Patient, Treatment, and Cost Characteristics Associated with Sport-Related Ankle Sprains: A Report from the Athletic Training Practice-Based Research Network

Marshall AN, Kikugawa TM, Lam KC. Athletic Training & Sports Health Care. 2019; Epub ahead of print. doi:10.3928/19425864-20190521-01

Take Home Message

On average a high school athlete is treated by an athletic trainer for 3 weeks after an ankle sprain with a total cost of $534, which is less than half the cost of an emergency room visit. Athletic trainers in this setting may consider using more rehabilitation and neuromuscular control interventions to reduce the long-term impact of ankle sprains.


Although ankle sprains are one of the most common lower limb injuries, there is little information about the services provided by athletic trainers and associated costs throughout the entire duration of care for high school athletes. Patient electronic medical records allow an athletic trainer to document all services provided and can provide much more information about a patient and care. We need to know the treatment strategy and estimated direct costs of care provided by athletic trainers to describe and quantify the value of the care they provide to athletes. Therefore, the authors used pre-collected CORE-AT electronic medical records from within the Athletic Training Practice-Based Research Network to provide details on patients, treatments, and costs of an ankle sprain as documented by athletic trainers in secondary school settings. The Network included 9 years of data (2009 to 2017) from secondary schools in 11 states. The authors included all types of ankle sprains if there was complete documentation from the initial injury until discharge of care, a description of a patient’s age, sex, sport, activity during injury, mechanism, and type of ankle sprain. The authors assessed length of care. They also used the Centers for Medicare and Medicaid Services Physician Fee Schedule to calculate the average cost per modality, rehabilitation, taping/bracing, or other intervention per ankle sprain case. The authors included 130 full ankle sprain cases (60% male), which an athletic trainer primarily documented as ankle sprain/strains (82%) that occurred during contact or twisting mechanisms (75%), and during contact field and court sports (75%). The average athlete received care for ~22 days, including 18 treatment services with a total cost of $534 ($71/visit, ~2 services/visit; see Figure). The most common treatment types were hot/cold packs (23%), therapeutic exercise (22%), re-evaluation (17%), and strapping (9%).


The authors illustrate the importance of having an athletic trainer in a secondary school setting to potentially reduce health care costs associated with ankle sprain injuries. The authors noted that a single emergency department visit for an ankle sprain typically costs about $1,200. This cost is about double the average cost for services provided over the entire treatment timeline of about 3 weeks. Although most patients after an ankle sprain never seek care and “walk it off”, this neglect can lead to long-term disability and future costs. Meanwhile, treatment interventions can successfully improve ankle sprain outcomes for a patient. Athletic trainers may share this information with administrators or other third-party individuals to educate them on the benefit of employing an athletic trainer in these settings. Furthermore, the authors showed that secondary school athletic trainers are following recommended ankle sprain interventions; however, few athletic trainers included evidence-based interventions (e.g.,  therapeutic exercise interventions, strapping, neuromuscular education). The NATA position statement on ankle sprains highlights the importance of these approaches for treatment and prevention of ankle injuries and long-term disability in athletes. Overall, we need to promote the use of these evidence-based treatment strategies to reduce injury burden after an ankle sprain. Furthermore, clinicians and administrators can use these findings to highlight that athletic trainers may reduce health care costs for ankle injuries in the secondary school setting.

Questions for Discussion

What types of interventions do you use for athletes with ankle sprains to reduce long-term injury burden? What other types of injuries do you think would be important to investigate in terms of treatment and costs from initial injury through to discharge besides ankle sprains? How do you think we can leverage this information to positively influence policy changes in the secondary school setting for hiring or maintaining athletic trainers?

Written by: Alexandra F. DeJong
Reviewed by: Jeffrey Driban

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