Electrical stimulation as a
treatment intervention to improve function, edema or pain following acute
lateral ankle sprains: A systematic review

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. 

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
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
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
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?

Nicole Cattano
by: Jeffrey Driban

Related Posts:

Feger, M., Goetschius, J., Love, H., Saliba, S., & Hertel, J. (2015). Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A Systematic Review Physical Therapy in Sport DOI: 10.1016/j.ptsp.2015.01.001