Impact of ankle injuries on joint range of motion and muscle viscoelasticity in female amateur volleyball athletes

Abstract

Introduction

This study aimed to compare ankle joint range of motion (ROM) and muscle viscoelastic properties in female amateur volleyball players with a history of ankle sprain (AS group) and without (non-AS group).

Methods

Forty-one female participants were included in the study: 25 in the AS group and 16 in the non-AS group. Ankle ROM was measured for inversion (IV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF). Viscoelastic properties were assessed in the tibialis anterior (TA), medial gastrocnemius (MG), lateral gastrocnemius (LG), and peroneus longus (PL) muscles.

Results

A significant difference in DF ROM was observed between the AS and non-AS groups (p = 0.030). Muscle frequency was significantly higher for TA (p = 0.010), MG (p = 0.008), and LG (p = 0.008) in the AS group. Additionally, muscle stiffness in TA (p = 0.010), MG (p = 0.014), LG (p = 0.021), and PL (p = 0.049) was significantly greater in the AS group. Significant differences in relaxation were found in TA (p = 0.010) and PL (p = 0.032), while creep differences were noted in TA (p = 0.007).

Conclusions

These findings suggest that ankle sprain may lead to persistent alterations in muscle mechanical properties and joint mobility, highlighting the importance of comprehensive assessment and targeted rehabilitation of all related muscles to prevent recurrent injuries and optimize recovery in female volleyball players.

Introduction

Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries, characterized by high recurrence rates and significant long-term consequences for joint stability and function [1, 2]. Chronic ankle instability (CAI), which often develops after an initial ankle sprain, is primarily associated with neuromuscular control deficits, proprioceptive impairments, and altered muscle activation patterns [3]. LAS injuries also represent the most prevalent sports injury among athletes [4–7]. Its etiology includes sudden and rapid inversion, internal rotation, level of play, skill level, shoe type, age, gender, previous injury, and inadequate rehabilitation [8, 9]. In fact, ankle sprains account for 47.4% of all injuries in contact sports such as football, handball, and basketball. Similarly, in non-contact sports such as badminton and volleyball, they remain the most common injury, with a reported prevalence of 25.4% [1, 10–13].

The consequences of ankle sprains are diverse, ranging from ankle instability and impaired proprioception to neuromuscular control deficits, reduced range of motion (ROM), and ligamentous laxity [6, 14, 15]. Among these, loss of ROM is recognized as the most common symptom [16]. Importantly, reduced ROM can alter the mechanical properties of muscles at rest and affect muscle tone, stiffness, and elasticity (collectively known as viscoelasticity) [17].

Muscle viscoelasticity plays a critical role in determining the mechanical properties of muscles, with direct implications for athletic performance [18, 19]. Previous studies have established that increased muscle tone is associated with decreased ankle ROM [20, 21], which, in turn, elevates the risk of re-injury to surrounding ankle tissues [22, 23]. Furthermore, high muscle tone has been shown to increase the risk of injury in sports that require advanced skills, such as sudden directional changes and jumping [24].

Although previous research has largely focused on neuromuscular deficits as the primary factor in CAI, rather than intrinsic mechanical tissue alterations [3], there is limited evidence regarding the impact of long-term (over five years) chronic ankle sprains on the mechanical properties of muscles. Clarifying whether prolonged chronic conditions result in tangible changes in viscoelastic properties would broaden our understanding of long-term physiological adaptations and offer valuable insights for clinical rehabilitation practices.

Sex-related differences have also been reported in individuals with ankle sprain injuries. For instance, one study found that women with sprained ankles exhibited smaller pronation and supination angles but greater dorsiflexion angles than men. This suggests that a history of ankle sprains may differently affect the mechanical changes and ROM of the ankle in men and women [25]. Additionally, other research has indicated sex-related differences in the epidemiology, outcomes, and prevention of ankle injuries among athletes [26]. Ankle sprain is the most prevalent injury in athletes, with a higher incidence observed in females than males; a meta-analysis reported incidence rates of 13.6 and 6.94 per 1,000 exposures for females and males, respectively [1, 27].

