Management and Prevention of Ankle Sprains in Athletes 2013
Taken from the National Athletic Trainers Association Position Statement and Guidelines
Treatment and Rehabilitation
- Cryotherapy (ICE IN VARIOUS FORMS) should be applied to acute ankle sprains to reduce pain, minimize swelling formation, and decrease secondary injury.
- Compression should be applied to acute ankle sprains to minimize swelling.
- The limb with the acute ankle sprain should be elevated to minimize swelling.
- Non Steroidal Anti-inflammatory drugs, administered orally or topically, reduce pain and swelling and improve short-term function after ankle sprains.
- Functional rehabilitation is more effective than immobilization in managing grade I and II ankle sprains.
- 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.
- Electrical stimulation can be used as an adjunct to minimize swelling during the acute phase of injury.
- 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.
- Cryokinetics can be used to reduce pain and thereby allow early rehabilitative exercises.
- Rehabilitation should include comprehensive range of motion, flexibility, and strengthening of the surrounding musculature.
- Balance training should be performed throughout rehabilitation and follow-up management of ankle sprains to reduce re-injury rates.
- Passive joint mobilizations and mobilizations with movement should be used to increase ankle dorsiflexion and improve function.
- 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.
- 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.
- 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
- 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.
- 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.
- 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