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.
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“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.”
Website: Jay Hertel
LinkedIn: Jay Hertel
Twitter: @Jay_Hertel
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
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)
Telehealth rehabilitation can be effective for people needing help to get back to their physical best who are geographically not able to attend appointments in person at POGO Physio (Mermaid Waters, Gold Coast).
Our team of physiotherapists routinely conduct telehealth consultations for patients who live:
There are several elements of an in person consultation that cannot be actioned when receiving a telehealth consultation. However in most instances this does not represent a barrier to an effective consultation being delivered.
Manual therapy (hands-on) treatment can also not be conducted remotely. If a patient will benefit or requires manual therapy it can be sought in the patient’s local area with guidance (if required) from a local provider.
Exercises are demonstrated and prescribed via our exercise prescription software and app TrackActive. Trackactive has viewable videos and photos, as well as detailed commentary on how to complete the exercises with accuracy at home or the gym. See below for an example series of exercises:
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