Editorial: Neuromuscular and Biomechanical AlteraƟons in Chronic Ankle Instability

Kevin Deschamps^1*Luciana Labanca²Giovanni Matricali¹

• ¹KU Leuven, Leuven, Belgium
• ²IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

Chronic ankle instability (CAI) is one of the most common long-term sequelae of lateral ankle sprains, which themselves represent the most frequent musculoskeletal injury in sport and physical ac vity (Gribble et al 2016). Epidemiological evidence suggests that up to 40% of individuals who sustain a first-me lateral ankle sprain will go on to develop CAI, characterized by recurrent sprains, frequent "giving-way" episodes, and persistent symptoms such as pain, swelling, weakness, and reduced func on (Gribble et al 2014, Wikstrom et la 2014).Recent conceptual advances, par cularly the updated model proposed by Hertel and colleagues, highlight CAI as a mul factorial condi on resul ng from the interac on of pathomechanical insufficiencies (e.g., ligament laxity, arthrokinema c restric ons), sensoryperceptual impairments (e.g., propriocep ve errors, altered somatosensa on, pain, kinesiophobia), and motor-behavioral altera (e.g., delayed neuromuscular responses, abnormal gait and landing mechanics) (Hertel et al 2019). This framework is situated within a biopsychosocial model, recognizing that personal and environmental factors, along with selforganiza on and percep on-ac on cycles, contribute to each pa ent's unique clinical outcome. Importantly, this heterogeneity underscores the need for individualized assessment and rehabilita on strategies.The Research Topic Neuromuscular and Biomechanical Altera ons in Chronic Ankle Instability was launched to advance understanding of these mechanisms, bridge the gap between laboratory findings and clinical applica ons, and s mulate novel approaches to preven on and rehabilita on. The five ar cles in this collec on offer diverse and complementary perspec ves-ranging from mechanis c insights into sensorimotor control, to biomechanical assessments of func onal movements, to applied strategies for rehabilita on. Collec vely, they underscore the importance of a mul dimensional approach to CAI that integrates neurophysiology, biomechanics, and clinical prac ce. In their study, Chang et al. (2025) examined the effects of combining acupuncture with strength training in college students with chronic ankle instability. Over an 8-week program, par cipants receiving both interven ons demonstrated greater improvements in balance, muscle strength, and ankle kinesthe c sensa on compared to those performing strength training alone. While both groups improved CAIT scores and ankle func on, the addi on of acupuncture enhanced dorsiflexion and plantar flexion strength as well as anterior-posterior balance control. The authors a ribute these benefits to acupuncture's role in promo ng circula on, neural regula on, and ssue repair. These findings suggest that integra ng with conven onal rehabilita on may offer a more comprehensive and effec ve strategy for managing CAI.Shao and colleagues introduced the Ankle Inversion Discrimina on Apparatus-Walking (AIDAW) as a novel tool for assessing ankle propriocep on during walking in individuals with chronic ankle instability (CAI) (Shao et al 2025). The device demonstrated good test-retest reliability and effec vely dis nguished between CAI and healthy par cipants. AIDAW scores were moderately correlated with both the Y Balance Test and the Cumberland Ankle Instability Tool, linking propriocep ve discrimina on to func onal balance and perceived instability. By providing ecologically valid assessments of ankle func on during walking, AIDAW seems to address a cri cal gap in current prac ce. These findings highlight its poten al for monitoring rehabilita on outcomes and guiding interven ons that target propriocep ve deficits in CAI.Altered balance and gait is another hallmark of CAI. Decker et al. ( 2025) assessed whether individuals with chronic ankle instability differ from uninjured controls in their ability to maintain balance and adapt gait when exposed to progressively challenging sensory perturba ons using the Sensory Organiza on Test and the Locomotor Sensory Organiza on Test (LSOT). The findings seem to point towards adapta on to sensory challenges in a manner similar to uninjured peers, sugges ng that standard SOT and LSOT protocols may not be sensi ve enough to capture CAI-specific deficits. This highlights the need for more demanding, ecologically valid balance and gait assessments to advance both research and clinical evalua on of CAI.In the fourth ar cle, et al. 2025 examined how dance training and chronic ankle instability (CAI) affect postural control and visual reliance. Individuals with CAI showed poorer sta c balance, par cularly without visual input, while dancers-regardless of CAI statusdemonstrated greater reliance on vision than non-dancers. No significant group differences were observed in dynamic postural control during landing tasks. The findings suggest that dance training may foster compensatory strategies based on vision, which can become a limita on when visual feedback is absent. The authors recommend that assessments of postural control should dis nguish between somatosensory dependence and visual reliance.Finally, the study of Peters Dickie et al (2025) inves gated how a history of lateral ankle sprains (LAS) and chronic ankle instability (CAI) influence gait biomechanics in runners. While individuals with CAI and acute LAS reported greater perceived instability and reduced selfreported func on, tradi onal biomechanical analyses at comfortable running speeds did not reveal significant group differences, sugges ng adap ve strategies that mask deficits. In contrast, walking assessments highlighted altered mechanical work recovery in copers, poin ng to subtle compensatory mechanisms. The findings emphasize the importance of integra ng self-reported outcomes into clinical assessments, as subjec ve deficits may not be detected through standard biomechanical tes ng. Clinically, the results support the safe reintroduc on of running during rehabilita on while also underscoring the need for more sensi ve and challenging biomechanical assessments to uncover hidden impairments. The ar cles collected within this Research Topic underscore the mul factorial and heterogeneous nature of chronic ankle instability. By examining novel rehabilita on strategies, advancing propriocep ve assessment tools, and characterizing adapta ons in balance and gait across different popula ons, these contribu ons collec vely extend the current understanding of neuromechanical altera ons associated with the condi on. A recurring theme across the studies is the importance of ecologically valid assessments and the integra on of pa ent-reported outcomes to capture deficits that may not be evident through tradi onal measures. These insights highlight the need for individualized and mul dimensional rehabilita on approaches that address both central and peripheral mechanisms of dysfunc on. To achieve this, mul disciplinary collabora on of (para-)medical specialists in rehabilita on, physiotherapy, orthopaedics, human movement science and social sciences is mandatory. Therefore, future progress will depend on sustained interdisciplinary collabora on, with the aim of transla ng not only mechanis c knowledge into more effec ve strategies to prevent reinjury, op mize func on, and improve long-term health outcomes in individuals with chronic ankle instability.