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Management of Acute Ankle Sprains in the Athlete

  • Sports Medicine Rehabilitation (J Soo Hoo and B Liem, Section Editors)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Ankle sprains are one of the most common sports injuries, resulting in sequelae that can ultimately affect function, return to play, and increase the risk of re-injury. This narrative review analyzes the scientific literature regarding acute ankle sprains in the athletic population and provides an overview of the clinical management as well as secondary prevention of this injury.

Recent Findings

A detailed clinical assessment is necessary to confirm diagnosis, establish the severity of the sprain, and document associated injuries. The rehabilitation program can include functional and early mobilization, manual therapy, and cryotherapy followed by a progression of strengthening, sports-specific exercises, and plyometrics. Topical and oral NSAIDs can be helpful in pain control. Return to sports should be a shared decision, encompassing both subjective and objective measures. Secondary preventive strategies should be incorporated in the treatment protocol as recurrence of this injury is common.

Summary

Ankle sprains are frequently seen by clinicians who care for athletes with sports injuries, particularly in the sideline and training room settings. These clinicians should be acquainted with the treatment and prevention of this condition.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fong DT, Chan YY, Mok KM, Yung PS, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:14. https://doi.org/10.1186/1758-2555-1-14.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Golano P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Gotzens V et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):944–56. https://doi.org/10.1007/s00167-016-4059-4. A detailed description of ankle anatomy and ligaments with anatomic dissection illustrations.

  3. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40. https://doi.org/10.1007/s40279-013-0102-5.

    Article  PubMed  Google Scholar 

  4. Comstock RDPLA. Summary report national high school sports-related injury surveillance study 2018–2019. Aurora, CO: Colorado School of Public Health; 2019.

    Google Scholar 

  5. Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med. 2017;45(1):201–9. https://doi.org/10.1177/0363546516660980.

    Article  PubMed  Google Scholar 

  6. Mauntel TC, Wikstrom EA, Roos KG, Djoko A, Dompier TP, Kerr ZY. The epidemiology of high ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med. 2017;45(9):2156–63. https://doi.org/10.1177/0363546517701428.

    Article  PubMed  Google Scholar 

  7. Kopec TJ, Hibberd EE, Roos KG, Djoko A, Dompier TP, Kerr ZY. The epidemiology of deltoid ligament sprains in 25 National Collegiate Athletic Association sports, 2009–2010 through 2014–2015 academic years. J Athl Train. 2017;52(4):350–9. https://doi.org/10.4085/1062.6050-52.2.01.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Walden M, Hagglund M, Ekstrand J. Time-trends and circumstances surrounding ankle injuries in men’s professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013;47(12):748–53. https://doi.org/10.1136/bjsports-2013-092223.

    Article  PubMed  Google Scholar 

  9. Herzog MM, Mack CD, Dreyer NA, Wikstrom EA, Padua DA, Kocher MS, et al. Ankle sprains in the National Basketball Association, 2013–2014 through 2016–2017. Am J Sports Med. 2019;47(11):2651–8. https://doi.org/10.1177/0363546519864678.

    Article  PubMed  Google Scholar 

  10. Farr BK, Nguyen D, Ken Stephenson K, Rogers T, Stevens FR, Jasko JJ. Ankle Sprains. In: Giangarra CE, Manske RC, editors. Clinical orthopaedic rehabilitation: a team approach (fourth edition). Elsevier; 2018. p. 255–72.

    Chapter  Google Scholar 

  11. Andersen TE, Floerenes TW, Arnason A, Bahr R. Video analysis of the mechanisms for ankle injuries in football. Am J Sports Med. 2004;32(1 Suppl):69S-79S. https://doi.org/10.1177/0363546503262023.

    Article  PubMed  Google Scholar 

  12. Delahunt E, Remus A. Risk factors for lateral ankle sprains and chronic ankle instability. J Athl Train. 2019;54(6):611–6. https://doi.org/10.4085/1062-6050-44-18. A recent review of risk factors for lateral ankle sprain.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wikstrom EA, Cain MS, Chandran A, Song K, Regan T, Migel K, et al. Lateral ankle sprain increases subsequent ankle sprain risk: a systematic review. J Athl Train. 2020. https://doi.org/10.4085/168-20.

    Article  PubMed  Google Scholar 

  14. Kobayashi T, Tanaka M, Shida M. Intrinsic risk factors of lateral ankle sprain: a systematic review and meta-analysis. Sports Health. 2016;8(2):190–3. https://doi.org/10.1177/1941738115623775.

