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Lateral ligament ankle sprains should be mobilised early

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
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 monthsPRCTFunctional disabilityNo significant differenceMany patients had previous injuries. 8 month follow-up in only 33%.
PainNo significant difference
SwellingNo significant difference
Recurrent injuryNo significant difference
Dettori JR et al
64 military personnel with ankle sprains Plaster cast vs air-stirrup vs elastic wrap for 2 weeks Followed during early course2 and at 1 year3PRCTReturn to work and runningQuicker with early mobilisation (P=0.029)Moderate and severe sprains only. Long term follow-up by postal questionnaire
Range of motionSignificantly more with early mobilisation
Swelling and painSignificantly less with early mobilisation
Difficulty running at 1 yearNo significant difference
Eiff MP et al
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 monthsPRCTReturn to workSignificantly more likely in elastic wrap group
PainLess pain (P=0.02) at 3 weeks in elastic wrap group
Residual symptomsNo significant difference
Ogilvie-Harris DJ and Gilbart M
84 articles on soft tissue ankle injuriesCritical reviewFunctional outcomeEarly mobilisation appears to be betterNo formal meta-analysis. Not all studies directly relevant to the study question.
Shrier I
13 RCTs on ankle sprainsCritical appraisalPainLess with early mobilisationNo formal meta-analysis. Not all studies directly relevant to the study question.
SwellingLess with early mobilisation
InstabilityLess with early mobilisation


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.


  1. Hedges JR, Anwar RA. Management of ankle sprains. Ann Emerg Med 1980;9:298-302.
  2. 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.
  3. 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.
  4. 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.
  5. 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.