Article Text

Download PDFPDF
13 Using a new classification system of posttraumatic ankle instability to quantify levels of neuromuscular and perceived function
  1. M Terada1,
  2. S Bowker2,
  3. CE Hiller3,
  4. AC Thomas4,
  5. B Pietrosimone5,
  6. PA Gribble1
  1. 1Division of Athletic Training, University of Kentucky, USA
  2. 2Kent State University, USA
  3. 3Faculty of Health Sciences University of Sydney, New South Wales, Australia
  4. 4Department of Kinesiology, University of North Carolina at Charlotte, USA
  5. 5Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA


Background Separating chronic ankle instability (CAI) into subgroups based on the major clinical symptoms of CAI, including perceived ankle instability (PI), repeated episodes of “giving-way”, and recurrent ankle sprains (RAS), may create more homogenous subgroups of participants with CAI and could help to identify mechanical, neuromuscular, and psychological characteristics in individuals with CAI.

Objective To determine if selected sensorimotor, mechanical, and self-reported measures are different among PAI subgroups healthy control participants, and PAI-copers.

Design Single-blinded, case-control.

Setting Research laboratory.

Participants Ninety-three participants (40M, 53F; age = 21.81 ± 3.63 years; BMI = 24.94 ± 4.26 kg/m2) volunteered and were categorised into PI in combination with RAS (PI-RAS;  n = 25), PI alone (n = 13), RAS alone (n = 12), PAI-copers  (n = 18), and controls (n = 25).

Interventions Participants completed self-assessed global, regional, and psychological health-related questionnaires and assessments of neuromuscular and mechanical joint stability.

Main outcome measurements Neuromuscular outcomes included spinal reflex excitability of the soleus muscle (Hmax:Mmax ratio) and static postural control assessed with the mean of time-to-boundary minima in the anterior-posterior (TTB-AP) and medial-lateral directions (TTB-ML). For mechanical outcome measures, ankle joint laxity was measured using an ankle arthrometer. Self-reported outcomes included the Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), the FAAM-Sports, the Tampa Scale of Kinesiophobia-17, and Physical and Mental Summary Components of the Short-Form 36. A backward, stepwise, multinomial logistic regression was used to determine the most influential factors to classify group membership. Cohen’s d effect sizes were calculated to determine the magnitude of difference in the most influential factors between groups.

Results Five outcome measures (Hmax:Mmax ratio, TTB-AP, TTB-ML, FAAM-ADL, FAAM-Sports) were the best set of indicators of group membership (χ2 (20) = 128.67, p < 0.001). Participants with PI-RAS demonstrated the greatest neuromuscular and perceived dysfunction.

Conclusions The combination of PI and RAS appears to lead to greater degree of neuromuscular and perceived dysfunction compared to CAI-copers and healthy controls.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.