Athletes with Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs

MN, Hoch JM, & Hoch MC. J Sport
2017; Epub ahead of print Jun 12 : 1-16.  
Take Home Message: An athlete with a history of ankle sprain
typically has higher fear avoidance beliefs than an athlete without a history
of ankle sprain.  This is worse for an athlete
with a history of multiple sprains.
After an ankle sprain – one of the
most common injuries in athletic participation – there are sometimes
complications including chronic instability and fear of reinjury, which may
result in avoidance and possibly functional detriments.  There has been some research with conflicting
findings on fear avoidance and kinesiophobia after ankle sprain.  Therefore, the authors investigated if
athletes with a history of single or recurrent ankle sprains had greater fear
avoidance beliefs than athletes without a history of an ankle sprain.  They investigated 147 total collegiate athletes
with no history of surgery from 3 NCAA universities; 75 with a history of a
single ankle sprain, 44 with recurrent sprains, and 28 without any ankle sprain
history.  Theauthors administered the 16-item Fear Avoidance Belief Questionnaire (FABQ) to
all athletes to assess their perceptions of fear and modified behaviors.  The authors found that an athlete with a history
of recurrent ankle sprains typically had higher fear avoidance beliefs than an athlete
with a single sprain or no ankle sprain history.  Also, an athlete with a single sprain history
on average had higher fear avoidance beliefs than an athlete without a sprain
Athletes who have an ankle sprain
history report more fear avoidance beliefs than those without a history, and
there is greater fear avoidance among athletes with a history of multiple ankle
sprains.  This highlights an area that
should be addressed in rehabilitation. 
While an athlete may appear to be performing well functionally, they may
have perceptions of fear that need to be addressed.  This may include adopting a slower
progression to return to sport, more sport-specific activities with goal
setting to build confidence, or modifying their activities to assist in coping
with their fear.  Other strategies may
include reflection, imagery, and relaxation techniques.  In extreme cases, it may warrant the need for
referral to a sport psychologist.  There
have been a couple of postings on Sports Med Res (see below) recently covering
research that has investigated former collegiate athletes.  Former athletes were recently reported to
have had poorer overall health than non-athletes, suspected partly due to their
history of injury.  It would be
interesting to continue to follow the group of athletes researched in this
article after they are done competitive play. 
It would also be interesting to investigate former athletes and whether
they have higher fear avoidance beliefs which may play a role in their poorer
physical health.  In the short-term, we
need to make sure that we are assessing patient perception of their health in
efforts to individualize rehabilitation to their specific needs – both
physically and mentally.
for Discussion:  Do you currently utilize
any psychosocial surveys when rehabilitating a patient?  What strategies do you find to be successful
in attempting to reduce fear/anxiety when dealing with injuries?
by: Nicole Cattano
by: Jeffrey Driban