Scimex: Physiotherapy given to patients with simple ankle sprains does not benefit recovery when compared to basic self management of the injury at home, reveals a study published by The BMJ today. Fewer than half of patients had not reached ‘excellent recovery’ by six months after injury, and there was little clinical difference between those who had received physiotherapy versus usual standard care. Experts say the finding is important because management of ankle sprains has substantial financial costs, and alternative treatments should be sought to help recovery.
Ankle sprains are
one of the most common musculoskeletal injuries and are associated with a
high number of visits to an emergency department. Morbidity has been
reported among 30-70% of patients, from six months to seven years after
Most ankle sprains are mild or moderate
ligament sprains, but clinical standards for the treatment of these
injuries are not well defined. In addition, there is a lack of high
quality evidence on role of physiotherapy.
So a team of Canadian
researchers carried out the largest randomised controlled trial to
evaluate the benefits of physiotherapy for ankle sprains.
study included 503 patients, aged 16-79 years, presenting with mild or
moderate ankle sprain injuries to one of two hospitals in Kingston,
Canada, between 2009 and 2013. They were randomly assigned to a control
group where they received usual care, or usual care plus physiotherapy.
Usual care consisted of medical assessment and a one page written
summary of instruction for basic management of the injury at home.
Recommendations focused on ankle protection, rest, ice, application of
compression bandage, elevation, use of painkillers, graduated weight
bearing activities and information about expected recovery.
The physiotherapy group included a regime of up to seven 30 minute sessions, along with usual care.
Participants were required to complete a questionnaire assessing
recovery at 1, 3 and 6 months. Questions focused on pain, symptoms,
function in activities of daily living, function in sport and
recreation, and quality of life.
Results show that 43% (90/208)
of participants in the physiotherapy group and 38% (75/195) in the
control group had not reached ‘excellent recovery’ by six months.
However, a limitation of the study may be that the strict protocol for
the recruitment of patients may have led to bias in the sample
The authors conclude: "While there was not a clinically important effect
with the standardised physiotherapy regimen provided to our
participants, there is potential for the investigation of alternative
interventions that would reduce morbidity in patients with these
In a linked editorial, Chris Bleakley from Ulster
University writes that the randomised controlled study is “an important
addition to the evidence base," but also calls for patients,
practitioners and researchers to consider other rehabilitative exercises
that can influence treatment success.
Clinical benefit of
rehabilitative exercises might depend on the nature, intensity, and
duration of treatment, he says. The maximum of seven lots of 30 minutes
of supervised physiotherapy in the latest study might be a “lower dose”
when compared to other studies.
He also says there’s an “urgent
need to diversify the exercise content of treatments beyond the ankle,”
such as the knee, hip, and in the torso, which can be implicated in long