Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms and risk factors for re-injury: A scoping review

Introduction: Many athletes suffer recurrent lateral ankle sprain (LAS) on return to sport. Common inciting events for re-injury include changing direction and jumping/landing; this is often mediated by excessive supination at initial contact and/or delay in Peroneus muscle activation. To optimally reduce the risk of recurrent LAS, rehabilitation interventions must reflect the aetiology and mechanisms of these injuries.

Aim: Determine if rehabilitation programs in the current literature address common impairments and mechanisms underpinning recurrent LAS

Materials and methods: We searched six electronic databases. Inclusion criteria were RCT’s including patients with acute LAS, managed through exercise-based rehabilitation. Each exercise was categorised by the primary impairment(s) addressed (muscle strength, mobility, neuromuscular training, joint positional sense), and by its: direction of movement (uni- vs multiplanar); base of support (single vs double limb); open vs closed chain; and use of a flight phase.

Results: The most addressed impairment was sensorimotor function (48%), followed by plantar flexion muscle strength (29%), and sagittal plane mobility (14%). Most exercises were limited to the sagittal plane (48%), with only 30% incorporating multiplanar movements. Two thirds of exercises (118/177) involved closed kinetic chain training, of which, half were undertaken on single leg (59/120). Just 18% of all exercises (33/177) incorporated a flight phase.

Conclusion: Rehabilitation strategies for LAS largely comprise simple exercises that do not reflect established mechanisms and risk factors associated with re-injury. Future interventions can be enhanced by incorporating more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.