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By Admin
Ankle Sprains: Rehabilitation and Prevention
Lateral ankle sprains account f or almost a quarter of all sports injuries and are a common presentation to
Emergency Departments [1]. Conventional treatments are varied and range f rom immobilization and minimal
wrapping to surgical repair. ScientiFIT investigates the ef f icacy of treatment protocols and prevention of
ankle sprains.
Photo Courtesy Of : Royalty-Free/Corbis
Establishing the Basics:
Def inition: A lateral ankle sprain is the rupture of one, two
or all three ligaments on the outside of an ankle; grades I,
II and III, respectively [2]. One should also distinguish
“acute” sprains versus “chronic” instability, the latter being
subsequent looseness of the ankle and recurrent sprains
months af ter a traumatic event [3].
Predisposing f actors: While causation is not supported by
studies, it has been suggested that activities with vertical
jumping and f ast cutting movements (i.e., basketball,
tennis, volleyball), running on uneven surf aces, high
arches and tight heel cords and more importantly, history of previous sprains are f actors that correlate with
acute injuries [5, 6].
Investigating Treatment and Prevention:
To RICE or not to RICE:
Rest, use of intermittent application of Ice (20 minutes per hour), a Compression wrap, along with Elevation
has proven to be an appropriate protocol f or pain management and reduction of swelling [8]. The RICE
protocol shows better results when compared to heating pads, ice alone and compression alone. Of note,
RICE is only usef ul in the f irst 24-36 hours af ter injury and may have a detrimental ef f ect on rehabilitation if
used longer [9].
Photo Courtesy Of : NY Times

2. Cast immobilization and Weight Bearing:
Review of scientif ic literature shows that long
immobilization (4 weeks or more) is signif icantly less
ef f ective when compared to other means of f unctional
therapy. Cast immobilization is noted to be slightly
ef f ective only when it is perf ormed f or less than a week
and in grade III ankle sprains [10]. Functional bracing and
continued weight bearing is superior in early recovery.
Pharmaceutical Management:
Over-the-counter NSAIDs (i.e. Advil, Aspirin, Naproxin) are
used both f or pain management and anti-inf lammation. A
review of literature shows no scientif ic evidence either f or
or against anti-inf lammatory use in ankle sprains. Though
reduction of swelling plays a role in healing, use of
medications alone has not shown conclusive results [12].
Pref erred Functional Therapy:
Multiple studies compare ef f icacy of semi-rigid braces, elastic bandages, taping and immobilization boots,
as well as casting f ollowing lateral ankle sprains. A systematic review of these papers suggests that when
used f or 4-6 weeks, a lace up or semi-rigid ankle brace (air cast) is superior to any other intervention both
transiently and long term [14].
Rehab and Prevention:
In an acute injury, the main objective is pain relief , but starting sub-acutely af ter injury, the rehabilitation
targets restoration of range of motion without loss of proprioception (i.e. sense of balance). A mainstay of
rehabilitation and recovery is f unctional physical therapy. This includes early weight bearing, ankle range of
motion exercises, proprioception training (on a balance board or comparable techniques) and early return
to activity with external bracing [16]. Physical therapy usually begins with supervision of a sport physical
therapist and exercises are then continued at home. Once recovered, prevention of f uture ankle sprains is
primarily mediated by use of ankle braces and continued balance training. Taping, though popular amongst
most athletes, has not shown comparable results [17].
Foot orthosis and shoe gear:
Although a plethora of biomechanical studies link ankle instability with pathological f oot types (i.e.
abnormally high arches), which are managed vis-à-vis f oot orthosis, studies have not been suf f iciently
powered to link use of orthotics with prevention of ankle injuries. Moreover, low or high top shoe gear has
not been thoroughly investigated in prevention of ankle sprains [18].
Surgical Intervention:
Surgical repair in an acute setting is controversial [19]. While surgical repair is perf ormed in both acute and
chronic settings, studies provide extensive support f or the ef f icacy of surgical intervention in chronic ankle
instability [20].

3. Photo Courtesy Of : Adam
Seeking medical care:
Distinguishing the extent of an injury is important in any setting. In an athlete, early and correct diagnosis of
an injury is the key to early return to activity. ScientiFIT recommends seeking medical care if there is any
doubt in extent of the injury, especially if bruising, pain on bone, pain with compression and pain with weight
bearing persist on the morning af ter the injury.
In Conclusion:
Following an injury:
• Seek medical care to rule out a f racture, high ankle sprain or dislocation and to start the treatment
process.
• Treat an acute injury with Rest, intermittent Icing, Compression, Elevation f or the f irst day.
• Start early weight bearing in a lace up or semi-rigid ankle brace as soon as pain is managed.
• Start a f unctional therapy routine targeting range of motion exercises and proprioception training within
the f irst week and increase sport-specif ic exercises at the start of 4th week of rehab.
• Prevention is the key and using a supportive lace up or semi-rigid brace during activity is the best option.
• Corrective orthotics are helpf ul but its role in prevention needs f urther investigation.
• Surgery could be benef icial in properly diagnosed ankle instability cases, and should be ultimately
discussed with a specialist.
Published by Sam Nosrati, DPM
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