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Conservative Treatment for Acute Ankle Sprain: A Systematic Review

Ana Belen Ortega-Avila
Pablo Cervera-Garvi
Ana Marchena-Rodriguez
Esther Chicharro-Luna
Christopher J. Nester
Chelsea Starbuck
4 and
Gabriel Gijon-Nogueron
Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
Department of Behavioral and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain
Faculty of Health and Society, University of Salford, Manchester M6 6PU, UK
Author to whom correspondence should be addressed.
These authors contributed equally to the study/paper.
J. Clin. Med. 2020, 9(10), 3128;
Submission received: 31 July 2020 / Revised: 14 September 2020 / Accepted: 25 September 2020 / Published: 27 September 2020
(This article belongs to the Section Orthopedics)


The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data. The quality of each paper was assessed using the Cochrane risk of bias tool included in RevMan 5. In all, 20 studies met the inclusion criteria. In terms of absence of bias, only nine papers were classed as “high quality”. Studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. Despite the generally low quality of the studies considered, it can be concluded that conservative treatment for acute ankle sprain normally achieves pain relief and rapidly improved functionality. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.

1. Introduction

Ankle sprain is the most prevalent musculoskeletal injury affecting the lower limb in physically active individuals [1]. It consists of the stretching or partial or complete tearing of one or more ligaments in the ankle joint caused by an involuntary twisting movement that exceeds the normal limits of the joint [2].
The most common mechanism of injury in ankle sprain is the combination of inversion and adduction of the foot in conjunction with plantarflexion (supination), which most usually provokes a deterioration of the external lateral ligament and also often impacts on the anterior peroneal tendons [3]. In exceptional circumstances, the anterior ligament may be torn, with associated capsular damage, and rupture of the peroneal tendons. The deltoid ligament may be damaged by traumatic eversion; although this type of sprain occurs only rarely, the possibility of associated injuries such as distal or proximal fracture of the fibula and even of the talus should be considered [4]. Furthermore, hyperdorsiflexion could damage the syndesmotic ligaments [5]. In addition to ligaments, other anatomic structures such as bone, muscles, tendons, nerves and vascular vessels may be affected [2].
The clinical manifestations of ankle sprain include the inability to walk or even move the joint, a searing or tearing sensation, pain that increases with mobility, colour change and rapid bruising. The intensity of these manifestations depends on the severity of the sprain [6]. Treatments to heal the structures and recover functionality after a sprain may be conservative or surgical. Conservative treatment is usually applied for Grade I and II sprains, and Grade III lesions are treated surgically, although for the latter a conservative approach is sometimes considered sufficient [7].
A wide range of conservative treatments are available, including short-term immobilisation [8], complete immobilisation, ice packs [9], local or systemic non-steroidal anti-inflammatory drugs (NSAIDs) [10], physical therapy [11] and electrical stimulation (with or without muscle contraction) [12]. All have been investigated for efficacy in the resolution or improvement of clinical manifestations of ankle sprain, in areas such as the persistence swelling [13] or the patient’s ability to return to work [14] or to playing sport [15]. However, these reviews have considered situations not only of acute sprain [16,17], but also of chronic ankle instability [18] or a combination of conservative and surgical treatments [19,20]. To our knowledge, none have focused specifically on acute ankle sprain.
In view of these considerations, our study aims to identify conservative treatments for acute ankle sprain and to evaluate their effectiveness in terms of pain relief and rapid recovery of functional capacity.

2. Methods

The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD 42020162500).

2.1. Design

This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [21].

2.2. Search Strategy

One member of the research team (ABOA) carried out the search to ensure that no previous studies had been conducted with the same study aim as our own. The following databases were searched: PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscuss, from inception until December 2019 using optimised search strategies (Appendix A). References were exported and duplicate articles removed using reference management software (Mendeley Desktop v 1.19.4).

2.3. Eligibility Criteria

The following eligibility criteria were applied:
In every case, the study population was diagnosed with acute ankle sprain and given conservative treatment as the first option.
All studies included in the review were randomised controlled clinical trials (RCTs) in which one or more types of conservative treatment were applied in response to an acute ankle sprain, with a maximum of 7 days after initial injury.
All the studies included evaluated pain, functionality and/or disability caused by an ankle sprain, using one or more measurement instruments.
The language of publication was Spanish or English.
Studies of the following types were excluded:
The study population was diagnosed with chronic or recurrent ankle sprain.
Those in which both conservative and surgical treatments were applied.
Those not consisting of an RCT (such as pilot studies, research protocols or quasi-experimental studies).
Those in which the assessment of risk of bias, using the Cochrane risk of bias tool included in RevMan 5 was high risk (it was not consider random sequence generation, allocation concealment and blinding of participants and personnel).

