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Background Eversion ankle sprains, although less common than inversion injuries, are often associated with greater severity and more complex recovery patterns. Their biomechanical origin remains less clearly understood. Objective To propose a functional, longitudinal kinetic chain model in which anterior innominate rotation (AS) may contribute to the development of eversion ankle sprain injuries. Methods This hypothesis-driven model is based on clinical observation and biomechanical reasoning. Anterior innominate rotation may lead to pelvic asymmetry, a functional long-leg pattern, internal femoral rotation, and toe-in mechanics. Results (Hypothesis) These adaptations may increase medial loading, promote collapse of the medial longitudinal arch, and alter ground reaction forces. This may compromise medial stability and reduce the capacity to control eversion forces, increasing susceptibility to injury. Conclusion Eversion ankle sprains may represent the distal expression of proximal biomechanical dysfunction. Recognition of anterior innominate rotation may improve injury prevention strategies.
Background Ankle sprains are among the most common injuries in sports, often characterized by high recurrence rates despite appropriate local treatment. Traditional approaches primarily focus on the injured joint, with limited attention to proximal biomechanical factors that may predispose athletes to injury. Objective To propose a functional, longitudinal kinetic chain model in which sacroiliac joint dysfunction may act as a predisposing factor for ankle sprain/strain injuries in athletes. Methods This paper presents a clinical hypothesis based on biomechanical reasoning and observational findings. The proposed model describes how sacroiliac joint dysfunction, particularly posterior innominate rotation (PI), may lead to pelvic obliquity and functional leg length discrepancy. These changes may induce compensatory femoral external rotation and foot toe-out, altering ground contact mechanics during gait and running. Results (Hypothesis) The altered alignment and loading pattern may increase the vertical impact force and modify the ground reaction vector on the functionally shorter limb, resulting in reduced mechanical stability at the ankle during heel strike or foot contact. Over time, this may increase susceptibility to inversion or eversion injuries, manifesting clinically as recurrent sprain/strain. Conclusion Ankle sprains in athletes may, in some cases, represent the distal expression of a proximal biomechanical imbalance. Incorporating assessment of the sacroiliac joint and the longitudinal kinetic chain into routine clinical evaluation may improve injury risk identification and contribute to more effective prevention strategies. Further research is needed to investigate this proposed relationship.