MANAGEMENT OF ACUTE GRADE II LATERAL ANKLE SPRAINS WITH AN EMPHASIS ON LIGAMENT PROTECTION: A DESCRIPTIVE CASE SERIES

Abstract

Background and purpose: Lateral ankle sprain the most common injury in physically active populations. Individuals who sustain an acute lateral ankle sprain may not receive timely formal rehabilitation and are at an increased risk to have subsequent sprains which can lead to chronic pain and instability. Attention to essential factors for ligament protection and healing while preserving ankle movement, may result in a more stable yet mobile ankle offering improved outcomes. The purpose of this case series was to describe the methods and observe the outcomes associated with a comprehensive strategy for managing acute first episode grade II lateral ankle sprains.

Study design: Prospective case series.

Case descriptions and interventions: Ten patients (mean age 26.7 years, range 16-51 years, mean 2.3 days from injury) with acute grade II lateral ankle sprain were treated with an approach to protect the injured ligament, prevent impairments to movement, restore strength and proprioception, and progress to full function. Patient outcomes were assessed at four, eight and 12 weeks. Follow-up interviews at six and 12 months assessed injury recurrence.

Outcomes: Patients were treated for an average of eight sessions over a mean of seven weeks. Rapid change in self-reported function, ankle ROM, and pain were observed in the first four weeks of care. Clinically meaningful improvements in function and ankle ROM were also noted at eight weeks and maintained at 12-week follow-ups. All patients returned to desired physical activity with only a single re-sprain event within one year after injury.

Conclusion: The results of this prospective case series suggest that a treatment approach designed to protect the injured ligament, maintain and restore normal ankle motion, and provide a tailored functional pathway to return to run and sport demonstrated resolution of symptoms and improvement in reported functional outcomes in a group of patients following grade II acute primary ankle sprain.

Level of evidence: Level IV, Case Series.

Keywords: Ankle sprain; joint mobilization; movement system; rehabilitation.

© 2019 by the Sports Physical Therapy Section.

Figures

Figure 1.

Mean Foot and Ankle Ability Measure (FAAM) scores (ADL and sport). The ADL and sport subscales gives a maximum score of 100% with the higher score meaning less disability.

Figure 2.

Mean Numeric Pain Rating Scale (NPRS) scores. The NPRS is an 11-point scale, ranging from zero to 10, with 10 being the most intense pain.

Figure 3.

Mean ALT scores (injured and uninjured ankles). The ALT is a weight bearing measurement of ankle ­dorsiflexion.

Figure 4.

Mean Y-Balance Test anterior reach (injured and uninjured ankles).

Figure 5.

Mean composite Y-Balance Test scores (injured and uninjured ankles). Composite scores are the sum of the 3 reach directions divided by 3 times leg length, then multiplied by 100. This permits reach distance to be normalized to leg length, allowing comparison between subjects.