Although ankle sprains receive abundant attention and focus in clinical practice and research, they persist as the most common injury that leads to recurrent injury in athletic activities. Understanding the cause of recurrent injury is crucial in implementing therapeutic interventions to ankle injury and reducing recurrent injury rate. Although excessive plantar flexion with inversion and external rotation in the ankle has been believed as the mechanism of an ankle sprain, it appears that the ankle sprain injury mechanism excessive rearfoot inversion and internal rotation coupled with ankle dorsiflexion. While various studies have shown that there are feed-forward and feedback alterations present in individuals with chronic ankle instability (CAI) as manifesting altered movement organization and muscle activation patterns during functional tasks, it is unclear whether these alterations are the result of the injury or initially contributed to it due to the lack of prospective studies. It is possible that compromised feedback responses, which may have been caused by the initial ankle sprain, contribute to the altered feed-forward control. Ankle instability appears to be linked to multiple aspects of insufficiencies. However, the potential synergistic relation between mechanical and sensorimotor impairments associated with CAI are unclear. It is important for future investigations to identify the source of alterations associated with CAI and identify exact factors that cause recurrent and secondary injury for developing more effective intervention and injury prediction model. Interventions that address multi-factorial aspects of impairments associated with CAI also are essential for improving both patient-oriented and clinician-oriented functional measures, decreasing disability, and preserving long-term healthy in individuals with CAI.
