Research Articles – Ankle

Adding hands-on therapy techniques to an exercise program leads to
better outcomes than exercise alone for patients who repeatedly sprain their ankles

Ankle sprains are the most common injury in physically active individuals, and up to 41% of those who sprain their ankle once will eventually develop chronic ankle instability (CAI). Patients with CAI continue to experience painful symptoms and a sensation that the ankle is giving out. As a result, they are more likely to sprain their ankle again, which can lead to serious long-term disability. Exercises that strengthen muscles and improve balance are commonly recommended for these patients, as is manual therapy, in which a physical therapist systematically moves joints to improve their mobility and alleviate symptoms. Research has shown that both exercise and manual therapy are effective for CAI, but no studies have evaluated manual therapy that focuses on the nerves of the ankle. For this reason, a powerful study was conducted to determine if manual therapy can provide any additional benefits to an exercise program for CAI patients. Results showed that patients in both groups improved in all outcomes measured, but those who underwent both interventions experienced greater improvements, particularly in ankle instability and strength measurements. These results suggest that adding manual therapy to an exercise program leads to even better overall outcomes, and patients with CAI are therefore encouraged to see a physical therapist if they have not already done so.

Bracing and balance training both reduce the
risk for ankle sprains in athletes

Ankle sprains are some of the most common injuries in sports, especially those that require quick direction changes, cutting movements and rapid acceleration and deceleration. After a first ankle sprain, between 35-73% of patients report ongoing symptoms, and the risk of having another sprain is about 70%. This is why measures are needed to reduce the risk for a first ankle sprain, and two ideas proposed for this goal are bracing and balance training. Unfortunately, studies evaluating these interventions are lacking, which led researchers to conduct a powerful pair of studies called a systematic review and meta-analysis. Results showed that both balance training and bracing were effective for reducing the risk and the incidence of ankle sprains in athletes, but it was unclear if either intervention alone or a combination of the two was better. Athletes who are concerned with their risk for ankle sprains are therefore encouraged to see a physical therapist for a balance training program or fitting for a brace to keep their ankle sprain risk as low as possible.

Prevention program reduces the number
of ankle sprains in the athletic population

Ankle sprains are by far the most common injuries in athletes, especially those who participate in sports with lots of jumping, changing direction and/or pivoting. After an athlete experiences one ankle sprain, the risk for experiencing additional sprains in the future increases significantly. One way to address this problem is by reducing the risk for the first ankle sprain with strategies like proprioceptive training. Proprioception allows one to know where their body is in space, by taking in sensory input from the outside world and integrating it into specific movements. A prime example of proprioceptive training for the ankle is balance exercise, which can enhance the body’s ability to adapt to a changing environment and protect it from injury. To investigate if this type of training could be effective, researchers conducted a review, and the results showed that proprioceptive training did reduce the risk for ankle sprains. In particular, individuals who completed the training had a 35% reduced risk for an ankle sprain compared to those who did not. Based on these findings, if you are interested in reducing your risk for an ankle sprain, consider seeing a physical therapist to receive an appropriate proprioceptive training program.

Hands-on treatment administered by a
physical therapist is beneficial for heel pain

Plantar fasciitis, or plantar heel pain, is a common condition that about 10% of the population will experience at least once in their lives. It occurs when a strong piece of tissue on the bottom of the foot—the plantar fascia—becomes inflamed or damaged, which leads to a stabbing pain in the heel. Manual therapy is a hands-on intervention frequently administered to patients with plantar heel pain by physical therapists, but there is only weak evidence available to support its effectiveness. Therefore, a study was conducted to review all the available research on manual therapy for plantar heel pain and to determine if it is beneficial for these patients. The results were generally supportive of manual therapy, with one type in particular – soft-tissue mobilization – being found to be more effective than other treatments and placebo. The quality of the included studies was rated as moderate-to-high, which shows that these findings are reliable and can guide physical therapists treating these patients.

Most patients with common foot injury don’t
seek out physical therapy services

Plantar fasciitis is a very common foot injury, with about one million individuals seeking out treatment for it every year. Patients with plantar fasciitis typically experience a stabbing pain in the bottom of the foot near the heel, which is usually the worst with the first few steps after awakening. Recommended treatments for plantar fasciitis include a variety of stretching and strengthening exercises, bracing and hands-on therapy called manual therapy, which is usually administered by a physical therapist. There is strong evidence showing that physical therapy-based treatments like manual therapy and exercises are effective for this injury, but it’s not completely clear if patients are actually taking advantage and seeking out this type of care. For this reason, a study was conducted to investigate how many patients with plantar fasciitis are referred to physical therapy. Of the more than 800,000 patients in the database, only 7.1% were actually evaluated by a physical therapist within 30 days of their diagnosis. Patients who were treated with manual therapy were found to have shorter lengths of care and paid less overall for their care than those who did not. These findings show that although physical therapy is strongly supported by evidence as a beneficial treatment for plantar fasciitis, the vast majority of patients with the injury do not seek out this type of care.

