The Relationship Between Perception Of Ankle Instability And Dynamic Balance In Individuals With A History Of Ankle Sprains

Abstract

PURPOSE: Ankle sprains are common injuries which can progress to chronic ankle instability (CAI) and balance impairments. While objective data guide treatment for individuals with CAI, the patient’s subjective experience is often overlooked and not counted in the adoption of plan of care. Individual perception of ankle instability is an important factor and has the potential to influence presentation of sensorimotor impairments either through neuromotor or fear-avoidance mechanisms. The purpose of this study was to explore the contribution of perception of unilateral and bilateral CAI on a dynamic balance test. METHODS: Subjects were males and females 18-35 years old (n=25, age= 23.8 ± 1.8 yr.). All subjects completed the Cumberland Ankle Instability Tool (CAIT) to measure perceived ankle instability (lower CAIT scores are associated with greater perceived instability). Dynamic balance was assessed using 3 repetitions in each direction (anterior, postero-medial, and postero-lateral) of the Y-Balance Test (YBT). Asymmetries in CAIT scores and reach distances were calculated by subtracting right leg values from left leg values. Further comparisons were analyzed between groups of bilaterally highest (>80%) and lowest (<20%) combined CAIT scores. RESULTS: There was a significant positive moderate correlation between CAIT asymmetries and asymmetries in the anterior reach (r=0.526, p=0.007) and the posteromedial reach scores (r= 0.554, p=0.004). Significant differences were found between participants with the highest (n=5) and lowest (n=5) bilateral CAIT scores in right posteromedial reach (101.60 ± 9.91 vs 86.80 ± 5.89, p=0.02), right posterolateral reach (96.40 ± 7.70 vs 76.80 ± 4.87, p=0.001), and right composite score (89.96 ± 5.93 vs 78.44 ± 3.85, p=0.007). CONCLUSION: Subjects reporting increased perceived ankle instability demonstrated decreased YBT performance on the side of perceived instability. Decreased reach distances may be attributable to neuromuscular consequences of ankle injury, changes in movement strategy associated with apprehension, or both. In fact, the larger the perceived asymmetries the greater the performance deficits. These findings may help clinicians contextualize sensorimotor assessment results in patients with a history of ankle sprain.