SLR - June 2014 - Brian Hunziker

Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients With Inversion Ankle Sprain: A Multicenter Randomized Clinical Trial

Reference:  Cleland JA, Mintken PE, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K, Whitman JM.  J Orthop Sports Phys Ther. 2013 July; 43(7): 443-55.

Scientific Literature Review

Reviewed By: Brian Hunziker, DPM
Residency Program: Trinity Regional Medical Center – Fort Dodge, Iowa

Podiatric Relevance: Physical therapy can be a useful adjunctive treatment modality in the management of ankle sprains. Often in podiatry practice, at home functional treatment is exclusively utilized for recovery following an ankle sprain. In a recent seperate study, it has been debated that an at home exercise program aimed at strengthening and reconditioning the ankle for the treatment of ankle sprains yields similar results as an exercise regimen administered by a physical therapist. The study reviewed here suggests that there has not been sufficient research comparing the outcomes of an at home exercise program to a program of manual therapy with exercise provided by a physical therapist in the treatment of ankle sprains. The authors conducted a multicenter randomized clinical trial to compare these two methods of treatment.

Methods: Seventy-four patients treated for an inversion ankle sprain participated in the randomized study. To be included the patients had to have current symptoms associated with a grade 1 or grade 2 ankle sprain, be between the ages of 16 and 60, have a pain rating of at least 3/10, and have a negative result from the Ottawa ankle rules. Half of the patients were placed into the at home exercise program (HEP) consisting of once a week instructional sessions with a physical therapist and subsequent at home range of motion and strength exercises for four weeks. The other half of the patients were treated with manual physical therapy (MPT) for two 30 minute sessions per week for four weeks with a physical therapist consisting of varying intensity range of motion and resistive type manipulative exercises.  This group also performed the same at home exercises as the first group. 

Results: The outcomes of the two treatment groups were measured using three different functional ability scales and a numeric pain rating scale. Follow ups were completed at four weeks and at six months. The functional ability scales for the MPT group resulted in statistically significantly greater improvement compared the HEP group at both four weeks and at six months. The MPT group also resulted in statistically significantly less pain on the numeric pain rating scale than the HEP group at four weeks and at six months.

Conclusions: This study provides helpful information on the benefits of manual physical therapy in the treatment of ankle sprains. The use of manual physical therapy in this study resulted in greater improvements in pain and function and earlier recovery compared to at home exercise programs and may be a useful adjunctive therapy for initial treatment of ankle sprains or persistent ankle sprain symptoms.  

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