2.4. Study Selection

In the first stage of the review, a double-blinded assessment of titles and abstracts was carried out by two reviewers (P.C-G and A.M-R), working independently, to determine whether each item met the requirements for inclusion. In case of doubt, the full text of the article was evaluated. Disagreements between the two reviewers were resolved by discussion, or if consensus was not possible, a further opinion was sought. It was also planned, if necessary, to send an email to the original authors to obtain further information regarding the study details, but in no case was this measure necessary.

2.5. Data Extraction

The following data were extracted from each study, using a standardised template: study details (author; year and country of publication), study participant characteristics (number of patients included in the sample, mean age, sex), characteristics of the sprain, study design, type of conservative treatment administered (intervention group and patients included), follow-up period and measurement instrument used.
No meta-analysis was carried out, due to the heterogeneity of the populations, follow-up characteristics and outcomes included in these studies.

2.6. Quality Assessment

Two reviewers (P.C-G and A.M-R), working independently, assessed the risk of bias in the studies considered, using the Cochrane risk of bias tool included in RevMan 5 for this purpose [22]. The following biases were assessed: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, attrition bias, selective reporting and other bias. Each criterion outcome was classed as high risk, low risk or unclear.

3. Results

An initial 10,556 studies were identified, but 9860 were duplicated among the different databases. The remaining 696 were screened against our inclusion/exclusion criteria, using the titles, abstracts and keywords, resulting in 31 studies that met the inclusion criteria. After quality appraisal (Risk of assessment bias), a further 11 were excluded, and so 20 studies remained in the final qualitative analysis. Figure 1 shows the PRISMA flow diagram for the studies included in the review [23].

3.1. Study Characteristics

The studies included a total of 2236 patients with a mean age of 28.86 years. Of these patients, 40.3% were female and 59.7% were male.
The conservative treatment applied was mainly for acute ankle sprains, Grades I, II or III. In many cases, the location of the sprain (right or left ankle) was not specified. The time elapsed from the start of the injury to the start of conservative treatment was recorded. This time was usually less than 48 h except in two studies which described a period of less than 5 days. The minimum follow-up period recorded was four weeks, with an average of 8.5 weeks (162 days).
The most common treatment described was based on manual or physiotherapeutic methods (eight studies), followed by the use of different types of bandage (three studies) (Table 1). The studies using one or more of the following measurement instruments: Visual Analogue Scale, McGill Pain Questionnaire, Numerical Pain Rating Scale, Total Function Score, Lower Extremity Functional Scale, EuroQol-5D (EQ-5D), American Orthopedics Foot and Ankle Score, Lower Limb Task Questionnaire, Motor Activity Scale, Karlsson Score, Adapted Hughston Clinic Subjective Rating Scale for Ankle disorders, Short Form-12 (SF-12) Foot and Ankle Outcome Score, Foot and Ankle Ability Measure. The most used instrument for evaluating the pain of the ankle sprain is the VAS, used in 13 of the found studies. On another hand, the instruments used more for the evaluation of the function are the SF-12, as a general instrument, and the LEFS as a specific instrument, and both are used in 3 different studies.
The measurement instruments used to assess improvement in terms of pain relief and the recovery of functional capacity in patients with an acute ankle sprain after the application of conservative treatment showed that in most cases significant improvement was achieved (p < 0.001) (Table 2). In all the studies is seen an improvement of the pain and the function in the patients. It is seen that this improvement, most of all of the function, is higher in the studies that made the treatments in a bigger period of time.

3.2. Risk of Bias

The risk of bias was evaluated in 20 studies (Figure 2 and Figure 3). Only nine studies presented a low risk of bias. Most studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. The blindness in the evaluation of the results was the bias less specified in the studies, not making it clear if the blindness of the evaluator was made or not.

