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BackgroundLateral ankle sprains are common in indoor sports. High shoe–surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes.MethodsIn this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or ‘do-as-usual’. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented.Results480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino.ConclusionCompared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms.Trial registration number NCT03311490.

Background Ankle sprain is one of the common traumatic injuries in daily life, and PRICE (protection, rest, ice, compression pressure bandaging, elevation of the affected limb) principle is routinely recommended at its early stage. In traditional Chinese medicine (TCM), bone-setting technique (BST) can quickly relieve ankle pain and improve walking function, but physicians require high skills and physical strength. In this study, we designed an exercise—heel kicking exercise (HKE) based on the principles and methods of BST. This study aims to observe its true efficacy and safety. Methods 68 patients (18–45 years old) with grade I and II lateral ankle sprain within 48 h were recruited from TCM hospital affiliated to Guangzhou medical university and 60 cases meeting the criteria were enrolled and randomized into control group and intervention group (30 cases separately). The patients in both groups were treated with the PRICE and ankle pump exercise, and the ones in intervention group added heel kicking exercise (HKE). The visual analogue scale (VAS) for pain, swelling degree, and American orthopedic foot & ankle society ankle-hindfoot scale (AOFAS) score before and after the intervention (within 4 W), and Karlsson score (the 26th week follow-up) were measured. Results Before treatment, there were no significant differences in VAS scores, swelling degrees and AOFAS scores between two groups. During the treatment for 4 weeks, VAS scores and swelling degrees of the patients in both groups gradually decreased, and the AOFAS score gradually increased ( p  < 0.01). In addition, patients in the intervention group were observed to get a quicker pain reliever, swelling subsiding, and ankle function restore than those in control group at most of time points of observation (1st d, 3rd d, 1st w, 2nd w, 4th w) ( p  < 0.05, p  < 0.01). But there was no significant difference in Karlsson scores between two groups at the 26th week follow-up. Conclusions HKE is a method designed to provide rapid movement rehabilitation for patients with ankle sprains, which can be used as one of its basic treatments. Trial registration This study was registered in China Clinical Trial Center (NO. ChiCTR2300073709). Trial registration date: August 16th 2022.

Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective: Randomized controlled clinical trial.Design: Laboratory.Setting: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).Patients or Other Participants: Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s): We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:

This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4–5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.

To determine the effect of mobilization with movement (MWM) on pain, ankle mobility and function in patients with acute and sub-acute grade I and II inversion ankle sprain. Randomized placebo controlled trial. A general hospital. 32 adults with inversion ankle sprain. The primary outcome was pain intensity on an 11 point Numeric Rating Scale (NRS) with higher score indicating greater pain intensity. Ankle disability identified by the Foot and Ankle Disability index (FADI) with higher score indicating lower disability, functional ankle dorsiflexion range, pressure pain threshold, and dynamic balance measured with the Y balance test were secondary outcomes. Thirty participants completed the study. At each follow-up point, significant differences were found between groups favouring those receiving MWM for all variables. Pain intensity showed a mean difference of 1.7 points (95% confidence interval, 1.4 to 2.1) and 0.9 points (95% confidence interval, 0.5 to 1.3) at one and six-months follow-up respectively. Benefits were also shown for FADI, ankle mobility, pressure pain threshold and balance. This study provides preliminary data for the benefits of MWM for acute and sub-acute ankle sprain in terms of pain, ankle mobility, disability and balance. •For grade I and II acute ankle sprain, manual therapy is effective with exercises.•Six sessions of MWM are effective to reduce pain, disability and improve balance.•MWM targeted to inferior tibiofibular joint should be reinforced with rigid tape.•Pain as tolerated can be permitted with care while performing exercises.

Introduction Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. Purpose To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. Methods Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18–30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. Results There was a significant interaction effect of Aquatic therapy and time for VAS ( p  < 0.001), single hop ( p  < 0.001), triple hop ( p  < 0.001), cross-over hop ( p  < 0.001), IAT ( p  = 0.019) and ATT ( p  < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected ( p  = 0.923), and nonaffected ( p  = 0.140). There was a significant main effect of time for all dependent variables ( p  < 0.001) except for 6-MHT of affected ( p  = 0.939), nonaffected ( p  = 0.109), and IAT ( p  = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides ( p  < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group ( p  < 0.001*). Conclusion Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.

Cryotherapy is a low-cost treatment option recommended by clinical practice guidelines in acute ankle sprain. However, the current quality of the evidence that supports cryotherapy is still unclear. New high-quality randomised controlled trials are needed. The aim of the Freeze On Sprain Trial (FROST) is to investigate the effectiveness of cryotherapy on function, pain intensity, swelling and dorsiflexion range of motion in people with an acute episode of ankle sprain. This is a protocol of a two-arm randomised controlled trial. Eighty-two participants over 18 years old presenting grade I or II ankle sprain up to 72 hours from the episode will be randomly allocated to Ice Group (i.e., home prescription to apply cryotherapy on the injured ankle with elevation plus non-steroidal anti-inflammatory medication - NSAID) or No Ice Group (i.e., elevation plus NSAID). Our primary outcome is function measured by the Lower Extremity Functional Scale (LEFS) questionnaire. Our secondary outcomes are pain intensity (11-point numerical rating scale), swelling (figure-of-eight method) and dorsiflexion range of motion (goniometry). Participants will be assessed at baseline, 24 hours, 7-10 days, and 12 weeks after allocation. The analysis will follow the intention-to-treat principle using linear mixed models. The results of this study will clarify the effectiveness of cryotherapy in acute ankle sprain for better clinical decision-making processes. Brazilian Clinical Trials Registry (REBEC) RBR-8v9gr9c.

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity.

Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy.

Ankle sprains are common injuries in pediatric populations, yet current literature lacks consensus on optimal management strategies. This study aimed to compare the effectiveness of non-restraint treatment versus bandaging in children with mild ankle sprains, focusing on functional recovery and pain management. A single-center, open-label, non-inferiority randomized clinical trial was conducted at a pediatric emergency service. Patients aged 5–16 years with mild ankle sprains were included. Participants were randomized in a 1:1 ratio to receive either a standardized functional bandage or only general measures with non-restraint. The primary endpoints were a 10-point difference in the OXAFQ-C and a 2-point difference in pain intensity at day 5 after discharge. A total of 113 participants were randomly assigned to receive a functional bandage ( n  = 51) or non-restraint measures ( n  = 62). At day 5, the OXAFQ-C score in the non-restraint group was 76.59 (SD 15.51) and 69.71 (SD 15.24) in the restraint group, with a mean difference of 6.295 (90% CI − 0.058 to 12.647). The mean difference in pain intensity was 0.048 (90% CI − 0.741 to 0.838). No differences were observed in the OXAFQ-C scores or pain intensity at 14 and 30 days. Conclusions : This single-center, randomized clinical trial demonstrates that non-restraint is non-inferior to bandaging for functional recovery and short- to medium-term pain management in pediatric patients with mild ankle sprains. The treatment was very well accepted among patients and no adverse effects were reported. Trial registration : Retrospectively registered in January 2024 on clinicaltrials.org with identifier: NCT06189625. What is Known • Current literature lacks consensus on optimal ankle sprain management, with no evidence supporting non-restraint approaches. Guidelines recommend immobilization despite insufficient comparative data on different restraint systems. Some studies seem to demonstrate that early mobilization may offer better outcomes. What is New • This study contributes novel evidence by demonstrating the non-inferiority of non-restraint treatment compared to bandaging in pediatric ankle sprains. It highlights the safety and efficacy of early mobilization without restraint, suggesting a potential shift in standard management practices.