Lateral ankle sprains – How should they be managed?

Diagnosis, Treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline – vuurberg et al., 2018.
Lateral ankle sprains, how should they be managed

Lateral (outside) ankle sprains are the most common ankle injury. Approximately 40% of all traumatic ankle injuries occur during sport, and only 50% of individuals seek medical attention.
Due to the poor attention to injury, a large population develop chronic ankle instability. 1-4 years following initial injury, 5-46% of individuals with chronic ankle instability still experience pain, 3-34% has recurrent sprains, and 33-55% report instability.
Risk Factors
Predisposing factors that increase the risk of sustaining a lateral ankle sprain compose of Intrinsic factors (patient-related), and Extrinsic factors (sport, environment).
Intrinsic risk factors
Modifiable risk factors include:
• Reduced strength around the ankle and calf
• Limited ankle mobility and range
• Poor proprioception (“the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement”)
• Low cardiorespiratory endurance
• Increased BMI (Body mass index)
• Preseason deficiencies in postural control/balance e.g single leg stand
Non-modifiable risk factors include:
• Anatomical abnormalities in the ankle, knee alignment, and multiple clinical defects
Extrinsic risk factors
• Sport dependent – Highest incidence of lateral ankle sprains were found in: Basketball, indoor volleyball (landing following jumping), field sports, climbing.
• Playing surface – Natural grass vs artificial turf vs court
• Position played in sport – e.g within soccer, defenders obtain 42.3% of lateral ankle sprains in the sport.
Treatment
Below is some of the latest evidence for the best treatment options, and how we can get you back running around with the kids, or back onto the sports field.

 R.I.C.E (Rest, Ice, Compression, Elevation)
Purpose: to reduce pain and swelling, improve patient function
RICE alone as a treatment is not enough, the best evidence is to apply the RICE principles alongside with exercise therapy.

 Non-steroidal anti-inflammatory drugs (NSAID’S) – E.g Ibuprofen, naproxen, diclofenac
Purpose: to reduce pain and swelling for acute injuries
If you have any concerns in regards to medication please discuss with your doctor.
Adverse effects may include: stomach discomfort, allergic reactions, heart burn, nausea, vomiting, diarrhea and/or constipation and more.

Immobilisation
A minimum of 4 weeks in a low leg cast following an acute lateral ankle sprain results in less optimal outcomes when compared with functional support (brace, tape, tubigrip/bandage) and exercise strategies with duration of 4-6 weeks.
However recent evidence showed a short period (less than 10 days) of immobilisation with plaster cast or rigid support (brace) can be of added value in the treatment of acute lateral ligament injuries as it helps reduce pain and oedema (swelling), and improves functional outcomes

Functional support i.e ankle brace/ tape/ tubigrip
Tubigrip/compression stocking following the acute phase of treatment begins to become unhelpful as it doesn’t provide sufficient support. Therefore using a lace up brace or semi-rigid brace will provide enough ankle support
Ankle braces results in better outcome compared to rigid or K-tape
K-tape is unlikely to provide sufficient mechanical support to unstable ankles

 Exercise
Consist of neuromuscular and proprioceptive exercises
Reduce the risk of recurrent injuries by reducing ankle instability, and associated with quicker time to recovery and enhanced outcomes

 Manual mobilisations
Manual mobilisations provide short term increase in ankle range of movement and can reduce pain in lateral ankle sprains
However manual therapy in combination with exercise therapy results in better outcomes than exercises alone

 Surgical therapy
60-70% of individuals who sustain lateral ankle sprains respond well to non-surgical treatment programmes
Surgery is mainly reserved for patients who have chronic ankle instability and who have not responded to comprehensive exercise-based physio programme.

Other therapies
Other treatment options are can also be used during treatment, although please discussed with your physio if these are beneficial for you.
These including: Acupuncture, Vibration therapy, laser therapy, electrotherapy, shockwave therapy, ultrasound.

Here at Bureta Physio we can properly assess your injury and give you the appropriate recommendations to get you back into what you love doing. Call 07 576 1860 to arrange an appointment time or click here to book online

 

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