Background Post-injury, collegiate athletes have reported elevated levels of fear. However, it is unclear how history of ankle sprain impacts injury-related fear.

Objective To determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between collegiate athletes with a history of a single ankle sprain, those with recurrent sprains, and healthy controls.

Design Cross-sectional.

Setting Athletic facilities.

Participants From a large database of collegiate athletes 76 participants with a history of a single ankle sprain (38M, 38F; age = 19.5 ± 1.4 years; height = 175.0 ± 10.8 cm; body mass = 71.5 ± 12.7 kg), 44 with a history of recurrent sprains (≥2) (11M, 33F; age = 19.3 ± 1.0 years; height = 170.9 ± 8.7 cm; body mass = 68.3 ± 11.4 kg) and 29 controls with no injury history (16M, 13F; age = 19.5 ± 1.4 years; height = 173.2 ± 10.9 cm; body mass = 73.0 ± 14.8 kg) were included. Athletes with a current injury or history of surgery were excluded.

Interventions Participants completed a self-reported injury history questionnaire and the FABQ. A Kruskal-Wallis test was used to compare FABQ scores across groups. Mann-Whitney U tests were performed to determine where group differences occurred. Alpha was set at p ≤ 0.05 for all analyses. Z-values were used to estimate non-parametric effect sizes (ES) and interpreted as small (0.10–0.29), medium (0.30–0.49), and large (≥ 0.50).

Main outcome measurements The dependent variable was FABQ score. The FABQ is a 16-item injury-related fear scale. FABQ scores range from 0–66 with higher scores representing elevated fear.

Results Group differences were detected for FABQ score (p = 0.002). Athletes with recurrent ankle sprains (41.4 ± 23.4) reported elevated levels of fear compared to those with a single sprain (31.8 ± 21.8, p = 0.03, ES = 0.20) and healthy controls (20.3 ± 21.3, p < 0.01, ES = 0.39). Athletes with a single sprain reported increased fear compared to healthy controls  (p = 0.02, ES = 0.23).

Conclusions Collegiate athletes with any history of ankle sprain exhibited elevated levels of fear compared to healthy controls. These findings suggest that ankle sprains in general may elevate injury-related fear but those with a history of recurrent sprains appear to be more vulnerable. Accordingly, fear should be addressed during rehabilitation.