Ankle sprains are probably the most dismissed injury there is. This could be because it is the most common injury sustained by our population, or just some old school thinking that has stuck with us to “walk it off”. Either way, we now know that the long term prognosis of acute ankle sprain is poor, with a high proportion of patients (up to 70%) reporting persistent residual symptoms and injury reoccurrence.
October 2016 saw the publishing of a paper titled “Treatment and prevention of acute and reoccurrent ankle sprain: an overview of systematic reviews with meta-analysis“. In other words, the best summary of all the good quality evidence that exists (and there is a lot!).
So what did it say? The paper broke the evidence into treating an acute ankle sprain or a chronicly unstable ankle. Under each category I have given the research, and a summary on what this means taken from the research as well as our experience.
Acute ankle sprains:
This would include any first time ankle sprain, without a previous history of instability.
The evidence: The evidence clearly suggests that hands on treatment (massage and joint mobilisation), physiotherapy exercises and bracing (boots and sitrrup braces) are beneficial when it comes to decreasing pain, increasing function and preventing reoccurence. The evidence is not so clear cut for surgery; it may decrease pain, but no research has shown it prevents reoccurence better the conservative management. Ultrasound is also used by some people in these injuries, the evidence now shows conclusively that it does not make a difference for any outcome following ankle sprains.
What to take from this: Early bracing is essential to decrease pain quickly and to allow the ligaments to heal, ensuring the ankle joint will still have ligaments to support it. It is very important these are supplied as quickly as possible to ensure a good outcome. Beyond this some hands on treatment is worthwhile where the patient has reduced movement or pain, and physiotherapy exercises are essential to restore strength and balance and to prevent further injury. Surgery is generally not needed for a first time sprain regardless of the severity of the tear, however they can be an option with severe bone injury or syndesmosis sprains. Ultrasound is not worthwhile and as a result we will not use it.
Chronic Ankle Instability:
The evidence: Similarly to acute ankle sprains, both physiotherapy exercises and hands on techniques will improve your pain, mobility, strength and chance of having a further ankle sprain. Bracing was also unanimously shown to decrease the risk of further injury. With taping however, the message was more unclear, it showed better results than having no support, but not as good as wearing a brace. Taping with bracing reduced injury reoccurrence by roughly 50%, while also reducing the severity of any further sprain. Surgery again has limited evidence, no good research has compared the likelihood of further sprains after surgery compared to without it.
What to take from this: Initially chronic unstable ankles are treated very similarly to acute sprains. A period of bracing to decrease pain and to give the ligaments a chance to heal is important, but in this scenario we can’t guarantee the ligaments will reattach and heal. Perhaps even more importantly hands on treatment and exercises will improve your ankle mobility, strength, balance and chance of further injury. In the situation where someone continues to roll their ankle, surgery is a good last resort to try and give someone supportive ligaments again. When returning to sport we generally start with taping for the first few weeks then use a brace longer term (up to around 1 year after the injury) in patients with more severe injuries.
The take home message:
- There is no such thing as a simple ankle sprain!
- 70% of people will have some ongoing symptoms or reoccurrence after an ankle sprain.
- The best evidence shows there is strong evidence for exercise therapy and bracing in preventing reoccurrence of an ankle sprain.
- Get your ankle injury assessed early by your physio, if treatment is not required they will tell you. Better to have it checked and not need treatment, than to “walk it off” when you needed treatment.
I hope this wasn’t too dense this month everyone! Plenty of good info from this consensus statement, if you have any questions please feel free to comment on Facebook, or to give us a call.
You can find the link to the research paper discussed here.