    Article  PubMed  Google Scholar 

  15. Vuurberg G, Altink N, Rajai M, Blankevoort L, Kerkhoffs G. Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis. J ISAKOS. 2019;4(6):313–27. https://doi.org/10.1136/jisakos-2019-000305.

    Article  PubMed  Google Scholar 

  16. Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956. https://doi.org/10.1136/bjsports-2017-098106. A recent review with evidence-based guidelines regarding diagnosis, treatment and prevention.

  17. Kerkhoffs GM, van den Bekerom M, Elders LA, van Beek PA, Hullegie WA, Bloemers GM, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854–60. https://doi.org/10.1136/bjsports-2011-090490.

    Article  PubMed  Google Scholar 

  18. Kofotolis N, Kellis E. Ankle sprain injuries: a 2-year prospective cohort study in fewomen Greek professional basketball players. J Athl Train. 2007;42(3):388–94.

    PubMed  PubMed Central  Google Scholar 

  19. Kofotolis ND, Kellis E, Vlachopoulos SP. Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period. Am J Sports Med. 2007;35(3):458–66. https://doi.org/10.1177/0363546506294857.

    Article  PubMed  Google Scholar 

  20. Halabchi F, Hassabi M. Acute ankle sprain in athletes: clinical aspects and algorithmic approach. World J Orthop. 2020;11(12):534–58. https://doi.org/10.5312/wjo.v11.i12.534.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen ET, Borg-Stein J, McInnis KC. Ankle sprains: evaluation, rehabilitation, and prevention. Curr Sports Med Rep. 2019;18(6):217–23. https://doi.org/10.1249/JSR.0000000000000603.

    Article  PubMed  Google Scholar 

  22. van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):1390–5. https://doi.org/10.1007/s00167-012-2252-7.

    Article  PubMed  Google Scholar 

  23. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.

    Article  Google Scholar 

  24. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121(4):324–31 e6. doi:https://doi.org/10.1016/j.amjmed.2007.11.018.

  25. Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008;43(5):523–9. https://doi.org/10.4085/1062-6050-43.5.523.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Linde F, Hvass I, Jurgensen U, Madsen F. Early mobilizing treatment in lateral ankle sprains. Course and risk factors for chronic painful or function-limiting ankle. Scand J Rehabil Med. 1986;18(1):17–21.

  27. Pourkazemi F, Hiller CE, Raymond J, Black D, Nightingale EJ, Refshauge KM. Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study. Physiotherapy. 2018;104(4):430–7. https://doi.org/10.1016/j.physio.2017.10.004.

    Article  PubMed  Google Scholar 

  28. Hamilton WG. Sprained ankles in ballet dancers. Foot Ankle. 1982;3(2):99–102. https://doi.org/10.1177/107110078200300208.

    Article  CAS  PubMed  Google Scholar 

  29. Kaikkonen A, Kannus P, Jarvinen M. A performance test protocol and scoring scale for the evaluation of ankle injuries. Am J Sports Med. 1994;22(4):462–9. https://doi.org/10.1177/036354659402200405.

    Article  CAS  PubMed  Google Scholar 

  30. Malliaropoulos N, Papacostas E, Papalada A, Maffulli N. Acute lateral ankle sprains in track and field athletes: an expanded classification. Foot Ankle Clin. 2006;11(3):497–507. https://doi.org/10.1016/j.fcl.2006.05.004.

    Article  PubMed  Google Scholar 

  31. Esterson PS. Measurement of ankle joint swelling using a figure of 8*. J Orthop Sports Phys Ther. 1979;1(1):51–2. https://doi.org/10.2519/jospt.1979.1.1.51.

    Article  CAS  PubMed  Google Scholar 

  32. van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM. Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthop Scand. 1996;67(6):566–70. doi:https://doi.org/10.3109/17453679608997757.

  33. van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br. 1996;78(6):958–62. https://doi.org/10.1302/0301-620x78b6.1283.

    Article  PubMed  Google Scholar 

  34. Hall EA, Docherty CL. Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test. J Sci Med Sport. 2017;20(7):618–21. https://doi.org/10.1016/j.jsams.2016.11.001.

