History of ankle sprain as a risk factor of future lateral ankle sprain in athletes

Despite the attention and focus lateral ankle sprains receive in athletic training practice and research, they remain the most common injury in many sports. Whereas the functional limitations and time loss from lateral ankle sprains are apparent, consistently reducing their incidence is less certain. One important step in preventing lateral ankle sprains is identifying their risk factors. Although previous literature summaries suggest that specific risk factors are inconclusive in predicting lateral ankle sprains, recent literature investigating the predictors of ankle sprains should be included as evidence. Determining the primary risk factors for lateral ankle sprains may lead to good prevention programs, which in turn may decrease time lost because of injury.     

Treatment options for ankle ligament sprain

There is a wealth of literature on the management of ankle sprains, but the quality of evidence is variable and conclusions diverge. Practice in emergency departments (EDs) also varies and in some cases does not reflect the evidence base. This article reviews some of the most recent research on the subject and suggests air-stirrup ankle braces can be used in EDs for management of moderate and severe ankle sprains.     

Acute ankle sprain: an update

Acute ankle injury, a common musculoskeletal injury, can cause ankle sprains. Some evidence suggests that previous injuries or limited joint flexibility may contribute to ankle sprains. The initial assessment of an acute ankle injury should include questions about the timing and mechanism of the injury. The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding a fracture in adults and children and determining if radiography is indicated at the time of injury. Reexamination three to five days after injury, when pain and swelling have improved, may help with the diagnosis. Therapy for ankle sprains focuses on controlling pain and swelling. PRICE (Protection, Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of ankle injury. There is some evidence that applying ice and using nonsteroidal antiinflammatory drugs improves healing and speeds recovery. Functional rehabilitation (e.g., motion restoration and strengthening exercises) is preferred over immobilization. Superiority of surgical repair versus functional rehabilitation for severe lateral ligament rupture is controversial. Treatment using semirigid supports is superior to using elastic bandages. Support devices provide some protection against future ankle sprains, particularly in persons with a history of recurrent sprains. Ankle disk or proprioceptive neuromuscular facilitation exercise regimens also may be helpful, although the literature supporting this is limited.     

Diagnosis and management options of ankle sprain injury

Ankle sprain is a common injury that accounts for a significant proportion of attendances at A&E. This article describes the anatomy and physiology of the ankle and discusses options for the diagnosis and management of ankle sprain injuries using a case study approach.     

Valdecoxib provides effective pain relief following acute ankle sprain

We sought to determine whether valdecoxib is as effective as diclofenac in treating acute ankle sprain. Patients (n=202) with acute first- and second-degree ankle sprain were randomized to valdecoxib (40 mg twice daily on day 1 followed by 40 mg once daily on days 2-7) or diclofenac (75 mg twice daily). The primary efficacy end-point was the Patient's Assessment of Ankle Pain visual analogue scale (VAS, 0-100 mm) value on day 4. Valdecoxib was as efficacious as diclofenac in treating the signs and symptoms of acute ankle sprain. The mean VAS reduction in ankle pain on day 4 was not different between groups; the two-sided 95% confidence interval for the between-group difference was within the prespecified limit for non-inferiority (10 mm). There were no significant differences between groups for all secondary efficacy end-points. The two treatments were similarly effective and well tolerated for treatment of acute ankle sprain.     

Compression stockings in ankle sprain: a multicenter randomized study

Objectives

Ankle sprain is a frequently encountered traumatic injury in emergency departments and is associated with important health expenses. However, the appropriate care of this traumatic injury remains a matter of debate. We tested the hypothesis that compression stockings speed up recovery from ankle sprain.

Methods

Recent (<48 hours) cases of ankle sprain without other traumatic injury in patients aged between 18 and 55 years were included. Patients were randomly allocated to placebo Jersey or class II compression stockings (Venoflex; Thuasne, Levallois-Perret, France). The primary end point was the time to recovery of normal painless walking without requirement for analgesic drug. Secondary end points were time to return to sport activity, pain, analgesic consumption, and ankle edema (bimalleolar and midfoot circumferences).

