Lateral ligament ankle sprains should be mobilised early
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Gordon Higgins, Medical Student (Manchester Royal Infirmary)
Search checked by:
Bruce Martin, Manchester Royal Infirmary
Three-Part Question:
In [adults with lateral ligament ankle sprains] is [immediate mobilisation better than immobilisation in a cast] at [decreasing pain and reducing time to full recovery].
Clinical Scenario:
A 28 year old man presents to the emergency department with a swollen, bruised and painful ankle following an inversion injury. After examination and appropriate investigations a grade 2 inversion ankle sprain is diagnosed. You wonder whether early mobilisation or immobilisation in a short leg cast is more suitable for this patient.
Search Strategy:
Medline 1966-12/98 using the OVID interface.
Search Details:
[{exp ankle OR ankle$.mp OR exp ankle injuries OR exp ankle joint OR exp lateral ligament, ankle} AND {exp sprains and strains OR sprain$.mp} AND {mobilis$.mp OR mobilisation$.mp OR mobilization$.mp}] LIMIT to human and english language.
Outcome:
20 papers found of which 15 were irrelevant to the study question or of insufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Ann Emerg Med Hedges JR, Anwar RA. Management of ankle sprains. 1980 UK | 93 patients aged 15-65 with ankle sprains Elastic bandage and early weight bearing vs non-weight bearing plaster splint Followed at 1 week and 8 months |
PRCT | Functional disability | No significant difference | Many patients had previous injuries. 8 month follow-up in only 33%. |
| Pain | No significant difference | ||||
| Swelling | No significant difference | ||||
| Recurrent injury | No significant difference | ||||
| Early ankle mobilisation, Pt 1: The immediate effect on acute, lateral ankle sprains. Dettori JR, Basmania CJ, Pearson BD et al. 1994 USA | 64 military personnel with ankle sprains Plaster cast vs air-stirrup vs elastic wrap for 2 weeks Followed during early course2 and at 1 year3 |
PRCT | Return to work and running | Quicker with early mobilisation (P=0.029) | Moderate and severe sprains only. Long term follow-up by postal questionnaire |
| Range of motion | Significantly more with early mobilisation | ||||
| Swelling and pain | Significantly less with early mobilisation | ||||
| Difficulty running at 1 year | No significant difference | ||||
| Early mobilization versus immobilization in the treatment of lateral ankle sprains. Eiff MP, Smith AT, Smith GE. 1994 USA | 82 military personnel with ankle sprains Elastic wrap for 2 days followed by air stirrup for 8 days vs non weight-bearing splint for 10 days Followed up at 3 and 6 weeks and 6 and 12 months |
PRCT | Return to work | Significantly more likely in elastic wrap group | |
| Pain | Less pain (P=0.02) at 3 weeks in elastic wrap group | ||||
| Residual symptoms | No significant difference | ||||
| Treatment modalities for soft tissue injuries of the ankle: a critical review. Ogilvie-Harris DJ, Gilbart M. 1995 Canada | 84 articles on soft tissue ankle injuries | Critical review | Functional outcome | Early mobilisation appears to be better | No formal meta-analysis. Not all studies directly relevant to the study question. |
| Treatment of lateral collateral ligament sprains of the ankle: a critical appraisal of the literature. Shrier I. 1995 Canada | 13 RCTs on ankle sprains | Critical appraisal | Pain | Less with early mobilisation | No formal meta-analysis. Not all studies directly relevant to the study question. |
| Swelling | Less with early mobilisation | ||||
| Instability | Less with early mobilisation |
Author Commentary:
While many papers have addressed the question there are few relevant RCTs. The two relevant reviews do not address the question directly and do not attempt formal meta-analysis.
Bottom Line:
Early mobilisation of ankle sprains leads to quicker short term recovery without affecting long term outcome. It is the treatment of choice.
References:
- Hedges JR, Anwar RA. Management of ankle sprains.. Ann Emerg Med
- Dettori JR, Basmania CJ, Pearson BD et al.. Early ankle mobilisation, Pt 1: The immediate effect on acute, lateral ankle sprains.
- Eiff MP, Smith AT, Smith GE.. Early mobilization versus immobilization in the treatment of lateral ankle sprains.
- Ogilvie-Harris DJ, Gilbart M.. Treatment modalities for soft tissue injuries of the ankle: a critical review.
- Shrier I.. Treatment of lateral collateral ligament sprains of the ankle: a critical appraisal of the literature.