Physiotherapy 'May Not Help Ankle Sprains'

Peter Russell

November 17, 2016

If you've sprained your ankle, you may be better off resting it, applying ice and taking some painkillers rather than getting physiotherapy, according to a study.

Canadian researchers found that fewer than half of people who had twisted their ankle were fully recovered 6 months later. Also, there was virtually no difference between those who had undergone physio and those who had followed simple instructions to treat themselves at home.

Swelling and bruising

Ankle sprains are common. They often happen when playing sport or when you change direction suddenly or land awkwardly. Ligaments become stretched and there is swelling and bruising.

Ankle sprains are also a common reason why people visit accident and emergency units.

Researchers looked at what happened to 503 people aged 16 to 79 who sought treatment for mild or moderate ankle sprains at 2 Canadian hospitals. The patients had been assigned at random to either receive the usual standard of care plus a course of physiotherapy, or just usual care.

In practise, usual care meant advice on protecting the damaged ankle, resting it, applying ice and a compression bandage. They were also advised to keep the ankle elevated, gradually put weight on it and take painkillers when needed.

Seven sessions of physio

Those who were also allocated physiotherapy received up to seven sessions lasting half an hour.

All the patients filled out a questionnaire in which they were asked to assess their pain, how well the ankle functioned in everyday activities and sport, and their quality of life.

The study, published in The BMJ, found that 43% of those who received physiotherapy and usual care had failed to achieve 'excellent recovery' after 6 months. This was slightly worse than the 38% of those who only got usual care.

New treatments needed

The researchers say their findings beg the question whether other strategies for managing ankle sprains might yield better results.

An editorial in the same journal written by Chris Bleakley, a lecturer at Ulster University in Northern Ireland, says ankle sprains should be taken seriously because more than 4 out of 10 patient fails to recover from them fully, experiencing persistent pain, further injury and continued weakness.

However, he says the treatment regime in the study of 7 physiotherapy sessions might not be sufficient to sustain a recovery. That said, there is an "urgent need to diversify the exercise content of treatments beyond the ankle," such as the knee, hip, and in the torso, he writes.

Physiotherapists' reaction

Commenting on the research, a spokesperson for the Chartered Society of Physiotherapy tells us by email: "The evidence base for physiotherapy intervention is broad, with the vast majority finding that rehab exercise improves function and reduces the risk of future injury. However, for many patients with a simple soft tissue injury – this may only require self-management applying the Protection, Rest, Ice, Compression and Elevation principle.

"For those that need it, with persistent disabling pain or where they are unable to do their normal daily activities, physiotherapists can provide full assessment, treatment and advice."

Editor's note: This article was updated after publication to include comment from the Chartered Society of Physiotherapy.


Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial, R Brison et al, The BMJ

Supervised physiotherapy for mild or moderate ankle sprain, C Bleakley, The BMJ

Chartered Society of Physiotherapy