Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

Abstract Research questions What is the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients who suffered an acute ankle sprain? Do prescribed exercises incorporate complex tasks associated with common ankle sprain injury mechanisms? Methods We searched six electronic databases (CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar) for randomized controlled trials including patients with acute ankle sprains, managed through exercise-based rehabilitation. Exercises were analysed based on: the primary impairment(s) addressed (muscle strength, mobility, neuromuscular training, performance); direction of movement (uni-vs multiplanar); base of support (single vs double limb); weightbearing status (open vs closed chain); and use of a flight phase. (PROSPERO: CRD42020210858) Results We included fourteen randomized controlled trials comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises (34/177) incorporated a flight phase. Conclusions Rehabilitation after LAS largely comprises simple exercises in the sagittal plane that do not reflect established mechanisms of 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.