Ankle sprains are one of the most common lower limb injuries we see as physiotherapists. As children, we were taught the principles of R.I.C.E � rest, ice, compression and elevation. Most people believe the best way to heal an ankle sprain is by resting it and keeping off it. However, recent evidence suggests otherwise!

The ankle joint helps to hold our body weight over our feet. It has a prime role in balance and coordination. There are three main ligaments that run along the outside of your ankle into your foot to help stabilize the joint.

There are many causes and contributing factors to ankle sprains. If you are an athlete involved in high impact sports with change of direction you are at risk of injuring these ligaments. Furthermore, if you are in poor footwear, have poor balance or exposed to uneven surfaces you are more likely to sprain your ankle.

So, you’ve rolled your ankle, its bruised and swollen and all you want to do is lie in bed with an ice pack. But, is rest really best?

An important study on ankle rehabilitation found ‘an accelerated exercise protocol during the first week after ankle sprain improved ankle function’ (Bleakely et al, 2010). The study compared two rehabilitation programs which both included ice and compression. One rehabilitation group performed therapeutic exercises in the first week post injury whilst the other simply rested. It was found that the group with early intervention had better overall outcomes and earlier return to activity – such as work and school.

This article challenges popular advice for rest and protection of minor to moderate ankle sprains. It highlights the importance of early management and implementation of therapeutic exercises in the successful rehabilitation of ankle sprains.

Rest is not really best! If you or a family member experiences an ankle injury please seek early medical advice. At CSSM, we specialize in the assessment and management of all sporting injuries.

The abstract of the article is outlined below, however if you’re interested in reading the full study please click here.

http://www.bmj.com/content/bmj/340/bmj.c1964.full.pdf

Bleakley et al (2010) Effect of accelerated rehabilitation on function after ankle sprain; randomized controlled trial

ABSTRACT

Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants101patientswithanacutegrade1or2ankle sprain.

Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity(53minutes,95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.