Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Phillip Gribble

Second Advisor

Dr. Richard Andreatta


Lateral ankle sprain (LAS) is among the most common lower limb musculoskeletal injuries impacting both the general and sport populations. Even more problematic is that approximately 70% of individuals who sustain an LAS develop residual deficits. Of that subgroup, roughly 40% develop chronic ankle instability (CAI). Chronic ankle instability is a clinical diagnosis defined by the presence of ongoing impairments following the initial LAS which may include perceived instability, pain, mechanical instability, and episodes of giving way during physical activity. Not all who sustain multiple ankle sprains or experience residual deficits fit the clinical diagnosis criteria for CAI; yet may still experience impairments and functional limitations due to their history of LAS. Furthermore, individuals with history of LAS consistently self report increased levels of injury-related fear, increased fear of re-injury, chronic bouts of re-injury, and exhibit decreased function, all of which negatively impact health-related quality of life (HRQL). Additionally, the presence of injury-related fear, as well as having a history of ligamentous injury are known to induce neuroplastic cortical changes. The neuroplastic changes associated with ligamentous injury combined with the presence of injury-related fear may be responsible for creating competition within the neural circuitry. This competition may potentially disrupt a person with history of LAS’s situational awareness by occupying their attention with fear or anxiety, thus diverting their attention from the task at hand. This disruption may impact the cognitive motor planning necessary to regulate a desired neuromuscular response, potentially contributing to a negative outcome like experiencing re-injury of the ankle joint. While an abundance of research has been performed in the anterior cruciate ligament (ACL) community, it is currently unknown whether injury-related fear is associated with maladaptive neuroplastic adaptations in those with history of LAS. Additionally, it is unknown whether these individuals exhibit altered neurophysiological responses as compared to uninjured-matched controls due to the presence of injury-related fear. The purpose of this dissertation was to further investigate the psychological and neurophysiological outcomes in those with history of LAS. The purposes of these studies were to summarize the patient-reported outcomes (PROs) utilized to quantify psychological health in those with a history of LAS compared to uninjured-controls and examine the effect of ankle injury on psychological health and to examine the presence of neurophysiological adaptations following LAS and their relationship to neurocognitive performance and functional outcomes. The results of these studies indicate that individuals with history of LAS have increased levels of injury-related fear and decreased psychological health, as well as neurophysiological adaptations that may be negatively impacting functional performance outcomes, as compared to uninjured-matched controls. These results objectively elucidate the presence of non-musculoskeletal impairments associated with LAS.

Digital Object Identifier (DOI)

Funding Information

1. Source: Award from the Endowed University Professor in Health Sciences at University of Kentucky

Title: Examining Physiological Responses to Injury-Related Fear and Anxiety in Female Young Adults with History of Lateral Ankle Sprain

Period: 2021; Amount $1441

2.SEATA Doctoral Student Research Grant Source: Southeast Athletic Trainers’ Association (SEATA)

Title: The Impact of Emotion Regulation on Neurocognitive Physical Task Performance in Female Young Adults with History of Lateral Ankle Sprain

Period: 04/2021 – 04/2022; Amount: $2,500