Effectiveness of Early Therapeutic Exercise Versus Rest, Ice, Compression, and Elevation in Treatment of Acute Lateral Ankle Sprains: A Critically Appraised Topic


  • Jonathan Herrick McAlester Regional Hospital
  • Karlee Alberty Chouteau-Maize Public Schools
  • Jennifer Volberding Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM)


Clinical scenario: Lateral ankle sprains are one of the most common musculoskeletal injuries and are associated with a high rate of emergency room visits. Ankle sprains have been reported to be 7-10% of all admissions to emergency departments, and occur at a rate of 2.15 ankle sprains per 1000 person/year in the United states. Clinical Question: Does the early inclusion of therapeutic exercises in the rehabilitation process of a lateral ankle sprain return patients to normal activities of daily living earlier than the RICE only protocol? Summary of Key Findings: There were significant effects in favor of the therapeutic exercise (strengthening and range of motion) group after week one and two for ankle function compared to the RICE therapy group. However, there was not a significant clinical difference between the two groups after month one, three, and six.1,3 In another study it was found that initial immobilization with a period of rest, ice, compression, and elevation (RICE) during the first 4-5 days is beneficial for the inflammatory phase of healing.2 Clinical Bottom Line: There is moderate evidence to support using a more active treatment consisting of therapeutic exercises to increase ankle range of motion (ROM) and ankle strength in patients that suffer from grade I and II ankle sprains during the first few weeks after injury. Strength of Recommendation: There is grade B evidence for using therapeutic exercises during the first two weeks after an ankle sprain improves ankle range of motion and ankle strength compared to the RICE protocol, but not after the first two weeks. The recommendation of a grade B was given to the consistency of conclusions of the level one evidence included in this CAT.






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