    Article  PubMed  Google Scholar 

  35. Delahunt E, Bleakley CM, Bossard DS, Caulfield BM, Docherty CL, Doherty C, et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018;52(20):1304–10. https://doi.org/10.1136/bjsports-2017-098885. A consensus statement regarding the clinical assessment after a lateral ankle sprain.

    Article  PubMed  Google Scholar 

  36. Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417. https://doi.org/10.1136/bmj.326.7386.417.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Devoogdt N, Cavaggion C, Van der Gucht E, Dams L, De Groef A, Meeus M, et al. Reliability, validity, and feasibility of water displacement method, figure-of-eight method, and circumference measurements in determination of ankle and foot edema. Lymphat Res Biol. 2019;17(5):531–6. https://doi.org/10.1089/lrb.2018.0045.

    Article  PubMed  Google Scholar 

  38. Tatro-Adams D, McGann SF, Carbone W. Reliability of the figure-of-eight method of ankle measurement. J Orthop Sports Phys Ther. 1995;22(4):161–3. https://doi.org/10.2519/jospt.1995.22.4.161.

    Article  CAS  PubMed  Google Scholar 

  39. Mawdsley RH, Hoy DK, Erwin PM. Criterion-related validity of the figure-of-eight method of measuring ankle edema. J Orthop Sports Phys Ther. 2000;30(3):149–53. https://doi.org/10.2519/jospt.2000.30.3.149.

    Article  CAS  PubMed  Google Scholar 

  40. Rohner-Spengler M, Mannion AF, Babst R. Reliability and minimal detectable change for the figure-of-eight-20 method of, measurement of ankle edema. J Orthop Sports Phys Ther. 2007;37(4):199–205. https://doi.org/10.2519/jospt.2007.2371.

    Article  PubMed  Google Scholar 

  41. Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32(4):166–73. https://doi.org/10.2519/jospt.2002.32.4.166.

    Article  PubMed  Google Scholar 

  42. Docherty CL, Valovich McLeod TC, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system. Clin J Sport Med. 2006;16(3):203–8. https://doi.org/10.1097/00042752-200605000-00003.

    Article  PubMed  Google Scholar 

  43. Hiller CE, Refshauge KM, Herbert RD, Kilbreath SL. Balance and recovery from a perturbation are impaired in people with functional ankle instability. Clin J Sport Med. 2007;17(4):269–75. https://doi.org/10.1097/JSM.0b013e3180f60b12.

    Article  PubMed  Google Scholar 

  44. Gribble PA, Hertel J, Plisky P. Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47(3):339–57. https://doi.org/10.4085/1062-6050-47.3.08.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hale SA, Hertel J. Reliability and sensitivity of the foot and ankle disability index in subjects with chronic ankle instability. J Athl Train. 2005;40(1):35–40.

    PubMed  PubMed Central  Google Scholar 

  46. Carcia CR, Martin RL, Drouin JM. Validity of the foot and ankle ability measure in athletes with chronic ankle instability. J Athl Train. 2008;43(2):179–83. https://doi.org/10.4085/1062-6050-43.2.179.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Shazadeh Safavi P, Janney C, Jupiter D, Kunzler D, Bui R, Panchbhavi VK. A systematic review of the outcome evaluation tools for the foot and ankle. Foot Ankle Spec. 2019;12(5):461–70. https://doi.org/10.1177/1938640018803747.

    Article  PubMed  Google Scholar 

  48. Larkins LW, Baker RT, Baker JG. Physical examination of the ankle: a review of the original orthopedic special test description and scientific validity of common tests for ankle examination. Arch Rehabil Res Clin Transl. 2020;2(3):100072. https://doi.org/10.1016/j.arrct.2020.100072. A recent review of special tests used in ankle examination and its sensitivity and specificity.

  49. Schumer R. A. HMM, Amendola A. Physical examination of the foot and ankle. In: Malanga GA, Mautner K. R., editor. Musculoskeletal physical examination: an evidence-based approach. 2nd edition ed. Philadelphia: Elsevier; 2017. p. 199–217.

  50. Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. Radiographics. 2017;37(6):1791–812. https://doi.org/10.1148/rg.2017170029.

    Article  PubMed  Google Scholar 

  51. Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012;4(1): e5. https://doi.org/10.4081/or.2012.e5.

    Article  Google Scholar 

  52. Baltes TPA, Arnaiz J, Geertsema L, Geertsema C, D’Hooghe P, Kerkhoffs G, et al. Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries. Eur Radiol. 2021;31(4):2610–20. https://doi.org/10.1007/s00330-020-07305-7.

