Edinburgh, Scotland
Saturday 27th October 2012
Since returning from my three week visit to the USA & Canada, I have been somewhat busy catching up with the athletes that have now returned from their end of season break & commenced their off-season training blocks.  Away from Lee Valley, I have been reviewing my notes & reflecting on my experiences at the New York Knicks, the New York Giants, the International Scientific Tendinopathy Symposium in Vancouver, the Seattle Seahawks, the University of Hawaii & DJO Global in San Diego.

One of the areas of my practice that I have been reviewing is the management of ankle ligament sprain injuries.  At the Giants & the University of Hawaii, such injuries were understandably more common than they are in athletics, whilst the presentations that Pete Rosenfeld delivered, in addition to the arthroscopic & open dissection revision we were able to undertake in the labs at DJO, were a great assistance in my reflection.

Last year at DJO Global, I presented on the conservative rehabilitation of functional ankle instability in an athletic population & whilst I was looking through the presentation alongside a few of the papers I referenced, I also came across a paper I downloaded more recently.  The consensus statement, written by Gino Kerkhoffs, Michel van den Bekerom & Leon Elders, with contributions by foot & ankle colleagues affiliated to the Royal Dutch Society for Physical Therapy, was published in the British Journal of Sports Medicine earlier this year.

The authors reviewed scientific papers published between 1996 & 2009, that fulfilled the selection criteria, in order to present a clinical guideline for the diagnosis, treatment & prevention of ankle sprain injuries.  

They concluded that whilst there was a variety of therapeutic interventions available for restoring function, stability & reducing pain & swelling, there was no uniform strategy for managing lateral ankle injury.  However, whilst several published articles contributed clinical evidence to the formulation of management guidelines for lateral ankle injury, a comprehensive, systematic evidence-based clinical guideline of the prevention, predictors, diagnosis, operative & conservative treatment & prognosis of lateral ankle injury was not forthcoming given the lack of research in critical areas.

Intrinsic risk factors for sustaining a lateral ankle injury were identified as strength, proprioceptive, range of motion & balance deficits in patients over the age of 15 with a primary or recurrent episode of lateral ankle ligament injury.  Meanwhile extrinsic risk factors were related to contact, playing surface & landing strategies in an athletic population.

Prognosis was less favourable in the athletic population & in those individuals demonstrating increased ligament laxity following an ankle distortion, whilst the ability to walk again within 48 hours post-trauma is indicative of a positive prognosis.  The authors promoted the use of the Ottawa Ankle Rules to eliminate the chances of an ankle fracture being missed during assessment.  From a diagnostic perspective, delaying physical diagnostic examination by 4-5 days gives a better diagnostic result than research in the first 48 hours.  

Meanwhile, the application of ice & compression in combination with rest & elevation during the first 48 hours was deemed to be important in managing swelling & pain in the immediate post-traumatic phase.  Furthermore, functional treatment alongside appropriate exercise therapy was shown to be more beneficial in reducing the risk of long term injury recurrence & more preferable than immobilisation or manual therapy in the early stages, whilst electrotherapy was found to be ineffective.

Functional rehabilitation was found to reduce recovery times, incidences of stiffness, impaired ankle mobility & complications in comparison to surgical intervention, except for in certain specific individual presentations.

Exercise therapy to address deficits in co-ordination & balance was shown by two randomised controlled trials to be effective in reducing the risk of ankle injury recurrence in athletes up to 12 months post-injury, although this wasn't the case in another study reviewed by the authors.

To read the consensus statement for yourself, click on the link below:

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