Notably, young female athletes are particularly susceptible to ankle sprains due to physiological factors such as increased joint laxity, hormonal fluctuations, and neuromuscular control characteristics [28–30]. Despite the high incidence of LAS in this group, relatively few studies have specifically investigated the long-term effects of ankle sprains on ankle function and muscle mechanical properties in young women, especially within the context of amateur sports [31, 32]. Addressing this gap could provide more tailored rehabilitation and preventive strategies for this high-risk population [33].

Evaluating changes in ROM and muscle viscoelasticity around the ankle joint is critical, as these parameters directly influence joint biomechanics, functional stability, and injury susceptibility [2]. Understanding these mechanical properties in patients with chronic ankle sprains could enable the development of more targeted rehabilitation protocols and improved preventive strategies.

Therefore, this study aimed to analyze the effects of ankle sprain experience on the ankle joint’s ROM and the viscoelastic properties of surrounding muscles in female amateur volleyball players. We hypothesized that the group with a history of ankle sprain would demonstrate lower ROM and higher muscle stiffness compared to those without such a history.

Method

Subjects

Forty-one female amateur volleyball players volunteered for the test (Table 1). All participants were deemed to be medically fit to perform the test. Subjects reported being physically active for a minimum of three hours per week and having played volleyball for a minimum of five years. The inclusion criteria were as follows: The non-ankle sprain (non-AS) group comprised individuals with no history of ankle injury or history of ankle injury in the previous five years. The group afflicted with ankle sprains (AS) comprised individuals who had sustained ankle injuries within the past five years and had received a diagnosis of a sprain from a doctor. To reduce variability in tissue healing and neuromuscular adaptation timelines, participants with a history of AS within the past 5 years were included in the study. This criterion was based on the findings of previous studies suggesting that neuromuscular and biomechanical alterations related to AS may persist for several years but tend to diminish or normalize over longer time frames [34, 35]. Therefore, the 5-year window was selected to ensure the inclusion of individuals who are more likely to exhibit relevant chronic adaptations, without introducing excessive heterogeneity in tissue state or motor control patterns. Importantly, the specific injured limb was not identified or used as a grouping criterion. This classification aligns with the study’s primary aim of examining differences according to ankle sprain history, rather than limb-specific effects. Therefore, all analyses were conducted considering participants’ overall ankle sprain status, irrespective of the injured side. All participants had the right and left sides of their feet measured in the test, resulting in 82 participants. The sample size was determined using G*Power 3.1.9.7 software [36]. A post hoc power analysis for an independent samples t-test (two groups; group 1: n = 32, group 2: n = 50), with an assumed effect size (Cohen’s d) of 0.8 (large), a significance level (α) of 0.05, and a one-tailed test indicated a statistical power (1–β) of 0.968. This suggests that the sample size was sufficient to detect a large effect between the groups with a power exceeding the conventional threshold of 0.8.

Table 1.

Characteristics

	AS (n = 50)	non-AS (n = 32)	p
Age [years]	22.16 ± 1.72	21.63 ± 1.78	0.346
Weight [kg]	62.14 ± 6.34	58.34 ± 8.44	0.108
Height [cm]	165.36 ± 4.86	164.85 ± 6.18	0.768
Fat [kg]	17.22 ± 3.97	15.99 ± 5.86	0.427
Fat [%]	27.60 ± 4.61	26.71 ± 6.31	0.607
Muscle mass [kg]	24.64 ± 2.69	23.21 ± 2.33	0.087
BMI [kg/m2]	22.69 ± 1.63	21.50 ± 3.18	0.180

Values are presented as mean ± standard deviation (SD). AS; ankle sprain, non-AS; non-ankle sprain, BMI; Body mass index

The study complied with the principles outlined in the Declaration of Helsinki. All procedures were approved by the Ethics Committee of Sungshin Women’s University, and informed consent was obtained from participants after the study was approved (SSWUIRB-2024-032). The study’s design and testing procedures were thoroughly explained to all participants. Before the commencement of the testing session, the participants were instructed to abstain from strenuous physical activity for 48 h, and no specific dietary directives were provided. Furthermore, all measurements were conducted in a controlled environment with constant temperature and humidity levels to minimize diurnal variations in muscle tone and stiffness. Prior to the application of myotonometry, participants were requested to repose quietly in a supine position for a minimum of 30 min to ensure a baseline, resting muscle state.

