Common Treatment of Ankle Sprains
Ankle sprains are one of the most common musculoskeletal injuries. I have only worked as a sports trainer for two years but in that time, I probably saw more ankle sprains than any other injury. The usual mechanism of injury is the foot rolling in, relative to the ankle, damaging the ligaments on the outside of the ankle. This results in pain, swelling and reduced function and mobility to the extent that some have to take time off work. For athletes, an ankle sprain can mean also poorer performance and absence from competition.
Around half of people with acute ankle sprains get the feeling that their ankle is going to give way and continue to suffer recurrent ankle sprains. When these symptoms persist, it is termed ‘chronic ankle instability.’ This was something I experienced as a sports trainer. Many of the players continued to have pain and recurrent sprains long after the initial injury which was frustrating for them to say the least. So what is the best way to treat acute ankle sprains and prevent this from happening? There have been a lot of studies published on this topic. So many, in fact, that an article published this year in the British Journal of Sports Medicine reviewed all of the reviews investigating the issue. There were 46 reviews in total which included 309 individual studies.
They evaluated common treatments provided by physiotherapists and how well they improved self-reported function and prevented recurrent strains. The reviews all agreed that exercise is effective in the treatment of acute ankle sprains and can significantly reduce the odds of recurrence. As for what type of exercise, it is still unclear as the studies used a wide variety of different exercise programmes. However, they most often consisted of ankle disc or balance, wobble-board training. The studies often didn’t describe the exact parameters they used (e.g. intensity, dose) but it appears that a larger dose is better (>900 minutes). The authors also suggested that the exercise programme be performed for a minimum of 4 to 6 weeks. In addition to exercise therapy, all of the studies agreed that braces and taping are effective in the treatment of ankle sprain.
Physiotherapists may also use manual therapy as part of their treatment of ankle sprains. It is unclear whether this is effective but ankle joint mobilisations may have an initial positive effect on ankle range of motion. Using the well-known RICE (rest, ice, compression, elevation) protocol did not seem to be effective on its own but when combined with exercise, treatment success was achieved. No beneficial effect was found for ultrasound but there is some evidence to support the use of nonsteroidal anti-inflammatories (NSAIDs) for short term pain relief immediately after ankle sprain. Some people may choose to use alternative/complementary medicines such as acupuncture. The authors suggested this may be effective in improving pain and swelling in the short term but there is insufficient evidence to say for sure.
Preventing Further Ankle Sprains
After an ankle sprain, many of the players I worked with would get their ankles strapped as a preventative measure. A few asked me whether taping actually does prevent re-injury and to be honest, I wasn’t 100% sure. Based on this review, external support does significantly decrease the risk of sustaining a recurrent ankle sprain. Taping was deemed just as effective as bracing, with a similar re-injury risk reduction of 50%. They can also reduce the severity of the sprain. The authors advised wearing braces for a minimum of 6 months and that the benefit lasts for up to 1 year. Greater benefit is achieved when the bracing/taping is combined with an exercise programme. Lace up ankle supports were considered superior to semi rigid supports.
Is Surgery Recommended?
Do you need surgery after an ankle sprain? This particular review came to the conclusion that conservative management should always be trialled first and only considered if symptoms persist and that ultimately it comes down to the individual. They noted the higher risk of complications with surgery such as wound healing and infection as well as the higher financial costs.
Like with all research, this information should be interpreted with caution as there are always limitations to studies. Overall, the optimal treatment for acute ankle sprains and preventing recurrence is unclear but the best evidence suggests that there is strong evidence for exercise and bracing and a lack of evidence for ultrasound, acupuncture and manual therapy.