Effect of Accelerated Rehabilitation on Function After Ankle Sprain: Randomised Controlled Trial
The authors of this study used a well-designed randomized control trial to compare early strengthening exercises after an ankle sprain to a standard treatment of ice, compression, and elevation. They enrolled 101 patients between the ages of 15 and 65 years from Royal Victoria Hospital in Belfast and a sports injury clinic at the University of Ulster. Only patients with grade 1 and 2 sprains were enrolled while patients with fractures or grade 3 sprains (as diagnosed by stress test or radiograph) were excluded. Also excluded were patients with multiple injuries. Fifteen people were lost from the trial and there were no adverse events.
While both groups received written advice and direct instruction on cryotherapy and compression, the test group also received verbal, written, and DVD instructions on therapeutic exercises to complete during the first week post injury. The test group performed range of motion (ROM) exercises that included active circumduction, plantar flexion, dorsi flexion, static muscle strengthening in all directions, functional movement patterns of the lower limb, and triceps surae stretching 3 times per day for 20 minutes. 1
The primary outcome measure was subjective ankle function as measured by the lower extremity functional scale—a scale on which users rate their ankle function with a score of 1 to 4 after 20 leg activities. There was no significant difference between the groups in this score; however, secondary endpoints of activity measured by step count and time spent walking at 1, 2, 3, and 4 weeks post injury did show a statistically significant difference (5621 more steps and 1.2 more hours walking in the early exercise group). The authors admit that their study is limited by its small sample size. This is a well-designed study that offers useful additions to our standard treatment of this common injury. Though not discussed specifically by the authors, a grade 1 or 2 ankle sprain, encountered in a wilderness setting such as trekking, would likely benefit from more than complete immobilization and early exercises such as circumduction and resistance strengthening. Such an approach might return the trekker to the trail more quickly.
(BMJ. 2010;340:1–7) CM Bleakley, SR O'Connor, MA Tully, LG Rocke, et al.
Prepared by Anil Menon, MD, UTMB/NASA Aerospace Medicine Fellow, Galveston, TX, USA