Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence.

To summarize the best available evidence in the last decade for managing ankle sprains in the community, data were collected using MEDLINE database from January 2000 to December 2009. Terms utilized: 'ankle injury primary care' (102 articles were found), 'ankle sprain primary care' (34 articles), 'ankle guidelines primary care' (25 articles), 'ankle pathways primary care' (2 articles), 'ankle sprain community' (18 articles), 'ankle sprain general practice' (22 articles), 'Cochrane review ankle' (58 articles). Of these, only 33 satisfied the inclusion criteria. The search terms identified many of the same studies. Two independent reviewers reviewed the articles. The study results and generated conclusions were extracted, discussed and finally agreed on. Ankle sprains occur commonly but their management is not always readily agreed. The Ottawa Ankle Rules are ubiquitous in the clinical pathway and can be reliably applied by emergency care physicians, primary care physicians and triage nurses. For mild-to-moderate ankle sprains, functional treatment options (which can consist of elastic bandaging, soft casting, taping or orthoses with associated coordination training) were found to be statistically better than immobilization for multiple outcome measures. For severe ankle sprains, a short period of immobilization in a below-knee cast or pneumatic brace results in a quicker recovery than tubular compression bandage alone. Lace-up supports are a more effective functional treatment than elastic bandaging and result in less persistent swelling in the short term when compared with semi-rigid ankle supports, elastic bandaging and tape. Semi-rigid orthoses and pneumatic braces provide beneficial ankle support and may prevent subsequent sprains during high-risk sporting activity. Supervised rehabilitation training in combination with conventional treatment for acute lateral ankle sprains can be beneficial, although some of the studies reviewed gave conflicting outcomes. Therapeutic hyaluronic acid injections in the ankle are a relatively novel non-surgical treatment but may have a role in expediting return to sport after ankle sprain. There is a role for surgical intervention in severe acute and chronic ankle injuries, but the evidence is limited.

A comparison of pain levels after the Biering-Sorensen and the modified 20-metre shuttle test in patients with chronic low back pain.

BACKGROUND AND OBJECTIVE: The Biering-Sorensen Test (BST) is a useful and well validated assessment tool in patients with chronic lumbar pain. However there is sometimes concern that it may lead to an unwarranted increase in pain. This study compared pain levels before and after the BST against a currently accepted functional assessment tool- the modified 20-metre shuttle test (MST)- in military patients with chronic low back pain. METHODS: 56 patients with non-specific lumbar pain of more than three months duration were tested on admission and discharge from a three week in-patient rehabilitation programme using the BST and the MST. A questionnaire was used to assess pain levels before and after both tests on admission and discharge from the group. The BST was carried out before the MST, with a time delay of 30-60 minutes. RESULTS: There were significant increases in pain immediately after both the MST and the BST (range of mean increase: 2.2 to 3.2 points, p< 0.001). The mean absolute levels of pain after the BST on admission and discharge were 0.26 and 0.80 more than the levels after the MST. The mean increases were 0.36 and 1.16 more after the BST compared to that after the MST. Pain levels returned to normal within 60 minutes of the BST being completed. CONCLUSION: Using either comparison method, although the initial increases after the BST were slightly more, the amounts were comparable and much less that the minimal clinically important difference in pain which is 1.5.