    Article  PubMed  Google Scholar 

  53. Alves T, Dong Q, Jacobson J, Yablon C, Gandikota G. Normal and injured ankle ligaments on ultrasonography with magnetic resonance imaging correlation. J Ultrasound Med. 2019;38(2):513–28. https://doi.org/10.1002/jum.14716.

    Article  PubMed  Google Scholar 

  54. Jennings J, Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. J Orthop Sports Phys Ther. 2005;35(7):409–15. https://doi.org/10.2519/jospt.2005.35.7.409.

    Article  PubMed  Google Scholar 

  55. McGovern RP, Martin RL. Managing ankle ligament sprains and tears: current opinion. Open Access J Sports Med. 2016;7:33–42. https://doi.org/10.2147/OAJSM.S72334.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mitsiokapa E, Mavrogenis AF, Drakopoulos D, Mauffrey C, Scarlat M. Fibular nerve palsy after ankle sprain: an update. Eur J Orthop Surg Traumatol. 2017;27(1):53–60. https://doi.org/10.1007/s00590-016-1845-0.

    Article  PubMed  Google Scholar 

  57. Camacho LD, Roward ZT, Deng Y, Latt LD. Surgical management of lateral ankle instability in athletes. J Athl Train. 2019;54(6):639–49. https://doi.org/10.4085/1062-6050-348-18.

    Article  PubMed  PubMed Central  Google Scholar 

  58. van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012;47(4):435–43. https://doi.org/10.4085/1062-6050-47.4.14.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Bleakley CM, Glasgow PD, Philips P. Guidelines on the management of acute soft tissue injury using protection rest ice compression and elevation. London: Association of Chartered Physiotherapists in Sports and Exercise Medicine; 2011.

    Google Scholar 

  60. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med. 2012;46(4):220–1. https://doi.org/10.1136/bjsports-2011-090297.

    Article  CAS  PubMed  Google Scholar 

  61. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72–3. https://doi.org/10.1136/bjsports-2019-101253.

    Article  PubMed  Google Scholar 

  62. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251–61. https://doi.org/10.1177/0363546503260757.

    Article  PubMed  Google Scholar 

  63. Cote DJ, Prentice WE Jr, Hooker DN, Shields EW. Comparison of three treatment procedures for minimizing ankle sprain swelling. Phys Ther. 1988;68(7):1072–6. https://doi.org/10.1093/ptj/68.7.1072.

    Article  CAS  PubMed  Google Scholar 

  64. Bleakley CM, O’Connor SR, Tully MA, Rocke LG, Macauley DC, Bradbury I, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010;340: c1964. https://doi.org/10.1136/bmj.c1964.

    Article  PubMed  Google Scholar 

  65. Airaksinen O, Kolari PJ, Miettinen H. Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains. Arch Phys Med Rehabil. 1990;71(6):380–3.

    CAS  PubMed  Google Scholar 

  66. Rucinkski TJ, Hooker DN, Prentice WE, Shields EW, Cote-Murray DJ. The effects of intermittent compression on edema in postacute ankle sprains. J Orthop Sports Phys Ther. 1991;14(2):65–9. https://doi.org/10.2519/jospt.1991.14.2.65.

    Article  CAS  PubMed  Google Scholar 

  67. Tsang KK, Hertel J, Denegar CR. Volume decreases after elevation and intermittent compression of postacute ankle sprains are negated by gravity-dependent positioning. J Athl Train. 2003;38(4):320–4.

    PubMed  PubMed Central  Google Scholar 

  68. Bendahou M, Khiami F, Saidi K, Blanchard C, Scepi M, Riou B, et al. Compression stockings in ankle sprain: a multicenter randomized study. Am J Emerg Med. 2014;32(9):1005–10. https://doi.org/10.1016/j.ajem.2014.05.054.

    Article  PubMed  Google Scholar 

  69. Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015(6):CD007402. doi:https://doi.org/10.1002/14651858.CD007402.pub3.

  70. Gonzalez de Vega C, Speed C, Wolfarth B, Gonzalez J. Traumeel vs. diclofenac for reducing pain and improving ankle mobility after acute ankle sprain: a multicentre, randomised, blinded, controlled and non-inferiority trial. Int J Clin Pract. 2013;67(10):979–89. doi:https://doi.org/10.1111/ijcp.12219.

