Three Part Question
In [adults with lateral ligament ankle sprains] is [immediate mobilisation better than immobilisation in a cast] at [decreasing pain and reducing time to full recovery].
Clinical Scenario
A 28 year old man presents to the emergency department with a swollen, bruised and painful ankle following an inversion injury. After examination and appropriate investigations a grade 2 inversion ankle sprain is diagnosed. You wonder whether early mobilisation or immobilisation in a short leg cast is more suitable for this patient.
Search Strategy
Medline 1966-12/98 using the OVID interface.
[{exp ankle OR ankle$.mp OR exp ankle injuries OR exp ankle joint OR exp lateral ligament, ankle} AND {exp sprains and strains OR sprain$.mp} AND {mobilis$.mp OR mobilisation$.mp OR mobilization$.mp}] LIMIT to human and english language.
Search Outcome
20 papers found of which 15 were irrelevant to the study question or of insufficient quality for inclusion.
Relevant Paper(s)
Author, date and country |
Patient group |
Study type (level of evidence) |
Outcomes |
Key results |
Study Weaknesses |
Hedges JR and Anwar RA 1980 UK | 93 patients aged 15-65 with ankle sprains
Elastic bandage and early weight bearing vs non-weight bearing plaster splint
Followed at 1 week and 8 months | PRCT | Functional disability | No significant difference | Many patients had previous injuries. 8 month follow-up in only 33%. |
Pain | No significant difference |
Swelling | No significant difference |
Recurrent injury | No significant difference |
Dettori JR et al 1994 USA | 64 military personnel with ankle sprains
Plaster cast vs air-stirrup vs elastic wrap for 2 weeks
Followed during early course2 and at 1 year3 | PRCT | Return to work and running | Quicker with early mobilisation (P=0.029) | Moderate and severe sprains only. Long term follow-up by postal questionnaire |
Range of motion | Significantly more with early mobilisation |
Swelling and pain | Significantly less with early mobilisation |
Difficulty running at 1 year | No significant difference |
Eiff MP et al 1994 USA | 82 military personnel with ankle sprains
Elastic wrap for 2 days followed by air stirrup for 8 days vs non weight-bearing splint for 10 days
Followed up at 3 and 6 weeks and 6 and 12 months | PRCT | Return to work | Significantly more likely in elastic wrap group | |
Pain | Less pain (P=0.02) at 3 weeks in elastic wrap group |
Residual symptoms | No significant difference |
Ogilvie-Harris DJ and Gilbart M 1995 Canada | 84 articles on soft tissue ankle injuries | Critical review | Functional outcome | Early mobilisation appears to be better | No formal meta-analysis. Not all studies directly relevant to the study question. |
Shrier I 1995 Canada | 13 RCTs on ankle sprains | Critical appraisal | Pain | Less with early mobilisation | No formal meta-analysis. Not all studies directly relevant to the study question. |
Swelling | Less with early mobilisation |
Instability | Less with early mobilisation |
Comment(s)
While many papers have addressed the question there are few relevant RCTs. The two relevant reviews do not address the question directly and do not attempt formal meta-analysis.
Clinical Bottom Line
Early mobilisation of ankle sprains leads to quicker short term recovery without affecting long term outcome. It is the treatment of choice.
References
- Hedges JR, Anwar RA. Management of ankle sprains. Ann Emerg Med 1980;9:298-302.
- Dettori JR, Basmania CJ, Pearson BD et al. Early ankle mobilisation, Pt 1: The immediate effect on acute, lateral ankle sprains. Military Med 1994;159:15-20.
- Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med 1994;22:83-8.
- Ogilvie-Harris DJ, Gilbart M. Treatment modalities for soft tissue injuries of the ankle: a critical review. Clin J Sport Med 1995;5:175-86.
- Shrier I. Treatment of lateral collateral ligament sprains of the ankle: a critical appraisal of the literature. Clin J Sport Med 1995;5:187-95.