Results

We randomized 126 patients and analyzed 117 patients (60 in the placebo group and 57 in the compression group). The median time to normal painless walking was not significantly decreased (P = .16). No significant differences were observed in pain, analgesic consumption, and bimalleloar and midfoot circumferences. No safety issue was reported. In the subgroup of patients with regular sport activity, the time to return to sport activity was shorter in patients treated with compression stockings (P = .02).

Conclusions

Compression stockings failed to significantly modify the time to return to normal painless walking in ankle sprain. A beneficial effect was observed only in a subgroup of patients, as compression stockings significantly decreased the time to return to sport activity.     

急性踝关节扭挫伤的处理与预防

<正>发生急性踝关节扭挫伤后,局部肌肉、韧带及肌腱等软组织会有不同程度的撕裂和毛细血管破裂出血,导致局部出现淤血斑、肿胀、疼痛、功能障碍等。此时切记不要     

Effect of neuromuscular electrical stimulation on ankle swelling in the early period after ankle sprain

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation (NMES) is frequently used to decrease swelling in the early period after ankle sprain. The purpose of this study was to evaluate its effectiveness in this treatment. SUBJECTS: Thirty-four subjects (11 female, 23 male; mean age=30.2 years) who were recovering from ankle sprain participated. METHODS: Outcome measures were ankle-foot volume, ankle girth, and self-assessed ankle function. Three testing raining sessions occurred within 5 days of injury. Subjects were randomly assigned to 1 of 3 groups: a group that received NMES treatment, a group that received submotor ES treatment (designed to act as a control group), and a group that received sham treatment. RESULTS: There were no statistically significant differences among the groups for ankle-foot volume and self-assessed ankle function. The statistically significant differences for ankle girth may have been compromised due to the significantly different values among groups at baseline. Ankle girth measurements were shown to be statistically significant from session 1 to session 3 for the NMES group but not for the other 2 groups. DISCUSSION AND CONCLUSION: The results indicate that NMES, as designed and used in this study, is not effective in decreasing ankle-foot volume or increasing self-assessed ankle function in the early period after ankle sprain.     

Individuals with mechanical ankle instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers

BACKGROUND: Chronic ankle instability commonly develops after lateral ankle sprain, but differences in movement patterns between subtypes of ankle instability have not been determined. We hypothesized mechanically and functionally unstable ankle subjects would demonstrate different kinematics and kinetics compared to a group of ankle sprain injury "copers". METHODS: Sixty-three recreational athletes, 21 in each of 3 groups (11 males, 10 females) matched for gender, age, height, mass, and limb dominance were tested. Knee and ankle sagittal and frontal plane motion, peak ground reaction forces, and time to peak ground reaction forces were measured during 5 tasks (walk, step down, run, drop jump, and stop jump). FINDINGS: Using 5 one-way Analyses of Variance with Tukey post hoc testing at alpha=0.05, the mechanically unstable group displayed at least one difference in sagittal and/or frontal plane ankle motion at initial contact, maximum, and/or in displacement than the functionally unstable and coper groups in each task except the run (P<0.05). The greatest number of differences occurred in the drop jump and stop jump tasks. The mechanically unstable group exhibited greater frontal plane displacement and maximum eversion, and decreased sagittal plane displacement and maximum plantar flexion in several tasks. INTERPRETATION: The mechanically unstable group demonstrated altered ankle motion patterns when compared to functionally unstable and coper groups. The landing pattern may help avoid ankle sprains, but may also increase risk of ankle joint degeneration. Unstable ankle groups exhibit different movement patterns and may require different treatment regimens.     

