Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review
Feger MA, Goetschius J, Love H, Saliba SA, & Hertel J. Physical Therapy in Sport. Online ahead of print, January 16 2015.
Take Home Message: There is no evidence to support the use of electrical stimulation after an acute lateral ankle sprain to reduce edema, decrease pain, or improve functional limitations.
Acute lateral ankle sprain treatment commonly includes rest, ice, compression, and elevation, but an earlier Sports Med Res post reported on an article that questioned the evidence behind this common clinical practice. Electrical stimulation is also sometimes applied in an effort to expedite recovery and help reduce pain and edema; however, little evidence exists to support the use of electrical stimulation for these purposes. The authors of this systematic review aimed to investigate whether or not there is evidence to support the use of electrical stimulation to facilitate recovery after an acute lateral ankle sprain. Only 4 articles met the inclusion criteria of being a randomized controlled trial on human participants with an acute ankle sprain (< 6 days post injury) who were assessed for pain, edema, or function. The included research studies had a variety of parameters for neuromuscular electrical stimulation and high-voltage pulsed stimulation. All 4 studies included were of high methodological quality when analyzed by three authors using the PEDro scale. Three of the 4 studies showed no meaningful improvement in function or time to return to participation. There was also no meaningful improvement in edema volume or girth in 3 and 2 of the studies, respectively. Only 1 study reported enough information to determine that there was no meaningful reduction in pain.
There is no evidence to support the use of electrical stimulation to reduce pain, swelling, or functional deficits in patients with an acute lateral ankle sprain. However, this systematic review highlights the need for more high quality studies with similar waveforms and parameters to truly investigate the value of electrical stimulation. Some of the parameters were specifically targeted towards edema prevention, while others may have been targeted towards reducing pain or edema reduction. Only 1 of the included studies included enough information to evaluate electrical stimulation effects on pain reduction. It would be interesting for future research studies to collect pain measurements, as pain reduction is a universally recognized and accepted goal of electrical stimulation. Due to the smaller number of studies and participants, there may simply be not enough data to find significance with a small treatment effect size. With so few studies it is difficult to determine what the optimal parameters might be as well as the optimal time to apply the treatment. This is a great example of an area of clinical research that would benefit from clinicians and researchers discussing what protocols may be ideal based on clinical and research experience so that more clinical trials can be performed. In the meantime, despite the lack of clinically meaningful improvements there was no detriment to electrical stimulation application. Seemingly, it may be safe for clinicians to use electrical stimulation after an ankle sprain in conjunction with other treatment strategies. Furthermore, it may be helpful for clinicians to review their medical records to determine which parameters seem to be effective after an ankle sprain and for which patients. This could help lead to improved patient care and inspire new research.
Questions for Discussion: Do you currently do anything within the first 48 hours after an ankle sprain to help reduce swelling, pain, or limitations? Are there any specific wave forms or parameters that you have found to be the most successful clinically?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban