The Prevalence of Pain in People With Chronic Ankle Instability: A Systematic Review

Abstract

Objective: To identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI.

Data sources: We searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017.

Study selection: Eligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded.

Data extraction: Studies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance.

Data synthesis: Of the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies.

Conclusions: Pain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.

Keywords: ankle injuries; chronic pain; discomfort; joint instability; sprains and strains.

Figure 1

Flow chart of the review process.

Figure 2

Percentage of participants with chronic ankle instability who had pain over time. The graph demonstrates the percentage of pain in participants with chronic ankle instability in 10 different studies over time. The time was calculated from the beginning of ankle sprain in months. Studies were divided according to the method of pain assessment.