Author: Trey Miles, SPT
Background
My primary interest is in treating sports and orthopedics populations. I would like to work with a physically active individuals and athletes. Jumping sports have always been interesting to me, especially when considering the variety of potential injuries these athletes experience. I have worked closely with high level athletes who continuously train their bodies to avoid injury, yet the risk still remains. I grew up playing basketball and experienced several ankle sprain injuries but never once sought out professional treatment. Now that I am aware of the anatomy and biomechanics behind this common injury, along with the risks associated with returning to sport following this injury, I wanted to explore the evidence for treatment and return-to-sport. This project has allowed me to dive deeper into an injury that myself and many other individuals have experienced. This will allow me to make better evidence-based decisions about treatment and return-to-sport, as well as educate those who experience this injury on the importance of proper treatment.
Statement of Need
Ankle sprains are the one of the most common lower limb injuries among physically active individuals and nearly half of these injuries occur during athletic activity.1 These acute injuries often result in decreased ability to participate in physical activity and decreased performance, but also have a high recurrence rate associated with the development of chronic ankle instability, CAI, which can further impact participation and quality of life.2 The highest rates of acute ankle sprain injuries occur in indoor and court sports characterized by running, cutting and jumping, such as basketball and volleyball. Due to the high incidence and recurrence rates, proper treatment guidelines and return to sport criteria are essential to maximize return-to-sport safety and minimize the risk for recurrent injury and CAI development. There is a significant amount of research on various treatment strategies and interventions for acute ankle sprains, however with such a variety it can be difficult to synthesize the evidence and determine the best strategies for a specific population. Interestingly, even with the commonality of the injury and high occurrence in sport, there is a lack of evidence-based return-to-sport criteria to help guide individual and provider decisions. Just as with other sports injuries, criteria-based guidelines for return to sport following acute ankle sprains could help reduce the risk of re-injury and maximize return to performance. The purpose of this Capstone project is to fill this gap by developing evidence-based return-to-sport guidelines for health professionals treating jumping athletes with lateral ankle sprains in order to assist with return-to-sport decisions. Along with this, the project will synthesize current evidence for conservative treatment of lateral ankle sprain injuries and develop updated guidelines for providers. Lastly, this project will educate athletes on ankle sprain injuries and treatment, along with the risk for developing CAI if the injury is not properly managed.
Products
RTS Criteria-based Guidelines Handout: This handout includes the criteria for return-to-sport and is intended for clinicians treating athletes with lateral ankle sprain, LAS, injuries.
RTS Guidelines Evidence: This document includes the evidence behind the return-to-sport criteria and an explanation for each of the test and measures.
Treatment Guidelines Handout: This handout includes the recommended treatment for individuals with LAS and is intended for clinicians treating these individuals.
Treatment Guidelines Evidence: This document includes the evidence behind the treatment recommendations for LAS injuries.
Athlete LAS and CAI Handout: This handout includes information intended for athletes and individuals with LAS injuries.
Evaluation and Self-Reflection
During the course of doing a literature review and developing the products, I communicated with my primary advisor, Mike Gross, who recommended changes and additions based on my proposal. I used the feedback to make changes and alter the products of this project. Prior to completing this project, I helped give a short presentation on lateral ankle sprains in basketball players during the sports elective course, along with classmate Kishan Patel. During the process of making this presentation, Kish and I met to review research articles and evidence, as well as to determine the best approach for developing criteria for return-to-sport. I also created a very short survey for those who review the products to determine if the original learning objectives were met. The survey is linked above.
When reviewing the personal learning objectives that I had set for myself at the beginning of the project, I looked at each and reflected on the progress that I had made. I believe that I have succeeded in expanding my personal knowledge on the treatment of LAS injuries and also developed quality resources for clinicians and athletes based on quality evidence. Not only did I learn a great deal about this topic, but I also feel more confident and prepared to see this patient population in the clinic. The literature review allowed me to feel confident in choosing the most appropriate and evidence-based guidelines. I am eager to apply what I have learned throughout this process to clinical practice in the future.
Acknowledgements
I want to thank Dr. Mike Gross for being my primary advisor and offering guidance and feedback throughout the process of completing this project. I want to thank Doug Halverson and Dr. Joshua Torrey for being committee members and offering feedback. I also want to thank Kishan Patel for being my partner and helping with the presentation in the sports elective that laid the foundation for this project. Lastly, I want to thank the entire Class of 2023, we made it!
References
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020;11(12):534-558. doi:10.5312/wjo.v11.i12.534
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Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496-1505. doi:10.1136/bjsports-2016-096189
- Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med. 2017;45(1):201-209. doi:10.1177/0363546516660980
2 Responses to “Lateral Ankle Sprain Treatment Guidelines and Return-to-Sport Criteria for Jumping Athletes”
krpatel8
Trey,
Great capstone choice! I too suffered from lateral sprains growing up as a result of basketball and never sought out treatment. It was because of this shared experience that we were interested in examining a return-to-sport criteria for our sports presentation. However, upon a look into the literature, we were both surprised to find that little evidence existed regarding this topic. That made our presentation that much harder to develop, but that much more fun to work on! I’m glad that you were able to use this capstone as an opportunity to take what we developed and dive in even further. When looking through your materials, there is some familiar content, but also a lot of new content that I am excited to learn more about. You did an amazing job here, and you were an awesome partner to work with!
Mike Gross
Trey- you did great work on this project and the information will really help you in working with these athletes and getting them back in the game. Mike