Ankle Sprains: What’s the Best Approach?

Caucasian male physical therapist massaging the ankles of a Caucasian female patient with text "Ankle Sprains: What's the Best Approach?"

Ankle sprains are a common injury, and it is widely held that they respond well to conservative treatment.  But don’t let their commonness lull you into thinking that time and a little protection is all you need to get back to 100%.  Up to 64% of conventionally treated ankle sprains have persisting symptoms even after three years.(1)   Simply exercising or getting back to full activity is not a replacement for targeted rehabilitation.  People with one ankle sprain are much more likely to have another ankle sprain in the future, especially in the absence of targeted rehabilitation.  One-year recurrence of ankle sprains has been reported as high as 53%.(1)  

Physical therapy involvement is definitely a plus.  But how much and what the best treatment plan is continues to be a matter that the healthcare profession and scientific research is defining.  Researchers Cleland and Mintken recently published a study in the Journal of Orthopaedic and Sports Physical Therapy that shows that rehabilitation for ankle sprains should usually include exercise therapy, proprioceptive rehabilitation, and joint manipulation or mobilization. 

In their randomized controlled trial, half the patients with ankle sprains received four physical therapy visits for teaching and supervision of an independent exercise program plus advice on ice, compression, and elevation.  The other half of the patients with ankle sprains received eight physical therapy visits.  In those eight visits they received the same exercise therapy and advice as the four-visit group.  However, the eight-visit group also received individualized manual therapy / joint manipulation.  After four weeks, the manual therapy group had 80% greater pain relief.  At six months, the manual therapy group had 31% better scores across three scales measuring function and ability.  After six months, about 16% of the four-visit group had re-sprained their ankle, while only 9% of the manual therapy group had re-sprained their ankle.

This study adds support to the idea that the best treatment for ankle sprains will be multi-factorial and will include exercise therapy, hands-on movement of the joint, and advice on home treatment.  When the best possible rehabilitation plan is implemented, patients can have the best functional outcomes and the lowest risk of re-injury.

  1. van Rijn J, van Os A, Bernsen R, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008; 121 (4): 324-331.
  2. Bassett S, Prapevessis H. Home-based physical therapy intervention with adherence-enhancing strategies versus clinic-based management for patients with ankle sprains. Phys Ther. 2007; 87: 1132-1143.
  3. Cleland J, Mintken P, McDevitt A, et al. Manual physical therapy and exercise versus supervised home exercise in the managment of patients with inversion ankle sprain: A multicenter randomised clinical trial. Journal of Orthapaedic & Sports Physical Therapy. 2013; 43 (7): 443-455.
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