Chronic Ankle Instability and Low Back Pain: A Narrative Review With a Conceptual Framework Linking Distal and Proximal Sensorimotor Dysfunction.

BACKGROUND

Chronic ankle instability and chronic low back pain are highly prevalent in musculoskeletal conditions. Emerging evidence suggests that they are interconnected through shared biomechanical, neuromuscular, and neurophysiological mechanisms, where deficits in proprioception, postural control, and load distribution contribute to persistent dysfunction across the kinetic chain.

METHODS

This study employed a narrative review with a conceptual framework, incorporating evidence from biomechanical, neuromuscular, and neurophysiological studies found through targeted database searches (PubMed, Scopus, and Google Scholar 2019-2025). Findings were thematically analyzed to establish connections between distal and proximal dysfunction within the kinetic chain.

RESULTS

A total of 23 studies were included. Overall, the evidence suggests consistent distal-to-proximal alterations in individuals with chronic ankle instability, including impaired ankle biomechanics, compensatory lumbopelvic movement patterns, and deficits in proprioception and neuromuscular control. Emerging findings also indicate neurophysiological adaptations affecting sensorimotor integration. Collectively, these findings suggest a potential association between chronic ankle instability and chronic low back pain.

CONCLUSION

Chronic ankle instability and chronic low back pain may coexist within a functionally interconnected kinetic system. Recognizing their potential interdependence supports a model of multi-segmental stability and highlights the importance of combined ankle-core rehabilitation strategies.