Collegiate Athletes with Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs
Houston MN, Hoch JM, & Hoch MC. J Sport Rehabil. 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.  The authors 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 history.


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.

Questions 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?

Written by: Nicole Cattano

Reviewed by: Jeffrey Driban


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