The main discrepancies we identified were related to the use of poor statistical methods or poor reporting standards. For example, no study reported performing a collinearity diagnostics to check for multi-collinearity between the prognostic factors presented in the final models. In addition, none of the studies included in the review explored or reported results for the performance of their models measures of interval validity or external validation.
The regression analyses employed were not reported in sufficient detail to identify whether prognostic factors were eliminated due to low statistical power or poor clinical utility. The high loss to follow-up identified in two studies [ 46 , 48 ] is a pointer to the risk of selection bias that may have been due to the method of recruitment employed. However, these studies did not provide information on the comparisons between participants who completed and who did not complete the final follow-up.
Consequently, the profile of the participants lost to follow-up cannot be accurately evaluated. This further highlights the poor reporting standards employed by the studies included in the review. Meta-analysis was inappropriate due to the heterogeneous nature of prognostic factors, recovery outcome measures, follow-up durations, and the limited number of included studies.
Sprained Ankle Injury, Treatment and Recovery | Sprained Ankle Crutches
No factor demonstrated strong evidence of an association with recovery. Number of days to return to full sports practice or competition Self-reported global function. Objective ambulation status. Finally, Medina McKeon et al. Only two [ 44 , 49 ] studies explored univariate correlations between variables included in the model. However, overall, measures of functional ability explained larger part of the variance of recovery compared with measures of symptoms of clinical severity alone. Greater age and female gender associated with slower and incomplete recovery.
Van Middelkoop et al. Self-reported recovery NRS, Summary of number of studies reporting prognostic factors for poor outcome in acute lateral ankle sprain. At short-term follow-up, we found consistent findings from at least two studies with moderate risk of bias, for weight-bearing status and injury grade, indicative of moderate evidence. There was limited evidence for age, pain reproduced by ligament stress test, and the patient reported measures of levels of physical activity.
The evidence for swelling, restricted joint range of motion, and self-report athletic ability was inconclusive, due to insufficient findings from two studies with a high risk of bias. At medium term follow-up, pain, weight-bearing, mechanism of injury and functional activity score were identified as prognostic indicators of recovery; demonstrating limited evidence from only one study with moderate risk of bias. At long term follow-up, there was limited evidence from one study [ 45 ] showing evidence for female gender and age as a prognostic factor for recovery.
However, these may be confounded by psycho-social factors such as recovery expectations, coping mechanisms or self-efficacy that have been linked to recovery in musculoskeletal conditions [ 51 ]. Other prognostic factors with insufficient evidence for long-term outcome include injury severity, the number of injured ligaments and the presence of bone bruise as determined by magnetic resonance imaging.
The observation of insufficient evidence for radiographic findings and recovery, suggests that structural pathology may not be indicative of clinical presentation. The lack of an association between structural changes in the ankle observed with imaging techniques and persistent impairment has also been reported by previous research [ 52 ]. It seems that diagnostic classifications may have a poor reliability in predicting recovery at long term.
In this review, baseline measures of pain at rest and re-sprain at long-term also showed no association with recovery [ 47 ]. This is, however, contrary to reports of an association between recurrent sprains and chronic ankle instability noted by a previous systematic review [ 53 ]. Studies with low risk of bias and larger sample sizes tended to report conservative estimates of the association between variables and recovery.
For example, the study by Akacha et al. Overall, while the included studies in this review do not provide definite evidence of a causal link between the factors identified and recovery, they do highlight the of role biomechanical factors on recovery. Overall, a number of the selected prognostic factors identified, demonstrated some consistency across short, medium and long-term recovery time-points. We defined factors as consistent when it was explored by at least two studies or at two different time points within the same study.
Measures of pain [ 42 , 47 — 49 ], swelling [ 42 , 43 , 48 ], injury severity [ 42 , 46 , 49 ], weight-bearing status [ 43 , 48 , 49 ] and self-reported functional ability [ 42 — 44 , 48 ] showed some degree of consistency, however, the evidence of an association with recovery is equivocal because of the poor quality of individual studies. Evidence for the prognostic value of age was, however, consistent according to results from one study with low risk of bias [ 45 ], and another study [ 49 ] with moderate risk of bias.
Higher baseline age was associated with poor recovery at short [ 49 ], medium [ 49 ] and long term follow-up time points [ 45 ]. We observed a trend where clinical indicators of symptoms such as swelling, injury severity, or restricted range of motion ROM demonstrated a greater prognostic ability of recovery at short- and medium term, than at long-term follow-up. This may be useful to inform clinical decision making earlier on in the recovery pathway.
Measures explored later in the course of recovery, rather than early on, seemed to have a good prognostic value. Examples of these factors include pain at rest, on palpation and on weight bearing, as well as self-reported functional ability. This may suggest that measures of functional ability may be more sensitive at identifying sensory or neuro-muscular deficits in patients experiencing functional or mechanical instability. Alternatively, this may imply that the timing of the measurements, influences association. To our knowledge, this is the first systematic review of prognostic factors specific to recovery from acute ankle sprains.
