Skip to main content
SpringerLink
Log in

Minimum Reporting Standards for Copers in Chronic Ankle Instability Research

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Lateral ankle sprains (LASs) are among the most common sports-related injuries and a high percentage of individuals who sprain their ankle go on to develop chronic ankle instability (CAI). The condition of CAI is often classified as having pain, loss of function, and a restriction of, or failure to, return to levels of previous activity. Historically, uninjured healthy controls are used as a comparison group to study the biomechanical and neuromuscular consequences of CAI. However, this model is not ideal to determine why a portion of the population experiencing an ankle sprain does not recover. A more appropriate comparison may be individuals who had an ankle sprain, and thus the exposure, but did not go on to develop CAI (i.e., copers). Thus, the purpose of this review was to determine the existing discrepancies and common standards in definitions of, terminology used for, and the inclusionary/exclusionary criteria used to describe copers within the CAI literature. Multiple databases were searched by keywords and specific authors. Potential studies were screened independently by both authors. Inclusion criteria consisted of an explicit definition of copers and explicit inclusionary/exclusionary criteria. A total of 21 studies were included in the current study and had four outcomes extracted: (1) the definition of copers; (2) the terminology used; (3) specific inclusionary/exclusionary criteria; and (4) injury characteristics of the copers. Based on the included operational definitions, it is recommend that future operational definitions of copers include three key components: (1) an initial LAS; (2) subsequent lack of CAI symptoms (i.e., no complaints of disability or giving way); and (3) a time since injury component. The term coper was overwhelming used within the existing literature (n = 15) and is thus recommended to be used in future studies when describing individuals who have suffered an LAS but failed to develop CAI. Minimal inclusionary criteria should consist of three things: (1) an initial LAS severe enough to warrant either the use of a protective device (e.g., ankle brace) for at least 1 week or immobilization and/or non-weight bearing for at least 3 days, or both; (2) a return to at least moderate levels of weight-bearing physical activity for at least 12 months without recurrent injury, episodes of giving way, and/or feelings of instability; and (3) minimal, if any, level of self-reported disability. Acute head and/or lower extremity injuries that occurred ≤3 months prior to testing, a history of ankle fractures and/or surgeries, and the presence of pain (constant or intermittent) should be used as minimal exclusionary criteria in future investigations dealing with copers. Finally, at least seven items should be reported to better contextualize copers across investigations. These items should include the initial mechanism of injury, the presence of mechanical laxity, number of days immobilized and/or non-weight bearing after the initial ankle sprain, time since the latest ankle sprain, percentage of coper participants with a recurrent ankle sprain or giving way episode, current physical activity levels, and whether copers attended formal rehabilitation for their involved ankle.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.

    Article  PubMed  Google Scholar 

  2. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.

    PubMed Central  PubMed  Google Scholar 

  3. Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med. 2007;14(7):641–5.

    PubMed  Google Scholar 

  4. McKay GD. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103–8.

    Article  CAS  PubMed  Google Scholar 

  5. Yeung MS, Chan KM, So CH, et al. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28(2):112–6.

    Article  CAS  PubMed  Google Scholar 

  6. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.

    PubMed Central  PubMed  Google Scholar 

  7. Delahunt E, Coughlin GF, Caulfield B, et al. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exer. 2010;42(11):2106–21.

    Article  Google Scholar 

  8. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46(2):133–41.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):1–4.

    Article  Google Scholar 

  10. Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986;14(6):465–71.

    Article  CAS  PubMed  Google Scholar 

  11. Peters JW, Trevino SG, Renstrom PA. Chronic lateral ankle instability. Foot Ankle. 1991;12(3):182–91.

    Article  CAS  PubMed  Google Scholar 

  12. van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121(4):324–31.

    Article  PubMed  Google Scholar 

  13. Konradsen L, Bech L, Ehrenbjerg M, et al. Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports. 2002;12(3):129–35.

    Article  CAS  PubMed  Google Scholar 

  14. Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg. 1979;61:354–61.