  71. Stovitz SD, Johnson RJ. NSAIDs and musculoskeletal treatment: what is the clinical evidence? Phys Sportsmed. 2003;31(1):35–52. https://doi.org/10.3810/psm.2003.01.160.

    Article  PubMed  Google Scholar 

  72. Paoloni JA, Milne C, Orchard J, Hamilton B. Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. Br J Sports Med. 2009;43(11):863–5. https://doi.org/10.1136/bjsm.2009.059980.

    Article  CAS  PubMed  Google Scholar 

  73. Fotiadis E, Kenanidis E, Samoladas E, Chytas A, Lyrtzis C, Koimtzis M, et al. Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial. Arch Orthop Trauma Surg. 2011;131(3):389–92. https://doi.org/10.1007/s00402-011-1266-9.

    Article  PubMed  Google Scholar 

  74. Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med. 2011;6(2):113–6. https://doi.org/10.1007/s11739-010-0474-6.

    Article  PubMed  Google Scholar 

  75. Bartholomew JR, Schaffer JL, McCormick GF. Air travel and venous thromboembolism: minimizing the risk. Cleve Clin J Med. 2011;78(2):111–20. https://doi.org/10.3949/ccjm.78a.10138.

    Article  PubMed  Google Scholar 

  76. Laver L, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, et al. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3383–92. https://doi.org/10.1007/s00167-014-3119-x.

    Article  PubMed  Google Scholar 

  77. Samra DJ, Sman AD, Rae K, Linklater J, Refshauge KM, Hiller CE. Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury. BMJ Open Sport Exerc Med. 2015;1(1): e000033. https://doi.org/10.1136/bmjsem-2015-000033.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Rowden A, Dominici P, D’Orazio J, Manur R, Deitch K, Simpson S, et al. Double-blind, randomized, placebo-controlled study evaluating the use of platelet-rich plasma therapy (PRP) for acute ankle sprains in the emergency department. J Emerg Med. 2015;49(4):546–51. https://doi.org/10.1016/j.jemermed.2015.03.021.

    Article  PubMed  Google Scholar 

  79. Blanco-Rivera J, Elizondo-Rodríguez J, Simental-Mendía M, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo C. Treatment of lateral ankle sprain with platelet-rich plasma: a randomized clinical study. Foot Ankle Surg. 2020;26(7):750–4. https://doi.org/10.1016/j.fas.2019.09.004.

    Article  PubMed  Google Scholar 

  80. Petrella MJ, Cogliano A, Petrella RJ. Original research: long-term efficacy and safety of periarticular hyaluronic acid in acute ankle sprain. Phys Sportsmed. 2009;37(1):64–70. https://doi.org/10.3810/psm.2009.04.1684.

    Article  PubMed  Google Scholar 

  81. Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2002(3):CD003762. doi:https://doi.org/10.1002/14651858.CD003762.

  82. Naeem M, Rahimnajjad MK, Rahimnajjad NA, Idrees Z, Shah GA, Abbas G. Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains. J Orthop Traumatol. 2015;16(1):41–6. https://doi.org/10.1007/s10195-014-0289-8.

    Article  PubMed  Google Scholar 

  83. Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2002(3):CD002938. doi:https://doi.org/10.1002/14651858.CD002938.

  84. Kemler E, van de Port I, Backx F, van Dijk CN. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med. 2011;41(3):185–97. https://doi.org/10.2165/11584370-000000000-00000.

    Article  PubMed  Google Scholar 

  85. Nunes GS, Vargas VZ, Wageck B, Hauphental DP, da Luz CM, de Noronha M. Kinesio taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial. J Physiother. 2015;61(1):28–33. https://doi.org/10.1016/j.jphys.2014.11.002.

    Article  PubMed  Google Scholar 

  86. Knapik DM, Trem A, Sheehan J, Salata MJ, Voos JE. Conservative management for stable high ankle injuries in professional football players. Sports Health. 2018;10(1):80–4. https://doi.org/10.1177/1941738117720639.

    Article  PubMed  Google Scholar 

  87. Postle K, Pak D, Smith TO. Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. Man Ther. 2012;17(4):285–91. https://doi.org/10.1016/j.math.2012.02.016.

    Article  CAS  PubMed  Google Scholar 

  88. Zech A, Hubscher M, Vogt L, Banzer W, Hansel F, Pfeifer K. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc. 2009;41(10):1831–41. https://doi.org/10.1249/MSS.0b013e3181a3cf0d.

