Many people who have LAS are not adequately rehabilitated to overcome their current injury or to prevent re-injury. In fact, most are not rehabilitated or educated at all. Medical literature supports conservative treatment with early functional rehabilitation for LAS. When compared to control groups, LAS patients who undergo an active supervised rehab program that includes manual therapy techniques demonstrate significantly improved function, reduced pain, and have about a 30% reduction in recurrent sprains. The links below are articles that support these claims:
Cleland, et al., 2013
Van Ochten, Van Middlekoop, Meuffels, & Bierma-Zeinstra, 2014
The primary goals of LAS rehabilitation is rapid pain relief, full restoration of range of motion, and proprioception, thereby restoring full activity as soon as possible.
- Phase 1 (approximately days 1-7) involves rest or relative rest, compression, elevation, and ice. We also begin non weight bearing range of motion exercises and walking as tolerated.
- Phase 2 (approximately days 7-21) emphasizes restoration of full ankle ROM through appropriate exercises and manual techniques. We transition to weight bearing exercises during this phase and begin early proprioception and balance exercises.
- Phase 3 (approximately days 21-30) emphasizes muscle strength, moderate to high-level proprioception exercises, balance and return to full function (non-athletic). This is generally the final phase of treatment for the non-athlete.
- Phase 4 of my program emphasizes full return to activity for the athlete. I use sports-specific activities and high-level exercises to ensure the patient is ready for discharge. An individual's progression through these phases is variable, it is my responsibility to ensure each patient is ready before I advance his/her program.
At Stover PT we use the Lower Extremity Functional Scale (LEFS) to measure the results of my rehab efforts. This is a self-report questionnaire scored from 0 (very low function) to 80 (very high function). The LAS patients we have treated had an average initial score on the LEFS of 43/80 and the average final LEFS rose to 67/80. The average number of visits to achieve these results was 10.
McKenzie, R., & May, S. (2000). The Human Extremities: Mechanical Diagnosis and Therapy. Wellington, New Zealand: Spinal Publications New Zealand Ltd.
Van Ochten, J. M., Van Middlekoop, M., Meuffels, D., & Bierma-Zeinstra, S. M. (2014). Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments. JOSPT, 44(11), 862-871.
Cleland, J., Mintken, P., McDevitt, A., Bieniek, M., Carpenter, K., Kulp, K., et al. (2013). Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: A multicenter randomized clinical trial. JOSPT, 443-455.