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Updated: Aug 7, 2026
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Evaluating Postural Control and Lower-extremity Muscle Activation in Individuals with Chronic Ankle Instability
Published on: September 18, 2020
Chronic Ankle Instability and Low Back Pain: A Narrative Review With a Conceptual Framework Linking Distal and
Ehab A Abdallah1,2, Ahmed M Elshinnawy3, Mahmoud Diab Abdelhaleem4
1Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Horus University, New Damietta, Egypt.
Summary
Chronic ankle instability and chronic low back pain are linked through the body's kinetic chain. Addressing both ankle and core issues together may improve overall stability and function.
Area of Science:
- Musculoskeletal biomechanics
- Neuroscience
- Rehabilitation science
Background:
- Chronic ankle instability (CAI) and chronic low back pain (CLBP) are common musculoskeletal issues.
- Emerging evidence suggests CAI and CLBP are interconnected via biomechanical, neuromuscular, and neurophysiological pathways.
- Proprioception, postural control, and load distribution deficits may link distal and proximal kinetic chain dysfunction.
Purpose of the Study:
- To explore the interconnectedness of chronic ankle instability and chronic low back pain.
- To synthesize evidence on shared mechanisms linking ankle and lumbopelvic dysfunction.
- To establish a conceptual framework for understanding kinetic chain interdependence.
Main Methods:
- Narrative review utilizing a conceptual framework.
- Searched PubMed, Scopus, and Google Scholar (2019-2025) for relevant biomechanical, neuromuscular, and neurophysiological studies.
- Thematic analysis of 23 included studies to identify connections within the kinetic chain.
Main Results:
- Evidence indicates distal-to-proximal alterations in individuals with CAI, including impaired ankle biomechanics and compensatory lumbopelvic patterns.
- Deficits in proprioception and neuromuscular control are consistently observed.
- Neurophysiological adaptations impacting sensorimotor integration suggest a link between CAI and CLBP.
Conclusions:
- Chronic ankle instability and chronic low back pain may coexist within a functionally interconnected kinetic system.
- Recognizing this interdependence supports a multi-segmental stability model.
- Combined ankle-core rehabilitation strategies are highlighted as important.
