Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial

SE Lamb , JL Marsh, JL Hutton, R Nakash , MW Cooke

Background

Severe ankle sprains are a common presentation in emergency departments in the UK. We aimed to assess the effectiveness of three different mechanical supports (Aircast brace, Bledsoe boot, or 10-day below-knee cast) compared with that of a double-layer tubular compression bandage in promoting recovery after severe ankle sprains.

Methods

We did a pragmatic, multicentre randomised trial with blinded assessment of outcome. 584 participants with severe ankle sprain were recruited between April, 2003, and July, 2005, from eight emergency departments across the UK. Participants were provided with a mechanical support within the first 3 days of attendance by a trained health-care professional, and given advice on reducing swelling and pain. Functional outcomes were measured over 9 months. The primary outcome was quality of ankle function at 3 months, measured using the Foot and Ankle Score; analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN37807450.

Results

Patients who received the below-knee cast had a more rapid recovery than those given the tubular compression bandage. We noted clinically important benefits at 3 months in quality of ankle function with the cast compared with tubular compression bandage (mean difference 9%; 95% CI 2·4—15·0), as well as in pain, symptoms, and activity. The mean difference in quality of ankle function between Aircast brace and tubular compression bandage was 8%; 95% CI 1·8—14·2, but there were little differences for pain, symptoms, and activity. Bledsoe boots offered no benefit over tubular compression bandage, which was the least effective treatment throughout the recovery period. There were no significant differences between tubular compression bandage and the other treatments at 9 months. Side-effects were rare with no discernible differences between treatments. Reported events (all treatments combined) were cellulitis (two cases), pulmonary embolus (two cases), and deep-vein thrombosis (three cases).

Interpretation

A short period of immobilisation in a below-knee cast or Aircast results in faster recovery than if the patient is only given tubular compression bandage. We recommend below-knee casts because they show the widest range of benefit.

The Lancet, Volume 373, Issue 9663, Pages 575 – 581, 14 February 2009 – abstract

doi:10.1016/S0140-6736(09)60206-3

Filed under: Injuries, Joints

Contrast therapy – A systematic review

WA Hing, SG White, A Bouaaphone, P Lee

Abstract

Contrast therapy is a strategy that is widely utilised in a number of sporting codes to aid recovery. This wide use might suggest that contrast therapy is an effective recovery modality however support for this assumption appears to be mainly anecdotal.

The purpose of this paper is to review the efficacy of contrast therapy. To achieve this objective, a systematic review of randomised controlled trials (RCTs) that have specifically evaluated the therapeutic efficacy of contrast therapy was performed. A search to identify appropriate literature was conducted across a number of electronic databases. The titles and abstracts of the papers identified were reviewed to select papers specifically relating to contrast therapy. Twelve RCTs met the inclusion and exclusion criteria. The PEDro Scale, a systematic tool used to critique RCTs, was employed to critique the methodological quality of these studies

This review highlights both the lack in quantity and quality of research regarding the efficacy of contrast therapy for sports recovery. There appears to be insufficient evidence that contrast therapy aids in recovery and the limited methodological quality of the reviewed studies makes it difficult to draw clear conclusions about this form of therapy. Future research needs to re-examine the use of contrast therapy and in particular whole body immersion recovery strategies within the appropriate sports setting. This research will need to be of sufficient quality to enable appropriate conclusions to be made with regards to its use as a recovery strategy.

Physical Therapy in Sport
Volume 9, Issue 3, August 2008, Pages 148-161- abstract

doi:10.1016/j.ptsp.2008.06.001

Filed under: Contrast, Recovery