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Abstract & Commentary
Synopsis: The degree and duration of swelling after a lateral ankle sprain did not correlate with function and perhaps should not be used for return to play criteria.
Source: Pugia ML, et al. Comparison of acute swelling and function in subjects with lateral ankle injury. J Orthop Sports Phys Ther. 2001;31(7):384-388.
Ankle sprains are an extremely common sports-related injury. In addition, approximately 85% of sprains are of the lateral ligaments of the ankle. Significant swelling is a common symptom following this type of injury. The purpose of this study was to determine the relationship between functional indices and the presence of swelling.
Twenty-nine subjects varying between the ages of 18-59 (mean age, 38.88 ± 11.37) participated in the study. Of these, 20 were male and 9 were female. All subjects had ankle sprains within 10 days of examination, with a mean of 3.28 days prior to examination. Exclusion criteria included bilateral ankle injuries and concomitant lower extremity fractures. Ankle girth was measured using a traditional figure 8 measurement (figure 8 around the ankle and foot with a tape measure). While several different examiners performed this measurement, inter-observer reliability was reported to be 0.99 and intra-observer reliability was 0.98-0.93. In addition, participants were asked to complete the ankle osteoarthritis scale (AOS) and the foot and ankle ability index (FAAI). Both of these measures are functional indices indicating the subject’s perception relative to their function. Validity and reliability have been established using the AOS. The FAAI has not yet established reliability and validity. However, the FAAI has a sports subscale and many of the questions were similar to the AOS, so it was hypothesized that these 2 indices should be strongly correlated to each other.
The results indicated that the FAAI sports subscale, the modified AOS scale, and weight-bearing status did not significantly correlate with swelling as determined by figure-of-8 girth measurements. Significant correlations were found between the various functional measures.
Comment By Clayton F. Holmes, EdD, PT, ATC
Measurements such as range of motion and swelling have long been performed with the assumption that these symptoms limit function. This simple, clean study indicates that swelling may indeed not be an indication of function, at least relative to the common lateral ankle sprain. This is a significant finding because sports participation is often limited due to observation of swelling, when in fact, function may well be close to normal. While there are certainly many variables that were not controlled for in this study, including adherence to a home program and degree of sprain severity, this is still an important study. The introduction of functional measures such as the AOS for use with such a common injury is critical and may affect examination of ankle sprains. It is also important to note that this was the first time the AOS scale was used relative to ankle sprains.
In summary, there certainly is not enough evidence to support not limiting an athlete’s participation secondary to swelling. This study is certainly a step in the right direction in using the recent move toward functional scales and away from a reliance solely on other "objective" measures, such as range of motion and swelling.
Dr. Holmes, Associate Editor of Sports Medicine Reports, is Associate Professor, University of Central Arkansas, Physical Therapy Department, Little Rock.