    Article  PubMed  Google Scholar 

  89. van der Wees PJ, Lenssen AF, Hendriks EJ, Stomp DJ, Dekker J, de Bie RA. Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review. Aust J Physiother. 2006;52(1):27–37. https://doi.org/10.1016/s0004-9514(06)70059-9.

    Article  PubMed  Google Scholar 

  90. van Rijn RM, van Ochten J, Luijsterburg PA, van Middelkoop M, Koes BW, Bierma-Zeinstra SM. Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review. BMJ. 2010;341: c5688. https://doi.org/10.1136/bmj.c5688.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Loudon JK, Reiman MP, Sylvain J. The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review. Br J Sports Med. 2014;48(5):365–70. https://doi.org/10.1136/bjsports-2013-092763.

    Article  PubMed  Google Scholar 

  92. Van Der Windt DA, Van Der Heijden GJ, Van Den Berg SG, Ter Riet G, De Winter AF, Bouter LM. Ultrasound therapy for acute ankle sprains. Cochrane Database Syst Rev. 2002(1):CD001250. doi:https://doi.org/10.1002/14651858.CD001250.

  93. van den Bekerom MP, van der Windt DA, Ter Riet G, van der Heijden GJ, Bouter LM. Therapeutic ultrasound for acute ankle sprains. Eur J Phys Rehabil Med. 2012;48(2):325–34.

    PubMed  Google Scholar 

  94. Feger MA, Goetschius J, Love H, Saliba SA, Hertel J. Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review. Phys Ther Sport. 2015;16(4):361–9. https://doi.org/10.1016/j.ptsp.2015.01.001.

    Article  PubMed  Google Scholar 

  95. de Bie RA, de Vet HC, Lenssen TF, van den Wildenberg FA, Kootstra G, Knipschild PG. Low-level laser therapy in ankle sprains: a randomized clinical trial. Arch Phys Med Rehabil. 1998;79(11):1415–20. https://doi.org/10.1016/s0003-9993(98)90237-4.

    Article  PubMed  Google Scholar 

  96. Stergioulas A. Low-level laser treatment can reduce edema in second degree ankle sprains. J Clin Laser Med Surg. 2004;22(2):125–8. https://doi.org/10.1089/104454704774076181.

    Article  PubMed  Google Scholar 

  97. Takenori A, Ikuhiro M, Shogo U, Hiroe K, Junji S, Yasutaka T, et al. Immediate pain relief effect of low level laser therapy for sports injuries: Randomized, double-blind placebo clinical trial. J Sci Med Sport. 2016;19(12):980–3. https://doi.org/10.1016/j.jsams.2016.03.006.

    Article  CAS  PubMed  Google Scholar 

  98. Calin MA, Badila A, Hristea A, Manea D, Savastru R, Nica AS. Fractionated Irradiation in photobiomodulation therapy of ankle sprain. Am J Phys Med Rehabil. 2019;98(8):692–8. https://doi.org/10.1097/PHM.0000000000001178.

    Article  PubMed  Google Scholar 

  99. Park J, Hahn S, Park JY, Park HJ, Lee H. Acupuncture for ankle sprain: systematic review and meta-analysis. BMC Complement Altern Med. 2013;13:55. https://doi.org/10.1186/1472-6882-13-55.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Kim TH, Lee MS, Kim KH, Kang JW, Choi TY, Ernst E. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev. 2014(6):CD009065. doi:https://doi.org/10.1002/14651858.CD009065.pub2.

  101. Liu AF, Gong SW, Chen JX, Zhai JB. Efficacy and safety of acupuncture therapy for patients with acute ankle sprain: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2020;2020:9109531. https://doi.org/10.1155/2020/9109531.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Zhao M, Gao W, Zhang L, Huang W, Zheng S, Wang G, et al. Acupressure therapy for acute ankle sprains: a randomized clinical trial. PM R. 2018;10(1):36–44. https://doi.org/10.1016/j.pmrj.2017.06.009.

    Article  PubMed  Google Scholar 

  103. Hawamdeh M. The effectiveness of capacitive resistive diathermy (Tecartherapy®) in acute and chronic musculoskeletal lesions and pathologies. Eur J Sci Res. 2014;118(3):336–40.

    Google Scholar 

  104. Stasinopoulos D, Papadopoulos C, Lamnisos D, Stasinopoulos I. The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains. Disabil Rehabil. 2017;39(5):450–7. https://doi.org/10.3109/09638288.2016.1146357.