Ankle ROM

Ankle ROM was measured using a Baseline 360˚ goniometer (GemRed Digital Goniometer, Guangxi, China). The subjects were instructed to assume a supine position with their legs outstretched on an examination table.

The stationary arm of the goniometer was placed along the midline of the fibula from the fibular head to the lateral malleolus, and the movable arm was along the midline of the fifth metatarsal. The position of the goniometer axis was determined at a point approximately 1.5 cm inferior to the lateral malleolus for the measurement of dorsiflexion (DF) and plantar flexion (PF). For inversion (IV) and eversion (EV), the goniometer was positioned with the stationary arm aligned with the midline of the leg and the movable arm aligned with the midline of the calcaneus. The position of the goniometer axis was then determined at the midpoint between the malleoli on the posterior aspect of the ankle. To increase the accuracy of the measurements, we had one researcher measure the ROM of all subjects. The ankle test position started at 90°. Subsequent measurements were taken three times each for the angles of DF, PF, IV, and EV of both ankle joints, and the average was calculated. The measurement protocol was based on standardized guidelines [37, 38]. Intra-rater reliability for ROM was evaluated using intraclass correlation coefficients [ICC(2,1); two-way random-effects model, absolute agreement, single measures]. ICC values ranged from 0.824 to 0.954, indicating good to excellent reliability (Table 2).

Table 2.

Intra-rater reliability for ROM

Variable	ICC(2.1)	95% CI	p-value	Interpretation
Dorsiflexion	0.920	(0.850–0.957)	0.000	Excellent
Plantar flexion	0.954	(0.913–0.975)	0.000	Excellent
Inversion	0.936	(0.902–0.961)	0.000	Excellent
Eversion	0.824	(0.671–0.906)	0.000	Good

ICC, Intra-rater reliability; ICC(2,1), two-way random-effects model, absolute agreement, single measures. Interpretation: Poor (< 0.5), Moderate (0.5–0.75), Good (0.75–0.9), Excellent (> 0.90)

Myotonometry

The Myoton PRO (Myoton AS, Tallinn, Estonia) is a sophisticated instrument measuring tissue response. It employs an accelerometer to record the damped oscillation induced by five mechanical impulses. The device then calculates various parameters from the recorded data: frequency represents muscle tone (Hz), defined as the natural frequency of the acceleration. Stiffness (N/m) is calculated via the damped natural oscillation response. The decrement is the shape restoration from deformation. Relaxation (ms) was calculated during the muscle recovery process. Creep is gradual tissue elongation under constant stress [39].

MyotonPRO measurements were performed over the centers of the muscle bellies of the peroneus longus (PL), tibialis anterior (TA), lateral gastrocnemius (LG), and medial gastrocnemius (MG), following the protocol described in previous studies [40]. Specifically, participants were positioned supine for measurements of the PL and TA muscles, and prone for the LG and MG muscles to ensure standardized assessment of muscle mechanical properties. Each muscle was measured on three occasions, and the mean value was used for analysis. To ensure the reliability of Myoton PRO measurements, an inter-measurement reliability analysis was performed, yielding ICC(2.1) ranging from 0.96 to 0.99 [41, 42].

