The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P = .030), and higher TTB anterior–posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.

Helly is with the Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA. Bain, Hoch, Heebner, Gribble, and Kosik are with the Department of Athletic Training and Clinical Nutrition, University of Kentucky College of Health Sciences, Lexington, KY, USA. Terada is with the Department of Sport and Health Science, Ritsumeikan University, Kyoto, Japan.

Kosik (kyle.kosik@uky.edu) is corresponding author.
  • 1.

    Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):22792284. PubMed ID: 20926721 doi:

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

    Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311319. PubMed ID: 17710181

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

    Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train. 2019;54(6):603610. PubMed ID: 31135209 doi:

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

    Gribble PA, Delahunt E, Bleakley C, et al. . Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48(13):10141018. PubMed ID: 24255768 doi:

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

    Houston MN, Van Lunen BL, Hoch MC. Health-related quality of life in individuals with chronic ankle instability. J Athl Train. 2014;49(6):758763. PubMed ID: 25299444 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hubbard-Turner T, Turner MJ. Physical activity levels in college students with chronic ankle instability. J Athl Train. 2015;50(7):742747. PubMed ID: 25898110 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Song K, Wikstrom EA. Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review. Phys Sportsmed. 2019;47(3):275283. PubMed ID: 30739572 doi:

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

    Wikstrom EA, Song K, Tennant JN, Dederer KM, Paranjape C, Pietrosimone B. T1rho MRI of the talar articular cartilage is increased in those with chronic ankle instability. Osteoarthritis Cartilage. 2019;27(4):646649. PubMed ID: 30634032 doi:

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

    Golditz T, Steib S, Pfeifer K, et al. . Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes. Osteoarthritis Cartilage. 2014;22(10):13771385. PubMed ID: 24814687 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54(6):572588. PubMed ID: 31162943 doi:

  • 11.

    Wikstrom EA, Naik S, Lodha N, Cauraugh JH. Balance capabilities after lateral ankle trauma and intervention: a meta-analysis. Med Sci Sports Exerc. 2009;41(6):12871295. PubMed ID: 19461536 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Pope M, Chinn L, Mullineaux D, McKeon PO, Drewes L, Hertel J. Spatial postural control alterations with chronic ankle instability. Gait Posture. 2011;34(2):154158. PubMed ID: 21600773 doi:

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

    Mettler A, Chinn L, Saliba SA, McKeon PO, Hertel J. Balance training and center-of-pressure location in participants with chronic ankle instability. J Athl Train. 2015;50(4):343349. PubMed ID: 25562457 doi:

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

    Houston MN, Hoch JM, Gabriner ML, Kirby JL, Hoch MC. Clinical and laboratory measures associated with health-related quality of life in individuals with chronic ankle instability. Phys Ther Sport. 2015;16(2):169175. PubMed ID: 25500148 doi:

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

    Hertel J, Buckley WE, Denegar CR. Serial testing of postural control after acute lateral ankle sprain. J Athl Train. 2001;36(4):363368. PubMed ID: 12937477

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

    Kaminski TW, Hertel J, Amendola N, et al. . National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528545. PubMed ID: 23855363 doi:

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

    Vuurberg G, Hoorntje A, Wink LM, et al. . Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956. PubMed ID: 29514819 doi:

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

    Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ, Orthopaedic Section American Physical Therapy A. Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther. 2013;43(9):A1A40. PubMed ID: 24313720 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Miklovic TM, Donovan L, Protzuk OA, Kang MS, Feger MA. Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction. Phys Sportsmed. 2018;46(1):116122. PubMed ID: 29171312 doi:

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

    McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35(2):103108. PubMed ID: 11273971 doi:

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

    Hiller CE, Nightingale EJ, Raymond J, et al. . Prevalence and impact of chronic musculoskeletal ankle disorders in the community. Arch Phys Med Rehabil. 2012;93(10):18011807. PubMed ID: 22575395 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Hubbard-Turner T. Lack of medical treatment from a medical professional after an ankle sprain. J Athl Train. 2019;54(6):671675. PubMed ID: 31116568 doi:

  • 23.

