Ankle Sprain Recovery Linked to Physiotherapy Adherence

A recent single-center retrospective cohort study published in BMC Sports Science, Medicine and Rehabilitation has identified significant associations between the completion of early supervised physiotherapy sessions and recovery outcomes for professional athletes suffering from acute lateral ankle sprains. The study included 118 professional athletes with acute lateral ankle sprains.

Acute lateral ankle sprains are common in professional athletes and may be followed by delayed return to sport, ankle instability, residual pain, and psychological barriers. The primary objective was to examine the associations of early supervised physiotherapy session-completion adherence with return to sport and residual symptoms.

Early rehabilitation adherence was defined in the study as the proportion of prescribed therapist-supervised physiotherapy sessions completed during the first four weeks after the injury. This metric was analyzed continuously in the primary models, with effects reported per 10-percentage-point increase in adherence. Groups defined by the cohort median of 78.5% were used only for descriptive presentation and sensitivity analyses.

Outcomes included time to qualifying unrestricted return to sport, CAIT-defined ankle instability at follow-up, residual pain intensity measured using the Visual Analog Scale, and concurrent kinesiophobia measured using the TSK-11. To analyze these variables, the researchers employed adjusted Cox, logistic, and linear regression models. Exploratory indirect-effect analyses were also performed using 5000 bootstrap resamples to investigate the potential mediating role of kinesiophobia in the relationship between adherence and residual symptoms.

The results indicated that 86 athletes, representing 72.9% of the cohort, achieved qualifying return to sport. In the descriptive median-defined comparison, the median time to return to sport was 8.0 weeks in the high-adherence group compared to 14.5 weeks in the low-adherence group, corresponding to a 6.5-week difference. In the primary continuous analysis, each 10-percentage-point increase in adherence was associated with a higher rate of achieving return to sport, with a hazard ratio of 1.27 and a 95% confidence interval of 1.16 to 1.39. This suggests a statistically significant association between higher adherence and a faster return to sport.

Furthermore, the primary cross-sectional models, which included concurrent kinesiophobia scores, revealed that each 10-percentage-point increase in adherence was associated with lower odds of CAIT-defined ankle instability at follow-up. The odds ratio was 0.70, with a 95% confidence interval of 0.55 to 0.90. Additionally, higher adherence was linked to lower residual pain intensity, with a beta coefficient of -0.36 and a 95% confidence interval of -0.56 to -0.17.

The study also found that higher adherence was associated with lower concurrent kinesiophobia scores, with a beta coefficient of -1.22 and a 95% confidence interval of -1.66 to -0.77. Significant exploratory concurrent indirect associations through kinesiophobia were observed for both residual outcomes. This suggests that kinesiophobia may play a role in the relationship between treatment adherence and recovery outcomes. However, the authors note that while kinesiophobia was an important concurrent psychological correlate, temporal or causal mediation cannot be inferred from this study design.

The authors conclude that greater completion of prescribed supervised physiotherapy sessions was associated with faster achievement of qualifying return to sport, lower odds of ankle instability, and less residual pain. They emphasize that early rehabilitation adherence should be considered one component of a multidimensional return-to-sport assessment. This assessment should also incorporate physical function, sport-specific performance, psychological readiness, and reinjury risk.

As a retrospective cohort study with cross-sectional follow-up, it cannot establish causality between adherence and outcomes. The single-center design may limit the generalizability of the findings to other populations or settings.

Subject of Research: Association between physiotherapy adherence and recovery outcomes in professional athletes with acute lateral ankle sprains

Article Title: Early supervised physiotherapy session-completion adherence and outcomes after acute lateral ankle sprain in professional athletes: concurrent indirect associations through kinesiophobia

Article References: Shi, M., Feng, Z., Wang, C., Zhang, Y., Wang, A., Jiang, A., Yang, R., & Qiao, G. (2026). Early supervised physiotherapy session-completion adherence and outcomes after acute lateral ankle sprain in professional athletes: concurrent indirect associations through kinesiophobia. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-026-02142-5

Image Credits: AI Generated

DOI: 10.1186/s13102-026-02142-5

Keywords: ankle sprain, physiotherapy, professional athletes, rehabilitation adherence, return to sport, kinesiophobia, cohort study, sports medicine, residual pain, ankle instability, Early, supervised