Abstract

Lateral ankle sprain is the most prevalent musculoskeletal injury sustained by people who partake in competitive sports or recreational activities. Internationally, lateral ankle sprains account for a large percentage of all musculoskeletal injury patients visiting Emergency Departments. Despite their high prevalence, lateral ankle sprains are continuously regarded as innocuous injuries that will resolve expediently with minimal treatment. The reality is quite different, as following an acute lateral ankle sprain, pain and swelling are commonplace, which contribute to reduced functional capacity, occupational absence and the potential for the development of chronic ankle instability (CAI). Considerable variation exists in lateral ankle sprain management across Emergency Departments and clinical centres. Cross-sectional research has illustrated that a passive approach is frequently taken to the management of lateral ankle sprains. Rest, ice, compression, elevation, and non-steroidal anti-inflammatory drugs are oftentimes the management strategies of choice; physiotherapy is recommended in selected cases but with little standardised criteria informing this decision. There is extensive evidence that there is up to a two-fold increased risk of re-injury in the year following lateral ankle sprain occurrence, with up-to 40% of people who sustain a first-time lateral ankle sprain developing CAI within 12 months of injury. Based on the high risk for the development of CAI it clearly evident that current management strategies for acute lateral ankle sprain are inadequate. The progression of chronic sequalae following lateral ankle sprain and development of CAI are considered to be belied, at least in part, by mechanical and sensorimotor impairments, which develop in the year after injury. We proposition that a structured clinical assessment following lateral ankle sprain occurrence, which can establish the presence/absence of mechanical and sensorimotor impairments and which can be subsequently used as a ‘management pathway’ can likely provide the ‘brake to stop the ankle joint rolling’.