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What is Chronic Ankle Instability (CAI)?

CAI is a condition characterised by repeated episodes of, or perceptions of, the ankle ”giving way” plus ongoing symptoms including pain, weakness or reduced ankle range of motion. After suffering an ankle sprain some people continue to experience ongoing feelings of instability in their ankle. This may be characterised by a sense of apprehension or the ankle ”giving way”, with or without recurrent ankle sprain/ankle rolling episodes. Usually the “giving way” occurs while walking or doing other activities, but it can also happen when you’re just standing.

People with chronic ankle instability often complain of:

  • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
  • Persistent (chronic) discomfort and swelling
  • Pain or tenderness
  • The ankle feeling wobbly or unstable

If this continues for greater than six months, the term chronic ankle instability (CAI) is used. There are a number of factors that may contribute to the development of this condition; they typically include contribution from neural, muscular and mechanical (laxity of the connective tissue) mechanisms. It’s also important to note that CAI may occur with or without actual increased laxity in the connective tissues (ligaments) of the ankle. On the other hand, increased laxity may be present without perceived instability.

Why do I keep rolling my ankle?

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is then often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains. If this happens, each subsequent sprain then leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle. It’s a whole fun circle. 

Will I end up with chronic ankle instability if I roll my ankle once?

Short answer, not necessarily. After spraining your ankle it’s important to follow a rehabilitation program that addresses strength, range of motion, balance and neuromuscular control. And most importantly, don’t stop rehab once the pain is gone! Residual symptoms were found to affect between 55-72% of patients between six and eighteen months following an initial injury. So there is still a lot of room for improvement once pain is no longer an issue.

I’ve sprained my ankle, what can I do to prevent developing CAI?

After spraining your ankle it’s important to contact your GP or physio so they can determine the severity of the injury and help you with setting up a rehabilitation plan. The following goals are also important to consider:

  • Use the RICE (Rest, Ice, Compression, Elevation) principle to reduce swelling, pain and the inflammatory response
  • Go easy for a little while – It’s important to protect the joint and to prevent a second ankle rolling episode soon after the first one (which might happen as a result of overly aggressive rehabilitation)
  • Begin with functional rehab right away for mild or moderate sprains/tears (grade 1 and 2), and continue until regular walking and functional activities are pain free and beyond
  • Target range of motion, strength, balance, and activity specific training during your rehab to ensure you can return to walking and your functional activities on a pre-injury level (or even better!)

If you have any questions or concerns please don’t hesitate to get in contact with us via phone (8080 8088) or email (

Written by Jacinta (physiotherapist)

Post Author: YS Physio

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