低频电磁场减轻踝关节扭挫伤患者肿胀疼痛的疗效观察

Background: Main symptoms of ankle joint sprain and bruise are local swelling, pain and dysfunction. Aim of physical therapy is to reduce swelling and ease pain and resume walking function. Magnetic therapy has effects of reducing swelling and easing pain and promoting local blood circulation. Low frequency electromagnetic field has synthetic treatment function of magnetic heat and concussion massage. But the curative effects are different as the differences of working condition and shaking strength of magnetic head. Objective:To compare curative effects of low frequency full wave and half wave magnetic field on ankle joint swelling of ankle joint sprain and bruise. Unit: Department of Physical Therapy of General Hospital of Shenyang Military District.     

Acupuncture analgesia in a new rat model of ankle sprain pain

The lack of suitable experimental animal models for persistent pain showing clear acupuncture analgesia, has been the major stumbling block in the investigation of the physiological mechanisms of acupuncture analgesia. The present study developed a new rat model of ankle sprain pain and the effect of electroacupuncture (EA) on this model was examined. A common source of persistent pain in humans is the lateral ankle sprain. To model this condition, the rat's right ankle was bent repeatedly, overextending lateral ligaments, for 4 min under halothane anesthesia. The rat subsequently showed swelling of the ankle and a reduced stepping force of the affected limb for the next several days. The reduced stepping force of the limb was presumably due to a painful ankle since systemic injection of morphine produced temporary improvement of weight bearing. EA was applied to the SI-6 acupuncture point on the contralateral forelimb for 30 min under halothane anesthesia. After the termination of EA, behavioral tests measuring stepping force were periodically conducted during the next 4h. EA produced a 40% recovery in the stepping force of the sprained foot lasting for at least 2h. The magnitude of this improvement was equivalent to that obtained after a systemic injection of 2mg/kg of morphine and this improvement of stepping pressure was interpreted as an analgesic effect. The analgesic effect was specific to the acupuncture point since (1). the analgesic effect on the ankle sprain pain model could not be mimicked by EA applied to a nearby point, LI-4 and (2). EA applied to the SI-6 point was not effective in the knee arthritis pain model. The analgesic effect could not be blocked by systemic injection of opioid antagonists naloxone or naltrexone. These data suggest that EA produces a potent analgesic effect on the ankle sprain pain model in the rat. This analgesic effect is produced by applying EA to a site remote from the painful area in a stimulus point-specific way. The present study provides a powerful experimental animal model that can be used for investigating the unique physiological mechanisms involved in acupuncture analgesia.     

Lateral and syndesmotic ankle sprain injuries: a narrative literature review

Objective

The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles.

Methods

Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing.

Discussion

Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care.

Conclusion

An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach.     

Postural stability and ankle sprain history in athletes compared to uninjured controls

Background

Diminished postural stability is a risk factor for ankle sprain occurrence and ankle sprains result in impaired postural stability. To date, ankle sprain history has not been taken into account as a determinant of postural stability, while it could possibly specify subgroups of interest.

Methods

Postural stability was compared between 18 field hockey athletes who had recovered from an ankle sprain (mean (SD); 3.6 (1.5) months post-injury), and 16 uninjured controls. Force plate and kinematics parameters were calculated during single-leg standing: mean center of pressure speed, mean absolute horizontal ground reaction force, mean absolute ankle angular velocity, and mean absolute hip angular velocity. Additionally, cluster analysis was applied to the ‘injured’ participants, and the cluster with diminished postural stability was compared to the other participants with respect to ankle sprain history.

Findings

MANCOVA showed no significant difference between groups in postural stability (P = 0.68). A self-reported history of an (partial) ankle ligament rupture was typically present in the cluster with diminished postural stability. Subsequently, a ‘preceding rupture’ was added as a factor in the MANCOVA, which showed a significant association between diminished postural stability and a ‘preceding rupture’ (P = 0.01), for all four individual parameters (P: 0.001–0.029; Cohen's d: 0.96–2.23).

Interpretation

Diminished postural stability is not apparent in all previously injured athletes. However, our analysis suggests that an (mild) ankle sprain with a preceding severe ankle sprain is associated with impaired balance ability. Therefore, sensorimotor training may be emphasized in this particular group and caution is warranted in return to play decisions.