Ankle exercises in combination with intermittent ice and compression following an ankle sprain improves function in the short term.

Question: What is the effect of an accelerated intervention incorporating early therapeutic exercise as compared to a standard intervention of protection, rest, ice, compression, and elevation after acute ankle sprain? Design: Randomised, controlled trial with blinded outcome assessment and intention-to-treat analysis. Setting: An emergency department and sports injury clinic in Northern Ireland. Participants: Men and women 16–65 years, with acute (< 7 days) grade 1 or 2 ankle sprain. Key exclusion criteria were complete (grade 3) rupture, bony ankle injury, and multiple injuries. Randomisation allocated 101 participants to an accelerated intervention incorporating early therapeutic exercises (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group). Interventions: During the first week after baseline both groups received written advice on using ice and compression. The exercise group also undertook 20 minutes of exercises three times a day focused on increasing ankle range of movement, activation and strengthening of ankle musculature, and restoring sensorimotor control. In the following four weeks a standardised treatment consisting of ankle rehabilitation exercises was provided to both groups. Outcome measures: The primary outcome was subjective ankle function assessed by the lower extremity functional scale (0–80) at weeks 1 to 4. Secondary outcomes assessed were: pain at rest and pain with activity with 10-cm visual analogue scales, swelling by a modified version of the figure of eight method, and physical activity by a physical activity logger. Ankle function by the Karlsson score and rate of reinjury were also assessed at 16 week follow-up. Results: 15 of the 101 patients dropped out during the trial, 11 in the exercise group and 4 in the standard group. An effect was found in favour of the exercise group with the lower extremity functional scale (0–80) at week 1 (MD 5.3, 98.75% CI 0.3 to 10.3) and week 2 (MD 4.9, 95% CI 0.3 to 9.6). In addition, the exercise group was more active in the first week as measured by time spent walking (0.4 hours per day, 95% CI 0.2 to 0.6). No between-group differences were observed for pain at rest, pain with activity, or swelling. At 16 weeks there were no significant differences between the groups in the Karlsson score or reinjury rate (2 in each group). Conclusion: An accelerated exercise protocol during the first week after ankle sprain improved ankle function and early return to weight bearing activity.