Phillip A Gribble

• PhD
• Managing Director at University of Kentucky

Objective: The purpose of this study was to evaluate the effect of a single treatment vs serial dry needling (DN) treatments of the fibularis longus on individuals with chronic ankle instability and to determine the longevity of any effect found. Methods: Thirty-five adults with chronic ankle instability (24.17 ± 7.01 years, 167.67 ± 9.15 cm, 74...

Purpose To perform an exploratory factor analysis of the Fear-Avoidance Beliefs Questionnaire in patients with chronic ankle instability. Methods A cross-sectional survey study was utilized. The Fear-Avoidance Beliefs Questionnaire was administered to patients with chronic ankle instability who met the inclusion criteria. Both an unrestricted and...

Context: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO...

Objective The objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR. Design Pilot Study. Setting Sports Medicine Research Laboratory. Participants 12 female participants with history of ACLR (≥ 1 year post-operative)...

Studies have demonstrated that individuals with chronic ankle instability (CAI) have diminished dynamic stability. Jerk-based measures have been utilized to examine dynamic balance because of their ability to quantify changes in acceleration and may provide an understanding of the postural corrections that occur during stabilizing following a jumpi...

Context: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is...

Background Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap. Methods We used a three-round Delphi survey approach to develop consensus...

Patient-reported outcomes (PROs) can be used to assess and monitor psychological health following musculoskeletal injury. Studies have reported decreased psychological health after lateral ankle sprain (LAS) using numerous PROs. The purpose of this systematic review was to critically evaluate individual studies, summarize PROs utilized to quantify...

Context The Sensorimotor Network (SMN) is often overlooked when determining relationships between postural control and sensorimotor function. SMN functional connectivity (FC) represents the temporal synchrony of functionally linked but spatially divergent brain regions. This study aimed to determine the relationship between SMN-FC and static postur...

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar...

Introduction Recent data indicate that patients treated in the emergency department for an ankle sprain receive multiple medications. However, research has not been able to accurately identify all the medications because of study limitations. The primary purpose of this study was to document the type of medication, number of doses, and number of en...

Decreased corticospinal excitability of the anterior tibialis muscle may contribute to the persistent deficits in dorsiflexion range of motion (DFRoM) associated with chronic ankle instability (CAI). The purpose of this study was to examine the association between corticospinal excitability and inhibition of the anterior tibialis muscle and active...

Athletic trainers are commonly responsible for clearing patients with ankle sprains for return to activity. What criteria athletic trainers typically use to determine return to activity readiness in this population remains unclear. The purpose of this qualitative study was to examine criteria athletic trainers use to determine patients’ return to a...

Athletic trainers’ reasons for selecting or avoiding certain evaluation techniques for patients with an ankle sprain are not fully understood. Such information is important to facilitating evidence-based practice and eliminating barriers. The purpose of this qualitative study was to determine what factors influence athletic trainers’ selection or a...

Objective The purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group. Methods This quasi-experimental university-laboratory study included 50 adult volunteers—25 with CAI (16 fema...

Context: Fear has been cited as the primary barrier to return to sport (RTS) by athletes after anterior cruciate ligament reconstruction (ACLR). Understanding the neural factors that contribute to fear after ACLR may help us to identify interventions for this population. Objective: To characterize the underlying neural substrate of injury-relate...

Clinical Scenario: Patients with chronic ankle instability (CAI) demonstrate deficits in both sensory and motor function, which can be objectively evaluated through static postural control testing. One intervention that has been suggested to improve somatosensation and, in turn, static postural control is plantar massage. Clinical Question: Does pl...

While knee injury-related pain and functional limitations are common in the physically active, the impact on general health is not well documented. Further, it is not known how much these outcomes differ among individuals that did or did not have surgery following the knee injury, as well as compared to those without knee injury history. We examine...

Purpose The aim of the study was to determine if corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs between individuals with chronic ankle instability (CAI), lateral ankle sprain coper, and healthy controls. Methods Twenty-three participants with CAI, 23 with lateral ankle sprain copers, and 24 he...