Statistical analysis

Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics for general characteristics are presented as mean ± standard deviation for continuous variables. The normality of data distribution was assessed using the Shapiro-Wilk test, and homogeneity of variances was evaluated with Levene’s test. Independent t-tests were used to compare ankle ROM and muscle myoton viscoelasticity (as measured by Myoton) between the AS and Non-AS groups. When the assumptions of normality or homogeneity of variance were not met, the Mann-Whitney U test was employed as a nonparametric alternative. Statistical significance was set at a two-tailed p-value < 0.05. Effect sizes for between-group differences were calculated using the method of Kazis et al., dividing the mean difference by the standard deviation at baseline [43]. Effect sizes were interpreted as small (0.2), moderate (0.5), or large (0.8) according to standard conventions.

Result

ROM of the ankle

Table 3 presents the ankle joint’s ROM. A statistically significant difference was observed in DF between AS and non-AS (p = 0.030, Cohen’s d = 0.82, large effect). However, statistical analysis revealed no significant differences between the two groups regarding plantar flexion (p = 0.188, d = 0.30), inversion (p = 0.242, d = 0.27), and eversion (p = 0.133, d = 0.34), all of which demonstrated small effect sizes.

Table 3.

Range of motion of the ankle

	AS (n = 50)	non-AS (n = 32)	95% CI of Difference	t-value	df	P	Effect size (Cohen’s d)
DF [º]	20.60 ± 6.98	29.81 ± 15.74	-15.18 ~ -3.24	-3.121	38.90	0.030*	0.82
PF [º]	56.92 ± 14.92	62.38 ± 22.32	-13.63 ~ 2.72	-1.328	80	0.188	0.30
Inversion [º]	28.24 ± 9.27	30.97 ± 11.55	-7.33 ~ 1.87	-1.180	80	0.242	0.27
Eversion [º]	23.39 ± 8.93	26.50 ± 9.24	-7.19 ~ 0.97	-1.518	80	0.133	0.34

Values are presented as mean ± standard deviation (SD). Mean difference, 95% confidence interval (CI), t-value, degrees of freedom (df), and p-value are shown. Effect size is calculated as Cohen’s d (small ≥ 0.2, medium ≥ 0.5, large ≥ 0.8). AS: Ankle sprain group; non-AS: non-ankle sprain group., DF; dorsiflexion, PF; plantarflexion, º; degree *; p ≤ 0.05.

Viscoelasticity

Table 4 presents the viscoelasticity results for the leg muscles. The frequency was found to differ significantly between the AS and non-AS groups in the TA (p = 0.010, d = 0.50), LG (p = 0.008, d = 0.56), and MG (p = 0.008, d = 0.45) muscles, with medium effect sizes. For muscle stiffness, significant differences were observed in the TA (p = 0.010, d = 0.60), LG (p = 0.014, d = 0.52), MG (p = 0.021, d = 0.53), and PL (p = 0.049, d = 0.46), all indicating medium or small-to-medium effect sizes. However, decrement did not demonstrate any statistical difference between the AS and non-AS groups (all p > 0.05; d < 0.20). Relaxation exhibited significant differences in the TA (p = 0.010, d = 0.60) and PL (p = 0.032, d = 0.50), both with medium effect sizes. Finally, for creep, only the TA (p = 0.007, d = 0.67) demonstrated a statistically significant difference, with a medium-to-large effect size between groups.

Table 4.

