Inversion Ankle Sprains 2015
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Transcript of Inversion Ankle Sprains 2015
Inversion Ankle SprainsNicole Stavro
Overview of the Ankle
Injury occurs 1/10,000 people a day
1/4 of all sports injuries of lateral ligament complex
Diagnosis: Clinical assessment Radiograph – no bone
fracture
Treatments Conservative treatment with plaster cast or splint immobilization Functional Treatment
Early Mobilization External Support (tape, brace, orthotic) Coordination Training
Surgical Treatment
Immobilization Treatment
Functional Treatment
Immobilisation for acute ankle sprain: a systematic review 22 studies Population:
Skeletally mature individuals with acute injury to lateral ligament complex Outcome Measures:
Return to sports and work Pain Swelling Subjective and objective instability Recurrent Injury ROM Satisfaction
Kerkhoffs et. Al., 2001
Characteristics of Included Studies
Return to Sports (10) Long term follow up: greater
return to sports with functional treatment RR = 1.85, 95% CI: (1.2 –
2.8) Time to return to sports was
shorter with functional treatment 4.57 days, 95% CI: (1.5 – 7.6)
Return to Work (9) Functional Treatment:
Shorter amount of time to return to work than immobilization
7.12 days, 95% CI: (5.6 – 8.7)
Return to Sports/Work
Pain & Swelling
Swelling (7) Functional Treatment:
Fewer reports of significant swelling as compared to immobilization group
RR 1.44, 95% CI: (1.1 – 2.0)
Pain (9) Patient complained of pain
equally between groups
Instability
Subjective (7) No significant differences
Objective (7) Sommer and Schreiber, 1993
Increased instability (TTT) with immobilization compared to functional treatment (2.48 deg, 95% CI: 1.3 – 3.6)
All other studies found no significant differences
Talar Tilt Test
Anterior Drawer Test
Recurrent Sprain & Range of Motion
Recurrent Sprain (10) No significant differences
between groups
Range of Motion (3) Immobilization had more
patients with impairments in ROM compared to functional treatment RR = 1.64, 95% CI: (1.1 –
2.6)
Patient Satisfaction (6)
Short and Intermediate Follow Up Patients were more satisfied
with functional treatment Short Term: RR = 6.50, 95%
CI: (1.8 – 24) Intermediate Term: RR =
4.25, 95% CI: (1.1 – 16)
Conclusion No benefit from immobilization
treatment following lateral ankle sprain
Functional Treatment Benefits: Return to Sports Shorter Time for Return to Work Decreased Swelling Decreased Objective Instability Less Limitations in Range of
Motion Higher Patient Satisfaction
Limitations Does not determine severity of
ankle sprains Functional treatment includes
a variety of treatment modalities More research needed to
determine effective treatments within functional treatment
Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patient with Inversion Ankle Sprain Randomized Clinical Trial Participants:
74 patients with Grades 1 or 2 lateral ankle sprain Treatment Groups:
Home Exercise Program Group 4 sessions Mobilizing and Strengthening Exercises
Manual Therapy and Exercise Group 8 sessions Manual PT interventions to ankle (Grades III and IV) Mobilizing, Strengthening, and Self Mobilization Home exercises
Cleland et. al., 2013
Results
Outcome Measures: FAAM ADL, FAAM Sports, LEFS, & NPRS
Insert graphs
Conclusion
Manual therapy with exercise had significant improvements in pain and function at 4 weeks and 6 months compared to home exercise program
Rate of Recurrence HEP almost double the rate of recurrence (15.6% versus 9.1%)
Not statistically significant
Lateral Ankle Sprain Treament Conclusion Systematic Review
Immobilization not beneficial for treatment of lateral ankle sprain Functional Treatment
Manual Therapy Improve Function Decrease Pain
ReferencesCleland JA, Mintken PE, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K, Whitman JM. Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(7):443-55. doi: 10.2519/jospt.2013.4792. Epub 2013 Apr 29. PubMed PMID: 23628755.
Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly KD, Struijs PA, van Dijk CN. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg. 2001 Sep;121(8):462-71. Review. PubMed PMID: 11550833.