Objectives Supervised physical therapy is the recommended care for an ankle sprain. Yet, recent evidence indicates some ankle sprain patients may not receive the recommended care, and instead, prescribed medication to alleviate symptoms. Therefore, the purpose of this study is to describe the percentage of patients reporting to an office-based phys...

Context People with chronic ankle instability (CAI) display a lower regional and global health-related quality of life (HRQoL). Examinations of HRQoL outcomes associated with CAI have addressed younger adults, restricting our understanding of the long-term consequences of CAI. Objective To compare ankle regional and global HRQoL in middle-aged par...

Clinical Question: Do individuals with chronic ankle instability have diminished plantar cutaneous sensation compared to ankle sprain copers or individuals with no history of ankle sprain? Clinical Bottom Line: Patients with chronic ankle instability have diminished plantar cutaneous sensation compared to healthy controls with no history of ankle s...

Context: Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-caus...

Objective To examine the factor structure and validity of the Quick-FAAM in individuals with chronic ankle instability (CAI) and those classified as ankle sprain copers (ASC). Design Cross-sectional. Setting Laboratory. Participants Adult participants were included in both groups based on previously established criteria. Main outcome measure(s)...

Objectives To compare ankle, knee and hip isometric peak torque between young and middle-aged adults with CAI, copers and un-injured controls. Design Cross-sectional. Setting Research Laboratory. Participants One hundred fifty-six young and middle-aged adults with or without CAI volunteered. Main outcome measures A handheld dynamometer measured...

Introduction: Recent research has demonstrated ankle sprain patients discharged from the emergency department (ED) are prescribed an opioid. Minimizing the exposure to opioids is important to prevent the potential for future abuse and misuse of these medications. Objective: Identify ED visit characteristics for an ankle sprain that are associate...

Background: An ankle sprain is a common musculoskeletal injury treated in the emergency department. Rest, ice, compression, and elevation is the preferred method for managing the symptoms after an ankle sprain. However, many patients receive a medication, such as a nonsteroidal anti-inflammatory drug (NSAID) or an opioid. Objectives: We sought t...

Given the prevalence of lateral ankle sprains (LASs) during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is th...

Background: The aim of the current study was to assess movement strategies during a single leg balance in chronic ankle instability individuals with unstable postural control strategy identified by Nyquist and Bode analyses in conjunction with sample entropy. Methods: Thirty-three participants with self-reported chronic ankle instability and 22...

Objectives: The purpose of this study was to compare dynamic balance and weight-bearing dorsiflexion range of motion between young and middle-aged adults with and without chronic ankle instability. Design: Cross-sectional. Methods: One hundred and two young adults were classified as either having chronic ankle instability (n = 38), coper (n =...

An episode of ‘giving way’ at the ankle is described as excessive inversion of the rearfoot that does not result in an acute ankle sprain and is a unique feature associated with chronic ankle instability (CAI). Limited data currently exists describing the preparatory movement patterns and those that occur during an episode of ‘giving way. Therefore...

Background: Chronic ankle instability (CAI) is associated with hip strength deficits and altered movement in the lower extremity. However, it remains unclear how hip strength deficits contribute to lateral ankle sprain (LAS) mechanisms. We aimed to compare lower extremity landing kinematics and isometric hip strength between individuals with and w...

Background Chronic ankle instability (CAI) is associated with an increased risk of developing post-traumatic osteoarthritis (PTOA). Altered temporal gait parameters likely contribute to the early development and progression of PTOA in CAI. However, it is unknown if increased clinical symptoms of ankle PTOA influence temporal gait parameters among t...

Clinical Scenario : Chronic ankle instability (CAI) is characterized by the residual symptoms and feelings of instability that persist after an acute ankle sprain. Current literature has identified several neuromuscular impairments associated with CAI that may negatively impact sagittal plane knee kinematics during dynamic activities. This has led...

Several investigators have aimed to predict recurrent injuries following acute ankle sprains, but none has done so in high school or collegiate athletes. The purpose of this study was to determine the ability of demographic, anthropometric, and disease- and patient-oriented outcomes to predict recurrent ankle sprains in athletes during the same com...

Decreased hip strength is often present in patients with chronic overuse lower extremity injuries. The hand-held dynamometer (HHD) can be used in a clinical setting to quantify hip strength; however, reliability of the device remains unclear. The purpose of this study was to determine the interexaminer and intersession reliability of a HHD when mea...

