Current Perspectives On The Role Of Manual Manipulation For Ankle Sprains

When treating ankle sprains, it is important to direct the treatment you want. Typically, physical therapy starts anywhere between two to four weeks, pending the grade level of the sprain. Overall, clinicians should avoid long-term immobilization as the literature supports greater recovery benefit with early weightbearing using less rigid bracing (i.e. ankle brace over fracture boot or casting).¹

In those higher-grade injuries in which either patient ability to or physician initiation of weightbearing is delayed, sending patients to physical therapy regardless of their functional ability is important. One important technique is manual manipulation. Physical therapists can employ techniques of soft tissue massage and joint mobilization and manipulation to decrease swelling and stiffness with increasing range of motion.¹

Researchers have demonstrated that manual therapy improves lateral ankle sprain results with restoring motion, decreasing pain and decreasing swelling, leading to faster returns to pre-sprain activity level.^1,2 Lymphatic drainage techniques can increase proprioceptive awareness and decrease ankle stiffness. Active mobilization can increase ankle range of motion through the use of passive talocrural joint glide or elastic band distraction techniques. What is great about these techniques is that clinicians can utilize them for a non-weightbearing patient. Early implementation of these techniques may have benefit for a quicker transition to higher level physical therapy and long-term positive benefits.

When filling out your prescription, make specific recommendations to the physical therapist based on your patient and his or her grade of sprain. Maybe even give the physical therapist a call or meet with him or her to discuss certain therapies you would like for your patients if it is someone you refer to often. I have worked in tandem with physical therapists on ankle sprains and other pathologies. They are more than happy to discuss their experience and what works along with your thoughts.

Questions for discussion: Is there anything specific you write for an ankle sprain physical therapy script? Have you visited the offices of physical therapists whom you refer patients to? Please share your experience with this by posting a comment on this blog.

Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm or check out his website www.footankleresource.com, which contains information on student/resident/new practitioner transitioning as well as links to academic and education resources found throughout the Internet.

References

1. McGovern RP, Martin RL. Managing ankle ligament sprains and tears: current opinion. Open Access J Sport Med. 2016;7:33-42.

2. Plaza-Manzano G, Vergara-Vila M, Val-Otero S, et al. Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: a randomized, controlled trial. Man Ther. 2016;26:141-149.