4. Discussion

This review has two main aims: to identify conservative treatments for acute ankle sprain level, Grades I, II and III, and to evaluate the effectiveness of these treatments in terms of pain relief and rapid recovery of functional capacity.
Concerning the first of these aims, our analysis was focused on RCTs investigating different types of short-term conservative treatment for patients with an acute ankle sprain. These treatment options included programmes of physical therapy (at home [11] or supervised by a physical therapist [28]), the prescription of NSAIDs such as diclofenac or traumeel [10], the use of a functional brace (for example, a tubular bandage or aircast brace) [2] or neuromuscular electrical stimulation [32]. On many occasions, these treatments are provided in conjunction with cryotherapy (ice packs) [27] and usual care (consisting of ankle protection, rest, the application of a compression bandage, elevation, analgesics as necessary and a gradual return to weight bearing activities) [9]. In all cases, notable pain relief is obtained and functional capacity regained, during the follow-up period considered, i.e., ranging from seven days to nine months (p < 0.001).
Among the studies that focused on identifying treatment effectiveness in terms of pain relief, special attention is paid to the use of cryotherapy, which reduces the sensation of pain when the ice pack is applied intermittently [27], although when it is combined with an exercise intervention programme initiated at an early stage, i.e., after the first week following the occurrence of the sprain, significantly improved results are obtained (p < 0.05) after a 16-week follow-up period [28]. In studies that have analysed the recovery of function following the application of conservative treatment, usual care [9], therapeutic physical intervention at home or supervised by a physical therapist [11,28] or the application of bandages are the methods most commonly employed [2]. The results published show there are no significant differences between the different intervention groups in terms of the improvement obtained, after a maximum follow-up period of nine months.
Regarding the presence of bias in the studies considered, our results show that these RCTs are generally of low quality, with only nine studies characterised as high quality (i.e., presenting a low risk of bias) [9,10,27,28,30,32,33,35,36]. The common weaknesses of the RCTs are “Blinding of participants and personnel” and “Uncertainty in blinding of outcome assessment and other bias”. We emphasise the importance of these deficiencies, as the research findings are inherently less reliable if the participants or the researchers are aware of the intervention that has been assigned. In consequence, the results obtained in terms of pain relief and recovery of functionality must be considered invalid and therefore not transferrable, having been altered by the presence of subjectivity and by the patient’s degree of adherence to treatment. Other types of bias may also be present if the procedure applied is not clearly described.
Recent findings indicate that different types of conservative treatment for patients with acute ankle sprain Grades I, II or III produce significant beneficial effects regarding pain relief and the recovery of functionality. However, very few studies of high methodological quality have focused on this study objective. In addition, a wide variety of treatments, measurement tools and follow-up periods have been reported. Our review findings are in line with those of Kosik et al., 2017 [40], Van Ochten et al., 2014 [41] and Kamper et al., 2012 [7]. These reviews, however, examine not only conservative treatment but also surgical methods and their application to patients with chronic ankle instability. Similarly, while Al bimani et al., 2019 [15] assessed the effectiveness of conservative treatments in enabling the patient to return to playing sports, the review takes into account all types of research design. Another of the reviews considered, by Feger et al., 2015 [42], assessed only electrical stimulation or functional treatment [13]. Moreover, the follow-up period considered is only ten weeks. Overall, nevertheless, these reviews highlight the general improvement achieved by patients from the treatments described, although they emphasise the need for further research with appropriate study methods, a common measurement instrument and sufficiently long-term follow-up.
The present systematic review presents numerous strengths. To our knowledge, it is the first to examine only conservative treatments for patients with acute ankle sprains, Grades I, II or III, and in which all studies included are RCTs (performed up to December 2019). Moreover, we applied specific instruments to analyse the risk of bias, and employed a rigorous methodological process, based on a literature search of six medical databases with no time limitation. On the other hand, certain limitations must be acknowledged. The first is the small number of studies extracted that focus on our study objective. In addition, the non-specificity of the location of the sprain (left or right ankle) is unfortunate, as this information could usefully be taken into account to determine whether there is a direct relationship with the laterality of the patient. Another factor is the heterogeneity of the data presented (several measurement instruments were used), which made it impossible to carry out a meta-analysis and, therefore, prevented us from conducting a joint assessment. Only two languages of publication (Spanish or English) were inclusion criteria, which increases the loss of some randomised control trial studies. Finally, there was a relatively high risk of common bias across the studies reviewed.
The most relevant clinical implications are conservative treatments for acute ankle sprain relieve pain and functional capacity, but the results showed there are no significant differences between the different conservative interventions in terms of the improvement obtained, after a maximum follow-up period of nine months. Clinicians should establish a protocol in terms of prevention and thus avoid recurrences or chronic ankle instability.

