Fear Avoidance Beliefs in College Athletes with a History of Ankle Sprain.

Fukano M, Mineta S, Hirose N. Int J Sports Med. Jan, 2020. DOI: 10.1055/a-1065-1940

Take-Home Message

A female athlete with greater ankle joint laxity after an ankle sprain is more likely to report a greater fear of movement/reinjury than their peers, even though they may not report functional instability.


Many patients experience a fear of movement or reinjury (kinesiophobia) during recovery from a musculoskeletal injury. Clinicians should try to address this fear to help restore a patient’s confidence and promote a safe and successful return to sport participation. Unfortunately, we know little about the relationship between fear of reinjury and reported instability and pathological ankle laxity after an ankle sprain. The authors conducted a cross-sectional study to examine if fear of movement/reinjury differed among people with and without functional ankle instability and healthy participants. They also assessed if fear and ankle joint laxity related differently among males or females. The authors collected complete data from 168 athletes (89 females). All participants reported to a laboratory to complete the Identification of Functional Ankle Instability (IdFAI), the Tampa Scale of Kinesiophobia, and the Athlete Fear Avoidance Questionnaire. The authors measured ankle inversion laxity with an ankle arthrometer. The authors divided the participants into 3 groups: 1) control (no previous ankle sprain), 2) functional instability (IdFAI ≥ 11 and previous ankle sprain), or 3) no functional instability (IdFAI ≤ 10 and previous ankle sprain). Ninety-five participants (51 female) classified as functional instability, 50 participants (25 female) classified as no functional instability, and 23 served as controls (13 females). The functional instability group (males and females) had more fear of movement/reinjury (based on both questionnaires) compared to the no functional instability group. Among females with a history of ankle sprains, especially those without functional instability, the fear of movement and reinjury correlated with their ankle inversion laxity. Specifically, a female with a history of an ankle sprain with more ankle inversion laxity typically reported more fear than their peers.


Fear of movement and re-injury may be heightened immediately after an injury or upon initial return to participation. However, these fears may subside as patients complete proper rehabilitation and return to competition without feelings of instability. Although the authors omitted the time since previous ankle sprains, female participants still reported high levels of fear of movement/reinjury and presented with higher ankle joint laxity compared to the male participants. Based on these findings alone, we should avoid suggesting that ankle laxity contributes to fear of movement/reinjury or that fear of movement/injury may contribute to functional ankle instability (or vice versa). Regardless, these findings highlight the importance of asking a patient about their fear of movement/reinjury to assess the patient’s mental and physical wellbeing. We should also acknowledge that the control group also reported high levels of fear. Although the authors excluded controls with an injury in the prior 6 months, a complete injury history in this cohort is unknown, which may be driving the high reports of kinesiophobia in this subgroup. In conclusion, clinicians should identify the psychosocial needs of their patients (e.g., fear of reinjury) after an injury as well as before and after full return to activity. These assessments may help clinicians identify patients that need psychological treatment to promote a safe and successful return to activity.

Questions for Discussion

Do you ask patients about their fear of reinjury before return to sport after an ankle sprain? How do you address a patient’s kinesiophobia after ankle sprains?

Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban

Related Posts

Athletes’ Ankle Sprain Fears
Identifying Risk of Persistent Symptoms Following Acute Musculoskeletal Injury
To Move or Not to Move: Kinesiophobia in the ACL Deficient Patient Before and After Reconstruction

7 evidence-based practice courses