Evidence for Rehabilitation Interventions After Acute Lateral Ankle Sprains in Athletes: A Scoping Review

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Eugene Tee
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Jack Melbourne
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Larissa Sattler
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Wayne Hing
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Context: Acute lateral ankle sprain (LAS) is a common injury in athletes and is often associated with decreased athletic performance and, if treated poorly, can result in chronic ankle issues, such as instability. Physical performance demands, such as cutting, hopping, and landing, involved with certain sport participation suggests that the rehabilitation needs of an athlete after LAS may differ from those of the general population. Objective: To review the literature to determine the most effective rehabilitation interventions reported for athletes returning to sport after acute LAS. Evidence Acquisition: Data Sources: Databases PubMed, Embase, CINAHL, SPORTDiscus, and PEDro were searched to July 2020. Study Selection: A scoping review protocol was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines and registered (https://osf.io/bgek3/). Study selection included published articles on rehabilitation for ankle sprain in an athletic population. Data Extraction: Parameters included athlete and sport type, age, sex, intervention investigated, outcome measures, measurement tool, and follow-up period. Data Synthesis: A qualitative synthesis for all articles was undertaken, and a quantitative subanalysis of randomized controlled trials and critical methodological appraisal was also conducted. Evidence Synthesis: A total of 37 articles were included in this review consisting of 5 systematic and 20 narrative reviews, 7 randomized controlled trials, a single-case series, case report, position statement, critically appraised topic, and descriptive study. Randomized controlled trial interventions included early dynamic training, electrotherapy, and hydrotherapy. Conclusions: Early dynamic training after acute LAS in athletes results in a shorter time to return to sport, increased functional performance, and decreased self-reported reinjury. The results of this scoping review support an early functional and dynamic rehabilitation approach when compared to passive interventions for athletes returning to sport after LAS. Despite existing research on rehabilitation of LAS in the general population, a lack of evidence exists related to athletes seeking to return to sport.

The authors are with the Bond Institute of Health and Sport, Bond University, Robina, QLD, Australia.

Tee (eugenetee93@gmail.com) is corresponding author.

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  • 1.

    Kerkhoffs GM, Van Dijk CN. Acute lateral ankle ligament ruptures in the athlete: the role of surgery. Foot Ankle Clin. 2013;18(2):215218. PubMed ID: 23707174 doi:10.1016/j.fcl.2013.02.003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN. WITHDRAWN: different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2013;(3):CD002938.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Malliaropoulos N, Papacostas E, Papalada A, Maffulli N. Acute lateral ankle sprains in track and field athletes: an expanded classification. Foot Ankle Clin. 2006;11(3):497507. PubMed ID: 16971243 doi:10.1016/j.fcl.2006.05.004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54(6):572588. PubMed ID: 31162943 doi:10.4085/1062-6050-344-18

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and cost of ankle sprains in United States Emergency Departments. Sports Health. 2016;8(6):547552. PubMed ID: 27474161 doi:10.1177/1941738116659639

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. J Chiropr Med. 2011;10(3):204219. PubMed ID: 22014912 doi:10.1016/j.jcm.2011.02.001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Kemler E, van de Port I, Backx F, van Dijk CN. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med. 2011;41(3):185197. PubMed ID: 21395362 doi:10.2165/11584370-000000000-00000

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Polzer H, Kanz KG, Prall WC, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev. 2012;4(1):e5. doi:10.4081/or.2012.e5

    • Search Google Scholar
    • Export Citation
  • 9.

    Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull. 2011;97(1):105135. PubMed ID: 20710025 doi:10.1093/bmb/ldq028

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Kerkhoffs GM, van den Bekerom M, Elders LAM, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854860. PubMed ID: 22522586 doi:10.1136/bjsports-2011-090490

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kyaw SL, Moore IS, Oo ML. A systematic review on the effectiveness of different functional treatments for acute ankle sprains. J Sports Med Doping Stud. 2019;9(1):213.

    • Search Google Scholar
    • Export Citation
  • 12.

    Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956. PubMed ID: 29514819 doi:10.1136/bjsports-2017-098106

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):1932. doi:10.1080/1364557032000119616

    • Search Google Scholar
    • Export Citation
  • 14.

    Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467473. PubMed ID: 30178033 doi:10.7326/M18-0850

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Peters MD, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Scoping reviews. Joanna Briggs Institute reviewer’s manual. 2017:408446.

    • Search Google Scholar
    • Export Citation
  • 16.

    McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22(3):276282. doi:10.11613/BM.2012.031

  • 17.

    Hariohm K, Prakash V, Saravankumar J. Quantity and quality of randomized controlled trials published by Indian physiotherapists. Perspect Clin Res. 2015;6(2):9197. PubMed ID: 25878954 doi:10.4103/2229-3485.154007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Kennelly J. Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes. New York, NY: Springer; 2011.

  • 19.

    Lyons K, Radburn C, Orr R, Pope R. A profile of injuries sustained by law enforcement officers: a critical review. Int J Environ Res Public Health. 2017;14(2):142. doi:10.3390/ijerph14020142

    • Search Google Scholar
    • Export Citation
  • 20.