5. Conclusions

Despite the generally low quality of the studies considered, it can be concluded that conservative treatments for acute ankle sprain relieve pain and achieve a rapid return to functionality. However, there is no evidence that any one form of conservative treatment is more effective than any other in terms of these parameters, for patients with acute ankle sprain Grades I, II or III, since a wide range of treatments have been studied for this pathology, using diverse measurement instruments. Future research in this field should ensure homogeneity in the size and composition of the study groups, in the follow-up period and in the description of the main outcomes considered, thus limiting the risk of bias. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.

Author Contributions

Conceptualization, A.B.O.-A.; methodology, G.G.-N. and A.B.O.-A.; formal analysis, P.C.-G., A.M.-R. and E.C.-L.; writing—original draft preparation, C.S., C.J.N.; writing—review and editing, A.B.O.-A., P.C.-G., A.M.-R.; visualization, G.G.-N.; supervision, A.B.O.-A. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Appendix A

Searching Strategy.
Table A1. PubMed. Total articles: 656.
Table A1. PubMed. Total articles: 656.
9Lateral Ligament ankle
10Medial Ligament ankle
111 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10
14Ankle injury
15Ankle sprain
16Inversion sprain
17Eversion sprain
1812 OR 13 OR 14 OR 15 OR 16 OR 17
1911 AND 18
20Conservative treatment
21Conservative management
22Non-surgical treatment
24Rehabilitation program
26Conservative program
27Manual Therapy
28Physiotherapeutic intervention
31Exercise programme
32Home exercise
3720 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 29 OR 30 OR 31 OR 32 OR 33 OR 34 OR 35 OR 36
3819 AND 37
Table A2. CINAHL. Total articles: 2176.
Table A2. CINAHL. Total articles: 2176.
1Ankle Sprains
2Inversion Sprain
3Eversion Sprain
4Ankle Injury
51 OR 2 OR 3 OR 4
6Conservative treatment
7Conservative management
8Rehabilitation programs
116 OR 7 OR 8 OR 9 OR 10
125 AND 11
Table A3. SCOPUS. Total articles: 597.
Table A3. SCOPUS. Total articles: 597.
1TITLE-ABS-KEY (Ankle Sprain)
2TITLE-ABS-KEY (Inversion Sprain)
3TITLE-ABS-KEY (Eversion Sprain)
4TITLE-ABS-KEY (Ankle Injury)
51 OR 2 OR 3 OR 4
6TITLE-ABS-KEY (Conservative treatment)
7TITLE-ABS-KEY (Conservative management)
9TITLE-ABS-KEY (Bandage)
10TITLE-ABS-KEY (Rehabilitation program)
11TITLE-ABS-KEY (Physiotherapeutic)
126 OR 7 OR 8 OR 9 OR 10 OR 11
135 AND 12
Table A4. SPORTSDiscus via EBSCOHost. Total articles: 5618.
Table A4. SPORTSDiscus via EBSCOHost. Total articles: 5618.
1Ankle Sprains
2Inversion Sprain
3Eversion Sprain
4Ankle injury
51 OR 2 OR 3 OR 4
6Conservative treatment
7Conservative management
8Rehabilitation program
106 OR 7 OR 8 OR 9 OR 10
115 AND 10
Table A5. PsycINFO. Total articles: 1371.
Table A5. PsycINFO. Total articles: 1371.
1Ankle Sprains
2Inversion Ankle sprain
3Eversion Ankle sprain
41 OR 2 OR 3
5Conservative treatment
6Conservative management
7Rehabilitation program
95 OR 6 OR 7 OR 8
104 AND 9
Table A6. PROSPERO. Total articles: 38.
Table A6. PROSPERO. Total articles: 38.
1Ankle Sprains