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Overall, results of previous reviews [ 53 , 54 ] support the findings of our review, and the relevance of these factors to the prediction of recovery in the management of ankle sprains remains conflicting. We observed a substantial amount of clinical and methodological heterogeneity. Furthermore, there was little overlap in the definition of outcome variables and considerable variation across the potential prognostic factors explored in studies.
This made the statistical pooling of the results a difficulty. It is worth noting that a significant proportion of the participants included in this review sustained grade I or II injuries, with considerably shorter duration for return to function. One of the strengths of this review is that we included a homogenous study population of acute lateral ankle ligament injuries, excluding other ligamentous injuries i. Furthermore, two-thirds of the sample included in this review were broadly representative of the age range, severity presentations and recreational activity levels of the general population, allowing transferability to most real world acute settings.
There were considerable differences in the measurement of study factors, poorly defined selection procedures for potential prognostic factors, and different outcomes with little or no overlap. For example, injury severity was reported as a prognostic factor associated with recovery, however, two studies used clinical symptoms [ 42 , 49 ], while a third study [ 46 ] used MRI to evaluate grade severity. This made direct comparisons difficult as previous research has shown poor associations between radiographic findings and recovery [ 53 ].
Subjective methods increase variability in measurement errors, but objective assessments using MRI are not readily available in acute settings. A number of studies did not use validated outcome measures. There was no pre-specification of this cut-off point from the wider literature; hence, this threshold may not be valid and could have introduced bias. It has been suggested that a minimum of 10 events may not be required for each prognostic factor considered in a study [ 55 ]. Although the treatments described in studies included in this review reflect current practice, most of these were not standardised and the nature of rehabilitation programmes such as neuromuscular training has been found to be correlated with better outcome [ 51 ].
Only one study [ 45 ] accounted for this confounding variable in their model. Two studies [ 47 , 49 ] with a cohort from a randomised trial considered the mean effect of treatments administered, but did include it in their model because there was no difference between the groups. Although we performed a comprehensive search strategy to reduce bias in our results, we did not perform hand searching of journals; hence, some studies that, generally, tend to be of poorer methodological quality may have been missed.
We evaluated our studies using a robust quality assessment tool — QUIPS that covered all the important criteria for addressing the objectives of prognostic studies, which was pilot-tested to ensure consistency. However, a possible limitation in our approach at this stage was not performing an assessment of the inter-rater reliability for evaluating the quality of the studies. Most factors identified exhibit a good degree of accessibility in clinical practice See Table 5.
The vast majority of the studies included in this review were of a short-term duration when symptoms are still severe and rapidly resolving, hence recovery at this stage is still quite variable. Larger studies with adequate sample size per prognostic factor are also needed.
Furthermore, psychosocial and contextual factors such as recovery expectations, coping mechanisms, self efficacy, which have been implicated in recovery from musculoskeletal disorders [ 56 ] should be considered in future studies. We suggest that future studies consider the replication and confirmation of existing prognostic factors; exploring measures of internal and external validity; and adhere to current recommendations for conducting and reporting prognostic studies [ 57 ].
This will enable the translation of definitive prognostic factors into clinical practice. Overall, the existing evidence from the studies identified by this review does not allow firm conclusions to be drawn about prognostic factors of recovery from an acute ankle sprain. At present, the associations between baseline prognostic factors and recovery are largely inconsistent. Age seems to be an independent prognostic factor identified in three studies with consistent evidence for predicting recovery in patients with acute ankle sprain.
However, we suggest a cautious interpretation due to the small associations between predictors and recovery. There is still some lack of clarity on the underlying mechanisms of recovery after an ankle sprain. More research is needed to inform an accurate understanding of the prognosis of acute ankle sprains. Factors that may be associated with poor recovery — at short-term include: pain intensity, difficulties bearing weight, restricted joint motion and functional ability.
Do I Have a Sprained Ankle? Symptoms and Diagnosis
There is a substantial gap in the literature for prognostic factors of poor recovery. Ankle Function Score. Allied and complementary medicine database. Cumulative index of nursing and allied health. Foot and ankle outcome score.
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Magnetic resonance imaging. Preferred reporting items for systematic reviews and meta-analyses. Quality in prognosis studies. Randomised controlled trial. Restricted range of motion. United Kingdom. United States of America. JT — made contributions to the acquisition of data, analysis, interpretation of data and drafting of the manuscript. CB — made contributions to the acquisition of data, analysis, interpretation of data and drafting of the manuscript. MAW — made contributions to the conception, design, acquisition of data and drafting of the manuscript.
