Physiotherapy vs ankle sprains


Physiotherapy is increasingly moving towards an evidence-based model of practice, where research evidence is combined with clinical experience and patient expectations and goals to create a treatment plan. One limitation of that approach is that the research is often low quality and incomplete. Large clinical trials are expensive and therefore few and far apart. But when a large-scale, well performed clinical trial is published it should absolutely be given full consideration and should affect decision-making.

One such large, high-quality clinical trial was recently published in the BMJ (1) and tested the efficacy of 7 sessions supervised evidence-based intervention with full clinical evaluation by the physiotherapist against a 1-page self-care guide.

Without going into too much detail, the physiotherapy intervention did not perform better than providing a 1-page self-care guide. This is not that unsurprising, an ankle sprain is an acute injury and as such a large part of the process is simply allowing time to pass for the tissues to heal. Daily activities may provide adequate rehabilitation for most people if braces or crutches aren’t used.

Studies like this provide good evidence of what the average outcome is, and if a decision will „pay off“ or not. On average, therefore, patients who come in with simple ankle sprains should be given an educational self-care guide. There can still be cases that can benefit from more personal guidance. It’s reasonable that people with learning disabilities will not benefit as much from the self-care guide and should, therefore, be followed up more closely. High-level athletes with a small room for error, where a difference in 2-3 days of returning to sports may be important can choose to have more supervision with their program as well to ensure optimal recovery (2).

Personally, I’d have loved to see this study support that physios should book simple ankle sprains for 7 sessions, it’s good for job security and as these treatments will most often be successful, patient satisfaction will tend to be high. However, reality does not always match expectations. I hope physios will take this to the clinic and discharge the majority of simple ankle sprains with a self-care guide, but as always some physios will continue to do whatever they have been doing anyway.

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