Physiotherapy may not help ankle sprains! Really?

We as physiotherapists have been seeing a lot in the press, on websites and via the Chartered Society of Physiotherapists (CSP) that the British Medical Journal (BMJ) have published an article recently that suggests physiotherapy has no benefit for ankle sprains! The CSP were quick to defend our profession by stating: 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."

If you have an ankle injury, there must be a reason that your ankle is getting injured! When we think ankle injury, we think sprained ankle. Technically, sprain means ligament damage. What we most likely really mean is we have turned our ankle inwards and we call this an ankle inversion. This more than likely reveals ligament sprains but the true term is an ankle sprain. By why has our ankle inverted? Surely there is something wrong somewhere in the body? Now I am not going to make out that I am great physiotherapist because a great physiotherapist would not do that! But when I am presented with an ankle injury, I immediately question the client's balance. I do not just look at the ankle in isolation, I look at the body as a whole. This incorporates several aspects of the human body, for example; vestibular (inner ear) local stabilisers and global stabilisers. But what does this mean? Our muscle system can be broken down into 3 types:

Local Stabilisers

These are hopefully self explanatory. For example, muscles that are found in the foot and ankle can be classed as such. If there is a weakness or problem with these, then this could be a contributing factor towards an ankle inversion in this instance.

Global Mobilisers

Again, these are hopefully self explanatory. These are the large muscles that move us, for example, quadriceps, hamstrings, gluteus maximus, calves in this example.

Global Stabilisers

This is probably not as obvious as you may think. And this is the aspect of my clinical explanation that some clients struggle to accept. many struggle to understand that their knee pain, their ankle, even their low back pain can be a secondary problem because their global stabilisers and not effective. These are gluteus minimus and gluteus medius in this example. These are critical and key muscles that our body requires to maintain balance. Try this

Stand on one leg, nortice that your ankle is wobbling? Also, notice your leg is wobbling? This is not just because your local stabilisers are not working as they should, but because your global stabilisers are not working as they should. Now try this Stand one one leg and squeeze your buttocks. Any easier? There you go, is it just your ankle muscles letting you down? At the risk of repeating myself, anyone who has been rehabilitated by me for any lower limb problem will have had their gluteals assessed and strengthened accordingly because this will help you reduce the risk of re-injury. So for the BMJ to publish an article that goes as far to question whether physiotherapy helps ankle injuries, I think we need to see the article in full and critique this in detail and question whether the correct exercises were given in the research to assist rehabilitate such ankle inversion injuries. Because if we only treat the ankle in isolation, you are highly likely to get a repeat later in life.