Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: A Prospective Cohort Analysis.
Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, and Delahunt E. Am J Sports Med. 2016; [Epub ahead of print].
Take Home Message: Following a first-time lateral ankle sprain, a patient who was unable to complete the single-leg drop landing and drop vertical jump at 2 weeks post injury was more likely to be classified as having chronic ankle instability. Patient-reported outcomes at 6 months was also associated with onset of chronic ankle instability.
Lateral ankle sprains are a common injury in sports and are the gateway to chronic ankle instability. No study has tracked people after their first lateral ankle sprain to identify early motor control impairments that may predict chronic ankle instability. By finding ways to identify patients who may be susceptible to chronic ankle instability, clinicians can begin to develop effective interventions that could halt the progression of chronic ankle instability. Therefore, Doherty and colleagues completed a cohort study of people with a first time lateral ankle sprain to identify motor control deficits that predict chronic ankle stability. Eighty-two (54 male) recreationally active patients who sustained a lateral ankle sprain in the past 2 weeks participated in the current study. The authors evaluated participants 3 times: 2 weeks, 6 month, and 12 months post injury. To assess chronic ankle instability, all patients completed the Cumberland Ankle Instability Tool and the activities of daily living and sport subscale of the Foot and Ankle Ability Measure. The authors classified participants with chronic ankle instability at the 12-month visit. Patients also completed 5 movement tasks: single-limb stance (eyes open and eyes closed), Star Excursion Balance Test (anterior, posterolateral, and posteromedial reach), single-leg drop landing, drop vertical jump and walking gait). The authors assessed range of motion and force plate data (for example, center of pressure or ground reaction force). Of the 70 patients who completed all follow-ups, 28 (40%) were categorized as having chronic ankle instability. At 2 weeks, a patient who was unable to complete the single-leg drop landing and drop vertical jump were more likely to develop chronic ankle instability. At 6 months, a participant who reported lower levels of activities of daily living on the Foot and Ankle Ability Measure and who had altered joint positions in the sagittal plane during the Star Excursion Balance Test were more likely to develop chronic ankle instability.
Overall, the data presented in this study suggests that there are early findings that may warn us about people at risk for chronic ankle instability following a patient’s initial lateral ankle sprain. If these findings are confirmed, clinicians could identify patients who may be susceptible to chronic ankle instability and begin to intervene as early as possible to mitigate motor control deficits. Specifically, the authors found that the inability to perform single-leg drop landing and drop vertical jump at 2 weeks was key as was patient-reported function during activities of daily living. This highlights the importance of using patient-reported outcomes in our assessments. Future research should focus on identifying the best possible rehabilitative methods of negating or reversing the onsets of chronic ankle instability. This can potentially lead to clinicians screening first time lateral ankle sprain patients within the first 2 weeks of injury and implementing a rehabilitation program, which would best suit the needs of that particular patient to avoid long-term deficits. Until this future research can be done, clinicians should consider using patient-reported outcomes and assess a patient’s ability to perform the two functional tasks to screen for potential risk of chronic ankle instability.
Questions for Discussion: Do you currently use any methods which you believe help identify patients who may be at risk for chronic ankle instability? Do you utilize any screening tools which were used in this study in your current practice?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Kinesiology Tape or Placebo Tape? The Effects of Tape Application on Balance Measurements in Chronic Ankle Instability SubjectsDoherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, & Delahunt E (2016). Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. The American Journal of Sports Medicine PMID: 26912285