National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

http://www.nata.org/sites/default/files/ankle-sprains.pdf

Objective:

To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes.

Background:

Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-toplay guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented.

Recommendations:

The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

Summary:

  • Diagnosis:
    • Consider history given of injury including previous injuries
    • Assess AROM, PROM, RROM
    • Special tests to assess injury to the lateral ankle ligaments, such as the anterior drawer and inversion talar tilt tests, performed soon after injury and before joint edema has accumulated, may have better diagnostic accuracy than tests performed after effusion has occurred
    • ATs must be vigilant in assessing associated lesions, both local and distant to the talocrural joint, that may accompany ankle sprains
    • The Ottawa Ankle Rules (OARs) are a valid clinical tool to determine the need for radiographs of the acutely injured ankle or midfoot
    • MRIs are a reliable tools to assess acute ligamentous tear and osteochondral lesions on the talus
  • Treatment
    • Use RICE techniques for acute injuries to decrease edema and pain
    • NSAIDS can improve short term functions and decrease pain
    • Functional rehabilitation is more effective than immobilization in managing grade I and II ankle sprains
    • Grade III sprains should be immobilized for at least 10 days with a rigid stirrup brace or below-knee cast and then controlled therapeutic exercise instituted
    • Rehabilitation should include comprehensive ROM, flexibility, and strengthening of the surrounding musculature
    • Be sure to include balance exercises in all phases of rehab
    • Joint mobs can be used to increase DF
  • RTP
    • The athlete’s perception of function should be part of the RTP decision
    • Functional testing of the ankle should be at least 80% of the non-effected leg
    • Athletes with previous injury should be braced or taped for participation
  • Prevention
    • A multi-intervention injury prevention program should be completed with all athletes with previous ankle injuries
    • Along with addressing the strength of all of the muscles associated with ankle ROM, the hip extensors and abductors should also have a focus
    • If DF is decreased be sure to address that to help decrease chance of injury
  • Special Considerations
    • Syndesmotic ankle sprain should be treated more conservatively than lateral ankle sprains
    • ATs should be aware of chronic ankle instability (CAI) and the instruments used to determine severity
    • Mechanical and functional deficits in patients with CAI should be identified
    • Strategies that focus on balance, strength, and dynamic movements with changes in direction may be effective in reducing the risk of recurrent ankle sprains in patients with functional deficits

 

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