Sports Physiotherapy interventions of ankle sprains: where is the evidence?

Clijsen, Ron and Taeymans, Jan and Clarys, Peter (2006) Sports Physiotherapy interventions of ankle sprains: where is the evidence? In: 11th Congress of the European College of Sport sciences , July, 2006 , Lausanne, Switzerland.

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Introduction Epidemiological data show a high injury incidence of the lateral capsular ankle ligaments. About half of the ankle injuries occur during sporting activities, due to an inversion trauma. They even total a quarter of all sports injuries. The medical assessment and treatment of these ankle injuries causes severe costs to society. Although inversion injuries of the ankle are a common problem in physical therapy, there is a converse variety of treatment strategies and differences in therapy outcome. There still seem to be a lack of evidence-based physical therapy strategies for this problem. The aim of this study was to scrutinize to reported literature for the effectiveness of the physical therapy in patients with ankle sprain. Methods Relevant studies were collected by conducting a literature search using the online databases; MEDLINE, PubMed, Pedro, and the Cochrane Database of Systematic Reviews. The following keywords were used: ankle, ankle injuries, acute ankle sprain, exercise therapy, physical therapy and ankle sprain, review, guidelines for physical therapy, cryotherapy, ultrasound and laser therapy. The selection criteria were randomised trails, clinical trails, review articles, and meta-analyses. Results A total of 36 studies met these criteria; among them were 18 articles, 3 reviews and 15 CCTs. 6 of the 15 CCTs had a Pedro score between 2 and 5. Conclusion For the diagnosis there seems to be no correlation between the medical classification of injury severity and the prognosis of recovery or between the severity of the ankle ligament injury and clinical findings. This may be partially caused due to the lack of a proper diagnosis definition of ankle sprain. Especially the use of a functional score, as often used in physical therapy, within the first five days after the initial injury is a valid and reliable diagnostic method to distinguish between mild and severe injury. In the rehabilitation of acute ankle sprain physical therapy intervention programmes are mainly based on the different phases of connective tissue healing. In general, there is no or only marginal evidence for the effectiveness of different physical therapies such as cryotherapy, electrotherapy and ultrasound. There is body of evidence that functional treatment is much more effective than immobilisation. Because there is a wide variety of treatment modalities and because in most studies multiple treatment regimens are used, no conclusions can be drawn concerning the effectiveness of specific treatment. For chronic ankle problems, literature indicates that a conservative treatment is superior compared to surgery. There is intermediate evidence about therapy effectiveness of chronic ankle problems. The therapy should involve an exercise program, training proprioception, muscle strength, ADL activities and normalizing mobility. Most studies conclude that there is a lack of valid instruments for a standardized assessment of the different therapy interventions in physical therapy. Inconsistent definition of both treatment aims and therapy outcome impede an estimation of the effectiveness of different forms of conservative therapy. Reference Kerkhoffs et al. Different functional treatment strategies for acute lateral ankle ligament injuries in adults: A systematic review. Acta Orthop Scand. 2003 Feb.

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