Early physiotherapy may not improve ankle sprain recovery

Giving people with severe ankle sprains physiotherapy soon after their injury doesn't necessarily result in better recovery compared to the usual rest, ice, compression and elevation, according to a new study.

People who suffer a bad sprain should have the injury assessed by an appropriate healthcare professional like a doctor or physical therapist to determine the severity of the injury and to get, at a minimum, advice and instruction on how to manage the injury, said co-lead author Brenda Brouwer of Queens University in Kingston, Ontario, Canada.

The researchers recruited 503 people aged 16 years and older who suffered an acute ankle sprain without other injuries or mobility-limiting conditions. Half of the patients received standard emergency department care, medical assessment and a page of instructions for at-home management, including wearing a brace, rest, ice, compression, elevation, pain medication and gradual return to weight-bearing activities.

The remaining half of patients received the same information in addition to supervised physiotherapy, including up to seven 30-minute clinic visits for exercise sessions designed to decrease pain and swelling, increase range of motion, strength and exercise tolerance.

"The therapy involves an initial assessment of the injury to determine the structures involved, the associated symptoms such as pain, swelling, bruising, and the development of a treatment plan to get the individual back to pre-injury function," Brouwer told Reuters Health by email. "Home exercises and strategies to promote normal joint mobility are prescribed."

In the usual care group, 37 percent of people had achieved "excellent recovery" by the three-month point, compared to 43 percent of people in the physiotherapy group. That difference is not large enough to rule out the possibility it was due to chance, according to the report published in BMJ.

There was little important difference between the groups at six months post-injury.

"As such, it may give pause to individuals who have experienced a simple ankle sprain in terms of deciding whether or not to access physiotherapy, it's a choice that our findings suggest will not impact recovery providing they have had their injury assessed and received general instruction on how to manage it," Brouwer said.

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Many participants in both groups failed to achieve excellent recovery, which is worrisome, and will need to be explored through further study, she said.

There was little information on the nature of the rehabilitation exercises in this study, said Chris Bleakley of Ulster University in Newtownabbey, U.K., who wrote an accompanying editorial.

"I feel that (physiotherapy) is an essential part of recovery post sprain," Bleakley told Reuters Health by email. "However, this study highlights clearly that not all physio treatments are equally effective - in our recent review, we have already shown that studies employ a wide range of exercises, treatment durations and intensities - but the optimal combination is not yet clear."

Quantity and dose of physiotherapy may determine effectiveness, he said.

"Indeed, it is analogous to a drug treatment - if it's under dosed, the treatment effect will be blunted - and overdosing can cause harmful side effects," he said.