubMed ID: 22773322 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Hegedus EJ, McDonough S, Bleakley C, Cook CE, Baxter GD. Clinician-friendly lower extremity physical performance measures in athletes: a systematic review of measurement properties and correlation with injury, part 1. The tests for knee function including the hop tests. Br J Sports Med. 2015;49(10):642648. PubMed ID: 25497489 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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