    Article  PubMed  Google Scholar 

  105. Javorac D, Stajer V, Ratgeber L, Olah A, Betlehem J, Acs P et al. Hydrotherapy with hydrogen-rich water compared with RICE protocol following acute ankle sprain in professional athletes: a randomized non-inferiority pilot trial. Res Sports Med. 2020:1–9. doi:https://doi.org/10.1080/15438627.2020.1868468.

  106. D’Hooghe P, Cruz F, Alkhelaifi K. Return to play after a lateral ligament ankle sprain. Curr Rev Musculoskelet Med. 2020;13(3):281–8. https://doi.org/10.1007/s12178-020-09631-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 consensus statement on return to sport from the first world congress in sports physical therapy. Bern Br J Sports Med. 2016;50(14):853–64. https://doi.org/10.1136/bjsports-2016-096278.

    Article  PubMed  Google Scholar 

  108. Wikstrom EA, Mueller C, Cain MS. Lack of consensus on return-to-sport criteria following lateral ankle sprain: a systematic review of expert opinions. J Sport Rehabil. 2020;29(2):231–7. https://doi.org/10.1123/jsr.2019-0038.

    Article  PubMed  Google Scholar 

  109. Smith MD, Vicenzino B, Bahr R, Bandholm T, Cooke R, Mendonca LM, et al. Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus. Br J Sports Med. 2021. https://doi.org/10.1136/bjsports-2021-104087. A consensus statement regarding return to sports after a lateral ankle sprain.

    Article  PubMed  Google Scholar 

  110. Kaminski TW, Needle AR, Delahunt E. Prevention of lateral ankle sprains. J Athl Train. 2019;54(6):650–61. https://doi.org/10.4085/1062-6050-487-17.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44(15):1082–8. https://doi.org/10.1136/bjsm.2010.076406.

    Article  CAS  PubMed  Google Scholar 

  112. McKeon PO, Mattacola CG. Interventions for the prevention of first time and recurrent ankle sprains. Clin Sports Med. 2008;27(3):371–82, viii. doi:https://doi.org/10.1016/j.csm.2008.02.004.

  113. Caldemeyer LE, Brown SM, Mulcahey MK. Neuromuscular training for the prevention of ankle sprains in fewomen athletes: a systematic review. Phys Sportsmed. 2020;48(4):363–9. https://doi.org/10.1080/00913847.2020.1732246.

    Article  PubMed  Google Scholar 

  114. Burger M, Dreyer D, Fisher RL, Foot D, O’Connor DH, Galante M, et al. The effectiveness of proprioceptive and neuromuscular training compared to bracing in reducing the recurrence rate of ankle sprains in athletes: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2018;31(2):221–9. https://doi.org/10.3233/BMR-170804. A recent review about secondary prevention of ankle sprains.

    Article  CAS  PubMed  Google Scholar 

  115. Janssen KW, Hendriks MR, van Mechelen W, Verhagen E. The cost-effectiveness of measures to prevent recurrent ankle sprains: results of a 3-arm randomized controlled trial. Am J Sports Med. 2014;42(7):1534–41. https://doi.org/10.1177/0363546514529642.

    Article  PubMed  Google Scholar 

  116. Wilson B, Bialocerkowski A. The effects of kinesiotape applied to the lateral aspect of the ankle: relevance to ankle sprains–a systematic review. PLoS ONE. 2015;10(6):e0124214. https://doi.org/10.1371/journal.pone.0124214.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Lysdal FG, Bandholm T, Tolstrup JS, Clausen MB, Mann S, Petersen PB, et al. Does the spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries. Br J Sports Med. 2021;55(2):92–8. https://doi.org/10.1136/bjsports-2019-101767.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Portugal Football School and Health and Performance Unit, Portuguese Soccer Federation, Cruz Quebrada, Portugal

    Rita Tomás

  2. CUF Alvalade Clinic, CUF Tejo Hospital and CUF Descobertas Hospital, Lisbon, Portugal

    Rita Tomás

  3. Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Christopher J. Visco

  4. NewYork-Presbyterian Hospital, New York, NY, USA

    Christopher J. Visco

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Tomás, R., Visco, C.J. Management of Acute Ankle Sprains in the Athlete. Curr Phys Med Rehabil Rep 10, 27–37 (2022). https://doi.org/10.1007/s40141-021-00336-1

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