Missing therapeutic exercises after an ankle sprain can lead to a bad year

The influence of therapeutic exercises after an ankle sprain on the occurrence of subsequent knee, hip and lumbar spine injuries

Foster KS, Greenlee TA, Fraser JJ, Young JL, Rhon DI. Medicine and science in sport and exercise. August 2022. doi: 10.1249/MSS.0000000000003035.
https://pubmed.ncbi.nlm.nih.gov/36084225/

Take home message

Performing therapeutic exercises after an ankle sprain reduces the chance of a knee, hip, or lumbar spine injury in the following year.

Background

Ankle sprains are the most common injury, especially among active individuals. However, not everyone receives care, which can contribute to chronic ankle instability and limitations in lower extremity movement, including instability and reduced sensorimotor function. These limitations can increase a person’s risk for later injury to other joints in the lower extremities. However, we have little evidence to support or refute this hypothesis.

Study aim

The authors evaluated the rate of secondary injuries after an ankle sprain and whether therapeutic exercises after an ankle sprain reduced the risk of future injuries to the knee, hip and lumbar spine.

Methods

The authors conducted a retrospective cohort study within the military health care system. They used diagnostic and billing codes to identify individuals who sought care for an ankle sprain between 2010 and 2011, regardless of whether or not they received therapeutic exercise within 90 days of the injury and whether or not they subsequently suffered an injury to the knee, hip, or suffered a knee injury. lumbar spine within one year of the ankle injury.

Results

Twenty percent of the subjects (6,848) were diagnosed with a proximal joint injury. Most of these were knee and lumbar spine injuries. Only 28% of all individuals received therapeutic exercises for their initial ankle sprain. Individuals who received therapeutic exercise were ~13%, ~18%, and ~32% less likely than their peers without exercise to sustain a knee, lumbar spine, or hip injury at any time during the year after an ankle sprain.

Viewpoints

Individuals may suffer a secondary injury after an initial ankle sprain due to decreased mobility, strength and muscle activation. Only 8% of total costs for ankle sprains go toward physical therapy, but those who do not seek care are more likely to report decreased function and develop chronic ankle instability. Ankle sprains are often thought of as minor injuries, which may explain the lack of care or referral for therapeutic exercises. However, physical rehabilitation after an injury can improve ankle range of motion, pain, gait, balance and stability. It is therefore obvious that this would have a positive influence on the risk of future injuries. It would have been helpful to know who made the initial diagnosis and how their background/training influenced referral to therapeutic exercise.

Clinical implications

We need to be more proactive in educating healthcare professionals about the need to refer people to physical rehabilitation after an ankle sprain. They need to recognize that this is not a minor injury and that one in five people will suffer an injury to the knee, hip or lumbar spine within a year of an initial ankle sprain, which is already the most common sports injury.

Questions for discussion

Have you encountered the perception among patients that ankle sprains are minor, and if so, how have you explained the problem to them? Conversely, how would you change the way you explain ankle sprains to patients, even if they seem minor?

related posts

1. Nothing to fear except the fear of themselves in people with chronic ankle instability
2. Ankle sprains are over-treated and under-rehabilitated
3. Chronic ankle instability starts earlier than we thought

Written by Jennifer Xu
Reviewed by Jeffrey Driban