Written by Pat Stanziano, MPT, Hons BSc Kin
Lateral ankle sprains (LAS) are a regular occurring musculoskeletal injury commonly found in the general population and those individuals who participate in sports. In fact, about 40% of all LAS occur during sports. That being said, only half of all ankle LASers seek medical attention which increases their risk of developing chronic ankle instability. Despite the numerous studies published on adequate diagnosis, long term effects, treatment and prevention, diversity on this topic persists. Here are recommendations for best practice, as per the recent consensus statement published in the British Journal of Sports Medicine (Gwendolyn, V et al, Mar 2018):
An athlete’s response to pain, their workload, and level of sports participation help formulate a safe return-to-play program.
In cases of a suspected fracture, the Ottawa Ankle Rules should be applied to rule in/out need for diagnostic X-Ray.
These guidelines bring to light that use of passive techniques and modalities in the management of musculoskeletal injuries brings little-to-no value to an athlete’s recovery. Dr. Jennifer Robinson, sport medicine physician in the Faculty of Medicine at the University of British Columbia, along with other sport medicine experts think it’s time to retire RICE from the health-care vocabulary (http://thischangedmypractice.com/move-an-injury-not-rice/). Instead, the sport medicine community needs to promote a more evidence-based approach by using the acronym, MOVE:
|M||Movement, not rest, starting with gentle range of motion exercises in unloaded or loaded positions, depending on pain response; and progressing to functional activities.|
|O||Options for cross training that involve exercises for structures not necessarily involved with the injury, but geared toward improving overall performance.|
|V||Vary rehabilitation with strength, balance, and agility exercises, and progressing them accordingly|
|E||Ease back to early activity starting with sport-specific movements and manipulating performance parameters to progress the athlete back to practice and eventually competition.|
A more active and functional rehabilitative approach to injury (excluding fractures and more catastrophic injuries) align well with with principles demonstrating that mechanical loading stimulates structural change. The difficulty lies in finding the optimal dose of loading vs. protection of the injured site (the proverbial ‘sweet spot’). When overloaded, vulnerable tissues can become further damaged. When not loaded enough, no positive adaptations will occur resulting in chronic pain, weakness, or instability. Furthermore injuries vary, so there is no one-size-fits all strategy. That’s why it is important to find a sport medicine professional that will thoroughly assess, diagnose, and devise a program of care routed in therapeutic exercise. But he or she must be able to make modifications on the fly, to get an athlete back to competition in a safe and time-efficient manner.