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Ankle sprains are common sports injuries. Although often perceived as innocuous, large proportions of patients develop a cluster of persistent symptoms, termed chronic ankle instability (CAI). In 1965, Freeman1 first described a clinical paradox whereby poor recovery after ankle sprain (characterised by feelings of ‘giving way’) was reported in both the presence and absence of mechanical instability (MI). Since then, researchers have tried to explain this anomaly using original research, theoretical frameworks and multicomponent aetiological models for CAI. In this editorial, we discuss perennial and fundamental shortcomings in the evidence base, that continue to limit our understanding of CAI causation.
Most original research examining CAI aetiology is case-controlled. While this is both practical and cost-saving, its data can only ‘explain’ CAI aetiology after the fact. Few studies have prospectively tracked recovery post ankle sprain,2 3 with even fewer prognostic factors emerging. As a result, the content of aetiological models in this field1 4 5 is either theoretical or driven primarily by cross-sectional data. An inevitable consequence is an …
Contributors CB, JW and FN-W were involved in the concept, design and writing. All authors were involved in final submission and revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.