{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:37:55Z","timestamp":1792791475469,"version":"4.5.0"},"reference-count":64,"publisher":"National Athletic Trainers' Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>The Hertel model of chronic ankle instability (CAI) is commonly used in research but may not be sufficiently comprehensive. Mechanical instability and functional instability are considered part of a continuum, and recurrent sprain occurs when both conditions are present. A modification of the Hertel model is proposed whereby these 3 components can exist independently or in combination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To examine the fit of data from people with CAI to 2 CAI models and to explore whether the different subgroups display impairments when compared with a control group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients or Other Participants:<\/jats:title>\n                    <jats:p>Community-dwelling adults and adolescent dancers were recruited: 137 ankles with ankle sprain for objective 1 and 81 with CAI and 43 controls for objective 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention(s):<\/jats:title>\n                    <jats:p>Two balance tasks and time to recover from an inversion perturbation were assessed to determine if the subgroups demonstrated impairments when compared with a control group (objective 2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s):<\/jats:title>\n                    <jats:p>For objective 1 (fit to the 2 models), outcomes were Cumberland Ankle Instability Tool score, anterior drawer test results, and number of sprains. For objective 2, outcomes were 2 balance tasks (number of foot lifts in 30\u00a0seconds, ability to balance on the ball of the foot) and time to recover from an inversion perturbation. The Cohen d was calculated to compare each subgroup with the control group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 56.5% of ankles (n = 61) fit the Hertel model, whereas all ankles (n = 108) fit the proposed model. In the proposed model, 42.6% of ankles were classified as perceived instability, 30.5% as recurrent sprain and perceived instability, and 26.9% as among the remaining groups. All CAI subgroups performed more poorly on the balance and inversion-perturbation tasks than the control group. Subgroups with perceived instability had greater impairment in single-leg stance, whereas participants with recurrent sprain performed more poorly than the other subgroups when balancing on the ball of the foot. Only individuals with hypomobility appeared unimpaired when recovering from an inversion perturbation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The new model of CAI is supported by the available data. Perceived instability alone and in combination characterized the majority of participants. Several impairments distinguished the sprain groups from the control group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4085\/1062-6050-46.2.133","type":"journal-article","created":{"date-parts":[[2011,3,10]],"date-time":"2011-03-10T12:48:39Z","timestamp":1299761319000},"page":"133-141","source":"Crossref","is-referenced-by-count":293,"title":["Chronic Ankle Instability: Evolution of the Model"],"prefix":"10.4085","volume":"46","author":[{"given":"Claire E.","family":"Hiller","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon L.","family":"Kilbreath","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn M.","family":"Refshauge","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"issue":"1","key":"i1062-6050-46-2-133-Fong1","series-title":"Sports Med","first-page":"73","article-title":"A systematic review on ankle injury and ankle sprain in sports.","volume":"37","author":"Fong, D. T.","year":"2007","unstructured":"Fong, D. T., Y.Hong, L. K.Chan, P. S.Yung, and K. M.Chan. A systematic review on ankle injury and ankle sprain in sports.Sports Med2007. 37 (1):73\u201394."},{"issue":"6","key":"i1062-6050-46-2-133-Bridgman1","series-title":"Emerg Med J","first-page":"508","article-title":"Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains.","volume":"20","author":"Bridgman, S. A.","year":"2003","unstructured":"Bridgman, S. A., D.Clement, A.Downing, G.Walley, I.Phair, and N.Maffulli. 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The etiology and prevention of functional instability of the foot.J Bone Joint Surg Br1965. 47 (4):678\u2013685."},{"issue":"4","key":"i1062-6050-46-2-133-Kaminski1","series-title":"J Athl Train","first-page":"394","article-title":"Factors contributing to chronic ankle instability: a strength perspective.","volume":"37","author":"Kaminski, T. W.","year":"2002","unstructured":"Kaminski, T. W. and H. D.Hartsell. Factors contributing to chronic ankle instability: a strength perspective.J Athl Train2002. 37 (4):394\u2013405."