Research Article: Physical activity levels among rural adolescents with a history of ankle sprain and chronic ankle instability

Date Published: April 30, 2019

Publisher: Public Library of Science

Author(s): Brittany Holland, Alan R. Needle, Rebecca A. Battista, Stephanie T. West, Richard W. Christiana, Kelly Naugle.


Ankle sprains and their common sequalae are thought to negatively affect physical activity levels and health-related quality of life among active populations, but limited evidence has described this among younger populations. This study aimed to determine the prevalence rate of ankle sprain and chronic ankle instability among rural adolescents and subsequently compare their physical activity levels based on ankle injury status. The study was conducted in a rural high school in North Carolina. High school students completed an online survey that assessed ankle injury history, perception of ankle instability and function, and physical activity. Respondents were categorized into one of four groups based on ankle injury history and complaints of instability: 1) uninjured (no history of injury); 2) unstable (history of injury >1 year and recurrent instability); 3) copers (history of injury >1 year and no recurrent instability); and 4) potentially unstable (injury within the past year). Frequency of physical activity was compared across groups using analysis of variance, Kruskall-Wallis test (α = 0.05), and responses to activity type were assessed using chi-square. Physical activity was found to differ significantly between the four groups (χ42=11.65,p<0.01,ηp2=.07) with unstable respondents reporting more physical activity than uninjured respondents (unstable = 4706.05 ± 4610.56 MET-minutes/week; uninjured = 2592.93 ± 2946.02 MET-minutes/week). No differences were found between other groups. Despite injury history and sensations of instability, respondents with chronic ankle instability reported greater physical activity levels than uninjured participants. As this is contrary to pre-existing hypotheses, it is possible that continued physical activity after injury among adolescents may contribute to deleterious outcomes such as increased frequency of chronic instability.

Partial Text

Physical activity (PA) behaviors develop through sports and recreation during childhood and decline with age beginning in adolescence [1, 2]. This trend, which can lead to increased health risks, is particularly prevalent among girls [3]. Given the association between PA and decreased risk of all-cause mortality, heart disease, obesity, asthma, and certain types of cancer [4–6], it is important to be able to identify factors, such as musculoskeletal injuries, that may contribute to long-term decreases in PA. Persistent pain, sensations of joint instability, and decrements in strength and proprioceptive acuity have the potential to interfere with individuals’ desire to participate in PA and recreational activities [7, 8].

Table 1 displays the demographic characteristics of the participants. The mean age of participants was 15.8 ± 1.2 years. Sixty percent of the participants were girls and 94% were white. The highest level of education that parents of participants have attained indicate that participants were from mostly well-educated families with over 70% having a college degree.

The present study aimed to quantify prevalence rates of ankle injury among an adolescent population and to determine if differences existed in the type and amount of PA performed across groups with varying levels of ankle injury. Despite the younger age of our respondents, the prevalence rates of ankle injury in this rural adolescent population were similar to those previously reported in collegiate and general populations [12, 13]. When comparing PA levels and type, our findings refuted our a priori hypotheses as respondents with CAI participated in more self-reported PA than uninjured respondents. These data provide valuable insight as to potential risk factors for development of CAI after injury and probable effects on lifelong PA.

The findings of this study indicate that ankle injury rates among a rural adolescent population are similar to those reported among collegiate athletes and the general population, with nearly 60 percent of individuals having experienced an ankle sprain, and 30 percent reporting symptoms of CAI. Surprisingly, and contrary to previous reports, participants with CAI had higher levels of PA, indicating that this population may have further increased exposure to subsequent injury that elucidate the symptoms of CAI. Future research should prospectively investigate changes in PA levels after initial ankle injuries to determine how participation in subsequent PA increases or decreases risk of injury and subsequent instability in these populations and throughout age.




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