Rehabilitation Guidelines for High Ankle Sprains

Introduction to High Ankle Sprains

High ankle sprains involve injury to the syndesmosis between the tibia and fibula, and can be detected using the crossed-leg test, where pressure applied to the medial side of the knee produces pain in the syndesmosis area 1

The British Journal of Sports Medicine recommends that exercise therapy should be started as soon as possible after a high ankle sprain to recover joint functionality, with supervised exercises focusing on proprioception, strength, coordination, and function 2
Current evidence indicates that RICE alone has no positive influence on pain, swelling, or patient function, according to the British Journal of Sports Medicine 3
NSAIDs may be used to reduce pain and swelling in the acute phase, as suggested by the British Journal of Sports Medicine 2
Functional support, particularly bracing, is preferred over immobilization, as recommended by the British Journal of Sports Medicine 2

Cryotherapy combined with exercise therapy has shown greater effect on reducing swelling compared to heat application, according to the British Journal of Sports Medicine 3
Supervised exercises with focus on proprioception, strength, coordination, and function are strongly recommended, as suggested by the British Journal of Sports Medicine 2

Exercise therapy has the strongest evidence (level 1) for effectiveness in ankle sprain rehabilitation, according to the British Journal of Sports Medicine 2
Functional treatment has been shown to help patients return to sports 4.6 days sooner than immobilization, as reported by the American Family Physician 1
Patients undergoing functional treatment returned to work 7.1 days sooner than those treated with immobilization, according to the American Family Physician 1
Manual mobilization is advised only in combination with other treatment modalities to enhance the treatment effect, as recommended by the British Journal of Sports Medicine 2

Inadequate treatment of ankle sprains can lead to chronic problems such as decreased range of motion, pain, and joint instability, as warned by the American Family Physician 4
Immobilization should be avoided as it shows no benefits compared to functional treatment, according to the British Journal of Sports Medicine 2
Proper diagnosis is crucial, and clinical assessment of ligament damage is optimized if delayed for 4-5 days post-injury when swelling has decreased, as suggested by the British Journal of Sports Medicine 3
For recurrent ankle sprains, exercise therapy should be incorporated into regular training activities as much as possible, as recommended by the British Journal of Sports Medicine 2

Immediate functional treatment and a return-to-work schedule are advised to minimize work absenteeism, as recommended by the British Journal of Sports Medicine 2
For sport resumption, supervised exercises focusing on proprioception, strength, coordination, and function are strongly recommended, according to the British Journal of Sports Medicine 2

The British Journal of Sports Medicine recommends applying the Ottawa Ankle Rules to determine if radiography is needed, which has high sensitivity and specificity for detecting fractures 5, 6, 7
Using the Ottawa Ankle Rules reduces unnecessary radiographs by approximately 60% and saves costs per patient 6, 7

The British Journal of Sports Medicine suggests implementing functional treatment with 3-5 days of rest, ice, compression, and elevation (RICE), followed by early weight-bearing and supervised exercise therapy, combined with a semirigid ankle brace for optimal recovery 5, 6, 7
The American Family Physician recommends NSAIDs to reduce swelling and pain in the acute phase and may decrease time to return to usual activities 8
A semirigid ankle brace should be applied immediately, as it is the most cost-effective option and superior to taping 5, 6, 7

The British Journal of Sports Medicine advises beginning supervised exercise therapy as soon as possible after the 3-5 day RICE period, which is the treatment with the strongest evidence (level 1) 5, 6
Supervised exercises must include proprioception training, strength exercises, coordination exercises, and should address muscle deficits and muscle response time 5, 6, 8
Supervised exercise provides better outcomes than non-supervised training, which is a key finding from recent evidence 6

The British Journal of Sports Medicine recommends continuing to wear a semirigid ankle brace, as bracing is superior to taping and neuromuscular training for preventing recurrent sprains (level 1 evidence) 5, 6, 7
Implementing neuromuscular training programs, including proprioceptive exercises, has proven beneficial for preventing recurrent sprains 5, 6, 7

With proper functional treatment, expect return to work approximately sooner than with immobilization, and functional approach leads to fastest resumption of work and daily life activities 5, 6, 7