Is ankle-sprain physio overkill?

3 minute read

What is the best course of treatment for a sprained ankle? A Canadian study questions the perceived wisdom


The largest study yet of ankle sprain treatment has found that physiotherapy is no better than standard at-home care when it comes to recovering from a sprained ankle.

But the conclusions have drawn a swift reaction from physiotherapists, who say the study has major flaws.

Canadian researchers randomly assigned treatments for 503 patients who attended the emergency department with grade one or two ankle sprains.

The study, published in the BMJ, found that patients who received usual care were as likely to heal fully within six months than those who received standard care as well as physiotherapy.

Just over half (57%) in the physiotherapy arm and 62% in the control arm had an “excellent recovery” within six months.

“Supervised physiotherapy … does not provide clinically important benefit in the management of simple ankle sprains in the general population,” the authors said.

Usual care for ankle sprains, as defined in the study, include ankle protection, rest, cryotherapy, application of a compression bandage, elevation, use of analgesics as necessary and graduated weight bearing activities.

On top of this, half of the study participants attended seven physiotherapy sessions, each 30 minutes in length.

Speaking with The Medical Republic, representatives from the Australian Physiotherapy Association defended physiotherapy for ankle sprains.

“Seeing a physiotherapist post-ankle sprain is highly recommended,” said Holly Brasher, the national chair of the APA sports physiotherapy group.

Ms Brasher argued that physiotherapy could help prevent long-term ankle instability and speed-up recovery time.

“Up to 50% of first-time sprained (ankles) can develop functional instability in the ankle,” she said. “The biggest risk factor for ankle sprains is a previous sprain, therefore, it is important to manage an acute sprain correctly.”

Phil Calvert, the association’s vice president, said continual review of patient progress and modification of exercise programs was very important.

Self-management had its place, however, and was often used as a treatment approach by physiotherapists, Mr Calvert said.

“But their care doesn’t stop there,” he said. “[Physiotherapists] triage, assess, diagnose, educate … and we review progress and refer on when appropriate.”

Dr Adam Castricum, a sport and exercise physician at the Olympic Park Sports Medicine Centre, said many patients with ankle sprains did not receive the level of instruction for self-care that was provided in the study.

“What this tells you is that if you give a patient the appropriate instructions at the initial point of care… [they] will probably get a good result,” Dr Castricum said.

The researchers were remiss for not including anti-inflammatories in their standard care, he added.

People with ankle sprains benefited from oral anti-inflammatories, although these should not be taken in the first 48 hours after a sprain as they might increase bleeding, he said.

Dr Castricum cautioned against denying physiotherapy to patients based on a generalised study.

“[The study] is not specific to the population that sometimes we look after, which are often people who play sport,” he said.

More active people had different rehabilitation needs and might benefit from physiotherapy, he said.

BMJ 2016, 16 November

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