Guidelines for management and prevention of athletic ankle sprains

Most common injury in sports must be dealt with accordingly

Ankle sprains are the most common injuries in sports. It's estimated that they account for nearly 45% of all athletic injuries, and that about 28,000 ankle injuries occur in the country every day. The highest rates of ankle sprains are seen in field hockey, followed by volleyball, football, basketball, cheerleading, ice hockey, lacrosse and soccer. Once experienced, ankle sprains will sideline athletes and may lead to long-term problems, and treatment for these injuries is extremely expensive in the health care industry. For these reasons, the National Athletic Trainers' Association (NATA) compiled a list of guidelines for certified athletic trainers and other allied health care professionals on the conservative management and prevention of ankle sprains in athletes.

Diagnosis should assess patient's abilities and factor in their history

If an ankle injury is experienced, a clinician should first evaluate the patient before any further action is taken. The patient's history is extremely important, as a previous ankle sprain is the most common predisposing factor for a recurrent ankle sprain. From there, the clinician should observe the foot, ankle and lower leg on the injured side of the athlete, and ask questions regarding any problems with their abilities. A number of other tests should also be performed, including an assessment of range of motion (ROM) and another special test to determine if there is a high ankle sprain. Radiographs such as magnetic resonance imaging (MRI) may be used in certain situations; however, in most cases, they are not necessary, and the physical examination and evaluation as described above is sufficient to make a clear diagnosis.

Management: RICE, NSAIDs and functional rehabilitation

The acute phase of an ankle sprain is defined as the period of time from the injury until the signs of inflammation (pain, heat, swelling, redness) peak and then start to fade. During this time, management that uses rest, ice, compression and elevation (RICE) is recommended. RICE is almost universally accepted as the best practice by athletic trainers and other health care professionals immediately after acute ankle sprains. Strong evidence also supports the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and improve function during this phase, and they are therefore recommended in small doses. To actually treat ankle sprains, functional rehabilitation is highly recommended. This should consist of ankle stabilization through bracing or taping, along with progressive weight-bearing exercise. These exercises are designed to increase strength and improve balance and ROM.

Patient self-reports should help determine returning to play

Determining when a player is ready to return to playing their sport is a very difficult process, and each case is different. Two of the most important measures to assist this process are patient self-reports and functional performance tests. No gold standard has been established for the numerous patient self-report questionnaires, such as the Foot and Ankle Disability Index, and any of these can provide important information on a patient's readiness to return. A combination of functional performance tests can also contribute objective measures on the patient's status, and should be used during rehab and when making return-to-play decisions. Finally, taping and bracing are highly recommended for athletes with ankle sprains while they make the return to sports.

Prevention of ankle sprains is possible through balance programs

While ankle sprains are so prevalent, they are also preventable. Injury prevention programs that focus on improving balance and increasing strength have been shown to reduce the rate of ankle sprains by as much as 36%, and can easily be given to athletes in high-risk sports. Special care should also be given to athletes with a history of ankle sprains as they return to sports to prevent additional injuries. Of particular concern are athletes who experience high ankle sprains or develop a condition known as chronic ankle instability, in which the athlete has pain/weakness in the ankle and may suffer more injuries in the future. Trainers should work individually with these athletes to restore their function and ensure they're doing everything possible to prevent another injury.

Combination of strategies can help reduce the likelihood of ankle sprains

Ankle sprains are impossible to eradicate entirely, but the rate of their occurrence can be dramatically lowered. Taken together, these guidelines should help to prevent ankle sprains from occurring in the first place, and manage them properly when they do occur to keep the athlete from experiencing an additional injury down the line. Most importantly, each case and every individual is different, and their treatment plan should be administered based on the needs and abilities of each athlete.

-As reported in the August '13 edition of Journal of Athletic Training