DJK — made contributions to the design, acquisition of data and drafts of the manuscript. MMS — made contributions to the design, acquisition of data and interpretation of data. SL - made contributions to the conception, design, interpretation of data, drafting of the manuscript, provided study area expertise and gained the funding for the study. I can confirm that all authors have read and approved the final manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is distributed under the terms of the Creative Commons Attribution 4. Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review.
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I have done my best to tell you about the powerful techniques in this program. I have provided the information that is critical to your success in rehabilitating your sprained or twisted ankles. And your purchase price will be promptly refunded. Because, again, this truly is the real thing here. Get ready to experience fast, effective and aggressive rehab so you can get to your normal routine. Order the program now on our secure server. Your credit card information is never seen by anyone and is protected by the best security system on the internet.
Goods and services provided by FastRehab. It reduced the swelling quickly and efficiently and even my doctor was impressed. The cost was very minimal, and the stretching and strengthening exercises and routine were very easy to do and easy to incorporate into a busy day.
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15 Exercises for Your Sprained Ankle
Your rehab program worked great. Your regimen worked great on my ankle. My walking and rehab began a lot quicker than I had expected. I sprained my ankle on Monday and was completely bummed because I was supposed to be flying to Vail for a snowboarding trip later that week and was scheduled to play basketball that Saturday. I thought I had no chance, but gave you program a shot. I wasn't better in one day, but I saw noticeable improvement every day and much to my surprise I was able to snowboard on Friday AND play basketball on Saturday, just 5 days after my sprain.
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With the 8th grade school basketball tournament finals just about to begin within the week, our pointguard daughter looked like a very likely scratch on the roster. Thankfully, my husband went online to see what type of fast, effective treatments for ankle sprains was available, and he found your website. We all agreed that it was her best chance to have the opportunity to play in the tourney, so we ordered your information and an ankle rotation board as you recommended to strengthen and retrain the injured muscles to respond properly again. Our daughter was able to complete 3 of the water baths and treadmill directives, and her ankle swelling shrank down to almost normal size — we were amazed and very gratetful for such an effective treatment.
Our daughter was able to compete, much to the relief and delight of her teammates, coaches, and, of course, us. Thanks for doing the research and for offering a real recourse to those who suffer with a sprained ankle, especially to the athletes who work hard to be competitive in their respective sports. I had the added problem of a horrible bruise from my ankle to my knee. I had heard about fast rehab and looked it up. This happened on a saturday evening before a monday holiday. I was told to go to the emergency room I started fast rehab instead.
A simple elastic wrap e. Raising your injured ankle also prevents fluid from accumulating in and around the ankle. You should try to have your ankle above the level of your heart for a few hours per day and while you are sleeping, especially if you have a lot of swelling. Leg elevation will only effectively reduce swelling when you are lying down. A few pillows under your ankle will adequately raise your leg while keeping your ankle comfortable. The less swelling and inflammation around your ankle, the quicker you can progress to your next phase of rehabilitation.
As the initial pain and swelling begin to subside, rehabilitation can begin. While most ankle injuries are simple and heal naturally over a short time, some injuries are more severe and necessitate interventional treatment. You may need pain medication or anti-inflammatory medication to reduce pain and swelling. Most of the time, your doctor will recommend an over-the-counter OTC medication, like Tylenol acetaminophen or Advil ibuprofen.
Be sure to get your doctor's advice before taking OTC medications, as some of them can increase bleeding and bruising. While uncommon, damage or injury to tendons, cartilage, or nerves may complicate and prolong your treatment.
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You may need surgery to help repair severe damage or to restore the integrity of an unstable joint. To ensure a full recovery, you will have to regain mobility, strength, and balance in your injured ankle joint. Working with a therapist, athletic trainer, or personal fitness coach can help ensure that you are taking the right approach to your ankle rehabilitation. Rehabilitation involves a number of exercises, some of which you can do under your therapist's supervision and some that you can do at home. You may be guided and instructed on how to do range-of-motion exercises, strengthening exercises, sensory activities, and sport-specific practices.
Proprioception, which is your ability to sense your body's position and movement, is a skill that can be built, which can help you avoid falls and other missteps that can lead to a sprained ankle. Consider working proprioception exercises into your routine. Sprained ankles are common. Having one does not mean that you will have long-term mobility problems.
However, being attentive to your injuries during the recovery and rehabilitation periods is very important because putting too much pressure on a sprained ankle can prolong this time and put you at risk of falling, which can lead to additional injuries. Dealing with joint pain can cause major disruptions to your day.
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The most common signs of an ankle sprain include:. Swelling of the ankle joint Bruising around the ankle Pain around the ankle Slight difficulty bending the ankle up or down Discomfort when trying to walk. When to See a Doctor Moderate pain and swelling are to be expected following a simple sprained ankle, but severe ankle pain, bone pain, or inability to stand should raise concern.
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