Evidence Based Guide to Lateral Ankle Sprains for Physical Therapists | Prevalence, Clinical Presentation and Risk Factors | FPF Show Episode 85

Evidence Based Guide to Lateral Ankle Sprains for Physical Therapists | Prevalence, Clinical Presentation and Risk Factors | FPF Show Episode 85

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Evidence Based Lateral Ankle Sprain "Cheat Sheet" for Clinicians

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In today's episode we go over an Evidence Based Guide to Lateral Ankle Sprains for Physical Therapists | Prevalence, Clinical Presentation and Risk Factors | FPF Show Episode 85:

Welcome, physical therapists, to this evidence-based guide on managing ankle sprains. Ankle sprains are among the most common lower extremity injuries encountered in clinical practice (and especially in sports). As experts in rehabilitation, it is crucial for us to stay up-to-date with the latest research to provide the best care to our patients. This guide aims to provide you with evidence-based strategies and interventions to optimize the rehabilitation process for ankle sprains.

1. Initial Assessment and Diagnosis: A comprehensive assessment is essential to determine the severity and nature of the ankle sprain. Key components of the assessment include patient history, mechanism of injury, physical examination, and imaging (if necessary). The Ottawa Ankle Rules can be a useful tool to determine the need for imaging in acute ankle injuries.
2. Management of Acute Phase: The RICE (Rest, Ice, Compression, Elevation) principle has traditionally been recommended for the acute management of ankle sprains. It's the best... NOT!  More recent evidence suggests that early mobilization and weight-bearing may lead to better outcomes. 
3. Strength and Proprioception Training:Weakness and impaired proprioception are common after ankle sprains, contributing to a higher risk of reinjury. Incorporate exercises that target ankle dorsiflexion, plantarflexion, inversion, and eversion, with a specific focus on exercise specificity to help your patient return to their sport or activity of choice. Proprioceptive training, such as balance exercises on unstable surfaces, can improve ankle stability and reduce the risk of recurrent sprains.
4. Neuromuscular Control and Agility Training: After regaining strength and stability, progress to neuromuscular control and agility training. This includes activities that challenge dynamic balance, multidirectional movements, cutting, jumping, and landing.  Emphasize proper movement mechanics and encourage reactive responses to simulate real-life situationss or sporting activities.
5. Manual Therapy Techniques: Consider using manual therapy techniques as adjuncts to exercise-based interventions. Joint mobilizations, soft tissue mobilizations, and proprioceptive taping techniques may help reduce pain, improve range of motion, and enhance motor control. However, their effectiveness as standalone treatments remains limited.
6. Return to Sport Criteria: To ensure a safe return to sport or physical activity, utilize evidence-based criteria rather than relying solely on the passage of time. The criteria should include functional assessments, such as single-leg hop tests, balance tests, and sport-specific tasks. Ensure that the athlete demonstrates symmetry, proper neuromuscular control, and the ability to perform sport-specific movements without pain or compensation.
7. Psychological Considerations: Acknowledge the psychological impact of ankle sprains on athletes and patients. Address their fears, concerns, and expectations during the rehabilitation process. Incorporate strategies such as goal setting, education, and motivational interviewing to enhance patient adherence and mental well-being.
8. Prevention Strategies: Educate patients on the importance of continuing exercises and functional supports (like lace up brace) to help prevent future ankle sprains. Consider implementing injury prevention programs that focus on balance, agility, and sport-specific movements.

In today's video we go over part 1 of our evidence based guide to lateral ankle sprains:

By incorporating evidence-based interventions, physical therapists can optimize the management of ankle sprains and facilitate a safe return to sport or daily activities. Individualize treatment plans based on patient characteristics and address both physical and psychological aspects throughout the rehabilitation process. By staying informed and implementing best practices, we can enhance patient outcomes and reduce the risk of recurrent ankle sprains.

Cankles no more...

- Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

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Dan Pope DPT, OCS, CSCS

References: 

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12. Ankle Sprain Image: 

1. URL: https://commons.wikimedia.org/wiki/File:Ankle_sprain_6_--_Smart-Servier.png 

2. Attribution: Laboratoires Servier, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

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15. Ankle Sprain Image: URL: https://commons.wikimedia.org/wiki/File:Sprained_foot.jpg Attribution: Boldie, Public domain, via Wikimedia Commons

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