Management and Prevention of Ankle Sprains in Athletes 2013

Taken from the National Athletic Trainers Association Position Statement and Guidelines


Treatment and Rehabilitation

  1. Cryotherapy (ICE IN VARIOUS FORMS) should be applied to acute ankle sprains to reduce pain, minimize swelling formation, and decrease secondary injury.
  2. Compression should be applied to acute ankle sprains to minimize swelling.
  3. The limb with the acute ankle sprain should be elevated to minimize swelling.
  4. Non Steroidal Anti-inflammatory drugs, administered orally or topically, reduce pain and swelling and improve short-term function after ankle sprains.
  5. Functional rehabilitation is more effective than immobilization in managing grade I and II ankle sprains.
  6. Grade III sprains should be immobilized for at least 10 days with a rigid stirrup brace or below-knee cast and then controlled therapeutic exercise instituted.
  7. Electrical stimulation can be used as an adjunct to minimize swelling during the acute phase of injury.
  8. Clinicians should refrain from thermotherapy(HEAT) during the acute and subacute phase of injury due to lack of evidence and the potential to exacerbate the injury.
  9. Cryokinetics can be used to reduce pain and thereby allow early rehabilitative exercises.
  10. Rehabilitation should include comprehensive range of motion, flexibility, and strengthening of the surrounding musculature.
  11. Balance training should be performed throughout rehabilitation and follow-up management of ankle sprains to reduce re-injury rates.
  12. Passive joint mobilizations and mobilizations with movement should be used to increase ankle dorsiflexion and improve function.


Return-to-Play Considerations

  1. The patient’s perception of function should be included in any return-to-play (RTP) decision making. Several instruments (eg, Lower Limb Task Questionnaire and Cumberland Ankle Instability Tool [CAIT]) may be used to help identify the patient’s perception of function and aid in the RTP decision process.
  2.  Functional performance testing should be a component of the RTP decision making. Several tests (eg, single-legged hop for distance, Star Excursion Balance Test [SEBT]) may be used to help determine the patient’s ability to RTP. Before the patient returns to sport-specific tasks, the injured limb’s functional performance should measure at least 80% of the uninjured limb.
  3. Athletes with a history of previous ankle sprains should wear prophylactic ankle supports in the form of ankle taping or bracing for all practices and games. Both lace-up and semirigid ankle braces and traditional ankle taping are effective in reducing the rate of recurrent ankle sprains in athletes.


Prevention of Ankle Sprains

  1. A multi-intervention injury-prevention program lasting at least 3 months that focuses on balance and neuromuscular control should be undertaken to reduce the risk of ankle injury. Athletes with a history of ankle injury may benefit more from this type of training.
  2. Addressing the strength of the leg muscles (evertors, invertors, dorsiflexors, and plantar flexors) and hip extensors and abductors may be an ankle injury preventions strategy.
  3.  Clinicians should consider assessing dorsiflexion range of motion in at-risk athletes. If dorsiflexion ROM is limited, clinicians should incorporate techniques to enhance arthrokinematic and osteokinematic motion for possible prevention of ankle injury