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Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram.
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram.
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Figure 2. Risk of bias graph.
Figure 2. Risk of bias graph.
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Figure 3. Risk of bias summary.
Figure 3. Risk of bias summary.
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Table 1. Characteristics of the studies included in the review.
Table 1. Characteristics of the studies included in the review.
Author Year CountryPatients (n)Age (years)SexType of RCT DesignType of SprainType of Treatment Follow UpOutcome
Pellow JE et al., 2001 [24].
South Africa
Total mean age: 24.9
Group 1: 23.7
Group 2: 26.1
Group 1: 9
Group 2: 2
Group 1: 6
Group 2: 13
Single-blind, comparative, controlled studySubacute ankle inversion sprains (<48 h after initial injury)Mortise separation adjustment, group 1 (n = 15)
Detuned ultrasound machine, group 2 (n = 15)
28 daysMcGill Pain Questionnaire
Numerical Pain Rating Scale 101
Kucera et al., 2004 [25]. Prague20318–50
Group 1: 27.7
Group 2: 28.3
Group 1: 38
Group 2: 40
Group 1: 66
Group 2: 59
Randomised, double-blind clinical multicentre parallel studyAcute lateral ankle distortions (24h after the injury)Verum, Group 1: Cream 10%
Reference, Group 2: Cream 1%
14 daysVAS-10
Truyols-Dominguez S. et al., 2013 [26]. Spain5028–38
Total mean age: 33
Group 1: 6
Group 2: 7
Group 1: 19
Group 2: 18
Randomised clinical trialAcute inversion ankle sprain
Grade I and II
(Injured <5 days)
Thrust and nonthrust manipulation and exercise interven tion, group 1 (n = 25)
The same protocol plus myofascial manual therapy techniques, group 2 (n = 25)
28 daysNumeric pain rating scale
Total Functional Score for Assessment of Acute Lateral Ankle Sprains
Bleakley et al., 2006 [27]. UK89Total mean age: 29.9
Group 1: 29.8
Group 2: 31.2
Group 1: 15
Group 2: 16
Group1: 28
Group2: 30
Randomised controlled trial, double-blind Mild/moderate ankle sprain
<48h after injury)
Grades I and II
Intermittent ice, group 1 (n = 43)
Standard ice application, group 2 (n = 46)
42 daysBinskley’s lower extremity functional scale
Cooke et al., 2009 [2]. UK58416–72
Total mean age: 30
Group 1: 31
Group 2: 30
Group 3: 29
Group 4: 30
Group 1: 64
Group 2: 54
Group 3: 65
Group 4: 64
Group 1: 80
Group 2: 88
Group 3: 84
Group 4: 85
Multicentred RCT with blinded assessment of outcomeAcute severe ankle
Group 1: Tubular bandage (n = 144)
Group 2: Below-knee cast (n = 142)
Group 3: Aircast brace (n = 149)
Group 4: Bledsoe boot (n = 149)
270 daysFAOS
Functional Limitations Profile
Bassett et al., 2007 [11]. New Zealand4713–6219
Group 1: 11
Group 2: 8
Group 1: 14
Group 2: 14
Controlled trialAcute ankle sprain (first-time) Grades I, II and IIIClinical intervention, group 1 (n = 25)
Home intervention, group 2 (n = 22)
14 daysLower Limb Task Questionnaire
Motor Activity Scale
Bleakley et al., 2010 [28]. UK10116–65 32
Group1: 17
Group2: 15
Group1: 34
Group 2: 35
Randomised controlled trial, blinded outcome
Acute ankle sprain
Grade I or II
Standard, group 1 (n = 51)
Exercise, group 2 (n = 50)
112 daysVAS
Brison et al., 2016 [9]. Canada504-280
Group1: 146
Group 2: 134
Group 1: 108
Group 2: 116
Randomised controlled
Simple Grade I or II ankle sprain.Physiotherapy, group 1 (n = 254)
