Effectiveness of Early Therapeutic Exercise Versus Rest, Ice, Compression, and Elevation in Treatment of Acute Lateral Ankle Sprains: A Critically Appraised Topic

Clinical scenario: Lateral ankle sprains are one of the most common musculoskeletal injuries and are associated with a high rate of visits to the emergency department. Ankle sprains have been reported to be 7-10% of all admissions to emergency departments, and are occurring at a rate of 2.15 ankle sprains per 1000 person/year in the United States.

Clinical Question: Does the inclusion of therapeutic exercises early in the rehabilitation process of a lateral ankle sprain return patients to normal activities of daily living earlier than the RICE therapy?

Summary of Key Findings: There were significant effects between the therapeutic exercise (strengthening and range of motion) group and the RICE group after week 1 and 2 for ankle function. However, there was not a significant clinical difference between the two groups after month 1, 3, and 6.1,3 In the systematic review it suggests that an initial immobilization period with rest, ice, compression, and elevation (RICE) during the first 4-5 days is beneficial for the inflammatory phase of healing.

Clinical Bottom Line: There is moderate evidence to support using a more active treatment consisting of therapeutic exercises to increase ankle range of motion (ROM) and ankle strength in patients that suffer from grade I and II ankle sprains during the first few weeks after injury.

Strength of Recommendation: There is a grade B evidence for using therapeutic exercises during the first two weeks after an ankle sprain improves ankle range of motion and ankle strength compared to the RICE protocol, but does not have a significant difference at month 1, 3, or 6. The recommendation of a grade B was given to the consistency of conclusions of the level 1 evidence included in this CAT.