},{"issue":"11","key":"i1062-6050-46-2-133-Garn1","series-title":"Phys Ther","first-page":"1667","article-title":"Kinesthetic awareness in subjects with multiple ankle sprains.","volume":"68","author":"Garn, S. N.","year":"1988","unstructured":"Garn, S. N. and R. A.Newton. 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Peroneal reaction times for diagnosis of functional ankle instability.Foot Ankle Surg2000. 6 (1):31\u201338."},{"key":"i1062-6050-46-2-133-MacAuley1","series-title":"Med Sci Sports Exerc","first-page":"S409","article-title":"Ankle injuries: same joint, different sports.","volume":"31","author":"MacAuley, D.","year":"1999","unstructured":"MacAuley, D.\n          \n          Ankle injuries: same joint, different sports.\n          Med Sci Sports Exerc\n          1999. 31:S409\u2013S411."},{"issue":"5","key":"i1062-6050-46-2-133-Wester1","series-title":"J Orthop Sports Phys Ther","first-page":"332","article-title":"Wobble board training after partial sprains of lateral ligaments of the ankle: a prospective randomised study.","volume":"23","author":"Wester, J. U.","year":"1996","unstructured":"Wester, J. U., S. M.Jespersen, K. D.Nielsen, and L.Neumann. Wobble board training after partial sprains of lateral ligaments of the ankle: a prospective randomised study.J Orthop Sports Phys Ther1996. 23 (5):332\u2013336."},{"issue":"3","key":"i1062-6050-46-2-133-Konradsen5","series-title":"Int J Sports Med","first-page":"290","article-title":"Prolonged peroneal reaction time in ankle instability.","volume":"12","author":"Konradsen, L.","year":"1991","unstructured":"Konradsen, L. and J. B.Ravn. Prolonged peroneal reaction time in ankle instability.Int J Sports Med1991. 12 (3):290\u2013292."},{"issue":"4","key":"i1062-6050-46-2-133-Hiller1","series-title":"Clin J Sport Med","first-page":"269","article-title":"Balance and recovery from a perturbation are impaired in people with functional ankle instability.","volume":"17","author":"Hiller, C. E.","year":"2007","unstructured":"Hiller, C. E., K. M.Refshauge, R. D.Herbert, and S. L.Kilbreath. Balance and recovery from a perturbation are impaired in people with functional ankle instability.Clin J Sport Med2007. 17 (4):269\u2013275."},{"issue":"1","key":"i1062-6050-46-2-133-Hiller2","series-title":"Clin J Sport Med","first-page":"44","article-title":"Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study.","volume":"18","author":"Hiller, C. E.","year":"2008","unstructured":"Hiller, C. E., K. M.Refshauge, R. D.Herbert, and S. L.Kilbreath. Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study.Clin J Sport Med2008. 18 (1):44\u201348."},{"issue":"9","key":"i1062-6050-46-2-133-Hiller3","series-title":"Arch Phys Med Rehabil","first-page":"1235","article-title":"The Cumberland ankle instability tool: a report of validity and reliability testing.","volume":"87","author":"Hiller, C. E.","year":"2006","unstructured":"Hiller, C. E., K. M.Refshauge, A. C.Bundy, R. D.Herbert, and S. L.Kilbreath. The Cumberland ankle instability tool: a report of validity and reliability testing.Arch Phys Med Rehabil2006. 87 (9):1235\u20131241."},{"issue":"4","key":"i1062-6050-46-2-133-Hubbard2","series-title":"J Athl Train","first-page":"481","article-title":"Kinesthesia is not affected by functional ankle instability status.","volume":"37","author":"Hubbard, T. J.","year":"2002","unstructured":"Hubbard, T. J. and T. W.Kaminski. Kinesthesia is not affected by functional ankle instability status.J Athl Train2002. 37 (4):481\u2013486."},{"issue":"8","key":"i1062-6050-46-2-133-Rozzi1","series-title":"J Orthop Sports Phys Ther","first-page":"478","article-title":"Balance training for persons with functionally unstable ankles.","volume":"29","author":"Rozzi, S. L.","year":"1999","unstructured":"Rozzi, S. L., S. M.Lephart, R.Sterner, and L.Kuligowski. Balance training for persons with functionally unstable ankles.J Orthop Sports Phys Ther1999. 29 (8):478\u2013486."},{"issue":"2","key":"i1062-6050-46-2-133-Docherty1","series-title":"J Athl Train","first-page":"154","article-title":"Development and reliability of the Ankle Instability Instrument.","volume":"41","author":"Docherty, C. L.","year":"2006","unstructured":"Docherty, C. L., B. M.Gansneder, B. L.Arnold, and S. R.Hurwitz. Development and reliability of the Ankle Instability Instrument.J Athl Train2006. 41 (2):154\u2013158."},{"issue":"5","key":"i1062-6050-46-2-133-Baumhauer1","series-title":"Am J Sports Med","first-page":"571","article-title":"Test-retest reliability of ankle injury risk factors.","volume":"23","author":"Baumhauer, J. F.","year":"1995","unstructured":"Baumhauer, J. F., D. M.Alosa, P. A. F. H.Renstrom, S.Trevino, and B.Beynnon. Test-retest reliability of ankle injury risk factors.Am J Sports Med1995. 23 (5):571\u2013574."