Sports Medicine Research: In the Lab & In the Field: More Is Better: Exercise Therapy for the Ankle (Sports Med Res)


Thursday, December 22, 2016

More Is Better: Exercise Therapy for the Ankle

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

Related Posts:
Fibular Taping Versus Traditional Taping in Patients With Chronic Ankle Instability

Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2016). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis British Journal of Sports Medicine DOI: 10.1136/bjsports-2016-096178


Kyle Hernden said...

As an athletic trainer, ankle sprains are one of most common injuries I deal with, and one of the injuries that cause the most recurring symptoms. When dealing with these injuries as young professional, one of the questions I ask myself most is “how much rehabilitation is enough?” I think most athletic trainers agree that athletes should continue rehab even after a full return to activity, but many athletes don’t understand this ideology and compliance typically drops off drastically. After all, if they can participate in their sport fully, why would they need to keep spending time doing single-leg balance and 4-way ankle exercises? I think this article answers this question really well. If a health care professional can present the findings from this article to their injured patient and explain that their outcomes will be improved to the fullest extent if they continue rehab, they would be more inclined to be compliant with their rehab. After reading this article, I’m excited to bring this to my clinical practice and see if the results can translate to real-life situations.

Unknown said...

Kyle, I'm glad you were able to take away some tangible information from the Doherty et al article on theimportance of continuing rehab after an athlete RTP.

I think you bring up a great point on how difficult it is to keep an athlete actively engaged and motivated to continue rehab after they RTP because they often view it as unnecessary and boring. In addition to providing education to athletes on the importance of continuing rehab after they RTP, I think a great way to keep athletes engaged is by being creative with the exercises that we give athletes. I think prescribing the same exercise routine everyday can be very monotonous for an athlete which likely causes them to become less interested. Yet, if we can continue to make the exercise more dynamic and goal oriented I think athletes are more likely to continue their rehab because it is less monotonous compared to 4-way ankle exercises and they see the process they are making. I also think being creative by incorporating some form of exercise (i.e. dynamic balance) into their warm-up routine is also a great way to keep an athlete continuing their exercise.

What have you found to be useful in keeping athletes committed to continuing with their rehabilitation program after they have RTP?

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