    CAS  PubMed  Google Scholar 

  15. Hintermann B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 2002;30(3):402–9.

    PubMed  Google Scholar 

  16. Hirose K, Murakami G, Minowa T, et al. Lateral ligament injury of the ankle and associated cartilage degeneration in the talocrural join: anatomic study using elderly cadavers. J Orthop Sci. 2004;9(1):37–43.

    Article  PubMed  Google Scholar 

  17. Hurd WJ, Axe MJ, Snyder-Mackler L. Influence of age, gender, and injury mechanism on the development of dynamic knee stability after acute ACL rupture. J Orthop Sports Phys Ther. 2008;38(2):36–41.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hertel J, Kaminski TW. Second international ankle symposium summary statement. J Orthop Sports Phys Ther. 2005;35(5):A2–6.

    Article  PubMed  Google Scholar 

  19. Brown C. Foot clearance in walking and running in individuals with ankle instability. Am J Sports Med. 2011;39(8):1769–76.

    Article  PubMed  Google Scholar 

  20. Brown C, Bowser B, Simpson KJ. Movement variability during single leg jump landings in individuals with and without chronic ankle instability. Clin Biomech. 2012;27(1):52–63.

    Article  Google Scholar 

  21. Brown C, Padua DA, Marshall SW, et al. Hip kinematics during a stop-jump task in patients with chronic ankle instability. J Athl Train. 2011;46(5):461–7.

    PubMed Central  PubMed  Google Scholar 

  22. Brown CN, Padua DA, Marshall SW, et al. Individuals with mechanical ankle instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers. Clin Biomech. 2008;23(6):822–31.

    Article  Google Scholar 

  23. Brown CN, Padua DA, Marshall SW, et al. Variability of motion in individuals with mechanical or functional ankle instability during a stop jump maneuver. Clin Biomech. 2009;24(9):762–8.

    Article  Google Scholar 

  24. Croy T, Saliba S, Saliba E, et al. Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. J Orthop Sports Phys Ther. 2012;42(7):593–600.

    Article  PubMed  Google Scholar 

  25. De Ridder R, Willems T, Vanrenterghem J, et al. Gait kinematics of subjects with ankle instability using a multisegmented foot model. Med Sci Sports Exer. 2013. doi:10.1249/MSS.0b013e31829991a2.

    Google Scholar 

  26. Gutierrez GM, Knight CA, Swanik CB, et al. Examining neuromuscular control during landings on a supinating platform in persons with and without ankle instability. Am J Sports Med. 2012;40(1):193–201.

    Article  PubMed  Google Scholar 

  27. Hubbard TJ. Ligament laxity following inversion injury with and without chronic ankle instability. Foot Ankle Int. 2008;29(3):305–11.

    Article  PubMed  Google Scholar 

  28. Liu K, Glutting J, Wikstrom EA, et al. Examining the diagnostic accuracy of dynamic postural stability measure in differentiating among ankle instability status. Clin Biomech. 2013;28(2):211–7.

    Article  Google Scholar 

  29. Miller H, Needle AR, Swanik CB, et al. Role of external prophylactic support in restricting accessory ankle motion after exercise. Foot Ankle Int. 2012;33(10):862–9.

    Article  PubMed  Google Scholar 

  30. Morrison KE, Hudson DJ, Davis IS, et al. Plantar pressure during running in subjects with chronic ankle instability. Foot Ankle Int. 2010;31(11):994–1000.

    Article  PubMed  Google Scholar 

  31. Plante JE, Wikstrom EA. Differences in clinician-oriented outcomes among controls, copers, and chronic ankle instability groups. Phys Ther Sport. 2013;14(4):221–6.

    Article  PubMed  Google Scholar 

  32. Shields CA, Needle AR, Rose WC, et al. Effect of taping on postural control deficits in subjects with healthy ankles, copers, and individuals with functional ankle instability. Foot Ankle Int. 2013;34(10):1427–35.

    Article  PubMed  Google Scholar 

  33. Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture. 2010;32(2):82–6.

