Date of Award

Summer 2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Rehabilitation Sciences


Kinesiology and Rehabilitation

Committee Director

Ryan S. McCann

Committee Member

Julie Cavallario

Committee Member

Jessica Martinez

Committee Member

Shelby Baez


About 40% of individuals who suffer a lateral ankle sprain develop chronic ankle instability (CAI). The mechanisms for developing CAI is believed to be multi-factorial, however, most literature has focused on the physical manifestations of the condition, leaving our understanding of psychological manifestations of the condition fairly unclear. Injury-related fear has been identified as a psychological factor that may be relevant to the condition, but our understanding is limited. Therefore, the purpose of this dissertation was to better understand injury-related fear in patients with CAI through three studies.

The first study systematically reviewed the literature to understand differences in injury-related fear between individuals with and without CAI. We found those who develop CAI report higher levels of injury-related fear compared to those who fully recover after their ankle sprain and to those without a history of one. Therefore, injury-related fear is a psychological factor that likely contributes to chronicity after ankle sprain.

The Fear-Avoidance Model (FAM) is a theoretical framework hypothesizing a relationship between injury-related fear and chronicity and disability, and so the second study used the FAM framework to understand the relationships between FAM components and function and disability in individuals with CAI. We found that beyond symptoms of instability and pain, greater pain catastrophizing and injury-related fear significantly predicted lower function and greater disability. This relationship necessitates a better understanding of these fears so that reduction strategies can be used to enhance patient outcomes.

Therefore, the third study explored perceptions and experiences of injury-related fear in individuals with CAI. Our participants described injury experiences along susceptibility and severity contributed to the magnitude and generalizability of injury-related fears and subsequent activity behaviors. Patient goals, values, and attitudes toward their condition and physical activity likely contribute to the impact of these fears and the condition on quality of life. Therefore, beyond identifying injury-related fear after ankle injury, clinicians should engage in patient discussions to understand patients’ injury-related fears, values, and goals to create individualized care plans that can best enhance their quality of life.


In Copyright. URI: This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).