Clinical Scenario : Patients with chronic ankle instability (CAI) commonly display lower levels of self-reported function and health-related quality of life. Several rehabilitation interventions, including manual therapy, have been investigated to help CAI patients overcome these deficits. However, it is unclear if the addition of manual therapy to...

Purpose: This study aimed to quantify differences in white matter microstructure and static postural control in individuals with and without a previous history of a lateral ankle sprain. Methods: Ten participants with a history of a lateral ankle sprain and 10 controls performed 3, 20-second trials of single-leg static balance on a force platfor...

This study aimed to compare time-to-boundary and sample entropy during a single-leg balance task between individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Twenty-two participants with CAI, 20 lateral ankle sprain copers, and 24 healthy controls performed a single-leg balance task during an eyes-clo...

Context:: High vertical ground reaction force (vGRF) when initiating ground contact during jump-landing is one biomechanical factor that may increase risk of anterior cruciate ligament injury. Intervention programs have been developed to decrease vGRF to reduce injury risk, yet generating high forces is still critical for performing dynamic activi...

Purpose Abnormal movement patterns and neuromuscular impairments at the ankle are thought to contribute to ankle joint degeneration in those with chronic ankle instability. However, these impairments are not confided to the ankle; rather, proximal neuromuscular deficiencies at the knee and aberrant movement patterns, thought to be responsible for r...

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequen...

Context: Compared with individuals who have a history of lateral ankle sprain (LAS) without markers of chronic ankle instability (CAI; LAS copers) and healthy people, those with CAI often exhibit neuromuscular impairments and dynamic-stability deficits at the hip. However, the influence of hip-strength deficits on dynamic stability remains unknown...

Objective: To identify whether baseline differences in hip and knee isometric strength exist among female runners who sustained a running related injury (RRI) and those that remained injury-free during a 16-week formalized training program. Design: Prospective Cohort. Setting: Laboratory Setting. Participants: 54 healthy female recreational...

Context: Knee osteoarthritis (OA) frequently develops following knee injury/surgery. It is accepted that knee injury/surgery precipitates OA with previous studies examining this link in terms of years after injury/surgery. However, post-injury OA prevalence has not been examined by decade of life; thereby, limiting our understanding of the age at...

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequen...

Background: Women's soccer has among the highest injury rates in collegiate sports, and lateral ankle sprains (LAS) are among the most commonly occurring injuries in that athletic population. However, no established LAS prediction model exists for collegiate women's soccer players.The purpose of this study was to develop a prediction model for acu...

Chronic ankle instability (CAI) is associated with altered energy dissipation patterns, but comparisons to lateral ankle sprain (LAS) copers have not been explored. The purpose of this study was to examine differences in relative sagittal plane energy dissipation during a single-leg landing between female CAI and LAS coper participants. We separate...

The current study aimed to examine postural control performance during a single-leg balance task in elderly individuals with and without a previous history of lateral ankle sprain (LAS). Eighteen adults with a previous hisoty of LAS (mean age=66years old) and 12 healthy controls (mean age=65years old) were included in the study. Participants perfor...

Study Design Case-Control Study. Objectives To determine the extent that strength, dorsiflexion range of motion (DFROM), self-selected gait velocity and star excursion balance test (SEBT) performance contribute to Identification of Functional Ankle Instability (IdFAI) score variance in individuals with chronic ankle instability (CAI). Background...

Study Design Case-control study. Objectives To explore self-reported responses for differentiating CAI(chronic ankle instability) and lateral ankle sprain(LAS)-Coper status. Background Self-reported instability and disability in conjunction with patient history have been used to differentiate CAI and LAS-Copers, but certain self-reported evaluati...

Study Design Case-control. Objectives Examine femoral cartilage thickness in physically active young adults with chronic ankle instability (CAI). Background A history of lateral ankle sprain that occurred early in life can lead to significant negative impact on joint health. Inadequate energy attenuation capability of the knee joints during a fun...

