Snijders EM, Thomas S, Verhagen AP. Assessment of the effectiveness of conservative treatment of acute ankle sprain. A review of the literature. Huisarts Wet 2008:51(1):17-23.
Introduction In this literature review our aim was to assess the effectiveness of conservative treatments of acute ankle sprain.
Methods We searched Medline and the Cochrane Library for systematic reviews and randomised studies of conservative treatment of acute ankle sprains. Included were articles scoring the following outcome measures: pain, return to work or sport or recurrence of injury.
Reasons for exclusion were recurrent injuries or fractures.
Results Except for medication, there is little or no evidence for the added value of any treatment versus placebo or no treatment. There is, however, strong evidence that as regards the group of functional treatments (a form of external support), a brace is more effective than a bandage. Furthermore, there is strong evidence that a functional treatment is more effective than immobilisation, and that physiotherapy is more effective than simply instructions or an elastic bandage. There is limited evidence that combining the use of an elastic bandage and a brace is more effective than merely using a brace. The thesis that additional physiotherapy is more effective than only functional treatment is also supported by limited evidence. Compared to placebo, there is limited evidence for the use of piroxicam and Wobenzym.
Conclusion For the treatment of pain, medication is the preferred intervention. It is not known whether any intervention is better than no treatment for return to work or sport. If a functional treatment is chosen, it seems to be: ’the more support, the better’. Additional physiotherapy shortens the time to return to sport. To prevent re-injury, physiotherapy is the best intervention. There is no place for physical interventions, operation or immobilisation, no matter how severe the sprain is.