Usual care, group 2 (n = 250)
180 daysFoot and Ankle Outcome Score
Cleland et al., 2013 [29]. USA7416–6036
Group 1: 19
Group 2: 17
Group 1: 18
Group 2: 20
Randomised clinical trial, non-blindedInversion ankle sprain, acute and subacuteManual therapy and exercise, group 1 (n = 37)
Home exercise programme, group 2 (n = 37)
180 daysFAAM
Numeric pain rating scale
Coudreuse et al., 2010 [30]. France23318–6586148Randomised, double-blind, placebo-controlled studyLateral ankle sprain
(<48 hours after the injury)
Novel plaster with diclofenac, epolamine and heparin, group 1
Placebo plaster, group 2
7 daysVAS
Fotiadis et al., 2011 [31]. Greece79Mean age
Group 1: 38.21
Group 2: 35.35
Group 1: 20
Group 2: 15
Group 1: 22
Group 2: 24
Prospective randomised studyType II and III acute (less than 24 h) lateral ankle sprainGroup 1: Micronized purified flavonoid fraction (Daflon 1000 mg) (n = 42)
Group 2: (Control group) Standard treatment (n = 39)
20 daysVAS
Gonzalez de Vega et al., 2013 [10]. Spain42018–40112
Group 1: 39
Group 2: 39
Group3: 34
Group 1: 104
Group 2: 101
Group 3: 103
Multicentre, randomised, blinded and active-controlled studyAcute unilateral ankle sprain
within the past 24 h. Grades I, II and III
Traumeel ointment (T-O), group 1 (n = 143)
Traumeel gel (T-G), group 2 (n = 140)
Diclofenac gel, group 3 (n = 137)
42 daysVAS
Man et al., 2007 [32]. UK34Total mean age 30.2
Group 1 34
Group 2 29
Group 3 28
1123Randomised trialAcute ankle sprain injury (within
5 days)
Neuromuscular electrical stimulation treatment, group 1 (n = 11)
Submotor ES treatment (control group), group 2 (n = 11)
Sham ES, group 3 (n = 12)
14 daysAdapted Hughston Clinic Subjective Rating
Scale for Ankle Disorders score
Kim et al., 2017 [33]. South Korea22Total mean age: 17.72022Cross-over randomised designGrades I and II lateral ankle sprainAnkle balance taping group 1
Placebo taping group 2
No taping group 3
28 days VAS
Naeem et al., 2014. [34]. Pakistan120Group 1: 28.77
Group 2: 29.83
Group 1: 35
Group 2: 42
Group 1: 25
Group 2: 18
Level I Randomised controlled trialGrade I or II lateral ankle sprainFunctional treatment tubigrip, group 1 (n = 60)
Plaster of Paris, group 2 (n = 60)
42 daysVAS
Karlsson score
Sandoval et al., 2010 [35]. Colombia28Total mean age: 21
Group 1: 21.3
Group 2: 22.5
Group 3: 20.3
1018Double-blind, controlled clinical trialGrade I and II sprain
mild or moderate,
Conventional treatment, group 1 (n = 10)
HVPC (+) group 2.
Conventional treatment and HVPC
(positive polarity) (n = 8)
HVPC (−) group 3.
Conventional treatment and HVPC
(negative polarity) (n = 10)
56 daysVAS
Stasinopoulos et al., 2016 [36]. Greece.5018–35
Group 1: 27.92
Group 2: 27.96
Group 1: 8
Group 2: 7
Group 1: 19
Group 2: 16
Single-centre, parallel group, single-blind,
controlled study
Acute ankle sprain Grade IIGroup 1: Cryotherapy plus Bioptron light therapy (n = 27)
Group 2: Control group, cryotherapy only
(n = 23)
5 daysVAS
Sultan et al., 2012 [37]. England36Group 1: 30
Group 2: 34
--Single-centre, randomised, single-blinded, clinical trialAnkle sprains sustained within 72 h. Grade I, II, III.Tubigrip, group 1 (n = 18)
Elastic stocking, group 2 (n = 18)
56 daysVAS
Tully et al., 2012 [38]. Northern Ireland.5216–65
Group 1: 24.1
Group 2: 26.1
Group 3: 21.9
Group 1 6
Group2: 8
Group 3: 9
