Balanced PT distributed this article to area physicians on 5/30/08
The reported recurrence rate for lateral ankle sprains (80%)Â suggests that the healthcare community should continue to explore options that will protect our patientsâ€™ future health.1Â Authors previously noted that immobilization of ankle sprains was a common treatment error.2Â Early mobilization has proven more likely to prevent future ankle sprains.3,4Â One good reason for early mobilization is that functional stress stimulates the incorporation of stronger replacement collagen.3Â For grades I & II ankles sprains, Michael Wolfe, MD (Lewis Gale Clinic in Salem, VA) recommends that functional rehabilitation begin on the day of injury.2Â More and more of the treatment protocol literature regarding acute ankle sprains now gives specific recommendations for functional stress, and it is likely that the healthcare community has improved its track record with this injury over the past decade.
Predictors for future ankle sprains include limited range of motion in the ankle (especially limited dorsiflexion),5 muscle weakness (especially peroneal),6-8 other mechanical instability, functional instability,9 and a history of ankle sprains.10Â Functional instability refers to the sensation of an unstable joint due to neuromuscular deficits, as opposed to structural deficits such as lengthened ligaments.Â For instance, Lofvenberg and colleagues found that patients with chronic ankle instability had 33% slower reaction times in the ipsilateral peroneus longus and tibialis anterior.11Â Note that physical therapy can modify almost all of the predictors listed above.
Multiple studies now demonstrate physical therapyâ€™s ability to speed recovery and prevent recurrent ankle sprains.2,3,6,12-18Â A military series found that lack of specific rehabilitation for ankle sprains delayed return to full duty for several months.17Â In a different study, Holme and colleagues compared patients receiving rehabilitation to patients receiving other usual care and found that the rehabilitation group had a 7% reinjury rate over one year vs. a 29% reinjury rate with the usual care group.14Â Given the current drive to reduce overall healthcare costs, proactive measures to prevent recurrence of an injury with an 80% recurrence rate makes good sense.Â At Balanced Physical Therapy, your patients can receive proactive therapy including pain relief and healing modalities, proprioceptive training, strengthening, prevention strategies including bracing, sports specific training, and a home exercise program.Â Please refer all of your patients with ankle sprains to Balanced Physical Therapy.
- Hertel J. Functional instability following lateral ankle sprain. Sports Med. May 2000; 29(5): 361-71.
- Wolfe M, Uhl T, McCcluskey L. Management of Ankle sprains. Am Fam Physician 2001; 63: 93-104.
- Karlsson J, Lundin O, Lind K, et al. Early mobilization versus immobilization after ankle ligament stabilization. Scan J Med Sci Sports 1999; 9: 299-303.
- Dettori J, Pearson B, Basmania C, et al.Â Early ankle mobilization. Part I: the immediate effect on acute, lateral ankle sprains (a randomized clinical trial). Mil Med 1994; 159: 15-20.
- Tabrizi P, McIntyre W, Quesnel M, et al. Limited dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg Br 2000; 82: 1103-6.
- Thacker S, Stroup D, Branche C, et al. The prevention of ankle sprains in sports. A systemaic review of the literature. Am J Sports Med 1999; 27: 753-60.
- Hartsell H, Spaulding S. Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle. Br J Sports Med 1999; 33: 255-8.
- Bosie W, Staples O, Russell S. Residual disability following acute ankle sprains. J Bone Joint Surg Am. Dec 1955; 37-A (6): 1237-43.
- Hubbard T, Kramer L, Denegar C. Contributing factors to chronic ankle instability. Foot Ankle Int. Mar 2007; 28 (3): 343-54.
- Garrick J, Requa R. The epidemiology of foot and ankle injuries in sports. Clin Sports Med 1988; 7:29-36.
- Lofvenberg R, Karrholm J, Sundelin G, et al. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995 jul-Aug; 23 (4): 414-7.
- Osborne M, Rizzo T. Prevention and treatment of ankle sprain in athletes. Sports Med. 2003; 33(15): 1145-50.
- Stasinopoulos D. Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players.. Br J Sports Med. 2004 Apr; 38(2): 182-5.
- Holme E, Magnusson S, Becher K, et al. The effect of supervise rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports 1999; 9: 104-9.
- Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports med 2004; 32: 1385-93.Â Â
- Handoll H, Rowe B, Quinn K, et al. Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev 2001; (3): CD000018.
- Weinstein M. An ankle protocol for second-degree ankle sprains. Mil Med 1993; 158-771-4.
- Kerkhoffs G, rowe B, Assendelft W. et al Imobilisation for acute ankle sprain. A systematic review. Arch orthop Trauma Surg 2001; 121:462-71.