    Feger MA, Glaviano NR, Donovan L, et al. . Current trends in the management of lateral ankle sprain in the United States. Clin J Sport Med. 2017;27(2):145152. PubMed ID: 27347860 doi:

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

    Feger MA, Herb CC, Fraser JJ, Glaviano N, Hertel J. Supervised rehabilitation versus home exercise in the treatment of acute ankle sprains: a systematic review. Clin Sports Med. 2015;34(2):329346. PubMed ID: 25818717 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Simon JE, Wikstrom EA, Grooms DR, Docherty CL, Dompier TP, Kerr ZY. Athletic training service characteristics for patients with ankle sprains sustained during high school athletics. J Athl Train. 2019;54(6):676683. PubMed ID: 29373057 doi:

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

    McKeon PO, Hertel J. Spatiotemporal postural control deficits are present in those with chronic ankle instability. BMC Musculoskelet Disord. 2008;9(1):76. PubMed ID: 18518994 doi:

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

    Hertel J, Olmsted-Kramer LC, Challis JH. Time-to-boundary measures of postural control during single leg quiet standing. J Appl Biomech. 2006;22(1):6773. PubMed ID: 16760569 doi:

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

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

  • 29.

    Gribble PA, Bleakley CM, Caulfield BM, et al. . Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):14961505. PubMed ID: 27259753 doi:

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

    Kosik KB, Hoch MC, Villasante-Tezanos AG, Gribble PA. Visit characteristics associated with opioids administered or prescribed during emergency department visits for ankle sprain between 2010 and 2015. PM R. 2020;12(7):647654. PubMed ID: 31950659 doi:

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

    Kosik KB, Hoch MC, Humphries RL, Villasante Tezanos AG, Gribble PA. Medications used in U.S. emergency departments for an ankle sprain: an analysis of the national hospital ambulatory medical care survey. J Emerg Med. 2019;57(5):662670. PubMed ID: 31606229 doi:

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

    Wester JU, Jespersen SM, Nielsen KD, Neumann L. Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study. J Orthop Sports Phys Ther. 1996;23(5):332336. PubMed ID: 8728532 doi:

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

    Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684. PubMed ID: 19589822 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. Rehabilitation exercises reduce re-injury post-ankle sprain, but the content and parameters of an optimal exercise program have yet to be established: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(7):13671375. PubMed ID: 30612980 doi:

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

    Mailuhu AKE, van Middelkoop M, Bierma-Zeinstra SMA, Bindels PJE, Verhagen E. Outcome of a neuromuscular training program on recurrent ankle sprains. Does the initial type of healthcare matter? J Sci Med Sport. 2020;23(9):807813. PubMed ID: 32307227 doi:

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

    Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113125. PubMed ID: 28053200 doi:

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

    Kim KM, Hart JM, Saliba SA, Hertel J. Modulation of the fibularis longus hoffmann reflex and postural instability associated with chronic ankle instability. J Athl Train. 2016;51(8):637643. PubMed ID: 27583692 doi:

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

    Tropp H, Odenrick P. Postural control in single-limb stance. J Orthop Res. 1988;6(6):833839. PubMed ID: 3171763 doi:

  • 39.

    Bowers LC, Gribble PA, Hoch MC, Villasante Tezanos AG, Kosik KB. Physical therapy referral and medication for ankle sprain visits to physician offices: an analysis of the national ambulatory medical care survey [published online ahead of print August 6, 2020]. Phys Sportsmed. doi:

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

    Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med. 2017;45(1):201209. PubMed ID: 27573356 doi:

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

    Medina McKeon JM, Bush HM, Reed A, Whittington A, Uhl TL, McKeon PO. Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes. J Sci Med Sport. 2014;17(1):2328. PubMed ID: 23689105 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Wikstrom EA, Mueller C, Cain MS. Lack of consensus on return to sport criteria following lateral ankle sprain: a systematic review of expert opinions. J Sport Rehabil. 2020;29(2):231–237. doi:

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

    McCann R, Kosik K, Terada M, Gribble P. Residual impairments and activity limitations at return to play from a lateral ankle sprain. Int J Athl Ther Train. 2018;23(2):8388. doi:

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

    Kosik KB, Johnson NF, Terada M, Thomas AC, Mattacola CG, Gribble PA. Decreased dynamic balance and dorsiflexion range of motion in young and middle-aged adults with chronic ankle instability. J Sci Med Sport. 2019;22(9):976980. PubMed ID: 31122877 doi:

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

    Kosik KB, Johnson NF, Terada M, Thomas AC, Mattacola CG, Gribble PA. Decreased ankle and hip isometric peak torque in young and middle-aged adults with chronic ankle instability. Phys Ther Sport. 2020;43:127133. PubMed ID: 32146433 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 875 875 110
Full Text Views 47 47 3
PDF Downloads 36 36 2