Acute Treatment of Inversion Ankle Sprains : Immobilisation versus Functional Treatment
Jones MH and Amendola AS.
Clinical Orthopaedics and Related Research 2007;(455):169-172.
Editorial Reviewer: Charmaine Korporaal, DC
Published: June, 2009
Journal of the Academy of Chiropractic Orthopedists
June 2009, Volume 6, Issue 2
Received: 14 May 2009
Accepted: 3 March 2009
The original article copyright belongs to the original publisher. This review is available from:http://www.dcorthoacademy.com © 2009 Korporaal and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Inversion ankle sprains are one of the most common injuries in sports. Although these injuries are often considered minor, they can lead to persistent disability in athletes. We conducted a systemic review of the literature to evaluate the effect of immobilisation versus early functional treatment on time to return to pre-injury activity after inversion ankle sprain. Residual subjective instability, recurrent injury and patient satisfaction were secondary outcomes. A systemic review identified 9 randomised clinical controlled trials. Return to pre-injury activity was less with early functional treatment in 4 of 5 studies that evaluated this outcome. Subjective instability was less in 3 of 5 studies. Similarly, re-injury rate was less in 5 of 6 studies. Patient satisfaction was not substantially different in the two studies that evaluated this outcome. Limitations of the identified trials included small sample size, heterogeneity of the treatment methods and lack of standardized outcome measures. However, based on our review the current best evidence suggests a trend favouring early functional treatment over immobilisation for the treatment of acute lateral ankle sprains. Level of evidence: Level II, therapeutic study. See guidelines for authors for a complete description of the levels of evidence.
- Literature utilised in this review of data was limited to that which was available on PubMed from inception to 2005 and was limited to studies that incorporated both immobilisation and functional treatments in their analysis. This implies the exclusion of other studies that may not have met these criteria, therefore the application of the outcome of this review in clinical practice needs to be based within the limitations of this review.
- Notwithstanding the limitations identified, it is important to consider that early functional improvement seems to support early return to pre-injury levels.
- It would also seem prudent in practice to educate patients on the possible benefits of early improvement in function, its role in return to activity and the role that they as patients have in this process. In addition patients favouring a less active involvement and preferring an immobilisation intervention as compared to early functional improvement should be educated in terms of the perceived detrimental effects that this might have on their clinical and rehabilitative progress.
- It is suggested that future studies evaluate various methods of functional treatment with the aims of decreasing the time to return to activity, decreasing re-injury, decreasing subjective instability and thus increasing overall patient satisfaction.
Texas Chiropractic Council of Orthopedics