DIAGNOSIS, TREATMENT AND PREVENTION OF ANKLE SPRAINS: UPDATE OF AN EVIDENCE-BASED CLINICAL GUIDELINE

DIAGNOSIS, TREATMENT AND PREVENTION OF ANKLE SPRAINS: UPDATE OF AN EVIDENCE-BASED CLINICAL GUIDELINE

WHAT´S NEW?? 

Findings of a report completed by the European Institute of Sports Physiotherapy 

INTRINSIC RISK FACTORS:
Individuals of the female sex, as well as potentially a lower BMI, were identified to be at higher risk for experiencing ankle sprains. Deficiencies in proprioception and range of motion are recommended to be identified and addressed in rehabilitation and prevention programs to decrease the risk of recurrence.

EXTRINSIC RISK FACTORS:
An increasing amount of new data identified soccer players, especially defenders playing on natural grass and/or on a competitive level to be at higher risk. Modifications of extrinsic factors may lower the risk of future injuries. Healthcare professionals should therefore especially notice the type of sport and other extrinsic risk factors.

PROGNOSTIC FACTORS:
New available data showed negative prognostic factors may indicate slow or incomplete rehabilitation and thus allow for recommendations. The patient´s level of pain, workload and level of sports participation may have a negative impact on recovery and may increase the risk of injury recurrence. It is therefore recommended to address those factors early.

DIAGNOSTICS:
“Regarding the clinical assessment of damage to the anterior talofibular ligament, the sensitivity (84%) and specificity (96%) of assessment using the anterior drawer are optimized if clinical assessment is delayed for between 4 and 5 days post-injury. In case of a suspected fracture, the OAR should be applied.”

TREATMENT:
An increased body of evidence suggests that the individual aspects of RICE, apart from cryotherapy + exercise therapy, are not sufficiently effective. “There is no evidence that RICE alone, or cryotherapy, or compression therapy alone has any
positive influence on pain, swelling or patient function. Therefore, there is no role for RICE alone in the treatment of acute LAS.”

NSAIDs (NON-STEROIDAL-ANTI-INFLAMMATORY-DRUGS):
“NSAIDs may be used by patients who have incurred an acute LAS for the primary purpose of reducing pain and swelling. However, care should be taken in NSAID usage as it is associated with complications (level 2) and may suppress or delay the natural healing process.”

IMMOBILISATION:
The preferred intervention remains exercise therapy. Immobilization should not exceed 10 days when used to treat pain and edema.

FUNCTIONAL SUPPORT:
Late evidence supports the preference of braces and other external supports over immobilization. Functional support should be used for 4-6 weeks. Using ankle braces showed the best outcomes in comparison with other functional support applications.

EXERCISE:
New evidence supports the use of exercsie therapy to optimise recovery, preventing recurrent sprains and reducing the risk of functional joint instability and dysfunction. However, the from current data, no conclusion is possible on whether exercise therapy should be supervised or not.

MANUAL MOBILIZATIONS:
Current evidence supports the use of manual mobilizations administered in alongside exercise therapy.

SURGICAL THERAPY:
Late evidence supports that treatment decisions have to be made according to individual cases. Despite functional rehabilitation still being the preferred treatment, surgical intervention shows good outcomes. Professional athletes may benefit from surgical treatment to ensure a return to play.

PREVENTION:
Bracing and taping remain to play a big role in the prevention of ankle sprains. However, there is little evidence on mechanisms, which cause the preventative effects. Personal preferences remain to determine the choice of usage.

EXERCISE THERAPY:
It is advised to start exercise therapy, especially in athletes, as soon as possible after injury. There is a sufficient body of research to support that this helps to prevent recurrent sprains.
Therefore, exercise therapy should be included in regular training regimes or as home-exercise.

FOOTWEAR:
No recommendations due to inconclusive evidence.

RESUMING WORK:
Bracing and immediate functional treatment alongside a return to work schedule are advised.

RESUMING SPORT:
According to latest evidence, a faster return to sport will be achieved by supervised exercise of proprioception, strength and coordination.


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