    Lynch SA, Renstrom PA. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med. 1999;27(1):6171. PubMed ID: 10028133 doi:10.2165/00007256-199927010-00005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Petersen W, Rembitzki IV, Koppenburg AG, et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg. 2013;133(8):11291141. PubMed ID: 23712708 doi:10.1007/s00402-013-1742-5

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Hubbard TJ, Aronson SL, Denegar CR. Does cryotherapy hasten return to participation? A systematic review. J Athl Train. 2004;39(1):8894. PubMed ID: 15085216

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    van der Wees PJ, Lenssen AF, Hendriks EJM, Stomp DJ, Dekker J, de Bie RA. Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: a systematic review. Aust J Physiother. 2006;52(1):2737. PubMed ID: 16515420 doi:10.1016/S0004-9514(06)70059-9

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Hausmann M, Ober J, Lepley AS. The effectiveness of deep oscillation therapy on reducing swelling and pain in athletes with acute lateral ankle sprains. J Sport Rehabil. 2019;28(8):902905. PubMed ID: 30526277 doi:10.1123/jsr.2018-0152

    • Search Google Scholar
    • Export Citation
  • 25.

    Hawkins SW, Hawkins JR. Clinical applications of cryotherapy among sports physical therapists. Int J Sports Phys Ther. 2016;11(1):141148. PubMed ID: 26900509

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kim E, Kim T, Kang H, Lee J, Childers MK. Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. PM R. 2010;2(8):703712. PubMed ID: 20598958 doi:10.1016/j.pmrj.2010.03.012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    May JM, Nasypany A, Paolino J, Baker R, Seegmiller J. Patient outcomes utilizing the mulligan concept of mobilization with movement to treat intercollegiate patients diagnosed with lateral ankle sprain: an a priori case series. J Sport Rehabil. 2017;26(6):486496. PubMed ID: 27834613 doi:10.1123/jsr.2015-0204

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Javorac D, Stajer V, Ostojic S. Case report: acute hydrotherapy with super-saturated hydrogen-rich water for ankle sprain in a professional athlete. F1000Res. 2020;9:245. PubMed ID: 32399209 doi:10.12688/f1000research.22850.1

    • Search Google Scholar
    • Export Citation
  • 29.

    Van Der Linde E, Oschman Z. Comparative ultrasound study of acute lateral ankle ligament injuries rehabilitated with conventional and jump stretch flex band programmes. Afr J Phys Health Educ Recreat Dance. 2011;17(4):591602.

    • Search Google Scholar
    • Export Citation
  • 30.

    Holme E, Magnusson SP, Becher K, Bieler T, Aagaard P, Kjaer M. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports. 1999;9(2):104109. PubMed ID: 10220845 doi:10.1111/j.1600-0838.1999.tb00217.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Ismail MM, Ibrahim MM, Youssef EF, El Shorbagy KM. Plyometric training versus resistive exercises after acute lateral ankle sprain. Foot Ankle Int. 2010;31(6):523530. PubMed ID: 20557819 doi:10.3113/FAI.2010.0523

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684. PubMed ID: 19589822 doi:10.1136/bmj.b2684

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Karlsson J, Eriksson BI, Swärd L. Early functional treatment for acute ligament injuries of the ankle joint. Scand J Med Sci Sports. 1996;6(6):341345. PubMed ID: 9046544 doi:10.1111/j.1600-0838.1996.tb00104.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Razzano C, Izzo R, Savastano R, Colantuoni C, Carbone S. Noninvasive interactive neurostimulation therapy for the treatment of low-grade lateral ankle sprain in the professional contact sport athlete improves the short-term recovery and return to sport: a randomized controlled trial. J Foot Ankle Surg. 2019;58(3):441446. PubMed ID: 30910488 doi:10.1053/j.jfas.2018.09.009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Nunes GS, Vargas VZ, Wageck B, Hauphental DP, da Luz CM, de Noronha M. Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial. J Physiother. 2015;61(1):2833. PubMed ID: 25499648 doi:10.1016/j.jphys.2014.11.002

    • Search Google Scholar
    • Export Citation
  • 36.

    Anderson SJ. Acute ankle sprains: keys to diagnosis and return to play. Phys Sportsmed. 2002;30(12):2935. PubMed ID: 20086506 doi:10.3810/psm.2002.12.579

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Kennedy JG, Hodgkins CW, Sculco P, Carter T, Robinson SP. Sports injuries of the foot and ankle in the adolescent athlete. Int Sport Med J. 2006;7(2):8597.

    • Search Google Scholar
    • Export Citation
  • 38.

    McKeon PO, Donovan L. A perceptual framework for conservative treatment and rehabilitation of ankle sprains: an evidence-based paradigm shift. J Athl Train. 2019;54(6):628638. PubMed ID: 31135210 doi:10.4085/1062-6050-474-17

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Hudson Z. Rehabilitation and return to play after foot and ankle injuries in athletes. Sports Med Arthrosc Rev. 2009;17(3):203207. PubMed ID: 19680118 doi:10.1097/JSA.0b013e3181a5ce96

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):13901395. PubMed ID: 23108678 doi:10.1007/s00167-012-2252-7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Kolt GS. Research on the ankle in sport. J Sci Med Sport. 2013;16(5):387. PubMed ID: 23891051 doi:10.1016/j.jsams.2013.07.001

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