Dr Jay Hertel. Chronic Ankle Instability in Athletes

In episode 373 of The Physical Performance Show, sports medicine expert Dr Jay Hertel shares an in-depth exploration of chronic ankle instability in athletes. Drawing on his extensive clinical and research experience, Dr Hertel discusses the prevalence, consequences, and complex rehabilitation of ankle sprains. The conversation covers the patho-mechanical, sensory-perceptual, and motor-behavioural impacts of repeated ankle injuries, including early onset osteoarthritis, proprioceptive deficits, and the psychological hurdles faced by patients—such as loss of confidence and fear of re-injury.

Dr Hertel explains the evolution of clinical models for assessing and treating chronic ankle instability, emphasising individualised care that considers not just the structural and neuromuscular factors, but also personal and environmental influences on recovery. The episode includes practical wisdom and a holistic approach and leaves athletes, clinicians, and listeners with a greater appreciation for the complexity of ankle injuries and a roadmap for improving outcomes both physically and mentally.

Listen in as we delve into the following

• Discussion of the prevalence of foot pain and ankle sprains.
• Jay explains how and why he began studying ankle sprains.
• Exploration of why ankle sprains tend to recur and the risks of long-term damage.
• Defining Chronic Ankle Instability.
• Explanation of the components of the latest clinical model for chronic ankle instability.
• Discussion of historical research and evolution in clinical thinking and terminology.
• Patho-Mechanical Impairments: Ligament laxity, arthrokinematic/osteokinematic restrictions, and secondary injuries explained.
• Sensory-Perceptual Impairments: Proprioceptive deficits, pain, perceived instability, kinesiophobia, and outcome measures.
• Motor-Behavioral Impairments: Topics include altered reflexes, neuromuscular inhibition, muscle weakness, balance, and movement patterns.
• Research discussion on decreased daily steps for people with chronic ankle instability.
• Rehabilitation and Future Research.

Quotes

“The most common risk factor for incurring an ankle sprain is having a history of one.”
“Let’s make sure we keep the bio in biomechanics.”

To Follow Dr Jay Hertel

Website: Jay Hertel
LinkedIn: Jay Hertel
Twitter: @Jay_Hertel

Timeline

00:00 Start
00:30 The prevalence of foot pain and ankle sprains.
04:04 Dr. Hertel shares how he began studying ankle sprains.
05:02 Risk of Recurrence: Discussion on why ankle sprains tend to recur and long-term damage risks.
08:05 Defining Chronic Ankle Instability: Symptoms, timeline, and key diagnostic concepts.
13:39 Updated Model Framework: Dr. Hertel explains the components of his latest model for chronic ankle instability.
16:37 Historical Evolution: The origins and evolution of clinical thinking and terminology for ankle instability.
24:24 Patho-Mechanical Impairments: Explanation of ligament laxity, arthrokinematic/osteokinematic restrictions, and secondary injuries.
34:47 Sensory-Perceptual Impairments: Discussion of proprioceptive deficits, pain, perceived instability, kinesiophobia, and outcome measures.
44:12 Motor-Behavioural Impairments: Focus on altered reflexes, neuromuscular inhibition, muscle weakness, balance, and movement patterns.
51:09 Reduced Physical Activity: Research highlighting decreased daily steps for those with chronic ankle instability.
52:41 Rehabilitation and Future Research: Current rehabilitation studies and optimizing outcomes.
54:13 Take-Home Message: Jay Hertel shares his core advice on finding joy in exercise.
55:22 Listener Challenge: “Toe yoga” challenge for strengthening intrinsic foot muscles.
59:09 Finish

People Mentioned

Stephanie Filbay – Researcher
Hans Tropp
Luke Kelly
Kathy (Kathryn) Refshauge
Claire Hiller

For questions and comments about this Episode Send to the Show Host @Brad_Beer (Twitter) and Huw Darnell @huwdarnell(Instagram)