Study Design Prospective cohort study. Objectives Determine the ability of clinical outcomes and anthropometrics to predict recurrent injuries in athletes during the same competitive season following return-to-play (RTP) from an ankle sprain. Background Prediction of recurrent injury may be a valuable step towards minimising long-term consequence...

Context: Feedback is an important factor of interventions designed to reduce anterior cruciate ligament injury risk. Self-analysis feedback requires participants to self-critique their jump landing mechanics; however it is unknown if individuals are able to effectively self-analyze their own biomechanics and if this self-analysis agrees with obser...

Ankle sprain is a common musculoskeletal injury throughout the world, affecting tens of thousands of patients daily. What treatments for lateral inversion ankle injury are most effective? When is a wait-and-see approach more beneficial than a training program, and functional interventions more appropriate than surgical treatment? What surgical inte...

Context: Altered lower extremity muscle activity has been suggested to be associated with lower extremity kinematics in individuals with patellofemoral pain (PFP). However, few studies examined these relationships and the results are inconsistent. Objectives: To compare the lower extremity muscle activity, kinematics, pain level, and reach dista...

Objectives To examine isometric hip strength in those with and without CAI, and determine the degree of Star Excursion Balance Test (SEBT) variance explained by isometric hip strength. Design Single-blinded, cross-sectional, case-control study. Methods Thirty individuals with CAI, 29 lateral ankle sprain (LAS) copers, and 26 healthy controls part...

Objectives: Determine the association between the number of ankle or knee injuries sustained and physical and mental quality of life. Methods: A total of 806 ankle-injured (age:45.2 ± 15.3 yrs; body mass index [BMI]:28.6 ± 7.4 kg/m(2)), 658 knee-injured (age:49.3 ± 16.1 yrs; BMI:28.4 ± 7.4 kg/m(2)), and 996 uninjured (age:43.4 ± 16.1 yrs; BMI:26...

Proximal neuromuscular alterations are hypothesized to contribute to the patient- and disease-oriented deficits observed in CAI individuals. The objective was to compare the efficacy of two 4-week intervention programs with or without proximal joint exercises. Twenty-three individuals with CAI completed this single-blinded randomized controlled tri...

Clinical question: What is the evidence to support ankle joint mobilization for improving performance on the SEBT in patients with CAI? Summary of Key Findings: The literature was searched for articles examining the effects of ankle joint mobilization on scores of the SEBT. A total of 3 peer-reviewed articles were retrieved; 2 prospective individu...

Objective To identify which therapeutic intervention may be most effective for improving self-reported function in patients with chronic ankle instability (CAI). Design Systematic literature review. Articles were appraised using the Downs and Black Checklist by 3 reviewers. Data sources PubMed along with CINAHL, MEDLINE and SPORTDiscus within EBS...

Context: Ankle instability is a common condition in physically active individuals. It often occurs during a jump landing or lateral motion, particularly when participants are fatigued. Objective: To compare muscle activation during a lateral hop prefatigue and postfatigue in individuals with or without chronic ankle instability (CAI). Design:...

Context: The Star Excursion Balance Test (SEBT) and Functional Movement Screen (FMS) are functional performance measures capable of predicting lower extremity injury risk. While suboptimal SEBT and FMS performances are influenced by multiple factors, the contribution of hip strength and flexibility to these tests is mostly unknown. Examination of...

Introduction: Quantifying corticomotor alterations is important to understand the neurophysiological mechanisms that likely contribute to the neuromuscular control deficits observed in patients with Chronic Ankle Instability (CAI). Corticomotor output mapping provides further insight into the changes within the motor cortex and identifies potentia...

Purpose: Persistent voluntary quadriceps activation deficits are common following anterior cruciate ligament reconstruction (ACLR), but the direct causes are unclear. The primary purpose of this study was to determine whether spinal reflex excitability deficits are present in individuals with a history of ACLR, and secondarily to determine if spin...

The purpose of this original investigation was to determine if selected sensorimotor, mechanical, and self-reported measures are different among chronic ankle instability (CAI) subgroups, healthy control participants, and lateral ankle sprain copers (LAS-Copers). Ninety-four participants volunteered and were categorized into perceived ankle instabi...

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We int...

Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronic...

