The document provides a comprehensive overview of lateral ankle sprains, covering their mechanisms of injury, epidemiology, economic burden, chronic ankle instability, and evidence-based treatments. It highlights the high incidence of these injuries in various sports, particularly among younger athletes and the significant costs associated with them. Recommendations for prevention, treatment, and return to sport protocols, including the effectiveness of exercise therapy and external supports, are also discussed.

1. Lateral Ankle Sprains:
Review of Current Evidence
By Mick Hughes
(B. Physio, Grad. Cert. Sports Physio., B. Ex. Sci.)

2. Lateral Ankle Sprains: Overview
• Mechanism of Injury
• Epidemiology
• Chronic Ankle Instability
• Evidence-Based Treatment
• Return to Sport Considerations
• Taping Technique

3. Lateral Ankle Sprains

4. Lateral Sprains: Mechanism of Injury

5. Lateral Ankle Sprains: Economic Burden
• During the late 90’s and early 2000’s in the USA; estimated to be $US2
billion dollars per year (Dallinga et al., 2012).
• Amateur Dutch Volleyball population; Predicted cost per injury was 360
euro. Based on number of participants and predicted injuries, the authors
concluded that LAS can cost 200million euro per annum (Verhagen et al.,
2005).
• Here in Australia (specifically the state of Victoria), lower limb sporting
injuries rose 26% between 2004 and 2010, equating to an accumulated
economic burden $110million during this time (Finch et al., 2015).

6. Lateral Ankle Sprains: Epidemiology
• Ankle most commonly injured body part in 24 of 70 sports
reviewed (Fong et al., 2007).
• Indoor/Outdoor Court Sports most common sporting activity
(Doherty et al., 2014).
• Peak incidence:
• 15-19 yrs of age.
• Males 1.5x more likely to sustain LAS in 15-24yrs.
• Females 2x more likely to sustain >30yrs (Waterman et al.,
2010).

7. Lateral Ankle Sprains: Epidemiology
• Most common injury diagnosis in NCAA athletes between 2009-15
(4.95/10,000 athlete exposures) – Roos et al., 2017.
• Men’s and Women’s Basketball have the highest rates of LAS injuries with
11.96/10,000 AEs and 9.50/10,000 occurring respectively.
• 12% recurrence rate
• Recurrence rates:
• Highest recurrence rates of all lower limb musculoskeletal injuries
• 2x increased risk of reinjuring within 12 months following primary LAS
(Hootman et al., 2007, Swensom et al., 2009).
• 40% of first LAS develop chronic ankle instability within 1 year
(Doherty et al, 2016).

8. Lateral Ankle Sprains: Chronic Ankle Instability
• “Feeling of instability and giving away for a minimum of 1 year post
initial sprain” (Hertel et al 2002 & Delahunt et al 2010).
• Prevalence of 25%-50% in sporting populations (basketball, soccer,
volleyball, handball, ballet) - Attenborough et al., 2015 & Tanen et al.,
2014.
• ?high prevalence due to:
• Rapid return to sport without addressing underlying deficits
(strength/ROM/proprioception)
• Only 50% of people seek formal medical care
• Initial treatment too passive or too aggressive

9. Lateral Ankle Sprains: Chronic Ankle Instability
• Persistent instability leads to ongoing disability & seniromotor control
issues with subsequent decrease in physical activity & quality of life
and early OA changes.
• Early work on CAI by Gerber et al (1998)
• 78% of grade 1 sprains and 48% of grade 2-3 sprains returning to full military
duties by 6 weeks – 28% overall still reported pain.
• At 6 months follow up; 25% of all ankle sprains still reported pain
• Konradsen et al (2002) found at 7 year follow-up following primary
LAS:
• 30% still had pain, swelling or recurrent injury (>3 sprains per year)
• 70% felt functionally impaired

10. Lateral Ankle Sprains: Chronic Ankle Instability
• 3 predictors have been found (Doherty et al., 2016):
1) Inability to perform single leg land from 45cm height at 2
weeks post injury
2) <89% on FAAMadl ankle outcome at 6 months
3) <86% leg length distance on PL component of Y-Balance Test
at 6 months
FAAM Outcome Measure: Link -
http://www.aaos.org/uploadedFiles/PreProduction/Quality/Measures/
Foot%20and%20Ankle%20Ability%20Measure.pdf

11. Lateral Ankle Sprains: Treatment
Primary outcome goals: Improved function and recurrence rates (Gribble et
al., 2016)
Acute LAS:
- Exercise therapy: Unanimous for function
- External supports: Unanimous for function and recurrence rates
Chronic ankle instability:
- Exercise: Unanimous for function and recurrence rates
- External supports: Unanimous for recurrence rates
- Manual therapy: Unanimous for initial increases in DF ROM (function)

12. Lateral Ankle Sprains: Treatment
Exercise interventions significantly decreased the risk of sustaining
recurrent LAS by 41%
• Provided that the exercise therapy is given in a high dose (>900mins)
• 5x30mins per week = 150mins p/wk
• 150mins x 6 weeks = 900mins
External supports significantly decreased risk of recurrent ankle sprains
by 62%.
• Recommended: minimum for 6 months after acute LAS to prevent
recurrence. Benefit lasts up to 1 year following the most recent LAS.

13. Lateral Ankle Sprains: Treatment
• Bracing considerations:
• Ankle braces are successful in reducing ankle inversion moments, but
also restrict ankle DF  altered knee mechanics.
• A study by Klem et al (2016) on semi-elite female basketball players
showed that hinged braces were able to restrict peak ankle inversion
compared to controls; whereas a lace-up ASO brace lace-up could
not.
• BUT!!!! Both hinged and lace-up ASO both increased peak knee
internal rotation and knee abduction angles (knee valgus) compared
to controls

14. Why we should encourage early mobilisation
following ankle sprains:
A) healthy control B) early mobilisation C) immobilised (Photo credit: Twitter: @RodWhiteley)

15. Lateral Ankle Sprains: Return To Sport
Return to sport testing following LAS (Clanton et al., 2012)
• Knee to wall test
• SEBT or YBT
• Agility T-Test
• Vertical Jump
Others to consider:
• Hop test battery (within 10% of uninjured side on all 4 tests)
• Single leg heel raises (>25 reps on each leg)

16. Lateral Ankle Sprains: Return To Sport
• Knee to wall test
• <9cm considered restricted
• Aim to have no >2cm difference between limbs
• SEBT/YBT
• Vertical Jump
• Compare to previous known measures or age matched “norms”

17. Lateral Ankle Sprains: Return to Sport

18. Lateral Ankle Sprains: Return To Sport

19. Lateral Ankle Sprains: Prevention > Cure
• SEBT or YBT

20. Lateral Ankle Sprains: Prevention > Cure
• 94 amateur female Netball players were screened in the pre-season.
• 4x greater risk of sustaining a future LAS if <77% leg length or less in PM
direction on SEBT (Attenborough et al., 2017)
• 606 American Football athletes (high school and college) were
screened in the pre-season.
• 3x more likely to sustain LAS if SEBT-ANT 67% or less leg length (Gribble et al.,
2016)
• 125 healthy recreational college athletes performed a series of
screening tests
• 48% increased risk of sustaining a LAS <80% leg length in the PL direction (de
Noronha et al., 2013)

21. Lateral Ankle Sprains: Taping
• Skin preparation / Underwrap / Fixomul
• Anchor on
• Stirrups
• Figure 6’s
• Heel locks
• Anchor off

22. Thank You!!