Document Type


Publication Date




Publication Title

Journal of Athletic Training


Article in Press





Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI.


To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI.


Cross-Sectional Study


Anonymous online survey

Patients or Other Participants:

A total of 259 people, recruited via e-mail and social media, with a history of ankle sprain completed the survey; of those, 126 participants (age=32.69±4.38, female=84.92%, highly active=73.81%) were identified to have CAI and were included in the analysis.

Main Outcome Measure(s):

Demographics included gender identity, age, and physical activity level. Assessments encompassed the Identification of Functional Ankle Instability (instability), the Pain Catastrophizing Scale (pain catastrophizing), the Tampa Scale of Kinesiophobia-11 (injury-related fear), a numeric pain rating scale and activity-based question (pain presence), the Quick-FAAM (ankle function), and the modified Disablement in the Physically Active Scale (disability). Relationships between variables were explored through correlation and regression analyses.


After controlling for instability and pain, pain catastrophizing and injury-related fear were significantly related to function and disability ratings in individuals with CAI. Together, the variables predicted 48.7% (P<.001) variance in function and 44.2% (P<.001) variance in disability.


Greater instability, pain, greater pain catastrophizing, and greater injury-related fear were predictive of decreased function and greater disability in those with CAI. This is consistent with the hypothesized relationships in the Fear-Avoidance Model, although further investigation is needed to determine causality of these factors in the development of CAI.


© by the National Athletic Trainers’ Association, Inc. All rights reserved.

Included with the kind written permission of the copyright holder.


0000-0003-3171-9141 (Cavallario), 0000-0003-2737-0186 (Martinez),

Original Publication Citation

Suttmiller, A. M. B., Cavallario, J. M., Baez, S. E., Martinez, J. C., & McCann, R. S. (2022). Perceived instability, pain, and psychological factors predict function and disability in individuals with chronic ankle instability. Journal of Athletic Training, 1-26.