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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Knock knees, flat feet, fallen arches – Should I be concerned about these with my child?

As children grow from babies through toddlers, young children, the dreaded teens and finally to adults they go through many growth stages. During different stages of growth their body is placed under varying stresses. There are a number of factors or biomechanical issues that are good to have checked out by a physio to help ensure your children stay pain and injury free.

Babies-toddlers: during this stage there are a number of milestones which are most often the largest concern. These include the recommended time to sit, crawl, walk and develop higher functions likes socialising and language. It is important to realise that all children develop at differing rates, and some may bottom shuffle instead of crawling or skip it altogether and go straight to walking. If you have concerns at this stage speak with your GP/paediatric nurse or physio. Odds are your child just has quite reached that stage yet.

Toddler-young children: during this stage changes in the alignment of the lower limb and growth spurts can result in a variety of problems. Many children will often suffer ‘growing pains’, flat feet, knock or bowed knees and clumsiness with sport and running. If you notice any of these it is important to have them checked to ensure that growing pains are not muscle/tendon injuries and that foot issues are within normal limits. Unchecked these can go on to generate further problems.

Teens: Once again an important area due to massive growth spurts and changes to the general structure of their body as puberty takes hold. It is also at this stage that we often see dramatic increases in the duration and intensity of activity.

Common problems during this stage for girls include frontal knee pain, ankle sprains, calf tears and shin splints.

For boys common issues include shoulder instabilities, sprained ankles and knees, tendon attachment inflammation (Osgood-schlatters etc) and shin splints.

During the school term between work, sports and after school events it can be hard to find time to get these niggling injuries or pains checked but it is important that these issues are sorted out SOONER rather than later and that the appropriate treatment and rehab programmes can be started.

For a Free assessment voucher or quick chat to see if your child is appropriate for a full assessment give us a call on 5761860 or email buretaphysio@xtra.co.nz for more information.