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Ashley M.B. Suttmiller and Ryan S. McCann

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.

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Ryan S. McCann and Phillip A. Gribble

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Ryan S. McCann, Kyle B. Kosik, Masafumi Terada, Megan Q. Beard, Gretchen E. Buskirk, and Phillip A. Gribble


The Star Excursion Balance Test (SEBT) and Functional Movement Screen (FMS) are functional performance measures capable of predicting lower-extremity injury risk. While suboptimal SEBT and FMS performances are influenced by multiple factors, the contribution of hip strength and flexibility to these tests is mostly unknown. Examination of hip strength and flexibility influences on the SEBT and FMS may direct clinicians to better methods of correcting functional deficits.


Determine the relationships of isometric hip strength and hip passive range of motion (PROM) with functional performance measures.




Athletic training facility.


43 NCAA Division I women’s soccer players (19.65 ± 1.12 y; 166.93 ± 3.84 cm; 60.99 ± 4.31 kg) volunteered.

Data Collection and Analysis:

All participants were tested bilaterally in the SEBT; the deep squat, in-line lunge, hurdle step, and straight leg raise, comprising a lower-extremity FMS (FMS-LE); hip internal and external rotation PROM; and isometric hip extension strength (HEXT). The mean of the 3 averaged, normalized SEBT scores was used as a composite score. Pearson product moment correlations assessed relationships of SEBT and FMS-LE scores with PROM and HEXT. Significance was set a priori at P < .05.


Pearson correlations revealed anterior (ANT) SEBT scores had a low negative association with HEXT (r = –0.33,P = .004) and a low positive association with hip internal rotation PROM (PROM-IR) (r = .43,P = .003). All other correlations were negligible.


Flexibility training aimed at PROM-IR may contribute to improved ANT scores. Targeting HEXT and hip external rotation PROM are likely not preferred means of correcting deficits in SEBT and FMS-LE performance.

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Ryan S. McCann, Ashley M.B. Suttmiller, Phillip A. Gribble, and Julie M. Cavallario

Athletic trainers are commonly responsible for clearing patients with ankle sprains for return to activity. What criteria athletic trainers typically use to determine return to activity readiness in this population remains unclear. The purpose of this qualitative study was to examine criteria athletic trainers use to determine patients’ return to activity readiness following an ankle sprain. Participants varied in selected clinician-, patient-rated, and functional assessments for patients with ankle sprains. As many selected methods did not agree with expert consensus recommendations, more work is likely needed to instill best practices for evaluation of patients with ankle sprains.

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Eric Schussler, Ryan S. McCann, Nicholas Reilly, Thomas R. Campbell, and Jessica C. Martinez

The effect of subconcussive impacts on balance are not well known. The purpose of this study is to determine the effect of subconcussive impacts on dynamic balance over the course of a rugby season. Significant negative linear correlations were found between total peak linear acceleration and dominant leg (r = −.585, p = .046) and bilateral score (r = −.615, p = .033); also between total impacts over 10g and dominant leg (r = −.653, p = .021), nondominant leg (r = −.687, p = .014), and the combined total (r = −.731, p = .007). Results indicate subconcussive impacts may affect dynamic balance over the course of a competitive season of women’s collegiate rugby.

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Ryan S. McCann, Ashley M.B. Suttmiller, Phillip A. Gribble, and Julie M. Cavallario

Athletic trainers’ reasons for selecting or avoiding certain evaluation techniques for patients with an ankle sprain are not fully understood. Such information is important to facilitating evidence-based practice and eliminating barriers. The purpose of this qualitative study was to determine what factors influence athletic trainers’ selection or avoidance of specific outcomes used to determine patients’ return to activity readiness following an ankle sprain. Participants cited many factors that facilitate and inhibit their use of best-practice recommendations and alternative methods for evaluating patients with ankle sprains. Athletic trainers’ should continue to promote facilitators and eliminate barriers to the use of best practices.

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Ryan S. McCann, Kyle B. Kosik, Masafumi Terada, and Phillip A. Gribble

Several investigators have aimed to predict recurrent injuries following acute ankle sprains, but none has done so in high school or collegiate athletes. The purpose of this study was to determine the ability of demographic, anthropometric, and disease- and patient-oriented outcomes to predict recurrent ankle sprains in athletes during the same competitive season following return to play from an ankle sprain. Only increased patient height and mass were associated with increased odds of sustaining a recurrent ankle sprain. Thus, taller and heavier patients might have the greatest risk of sustaining a recurrent ankle sprain in the same season as a previous ankle sprain.