Large-scale review shows that exercise therapy is one
of the most effective treatments for ankle sprains

Ankle sprains are the most common injury in athletes and those who are physically active. After spraining an ankle, up to 40% of patients will go on to develop a condition called chronic ankle instability, which increases the chances of another ankle sprain occurring in the future. Many treatments are available to reduce the chances of this condition developing, but there is so much research out there that it is difficult to determine which is most effective. For this reason, a large-scale review was conducted of these studies to summarize them and figure out which treatments are best. Results showed that exercise therapy was capable of reducing pain, swelling and function in patients with ankle sprains, and was helpful for preventing future ankle sprains from occurring.

A treatment program that includes specific exercises and hands-on therapy
is helpful for patients with repeated ankle sprains

Ankle sprains are the most common injury in athletes and those who are physically active. In addition to the initial pain and disability that these injuries cause, up to 40% of patients who sprain their ankle once will go on to develop a condition called chronic ankle instability. Those who experience chronic ankle instability deal with continual pain and soreness, and are more likely to sprain their ankle again in the future. Two strategies used by physical therapists for treating these patients are manual therapy and exercise therapy. Both have been found to lead to benefits, but it’s not completely clear what effect they have when used together. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted. Results showed that the combination of manual therapy and exercise therapy led to lower levels of pain, better ankle stability and greater flexibility overall. Patients with chronic ankle instability should therefore seek out these services from a physical therapist to reduce their chance of future ankle sprains.

Training program effective for reducing the rate of ankle sprains in athletes

Ankle sprains are the most common injury in sports, especially those that require lots of jumping, pivoting and/or changing direction. In addition to experiencing pain and disability, athletes that sprain their ankles once are more likely to sustain another sprain in the future, which makes it important to reduce the chances of this occurring. Measures like taping and bracing may be effective, but they have some disadvantages, and it’s been suggested that prevention exercise programs are better and avoid these disadvantages. A study followed up on this to determine if specific exercises could reduce the rate of ankle sprains, and results showed that athletes with a history of ankle sprain could benefit substantially from such a program and cut their chances of experiencing another sprain in the future.

Balance training program helps reduce the likelihood of repeated ankle injuries

One ankle sprain is usually bad enough for the person who experiences it, but for some, if the proper moves aren’t made, it could mean the start of an ongoing and bothersome condition known as chronic ankle instability (CAI). CAI is the tendency towards repeated ankle sprains and recurrent symptoms (pain, weakness, giving way), and occurs in about 40-70% of patients who suffer from an initial lateral ankle sprain. One suggested method to prevent CAI from occurring is by improving balance and proprioception (the sense of your joint’s position in your body) after the first ankle sprain. To investigate this theory, a study evaluated the effect of a balance training on study subjects and found it to significantly improve balance and proprioception, meaning such a program has the potential to reduce the occurrence of CAI if administered after the initial injury is sustained.

Ankle sprain prevention program dramatically saves money for health-care system

Acute ankle injuries are far and away the most common musculoskeletal injuries throughout the world, with lateral ankle sprains occurring more often than any other. To combat this issue, a number of preventative intervention programs have emerged as of late, and many of them have proven to be effective in reducing ankle sprain recurrence. The only thing lacking is a full-scale analysis on the cost-effectiveness of such a program on the health-care system. Therefore, researchers tested a particular program and calculated the savings of a reduction in ankle sprains, finding it to beneficial and economically advantageous to those who implement it.

Surgical vs. non-surgical treatment for Achilles tendon rupture

The course of treatment for Achilles tendon rupture is one that continues to change on a regular basis, and a general consensus on the best way to approach it is yet to be reached. While re-rupture rates are slightly lower with surgery compared to rehab, the complications and costs associated with surgical intervention are much higher, and some meet it with caution. The recent development of a functional brace that allows movement, however, has given more credence to the possibility of a non-surgical intervention. To determine the effectiveness of this new brace, a study compared it to patients who underwent surgery, and found only minimal differences in re-rupture rates, boosting the stock of rehab over surgery.