Treatment and Prevention of Acute and Recurrent Ankle Sprain: An Overview of Systematic Reviews with Meta-Analysis.
Doherty C, Bleakley C, Delahunt E, Holden S. British Journal of Sports Medicine. 2016;0:1-17. doi: 10.1136/bjsports-2016-096178
Take Home Message: Exercise therapy and external supports reduce the chance of an ankle sprain; increasing the volume of exercise further reduces the odds.
Several treatment options have been designed to manage persistent symptoms following an ankle sprain and reduce the chance of a recurrent joint injury. This has led to numerous systematic reviews to synthesize the best evidence for treatment and prevention. However, the large number of systematic reviews has made it difficult to understand the pros and cons of current treatment options. Therefore, Doherty and colleagues performed a systematic review by consolidating the systematic reviews that evaluated the treatment or prevention of acute ankle sprain and/or chronic ankle instability. They included systematic reviews that focused on (re-) injury incidence/prevalence or self-reported function/disability as a primary outcome. The authors retrieved 46 systematic reviews, which included 309 individual reports. The authors performed a meta-analysis with extracted data from the randomized clinical trials, which were included in the systematic reviews. In summary, exercise therapy and external support improve self-reported function and reduce the odds of sustaining an acute/recurrent ankle sprain by 40 to 62%. There is little evidence to support the use of ultrasound therapy, acupuncture, and manual therapy in the treatment of recurrent ankle sprain.
The conclusions from this systematic review reinforce current clinical practice by demonstrating the efficacy of exercise therapy and external supports. Interestingly, the authors found that when exercise therapy is performed at high doses (>900 minutes) the odds of preventing a recurrent ankle sprain further increase. These findings indicate that the overall amount of time performing exercise therapy has a significant impact on improving outcomes. Therefore, clinicians should educate their patients on the need to continue with their exercise therapy program long after their acute symptoms have subsided. The limited amount of time clinicians often have with patients following an ankle sprain highlights the need for a home-exercise therapy program.
Questions for Discussion: How much time do you spend with your athletes/patients after an ankle sprain? What are some resources that you have given to your athletes/patients to continue their exercises after you are finished working with them?
Written by: Kyle Kosik
Reviewed by: Jeffrey Driban
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