Ankle sprain: What do we need to know?

Today, we are going to review one of the most common injuries, even more when we do sports, regularly or eventually. Who has never twisted his ankle or had an ankle sprain? The foot gets stuck on the floor, we trip or step in something unstable, our ankle gives way and we feel an acute pain, sometimes followed by a clunk or a crack. Then it comes the swelling and pain, for a few days; occasionally even weeks.

Well, recently the guideline about the lateral ankle sprain has been updated, thanks to a meta-analysis and a systematic review of hundreds of articles. And, I though would be nice to do a short summary, focalizing in some interesting points. Always from the point of view of the physiotherapy.

Key points regarding Lateral Ankle Sprain:

• About 40% ankle sprains are sport injuries or sports related. The 50% of people who has an ankle sprain do not seek for medical assessment. A big amount of those cases can become chronic!

• Predisposing factors of the lateral ankle sprain.

1. Intrinsic factors: New factors have been included like BMI, not only obesity but also a low BMI affects negatively. Also, movement restriction and poor proprioception are predisposing factors, and they should be included in the re-education, rehabilitation and prevention of the ankle sprain.

2. Extrinsic factors: different kinds of sports, especially those involving high impact or contact sports like basketball, football or rugby.

• Prognosis: Around 40% of ankle sprains become chronic (pain, instability and recurrence). That is frequently bounded to neuromuscular factors, that´s why physiotherapy is so important to have a full recovery.

• The importance of a good diagnose to know how serious is the ankle sprain. Talking about physiotherapy the anterior drawer test is important to assess if the ligament has been damaged, even more if the diagnose is not immediate and has been delayed more than 4-5 days from the injury

• There is no evidence to say that RICE method (rest, ice, compression, elevation) or the application of its elements separately, is effective. Instead, RICE combined with progressive exercise helps to reduce swelling and pain; and increases ankle range of movement.

• NSAID´s have the same effect than other analgesia to reduce pain after an ankle sprain. But they can interfere and delay the natural healing process.

• Early mobilisation is better than short period (around 4 weeks) immobilization. Functional taping or ankle supports can help to reduce symptoms, and also can facilitate ankle movement giving support to the injured ligament.

• It has been proved that with active exercise combined with manual therapies we can obtain better outcome and reduced post-injury convalescence after lateral ankle sprain. The healing process and return to work/sports period it is also shortened by this kind of treatment.

• Prevention and neuromuscular training once the ankle sprain seems healed is essential to avoid recurrence.

Here at the end you can see the link to the reseach published in the BJSM

https://bjsm.bmj.com/content/52/15/956