    Article  PubMed  Google Scholar 

  34. Wikstrom EA, Hass CJ. Gait termination strategies differ between those with and without ankle instability. Clin Biomech. 2012;27(6):619–24.

    Article  Google Scholar 

  35. Wikstrom EA, Tillman MD, Chmielewski TL, et al. Self-assessed disability and functional performance in patients with and without ankle instability: a case control study. J Orthop Sports Phys Ther. 2009;39(6):458–67.

    Article  PubMed  Google Scholar 

  36. Wikstrom EA, Tillman MD, Chmielewski TL, et al. Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability and uninjured controls. Scand J Med Sci Sports. 2010;20(1):e137–44.

    Article  CAS  PubMed  Google Scholar 

  37. Wikstrom EA, Tillman MD, Chmielewski TL, et al. Discriminating between copers and people with chronic ankle instability. J Athl Train. 2012;47(2):136–42.

    PubMed Central  PubMed  Google Scholar 

  38. Willems T, Witvrouw E, Verstuyft J, et al. Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability. J Athl Train. 2002;37(4):487–93.

    PubMed Central  PubMed  Google Scholar 

  39. Wright CJ, Arnold BL. Clinical exam results differ among individuals with functional ankle instability and ankle sprain copers. J Athl Train. 2013;48(5):581–9.

    Google Scholar 

  40. Gutierrez GM, Kaminski TW. A novel dynamic ankle-supinating device. J Appl Biomech. 2010;26:114–21.

    PubMed  Google Scholar 

  41. Hiller CE, Nightingale EJ, Raymond J, et al. Prevalence and impact of chronic musculoskeletal ankle disorders in the community. Arch Phys Med Rehabil. 2012;93(10):1801–7.

    Article  PubMed  Google Scholar 

  42. Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurological physical therapy. J Neurol Phys Ther. 2006;30(3):120–9.

    Article  PubMed  Google Scholar 

  43. Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med. 2008;27(3):353–70.

    Article  PubMed  Google Scholar 

  44. McKeon PO, Hubbard-Turner TJ, Wikstrom EA. Consequences of ankle inversion trauma: a novel recognition and treatment paradigm. In: Zaslav KR, editor. An international perspective on topics in sports medicine and sports injury. 1st ed. Rijeka: InTech; 2012. p. 457–80.

    Google Scholar 

  45. Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 2013;43(6):385–93.

    Article  PubMed  Google Scholar 

  46. McKeon PO, Hertel J. The dynamical-systems approach to studying athletic injury. Athl Ther Today. 2006;11(1):31–3.

    Google Scholar 

  47. Verhagen E, Van der Beek A, Twisk J, et al. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. 2004;32(6):1385–93.

    Article  PubMed  Google Scholar 

  48. Eastlack ME, Axe MJ, Snyder-Mackler L. Laxity, instability, and functional outcome after ACL injury: copers versus noncopers. Med Sci Sports Exerc. 1999;31(2):210–5.

    Article  CAS  PubMed  Google Scholar 

  49. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium. J Orthop Sports Phys Ther. 2013;43(8):585–91

    Google Scholar 

  50. Hass CJ, Bishop M, Doidge D, et al. Chronic ankle instability alters central organization of movement. Am J Sports Med. 2010;38(4):829–34.

    Article  PubMed  Google Scholar 

  51. Pietrosimone BG, Gribble PA. Chronic ankle instability and corticomotor excitability of the fibularis longus muscle. J Athl Train. 2012;47(6):621–6.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

No funding was provided for the preparation of this paper and no author has or had a real or perceived conflict of interest to report.

Author information

Authors and Affiliations

  1. Department of Kinesiology, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA

    Erik A. Wikstrom

  2. University of Georgia, Athens, GA, USA

    Cathleen N. Brown

Authors
  1. Erik A. Wikstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathleen N. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik A. Wikstrom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wikstrom, E.A., Brown, C.N. Minimum Reporting Standards for Copers in Chronic Ankle Instability Research. Sports Med 44, 251–268 (2014). https://doi.org/10.1007/s40279-013-0111-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-013-0111-4

Keywords

Search

Navigation