Viscoelasticity

	AS (n = 50)	non-AS (n = 32)	95% CI of Difference	t-value	df	P	Effect size (Cohen’s d)
Frequency [Hz]
TA	24.75 ± 9.75	20.84 ± 2.71	0.99 ~ 6.83	2.676	60.19	0.010**	0.50
LG	15.15 ± 2.39	14.04 ± 1.28	0.31 ~ 1.93	2.744	77.94	0.008**	0.56
MG	14.28 ± 1.55	13.56 ± 0.88	0.19 ~ 1.26	2.705	78.99	0.008**	0.45
PL	15.25 ± 1.60	14.82 ± 1.30	-0.25 ~ 1.10	1.263	80	0.210	0.30
Stiffness [N/m]
TA	461.53 ± 87.17	413.28 ± 68.20	13.91 ~ 82.59	2.798	76.68	0.010**	0.60
LG	285.95 ± 59.96	258.45 ± 39.56	5.62 ~ 49.37	2.501	79.90	0.014*	0.52
MG	265.32 ± 41.81	245.23 ± 30.14	4.24 ~ 35.93	2.524	78.78	0.021*	0.53
PL	314.09 ± 43.71	295.48 ± 36.09	0.82 ~ 36.39	2.084	74.62	0.049*	0.46
Decrement
TA	1.27 ± 0.23	1.33 ± 0.40	-0.22 ~ 0.10	-0.760	43.74	0.451	0.16
LG	1.32 ± 0.20	1.25 ± 0.18	-0.02 ~ 0.16	1.635	80	0.106	0.37
MG	1.39 ± 0.19	1.33 ± 0.16	-0.02 ~ 0.14	1.455	80	0.150	0.33
PL	1.10 ± 0.16	1.11 ± 0.19	-0.08 ~ 0.08	-0.025	80	0.980	0.06
Relaxation [ms]
TA	12.50 ± 1.96	13.64 ± 1.79	-1.98 ~ -0.30	-2.708	70.64	0.010**	0.60
LG	19.00 ± 2.54	19.92 ± 2.03	-1.93 ~ 0.09	-1.811	75.97	0.088	0.39
MG	19.27 ± 2.07	19.97 ± 1.59	-1.51 ~ 0.10	-1.737	77.27	0.105	0.37
PL	17.43 ± 1.94	18.40 ± 1.97	-1.85 ~ -0.08	-2.171	65.45	0.032**	0.50
Creep
TA	0.82 ± 0.11	0.89 ± 0.10	-0.12 ~ -0.02	-2.841	72.54	0.007**	0.67
LG	1.22 ± 0.14	1.25 ± 0.14	-0.09 ~ 0.04	-0.800	80	0.426	0.22
MG	1.22 ± 0.12	1.24 ± 0.11	-0.07 ~ 0.03	-0.674	80	0.502	0.18
PL	1.13 ± 0.18	1.19 ± 0.11	-0.12 ~ 0.01	-1.822	79.83	0.104	0.39

Values are presented as mean ± standard deviation (SD). Mean difference, 95% confidence interval (CI), t-value, degrees of freedom (df), and p-value are shown. Effect size is calculated as Cohen’s d (small ≥ 0.2, medium ≥ 0.5, large ≥ 0.8). AS: Ankle sprain group; non-AS: non-ankle sprain group, TA; tibialis anterior, LG; lateral gastrocnemius, MG; medial gastrocnemius, PL; peroneus longus, *; p ≤ 0.05, **; p ≤ 0.01

Discussion

Ankle injuries typically result in significant alterations in muscle function, including a reduction in ankle joint ROM. These mechanical changes following an ankle injury are more prevalent in women than in men and have been reported to coincide with or be associated with diminished lower extremity muscle function, persistent pain, and an elevated risk of ankle re-injury, particularly in female athletes [44]. The present study aims to determine the effect of ankle sprain history on the internal mechanical properties (viscoelasticity) of the TA, PL, LG, and MG muscles involved in ankle movement in amateur female volleyball players.

The findings of this study demonstrated that the ROM of dorsi flexion (DF) in female amateur athletes who had sustained an ankle sprain was considerably diminished in comparison to those who did not experience such an injury. The occurrence of low DF is a frequent consequence of an ankle sprain [45], and athletes exhibiting diminished plantar flexion (PF) ROM encounter biomechanical deficiencies [46]. This has been demonstrated to elevate the probability of recurrent ankle injury when executing functional movements, such as abrupt directional changes during sporting activities [47]. In view of the findings of earlier research, which demonstrated that women exhibit greater laxity of the ankle ligaments in comparison to men, and a greater range of motion of the ankle during sporting activities [48, 49], it is probable that a reduction in plantar flexion range of motion in women will exert a more deleterious effect on the mechanical movement of the ankle than in men.