Group 1: 10
Group 2: 10
Group 3: 9
controlled trial
Acute ankle sprain (<7 days)
Grade I or II
Standard, group 1 (n = 16)
Exercise, group 2 (n = 18)
Non-injured control. Group 3 (n = 18)
7 daysLower Extremity Functional Scale
Zhao et al., 2018 [39]. China.62Group 1: 34
Group 2: 30
Group3: 33
--Randomised controlled trialAcute ankle sprains identified at 48 hours since the injury.
Grades I and II
Standard treatment (RICE), group 1 (n = 19)
Standard treatment (RICE) plus
acupressure therapy, group 2 (n = 21)
Standard treatment plus mock acupressure therapy, group 3 (n = 22)
56 daysVAS
American Orthopedic Foot and Ankle Score
RCT: Randomised control trial; VAS: Visual Analogue Scale; FAOS: Foot and Ankle Outcome Score; SF-12: Short Form-12; EQ-5D: EuroQol-5D; LEFS: Lower Extremity Functional Scale; FAAM: Foot and Ankle Ability Measure.
Table 2. Reported outcomes for pain relief and recovery of functional capacity.
Table 2. Reported outcomes for pain relief and recovery of functional capacity.
Pellow JE et al. [24] Experimental group: Mortise separation adjustmentControl group: Detuned ultrasound machine
PrePost 1 monthp-valuePrePost 1 monthp-value
McGill Pain Questionnaire0.200.030.420.240.120.01
NPRS (0–10)28.738.330.7230.7316.870.040
Kucera et al. [25] Cream 10%Cream 1%
Visit 3/4Visit 14Visit 3/4Visit 14
VAS-10 pain at rest (mm)28.7 ± 17.143.9 ± 22.3 4614.7 ± 13.541.6 ± 21.1
VAS-10 functional (mm)28.7 ± 18.050.8 ± 18.918.1 ± 13.648.1 ± 19.8
Truyols-Dominguez S. et al. [26] Experimental GroupComparison Group
Pre-treatmentPost-treatmentPre-treatmentPost-treatmentPre p-value
NPRS (0–10)5.4 ± 2.02.1 ± 1.45.1 ± 1.03.2 ± 1.50.641
Total Functional Score38.9 ± 8.878.6 ± 13.940.9 ± 18.064.0 ± 17.80.621
Bleakley et al. [27] Intermittent ice groupStandard ice application groupp-value
LEFS24.6 ± 1.9622.3 ± 2.230.38
Pain intensity at rest (0–10)1.0 ± 0.161.7 ± 0.220.08
Pain intensity activity (0–10)3.9 (0.28)4.7 (0.27)0.3
Cooke et al. [2] Tubular bandage (mean)Bledsoe (difference)Aircast differenceBelow-knee cast difference
4 weeks9 months4 weeks9 months4 weeks9 months4 weeks9 months
FAOS pain62.381.
FAOS symptoms59.879.2−0.8−0.04−1.1−
FAOS ADL82.393.1−0.1−
FAOS sports44.776.8−0.3−
FLP ambulatory16.−1.5−0.18−0.10.00−2.2−0.26−3.1−0.24−1.7−0.21
SF-12 physical39.249.7−1.3−−1.4−0.17−0.1−
SF-12 mental43.447.−0.6−
VAS pain at rest19.210.1−0.7−−0.7−0.04−2.9−0.19−4.8−0.27−0.8−0.05
Bassett et al. [11] Clinical intervention groupHome intervention group
LLTQ recreational subscale27.92 ± 11.3612.00 ± 10.1020.27 ± 12.588.18 ± 7.24
LLTQ ADL subscale13.72 ± 11.292.32 ± 3.607.18 ± 7.061.82 ± 3.58
Motor Activity Scale1.20 ± 2.005.14 ± 1.281.77 ± 1.605.73 ± 1.08
Bleakley et al. [28] StandardExercise
Pain intensity at rest1.7 ± 0.221.0 ± 0.160.008
Pain intensity on activity4.7 ± 0.273.9 ± 0.280.3
Subjective function (LEFS)22.3 ± 2.2324.6 ± 1.960.38
Brison et al. [9] Physiotherapy groupUsual care group
1 month6 months1 month6 monthsp-value 1 monthp-value 6 months
Cleland et al. [29] Home Exercise ProgrammeManual Therapy and Exercise (MTEX)Between-Group Differences
4 weeks6 months4 weeks6 months4 weeks6 months
FAAM ADL (0–100%)9.624.621.330.811.76.2
FAAM sports (0–100%)13.833.527.140.713.37.2
LEFS (0–80)5.617.318.425.312.88.1
NPRS (0–10)−1.5−3.1−2.7−3.6−1.2−0.47
Coudreuse et al. [30] DHEP groupPlacebo groupp-value
