Dont Just Walk It Off!

The latest research about returning to sport after a sprained ankle

Back in the day, the acute management of sprained ankle was to walk it off. The management protocol has evolved greatly since those times. With an increased awareness of chronic pain and instability issues (not to mention the estimate annual costs due to ankle sprains), the rehabilitation of the injured ankle is now a bit more evidence based.

An ankle sprains is an injury to a ligament. They are classified or graded as I, II or III according to severity. A grade I sprain is diagnosed when there is stretching of the ligament, a grade II, when there is a partial tear, and a grade III with the complete rupture of the ligament. Pain, swelling and difficulty weight-bearing are common symptoms. These symptoms as well as a progressive loss in dynamic balance can persist in instances where the ankle is poorly rehabilitated or when rehabilitation is incomplete. Today, in the acute stage of an ankle injury, we are more likely to follow the RICER regime: Rest, Ice, Compression, Elevation and Referral to a health professional. A recent study in the British Medical Journal (Bleakely et.al, 2010) challenged this method with an accelerated protocol for treatment involving supervised early exercise. Despite the small sample size, the study did conclude that the group that received the exercise protocol were more active earlier.There was however, no difference in re-injury rates.

Beyond the acute stage, it appears that manual therapy can offer a short term reduction in pain and an improvement in range of motion allowing pain free exercise. (Cosby et,al 2011). It is a well known fact in the rehabilitation scene, that proprioceptive training reduces the recurrence of injury. There is also some evidence to support unsupervised proprioceptive exercises at home for reducing self-reported symptoms of re-injury. (Hupperrets et.al 2009).

While it is hard to predict re-injury rates, the research offers some insight into who might be more prone to re-injury. A study by Malliaropoulus et.al (2009) conducted on a population of elite track and field athletes also discovered that those with low grade injuries-I or II were more likely to re-injure themselves than those with grade III injuries! The fact is that ankle sprains are common and a large fraction of them either re-sprain or do not resolve completely in a year. The latest research (Middelkoop et.al, 2012) discovered that the self reported symptoms of pain at rest and re-sprains at three months is a predictor for incomplete recovery at one year!

Complete recovery means that the injured ankle feels and works the same or better than at pre-injury level. That includes feeling pain free with all daily activities and sport, experiencing no swelling, stiffness or feeling of instability as well as being able to balance on one leg with your eyes open and closed for about half minute (if you cant do that last bit already, Id probably start practicing now). As an athlete recovering from an ankle sprain, it is important to be aware of any residual symptoms of discomfort that may affect your return to sport. If in doubt, do consult your Brisbane Physio!

Are you interested in attending Balance and strength classes to improve your flexibility and increase strength do come to us and we will serve you the best.

by: Adam J. R. Roberts

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