Firstly, our myotonometry results showed that muscle frequency characterizes non-neurogenic muscle tone (intrinsic tension), and muscle stiffness describes the resistance of the muscle to external forces that deform the initial shape of the muscle [50]. Consequently, the values of these two parameters increase with muscle stiffness or high tension. In the present study, elevated levels of muscle stiffness and tension were observed in the TA, LG, MG, and PL muscles of subjects in the AS group. This finding stands in contrast to the results of a prior study in male subjects, which reported that ankle sprains did not affect the TA and MG muscles but rather the LG muscles [5]. Conversely, a previous study [51] did not observe significant differences in muscle stiffness between male and female athletes in their study; however, our results suggest that female athletes with ankle sprain may exhibit distinct patterns of muscle adaptation, potentially indicating gender-specific responses in muscle mechanical properties after injury. Possible mechanisms underlying the greater post-injury muscle stiffness observed in women likely involve several interrelated factors. First, hormonal influences—particularly the effects of estrogen on collagen metabolism and tendon properties—may alter muscle and connective tissue stiffness, resulting in heightened rigidity following injury [28, 29] Second, increased joint laxity commonly seen in women may necessitate greater compensatory muscle activation to stabilize the joint, thereby elevating baseline muscle tone and stiffness [29, 52] Third, sex-specific differences in neuromuscular control and movement patterns, such as distinct landing, jumping, or cutting strategies, may further contribute to elevated muscle stiffness and injury susceptibility among female athletes [29, 30]. Collectively, these physiological and biomechanical differences may help explain why post-injury muscle adaptations and increases in stiffness are more pronounced in women compared to men. The observed discrepancies between studies may be attributable to differences in study populations (e.g., sex, athletic level, chronicity of injury) or measurement protocols. To date, few studies have simultaneously evaluated ankle range of motion and muscle mechanical properties using myotonometry in young female athletes. Most available research has focused either on male athletes or mixed-gender populations. For example, Stefaniak et al. [5] reported increased tone and stiffness in the peroneus longus and tibialis anterior muscles among male athletes with chronic ankle instability. Similarly, Malliaras et al. [53] conducted a cross-sectional study in 113 volleyball players (including both male and female) and found that reduced ankle dorsiflexion ROM was significantly associated with patellar tendinopathy (p < 0.05), emphasizing the clinical relevance of ankle flexibility in preventing lower-extremity overuse injuries. A more recent study involving professional female volleyball players demonstrated increased Achilles tendon and soleus stiffness compared to swimmers [54], suggesting sport- and sex-specific adaptations in muscle–tendon properties. Such comparisons emphasize the importance of evaluating ankle ROM and myotonometric properties in female volleyball athletes and highlight the novelty of our study. Therefore, further research directly comparing male and female athletes using standardized Myoton parameters in young populations is warranted to clarify the clinical significance of these gender-specific muscle adaptations following ankle injury. Secondly, the myoton result demonstrates that ‘Decrement’ represents the process of deformed muscle restoring or recovering. In the present study, there was no significant difference between the AS and non-AS groups. However, ‘Relaxation’ demonstrated a significant difference in TA and PL, and Creep exhibited a significant difference in TA based on ankle sprain experience. Relaxation represents the time required for the muscle to restore and recover. Therefore, Relaxation can be considered an indirect measure of elastic potency. ‘Creep’ is the Relaxation ratio divided by the recovery time, indirectly reflecting the muscle’s resistance potency [55]. Consequently, no significant difference in the recovery rate of the muscles affected by the ankle sprain was observed. However, the TA and PL muscles exhibited variations in the rate of recovery and the rate of recovery over time.

Therefore, female amateur volleyball players with ankle sprains were observed to exhibit increased tension, stiffness, and reduced elasticity in the TA, the dominant muscle of ankle DF, as well as in the antagonist muscles LG and MG, and the PL, which contributes to passive stability during DF.