Introduction/purpose: Previous investigations have identified impaired trunk and postural stability in individuals with chronic ankle instability (CAI). The diaphragm muscle contributes to trunk and postural stability by modulating the intra-abdominal pressure. A potential mechanism that could help to explain trunk and postural stability deficits...

Background: Understanding the mechanisms of neurophysiological alterations with chronic ankle instability (CAI) may be essential in the development of the most-effective intervention programs to treat neuromuscular dysfunction in patients with CAI. Specifically, the presence of CAI may be associated with an altered supraspinal mechanism within the...

Context: Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy...

Introduction/purpose: Quadriceps strength is a useful clinical predictor of self-reported function following anterior cruciate ligament reconstruction (ACLR). However, it remains unknown if quadriceps strength normalized to body mass (QBM) or quadriceps strength limb symmetry index (QLSI) is the best predictor of self-reported function in individu...

Background: Poor neuromuscular control can increase the risk of anterior cruciate ligament (ACL) injury. Landing with decreased knee and hip flexion may increase the risk of lower extremity injury. Feedback interventions have demonstrated changes in jump-landing biomechanics. Traditional feedback (TF), provided after task completion, includes crit...

Background: The lateral ankle sprain (LAS) is the most common injury suffered in sports, especially in football. While suggested in some studies, a predictive role of clinical tests for LAS has not been established. Purpose: To determine which clinical tests, focused on potentially modifiable factors of movement patterns and body mass index (BMI...

Chronic ankle instability (CAI) commonly develops after a lateral ankle sprain (LAS). Widespread residual complaints suggest that rehabilitation provided for many LAS is insufficient. We propose a theoretical model for CAI development impacted by patient resilience and self-efficacy, social constructs, and rehabilitation adherence. An exclusive soc...

Background Limited work suggests effective lateral ankle sprain (LAS) prediction with the star excursion balance test (SEBT) and Functional Movement Screen (FMS), but with small data sets using many different demographics. The utility of these tests needs to be confirmed in larger data sets. Objective Establish LAS risk identification across multip...

Background Recent evidence has suggested that corticospinal excitability alterations are present in the surrounding ankle musculature in individuals with chronic ankle instability (CAI). However, there is limited support for the effect of CAI on corticospinal excitability of the tibialis anterior (TA) muscle, specifically. Traditional corticospinal...

Background The influence of CAI on general health and quality of life is largely unknown. In particular any associations between CAI and cardio-metabolic disease risk factors, chronic musculoskeletal co-morbidities, or reduced quality of life have not been substantiated. Objective To examine the association between CAI and detrimental long-term hea...

Background Separating chronic ankle instability (CAI) into subgroups based on the major clinical symptoms of CAI, including perceived ankle instability (PI), repeated episodes of “giving-way”, and recurrent ankle sprains (RAS), may create more homogenous subgroups of participants with CAI and could help to identify mechanical, neuromuscular, and ps...

Context: Epidemiological data demonstrate the need for lower extremity injury prevention training. Neuromuscular control (NMC) programs are immediately effective at minimizing lower extremity injury risk and improving sport-related performance measures. Research investigating lasting effects following an injury prevention program is limited. Obje...

Study Design Case report. Background Little evidence exists about impairments and perceived disability following eversion injury to the deltoid ligament. This case study prospectively examined the neuromuscular, biomechanical, and psychological consequences of a case of a medial ankle sprain. Case Description A recreationally active man with a hi...

Following anterior cruciate ligament (ACL) injury and reconstruction, abnormal biomechanics during daily tasks may have prominent and detrimental long-term consequences on knee joint health. The purpose of this study was to longitudinally evaluate hip and knee joint biomechanics during stair ascent and descent in acutely ACL injured patients, and a...

Context: Neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control, is common in patients with chronic ankle instability (CAI). Understanding how CAI affects specific neural pathways may provide valuable information for targeted therapies. Objective: To investigate differences in spinal reflexi...

The purpose of this investigation was to examine the effects of the combination of chronic ankle instability (CAI) and altered visual focus on strategies for dynamic stability during a drop-jump task. Nineteen participants with self-reported CAI and 19 healthy participants performed a drop-jump task in looking-up and looking-down conditions. For th...