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26 Resilience and self-efficacy: a theory-based model of chronic ankle instability
  1. RS McCann,
  2. PA Gribble
  1. Division of Athletic Training, University of Kentucky, USA


Chronic ankle instability (CAI) commonly develops after a lateral ankle sprain (LAS). Widespread residual complaints suggest that rehabilitation provided for many LAS is insufficient. We propose a theoretical model for CAI development impacted by patient resilience and self-efficacy, social constructs, and rehabilitation adherence.

An exclusive social structure within team sports often acts as an important support system to those within it, but may allow individuals to rationalise placing oneself at elevated risk of injury for the team’s benefit. Social attitudes may lower perceived control of patients (decreased resilience), making them feel less capable of carrying out a course of action (decreased self-efficacy), such as rehabilitation. Highly resilient student-athletes may communicate a need or desire for extensive care. Greater self-efficacy can facilitate patients’ insistence for thorough care, which may further boost resilience and self-efficacy, improving rehabilitation adherence, and decreasing the prevalence of CAI.

Due to the perceived benign nature of LAS in the general population, many rely on self-treatment or emergency department recommendations involving rudimentary treatment methods that may not address all underlying deficits, nor prevent recurrent LAS. Although deficiencies in postural control, gait, and other functional tasks are commonly reported in CAI populations, these deficits often do not receive adequate attention during rehabilitation. However, the supervision of a clinician specialising in the management of sport-related musculoskeletal injuries will improve the quality and breadth of rehabilitation needed to address the host of potential deficits that arise from a LAS.

Resilience, self-efficacy, and social constructs, in addition to clinician expertise, can affect injury outcomes, and should be considered and promoted in each patient through goal setting, buddy systems, and flexible scheduling. Legislation outlining rights of student-athletes may further affect psychosocial influences. Ultimately, elevated patient resilience and self-efficacy in LAS patients may facilitate rehabilitation adherence, reducing CAI development.

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