Inversion Ankle SprainsNicole Stavro

Overview of the Ankle

Injury occurs 1/10,000 people a day

1/4 of all sports injuries of lateral ligament complex

Diagnosis: Clinical assessment Radiograph – no bone

fracture

Treatments Conservative treatment with plaster cast or splint immobilization Functional Treatment

Early Mobilization External Support (tape, brace, orthotic) Coordination Training

Surgical Treatment

Immobilization Treatment

Functional Treatment

Immobilisation for acute ankle sprain: a systematic review 22 studies Population:

Skeletally mature individuals with acute injury to lateral ligament complex Outcome Measures:

Return to sports and work Pain Swelling Subjective and objective instability Recurrent Injury ROM Satisfaction

Kerkhoffs et. Al., 2001

Characteristics of Included Studies

Return to Sports (10) Long term follow up: greater

return to sports with functional treatment RR = 1.85, 95% CI: (1.2 –

2.8) Time to return to sports was

shorter with functional treatment 4.57 days, 95% CI: (1.5 – 7.6)

Return to Work (9) Functional Treatment:

Shorter amount of time to return to work than immobilization

7.12 days, 95% CI: (5.6 – 8.7)

Return to Sports/Work

Pain & Swelling

Swelling (7) Functional Treatment:

Fewer reports of significant swelling as compared to immobilization group

RR 1.44, 95% CI: (1.1 – 2.0)

Pain (9) Patient complained of pain

equally between groups

Instability

Subjective (7) No significant differences

Objective (7) Sommer and Schreiber, 1993

Increased instability (TTT) with immobilization compared to functional treatment (2.48 deg, 95% CI: 1.3 – 3.6)

All other studies found no significant differences

Talar Tilt Test

Anterior Drawer Test

Recurrent Sprain & Range of Motion

Recurrent Sprain (10) No significant differences

between groups

Range of Motion (3) Immobilization had more

patients with impairments in ROM compared to functional treatment RR = 1.64, 95% CI: (1.1 –

2.6)

Patient Satisfaction (6)

Short and Intermediate Follow Up Patients were more satisfied

with functional treatment Short Term: RR = 6.50, 95%

CI: (1.8 – 24) Intermediate Term: RR =

4.25, 95% CI: (1.1 – 16)

Conclusion No benefit from immobilization

treatment following lateral ankle sprain

Functional Treatment Benefits: Return to Sports Shorter Time for Return to Work Decreased Swelling Decreased Objective Instability Less Limitations in Range of

Motion Higher Patient Satisfaction

Limitations Does not determine severity of

ankle sprains Functional treatment includes

a variety of treatment modalities More research needed to

determine effective treatments within functional treatment

Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patient with Inversion Ankle Sprain Randomized Clinical Trial Participants:

74 patients with Grades 1 or 2 lateral ankle sprain Treatment Groups:

Home Exercise Program Group 4 sessions Mobilizing and Strengthening Exercises

Manual Therapy and Exercise Group 8 sessions Manual PT interventions to ankle (Grades III and IV) Mobilizing, Strengthening, and Self Mobilization Home exercises

Cleland et. al., 2013

Results

Outcome Measures: FAAM ADL, FAAM Sports, LEFS, & NPRS

Insert graphs

Conclusion

Manual therapy with exercise had significant improvements in pain and function at 4 weeks and 6 months compared to home exercise program

Rate of Recurrence HEP almost double the rate of recurrence (15.6% versus 9.1%)

Not statistically significant

Lateral Ankle Sprain Treament Conclusion Systematic Review

Immobilization not beneficial for treatment of lateral ankle sprain Functional Treatment

Manual Therapy Improve Function Decrease Pain

ReferencesCleland JA, Mintken PE, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K, Whitman JM. Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(7):443-55. doi: 10.2519/jospt.2013.4792. Epub 2013 Apr 29. PubMed PMID: 23628755.

Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly KD, Struijs PA, van Dijk CN. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg. 2001 Sep;121(8):462-71. Review. PubMed PMID: 11550833.