Baseline7 daysBaseline7 daysBaseline7 days
VAS pain (0–100)73.2 ± 1.0 69.3 ± 1.1 p = 0.007p < 0.01
Fotiadis et al. [31] Daflon groupControl groupp-value
2 days20 days2 days20 days2 days20 days
VAS pain (1–10)2.26 ± 1.860.64 ± 1.392.0 ± 1.640.32 ± 0.570.6250.908
Gonzalez de Vega et al. [10] Traumeel ointmentTraumeel gelDiclofenac gel
VAS ankle pain52.
FAAM ADL51.241.756.040.551.241.7
FAAM Sports18.850.
Man et al. [32] NMES GroupSubmotor ES GroupSham ES Group
Session 1Session 3Session 1Session 3Session 1Session 3
Adapted HCSRSAD65 (13)42 (20)70 (10)45 (17)63 (12)46 (16)
Kim et al. [33] Aquatic exerciseLand-based ExerciseInteraction Effect
Baseline4 weeksBaseline4 weeks
VAS for pain5.70 (0.36)0.17 (0.16)5.66 (0.36)0.73 (0.16)F = 3.75P = 0.033
Naeem et al. [34] Functional Treatment Tubigrip groupPlaster of Paris (POP) groupp-value
At presentationAt 6 weeksat presentationat 6 weeksAt presentationAt 6 weeks
VAS8.40 ± 0.923.88 ± 0.858.27 ± 0.944.97 ± 0.820.434<0.001
Karlsson score21.17 ± 6.3176.25 ± 10.6723.67 ± 5.2470.10 ± 6.350.571<0.001
Sandoval et al. [35] Conventional treatment GCConventional treatment EEAV (+)Conventional treatment EEAV (−)p value
VAS at rest1.0 ± 1.60.03 ± 0.091.6 ± 2.800.8 ± 1.800.750.29
VAS palpation5.8 ± 2.90.7 ± 0.845.6 ± 3.30.4 ± 0.66.9 ± 1.40.91 ± 0.910.530.41
Stasinopoulos et al. [36] Cryotherapy and Bioptron Light groupCryotherapy only groupp-values
Pre-treatmentPost-treatmentBefore treatmentPost-treatmentPost-treatment
VAS pain (0–10)6.66 (6.89–6.46)4.46 (4.62–4.30)6.62 (6.79–6.41) 62.885.34 (5.48–5.28)p < 0.0005
Stocking groupTubigrip
Sultan et al. [37] Initial8 weeksInitial8 weeks
Total SF-12 score100 (95–105)119 (118–121)100 (94–107)102 (99–107)
VAS score65 (56–73)5 (0–11)66 (59–73)18 (10–26)
Standard groupExercise groupp Value
Tully et al. [38] At baselineAt 1 weekAt baseline1 weekBaseline1 week
LEFS35.31 ± 16.5654.00 ± 12.6138.22 ± 19.8161.63 ± 13.050.650.10
VAS Pain at rest26.5 (23.3)7.1 ± 7.519.6 (17.5)3.3 ± 4.40.330.98
VAS Pain with activity53.06 ± 27.734.3 ± 22.953.3 ± 22.725.7 ±
Zhao et al. [39] STG group APG groupMock APG group
Baseline8 weeksBaseline8 weeksBaseline8 weeks
VAS pain5.
Total SF-12 score107.63116.21106.14119.67104.95112.05
VAS: Visual Analogue Scale; EQ-5D: EuroQol-5D, LLTQ: Lower Limb Task Questionnaire; NPRS: Numerical Pain Rating Scale; SF-12: Short Form-12; FAOS: Foot and Ankle Outcome Score; FAAM: Foot and Ankle Ability Measure; LEFS: Lower Extremity Functional Scale.

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Ortega-Avila, A.B.; Cervera-Garvi, P.; Marchena-Rodriguez, A.; Chicharro-Luna, E.; Nester, C.J.; Starbuck, C.; Gijon-Nogueron, G. Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J. Clin. Med. 2020, 9, 3128.

AMA Style

Ortega-Avila AB, Cervera-Garvi P, Marchena-Rodriguez A, Chicharro-Luna E, Nester CJ, Starbuck C, Gijon-Nogueron G. Conservative Treatment for Acute Ankle Sprain: A Systematic Review. Journal of Clinical Medicine. 2020; 9(10):3128.

Chicago/Turabian Style

Ortega-Avila, Ana Belen, Pablo Cervera-Garvi, Ana Marchena-Rodriguez, Esther Chicharro-Luna, Christopher J. Nester, Chelsea Starbuck, and Gabriel Gijon-Nogueron. 2020. "Conservative Treatment for Acute Ankle Sprain: A Systematic Review" Journal of Clinical Medicine 9, no. 10: 3128.

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