Ankle Sprain That Did Not Fully Respond to Initial Treatment
When standard first-line care for an acute ankle sprain fails to achieve adequate pain reduction, control of swelling, and restoration of self-reported ankle function, a structured next-step protocol is indicated to address the risk of ongoing instability and recurrent injury.
Why This Step Is Needed
Initial management — including anti-inflammatory medication, early mobilisation, exercise therapy with proprioceptive and neuromuscular training, manual therapy to the ankle and foot, and external ankle support with bracing or taping — did not achieve the expected outcomes of reduced pain, reduced swelling, and improved self-reported ankle function.
Next-Step Approach (Partial Overview)
The protocol involves a structured neuromuscular and proprioceptive exercise programme delivered at an intensified total dose, paired with a sustained course of ankle bracing. The precise parameters, sequencing, and duration are set out in the full protocol.
Clinical Goals
Target outcomes include absence of recurrent ankle sprain, improved subjective ankle joint stability, and improved self-reported ankle function — assessed within 12 months.
References
DOI: 10.1136/bjsports-2016-096178
- Exercise therapy is generally considered effective in the treatment of CAI for the outcomes of self-reported function and reinjury incidence.
- Removal of interventions with a lower dose of total exercise (<900 min) improved the odds of the exercise intervention for injury risk.
- There was unanimous consensus among the reviews that bracing is effective at preventing a recurrence of an ankle sprain.
- It was recommended that a brace be worn for a minimum of 6 months after an acute ankle sprain to prevent recurrence, and that the benefit of wearing a brace lasts for up to 1 year following the most recent ankle sprain.
- Braces were recommended for all athletes with a previous history of ankle sprain, particularly when engaging in high-risk activities such as indoor/court and field sports.
- Exercise interventions significantly decreased the risk of sustaining a recurrent ankle sprain.
- Proprioceptive training programmes are effective at reducing the rate of ankle sprains in sporting participants, particularly those with a history of ankle sprain.
- Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain.
- The addition of proprioceptive training demonstrated a significant reduction in subjective instability and functional outcomes.
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