Based on these findings, rehabilitation programs for female amateur volleyball players with lateral ankle sprain should incorporate targeted interventions not only for the primary dorsiflexor muscles but also for the antagonist and stability-related muscles. Such comprehensive approaches may enhance muscle function and ankle stability, thereby potentially reducing the risk of recurrent injuries after returning to play. Additionally, clinicians are encouraged to routinely assess muscle properties, including tension, stiffness, and elasticity, to develop and monitor individualized rehabilitation strategies for optimal recovery. Future studies are needed to determine whether these muscle property characteristics are specific to female athletes or if similar patterns are also found in males, which could inform the development of gender-specific rehabilitation protocols.

Clinical implications

This study highlights important findings regarding ankle sprains in young female volleyball players and supports previous research emphasizing the high incidence and risk of ankle injuries in this population. Given the critical role of the ankle in volleyball, our results provide new insights into the viscoelastic properties of ankle-surrounding muscles and their potential impact on recovery and rehabilitation.

Early assessment of muscle properties and ankle function is clinically important, as it enables timely preventive strategies and targeted interventions. Implementing early evaluation and individualized rehabilitation protocols in young athletes may reduce recurrence and improve functional outcomes. Increasing awareness and education on appropriate post-sprain management among athletes, coaches, and trainers is also recommended to optimize recovery and minimize the risk of re-injury.

Limitations

Several limitations of this study should be acknowledged. First, as a cross-sectional design was employed, causal relationships between ankle sprain history and changes in muscle properties cannot be established. Second, the study population was limited to amateur female volleyball players, which may restrict the generalizability of the findings to male athletes, professional players, or those involved in other sports. Third, although objective devices such as Myoton were used to measure muscle properties, other confounding factors—including training volume, history of rehabilitation, and variations in measurement techniques—may have influenced the results. Fourth, the use of self-reported injury history may be subject to recall bias. Finally, long-term outcomes, such as recurrence rates or functional recovery over time, were not assessed in this study.

Conclusion

This study demonstrated that female amateur volleyball players with a history of ankle sprain exhibited significantly reduced ankle dorsiflexion range of motion compared to those without a history of ankle sprain. Additionally, increased muscle tension and stiffness were observed in the tibialis anterior, lateral gastrocnemius, medial gastrocnemius, and peroneus longus muscles in the ankle sprain group, along with decreased elasticity of the tibialis anterior and peroneus longus muscles. These findings suggest that ankle sprain may lead to persistent alterations in muscle mechanical properties and joint mobility, highlighting the importance of comprehensive assessment and targeted rehabilitation of all related muscles to prevent recurrent injuries and optimize recovery in female volleyball players.

Abbreviations

ROM

range of motion

AS

ankle sprain

IV

inversion

EV

eversion

PF

plantar flexion

DF

dorsiflexion

TA

tibialis anterior muscles

MG

medial gastrocnemius muscles

LG

lateral gastrocnemius muscles

PL

peroneus longus muscle

LAS

lateral ankle sprain

CAI

chronic ankle instability

BMI

body mass index

ICC

intra-class correlation coefficients

CI

confidence interval

SD

standard deviation

Df

degrees of freedom

Author contributions

Conception and study design, statistical analysis, investigation, data interpretation, writing-original draft preparation, and writing-review and editing: ES Sung.

Funding

This work was supported by the Sungshin Women’s University Research Grant of 2024.

Data availability

The datasets used during the current study are subject to restrictions from the funding organization and are available from the corresponding author upon reasonable request, pending approval from the funding body.

Declarations

Ethics approval and consent to participate

All procedures were approved by the Ethics Committee of Sungshin Women’s University, and informed consent was obtained from participants after the study was approved (SSWUIRB-2024-032).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial

Clinical trial number: not applicable.

Disclaimer

The funding organizations did not have a role in the design and conduct of the study, collection, management, analysis, interpretation of the data, preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication