Altered spinal-level sensorimotor control related to pain and perceived instability in people with chronic ankle instability

Objectives: To compare soleus spinal reflex excitability, presynaptic inhibition and recurrent inhibition between chronic ankle instability (CAI), acute Lateral Ankle Sprain coper (LAS-coper) and healthy populations. The relationship between spinal reflex excitability and pain and perceived instability in people with CAI was also examined. Design: Cross-sectional laboratory experiment. Methods: Twelve individuals with CAI, twelve 'copers' and twelve healthy age, limb and gender-matched controls participated. Soleus H-reflex recruitment curves, pre-synaptic excitability and recurrent inhibition of the spinal-reflex pathway were examined during static double- and single-leg stance. Reporting of pain and perceived instability were used to perform a regression analysis on measures of soleus spinal excitability in people with CAI, LAS-coper and healthy controls. Results: Soleus spinal reflex excitability was greater during single-leg stance in CAI compared to healthy and coper individuals (p = <0.001). Pre-synaptic inhibition was three-times less in CAI participants compared to both healthy controls and copers (p = <0.001). There were no differences between healthy and coper participants in spinal-level measures of sensorimotor control. Reports of pain explained 15–16% of the variance in soleus spinal reflex excitability and presynaptic inhibition during single and double-leg stance, while perceived instability explained 20% of the variance in spinal reflex during single leg stance only. Conclusions: CAI participants presented with an inability to suppress soleus spinal reflexes during tasks with increased postural threat; likely due to disinhibition of pre-synaptic mechanisms. Pain and perceived instability may contribute to changes in spinal-level sensorimotor control in CAI.