A curated look at what’s worth reading across sports performance, biomechanics, and athlete health, with a few notes from us on why each one caught our attention.
Nearly 7,000 real-world ankle assessments later, the deficits land where you’d expect
Journal of Clinical Medicine, July 2026
The first large-scale look at how the Ankle-GO is used outside a research cohort covers every session recorded in the tool’s web application during 2024: 6,934 patients, 11,055 sessions, 88.5% of them assessed after a lateral ankle sprain. Just under four in five were assessed before returning to sport, at a median of 2.33 months post-injury, close to the timing used in the validation work. What those assessments found is consistent across the cohort. Injured-ankle composite scores averaged 15.4 to 16.2 out of 25 at first session, sitting consistently below the healthy contralateral side, and most first-session results fell below the published return-to-sport cut-offs for the balance and hop tests. Psychological readiness improved more slowly than physical function, and apprehension during the single-leg stance was higher on the injured side regardless of session. Only 14% of sessions were follow-ups, so most patients were scored once. → Read the study
LigaSys take: In Cleared to Play we wrote that athletes tend to go back on a calendar, and that measurable deficits persist well past the point most of them return. That piece cited the authors’ original Ankle-GO validation study on a cohort of 54 participants, and the pattern identified there holds across the larger field sample: function below cut-off, psychological readiness lagging behind it, apprehension still present two months out. The tool is also clearly being adopted, which is the more encouraging finding. Most of these patients were assessed before returning, which is more structure than the return decision usually gets. The obvious next step is the second assessment. A single score describes a moment; two describe a direction, and only one in seven patients here got the second one.
Unstable ankles sense less, and bracing early doesn’t stop the roll
Journal of Sport Rehabilitation, Journal of Foot and Ankle Research, Journal of Biomechanics, 2026
Three small lab studies take the sensing side and the motor side of chronic ankle instability in turn. In the first, 20 people with CAI and 19 controls judged which of four inversion angles their ankle was set at while standing, walking, drop landing, and descending stairs. The CAI group was less accurate on every task. Controls got more accurate as the task became harder and more heavily loaded, and the CAI group didn’t show that gain. In the second, 20 people with CAI and 20 controls walked across a platform with a trapdoor that dropped the foot into 24 degrees of inversion without warning. The CAI group fired peroneus longus and lateral gastrocnemius harder in the 200 milliseconds before the drop, and still reached excessive inversion after it. In the third, 15 people with CAI, 15 copers who had sprained once and recovered, and 15 controls performed 30 cm single-leg drop landings. The CAI group switched on peroneus longus earlier than controls, 260 milliseconds before contact versus 102, at about half the amplitude, and swayed more from side to side after landing. The copers activated lateral gastrocnemius earlier and more strongly, and swayed less than the CAI group. → Proprioception study · Trapdoor study · Landing study
LigaSys take: Read together, the unstable ankle has a poorer sense of where it is, and it prepares differently from a healthy one, harder before the trapdoor and earlier but weaker before a landing, without getting a healthy ankle’s result either time. None of the three studies followed anyone for reinjury, all are cross-sectional with 15-20 people per group, and a 24-degree drop at walking speed is well short of a sprain. The coper pattern may be a consequence of recovering well as much as a cause of it. The useful detail for rehab is where the sensing deficit shows up: in the healthy group, accuracy improved with load, so the loaded, dynamic end of a progression is where the gap between a stable and an unstable ankle is widest.
Where the load goes
Computer Methods in Biomechanics and Biomedical Engineering, July 2026 · Physical Therapy in Sport, 2026
Two studies, two very different questions, one shared subject. In the first, 30 elite male sprinters ran with resistance at 10%, 20%, and 30% of body weight while researchers captured kinematics and kinetics and ran finite element analysis on the ankle. Peak dorsiflexion and its moments rose with load while peak inversion angle fell. The 30% condition produced the highest stress in the tibia, talus, and second and third metatarsals, concentrated in the metatarsal shafts. In the second, 84 male Tier 2 and 3 athletes split evenly into high-pain CAI, low-pain CAI, and healthy controls performed single-leg drop landings. The high-pain group produced a lower ankle plantarflexor moment, did less eccentric work at the ankle, and took a larger share of landing energy at the knee. → Sprint study · Landing study
LigaSys take: Load that the ankle doesn’t absorb goes somewhere. In the sprint study, a training variable moved stress around the foot and ankle and changed inversion along the way. In the landing study, painful unstable ankles absorbed less and the knee absorbed more. Both are male-only, the sprint stress figures come from a model, and the landing study can’t say whether pain drives the strategy or the strategy drives pain. For anyone managing an athlete with a history of ankle sprains and a newer knee complaint, the two may be one problem.
What ankle sprains cost the amateur athlete
Science and Medicine in Football, July 2026
Three years of Australian insurance records covering amateur soccer produced 749 ankle sprain claims totaling AU$1,727,858, a mean of AU$2,307 per claim. Indirect costs (such as lost wages) accounted for 65% of the total and ran six times higher than direct medical costs. Senior-level players aged 18 to 34 carried 74% of the financial burden. Syndesmosis (high-ankle) sprains were only 3% of claims but the most expensive per claim at AU$7,690. Direct contact was the most common mechanism at 56%, though non-contact sprains cost more on average. → Read the study
LigaSys take: The six-to-one ratio of indirect to direct costs is the number to sit with. Almost everything written about ankle sprain economics puts treatment and management costs on a pedestal, and treatment turns out to be the small part. It also puts a spotlight on syndesmosis injuries, which are rare and expensive.
Two prospective studies put a number on injury prediction
Frontiers in Physiology · Sports Medicine – Open, 2026
The first followed 161 collegiate athletes for a season, combining Functional Movement Screen scores with IMU-derived measures: peak tibial acceleration asymmetry, a surrogate vertical loading rate, and pelvis-trunk stability. The fused model reached an out-of-fold AUC of 0.70 (95% CI 0.61 to 0.79) for load-related time-loss injury, against 0.62 for the screen alone and 0.64 for the wearables alone, across 37 injuries of mixed lower-limb types. The second is ankle-specific. One hundred physically active university students with chronic ankle instability were followed for two years; 96 completed follow-up and 41 of them, or 43%, reinjured the ankle. Fourteen baseline measures fed six algorithms, and the selected model reached an AUC of 0.81 (95% CI 0.71 to 0.89), with sex, arch height index, previous sprains, dorsiflexion range, and a Biodex stability score carrying the most weight. A single decision threshold performed unevenly for male and female participants, which sex-specific thresholds partly corrected. → Collegiate athlete cohort · CAI reinjury cohort
LigaSys take: Both models were validated out-of-fold, but neither has been tested outside the cohort it was built on. An AUC of 0.70 means the model ranks an injured athlete as higher risk about 70% of the time; 0.81 is better, in a group where the base rate of reinjury was already 43%. Here’s the kicker: a risk score works on the scale of weeks, informing who gets extra screening, a load adjustment, or targeted prehab. It has nothing to offer in the moment a foot lands wrong. Of the ankle model’s top inputs, sprain history and dorsiflexion range need no equipment, while arch height index and a Biodex score need a clinic. For a program already running FMS, tibial acceleration asymmetry from a shank-worn IMU is the one addition the first study supports.
LigaSys is developing Smart Ligament™ systems — reactive wearable hardware designed to sense dangerous joint motion and respond mechanically in real time. If you’re working on athlete availability and performance outcomes, we’d like to hear from you.
