Author Requirements/Preferences: Ji Yeon Choi is a PhD student in the Department of Biomechanics and Kinesiology at The University of Nebraska at Omaha and certified AT. She has extensive background working with ankle injury extending from her education, research, and clinical experience.

The effects of kinesiophobia on postural controls with chronic ankle instability

Seunguk Han, Minsub Oh, Hyunwook Lee, Jon Tyson Hopkins

Take-to-the-clinic message: CAI patients with kinesiophobia rely more on visual feedback for static balance and show reduced performance in dynamic balance compared to those without kinesiophobia and controls. Clinicians should address both psychological and physical factors in rehab programs.

Background: Following ankle injuries, patients with chronic ankle instability (CAI) may develop kinesiophobia, which is characterized as an injury-related fear that occurs during physical activity and movement.¹ Although the influence of kinsiophobia in patients with CAI is unknown.² 

Purpose: The purpose of this study was to examine the impact of kinesiophobia on static and dynamic balance within a CAI population.

Methods: Seventy patients were recruited for this study, 25 with kinesiophobia (CAI-K), 25 without kinesiophobia (CAI-N), and 20 controls. Inclusion criteria for CAI are consistent with the guidelines of the International Ankle Consortium.³ Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK-17), with a score of 37 or higher indicating the presence of kinesiophobia.⁴ Static balance was measured using force plate. All participants performed a single-leg balance test with eyes open (EO) and eyes closed (EC). Participants performed the Y-balance test (YBT) for dynamic balance with EO. Romberg ratios were calculated as EC/EO and used for statistical analysis.

Results: There were no significant differences on the static balance among three groups. However, the CAI-K group showed a greater Romberg ratio in the mediolateral direction during static balance compared to CAI-N and control groups. On dynamic balance, the CAI-K group demonstrated less reaching distance in the anterior direction compared to CAI-N and control groups during YBT.

Rolling the field forward: This study found that CAI patients with kinesiophobia demonstrated increased visual reliance during static postural control in the ML direction and reduced reaching distance in the anterior direction during YBT compared to CAI patients without kinesiophobia and control groups. This study provides an approach for preventing further lateral ankle sprain for the CAI population by integrating both psychological and physical elements into rehabilitation programs.

Question for the researchers: What interventions would be beneficial for CAI patients with kinesiophobia? Given that kinesiophobia can occur in individuals with various musculoskeletal injuries, are there specific interventions that would be particularly effective for addressing patients with ankle injuries?

References

1. Larsson C, Ekvall Hansson E, Sundquist K, Jakobsson U. Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain. BMC Geriatr. 2016;16:128. Published 2016 Jul 7. doi:10.1186/s12877-016-0302-6
2. Devecchi V, Alalawi A, Liew B, Falla D. A network analysis reveals the interaction between fear and physical features in people with neck pain. Sci Rep. 2022;12(1):11304. Published 2022 Jul 4. doi:10.1038/s41598-022-14696-8
3. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2013;43(8):585-591. doi:10.2519/jospt.2013.0303
4. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554-559. doi:10.1136/bjsports-2017-098673