Sports Medicine Research: In the Lab & In the Field: Ain’t no Half Stepping - Students with Chronic Ankle Instability are Less Active (Sports Med Res)
Wednesday, September 2, 2015

Ain’t no Half Stepping - Students with Chronic Ankle Instability are Less Active

Physical Activity Levels in College Students With Chronic Ankle Instability

Hubbard-Turner T & Turner TJ. J Athl Train. 2015; 50(7): 742-747.

Take Home Message: College students with chronic ankle instability have lower activity levels and more symptoms than healthy students.  Activity levels appear to be related to the amount of ankle laxity.

Ankle sprains, one of the most common orthopedic injuries, can cause chronic ankle instability (CAI), which can result in long-term pain, instability, and potentially decreased quality of life.  Individuals with CAI report lower function and more symptoms, but it is unknown if these findings translate into functional differences.  The authors of this study compared total weekly steps between 40 college students with CAI and healthy control students. The authors also tested whether physical activity level (steps) was associated with ankle laxity.  Students completed the Foot and Ankle Ability Measure survey and the International Physical Activity Questionnaire to assess physical function and types/intensity of activity levels, respectively.  Ankle laxity in anterior-posterior and inversion-eversion was assessed by the investigators through use of an ankle arthrometer. Students were given pedometers to record their daily step count in logs over the course of 1 week.   CAI participants had overall lower activity levels based on lower step counts, moderate activity level time, vigorous activity level time, and metabolic equivalents in comparison to healthy controls.  There were negative correlations between ankle laxity measures and total daily step count, which means that as laxity increases students tend to be less active. 

This study is important because it is one of the first studies to demonstrate that individuals with CAI are less physically active than healthy controls.  The lower activity levels may be related to objective laxity or subjective symptoms that the CAI participants are experiencing.  It would be interesting to see if treatments that improve symptoms among patients with CAI also result in increases in activity levels.  Research on intervention programs or long-term changes after ankle sprains would provide valuable information about this.  The authors of this study followed physically active college participants over the course of 1 week, but it may be interesting to follow students over longer time periods or to follow college-aged athletes during a competitive season.  As participants recover from an ankle sprain, a thorough rehabilitation program is key to avoiding long-term complications.  As clinicians return to physical activity/function should not be our end goal.  We should also focus on improving a patient’s perceived function and symptoms as well as patient education in efforts to maintain long-term healthy lifestyles.

Questions for Discussion:  Are there any interventions or training programs that you clinically use to improve subjective pain or function after an ankle sprain? 

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Hubbard-Turner, T., & Turner, M. (2015). Physical Activity Levels in College Students With Chronic Ankle Instability Journal of Athletic Training DOI: 10.4085/1062-6050-50.3.05

2 comments:

John J Fraser, PT, MS, OCS said...

Nicole, thank you for your review. I have found that patients who sustain lateral ankle sprains (LAS) often times have midfoot involvement, specifically hypomobility of the lateral midfoot and the 1st tarsometarsal (TMT) articulation. The kinematics of foot adduction/inversion observed in LAS have also been described in the midfoot injury literature, with foot injury often occurring concurrently with LAS (Blakeslee J Am Podiatr Med Assoc. 1987, Søndergaard, Foot Ankle Int. 1996). Clinically, I have observed midfoot impairment both acutely and out to at least 1-year post injury. To address this, I perform joint manipulation of these two joints and have anecdotally observed improved patient reported pain and functional outcomes earlier in the treatment course. I have prepared a clinical commentary/current concepts review manuscript that will be submitted for publication that covers this concept more in detail. The paper also offers the clinician some assessment and treatment techniques to address ankle-foot complex injury. I would appreciate any feedback/anecdotes if and when it is published.

Jeffrey Driban said...

Thanks for the comment John and please keep us posted on when your paper comes out. It sounds like an interesting read.

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