},{"issue":"1","key":"i1062-6050-46-2-133-Hiller4","series-title":"Am J Sports Med","first-page":"216","article-title":"Sensorimotor control is impaired in dancers with functional ankle instability.","volume":"32","author":"Hiller, C. E.","year":"2004","unstructured":"Hiller, C. E., K. M.Refshauge, and D. J.Beard. Sensorimotor control is impaired in dancers with functional ankle instability.Am J Sports Med2004. 32 (1):216\u2013223."},{"issue":"4","key":"i1062-6050-46-2-133-Belia1","series-title":"Psychol Meth","first-page":"389","article-title":"Researchers misunderstand confidence intervals and standard error bars.","volume":"10","author":"Belia, S.","year":"2005","unstructured":"Belia, S., F.Fidler, J.Williams, and G.Cumming. Researchers misunderstand confidence intervals and standard error bars.Psychol Meth2005. 10 (4):389\u2013396."},{"issue":"6","key":"i1062-6050-46-2-133-Brown1","series-title":"Clin Biomech (Bristol, Avon)","first-page":"822","article-title":"Individuals with mechanical instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers.","volume":"23","author":"Brown, C.","year":"2008","unstructured":"Brown, C., D.Padua, S. W.Marshall, and K. M.Guskiewicz. Individuals with mechanical instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers.Clin Biomech (Bristol, Avon)2008. 23 (6):822\u2013831."},{"issue":"3","key":"i1062-6050-46-2-133-Hubbard3","series-title":"Phys Ther Sport","first-page":"146","article-title":"Anterior\u2013posterior mobility of the talus in subjects with chronic ankle instability.","volume":"6","author":"Hubbard, T. J.","year":"2005","unstructured":"Hubbard, T. J., L. C.Olmsted-Kramer, J.Hertel, and P.Sherbondy. Anterior\u2013posterior mobility of the talus in subjects with chronic ankle instability.Phys Ther Sport2005. 6 (3):146\u2013152."},{"issue":"3","key":"i1062-6050-46-2-133-Santos1","series-title":"J Orthop Sports Phys Ther","first-page":"150","article-title":"Possible factors related to functional ankle instability.","volume":"38","author":"Santos, M. J.","year":"2008","unstructured":"Santos, M. J. and W.Liu. Possible factors related to functional ankle instability.J Orthop Sports Phys Ther2008. 38 (3):150\u2013157."},{"key":"i1062-6050-46-2-133-Isakov1","series-title":"Int J Sport Biomech","first-page":"100","article-title":"Response of the peroneal muscles to sudden inversion of the ankle during standing.","volume":"2","author":"Isakov, E.","year":"1986","unstructured":"Isakov, E., J.Mizrahi, P.Solzi, Z.Susak, and M.Lotem. Response of the peroneal muscles to sudden inversion of the ankle during standing.Int J Sport Biomech1986. 2:100\u2013109."},{"issue":"3","key":"i1062-6050-46-2-133-Hubbard4","series-title":"J Athl Train","first-page":"361","article-title":"Correlations among multiple measures of functional and mechanical instability in subjects with chronic ankle instability.","volume":"42","author":"Hubbard, T. J.","year":"2007","unstructured":"Hubbard, T. J., L. C.Kramer, C. R.Denegar, and J.Hertel. Correlations among multiple measures of functional and mechanical instability in subjects with chronic ankle instability.J Athl Train2007. 42 (3):361\u2013366."},{"issue":"11","key":"i1062-6050-46-2-133-Martin1","series-title":"Foot Ankle Int","first-page":"968","article-title":"Evidence of validity for the Foot and Ankle Ability Measure (FAAM).","volume":"26","author":"Martin, R. L.","year":"2005","unstructured":"Martin, R. L., J. J.Irrgang, R. G.Burdett, S. F.Conti, and J. M.Van Swearingen. Evidence of validity for the Foot and Ankle Ability Measure (FAAM).Foot Ankle Int2005. 26 (11):968\u2013983."},{"issue":"10","key":"i1062-6050-46-2-133-Roos1","series-title":"Foot Ankle Int","first-page":"788","article-title":"Validation of the foot and ankle outcome score for ankle ligament reconstruction.","volume":"22","author":"Roos, E. M.","year":"2001","unstructured":"Roos, E. M., S.Brandsson, and J.Karlsson. Validation of the foot and ankle outcome score for ankle ligament reconstruction.Foot Ankle Int2001. 22 (10):788\u2013794."}],"container-title":["Journal of Athletic Training"],"original-title":[],"link":[{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/46\/2\/article-p133.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jat\/article-pdf\/46\/2\/133\/1453514\/1062-6050-46_2_133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/nata.kglmeridian.com\/downloadpdf\/journals\/attr\/46\/2\/article-p133.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/nata.kglmeridian.com\/downloadpdf\/journals\/attr\/46\/2\/article-p133.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T20:42:11Z","timestamp":1749674531000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/46\/2\/article-p133.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,3]]},"references-count":64,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-46.2.133","relation":{},"ISSN":["1062-6050"],"issn-type":[{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2011,3]]}}}