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Ankle Sprains – Treatment and Recovery Explained Simply

Ankle Sprains – Treatment and Recovery Explained Simply

Last Updated: July 1st, 2013

Welcome to the ‘Understanding Ankle Sprains’ e-book.

This is an educational resource describing the latest in ankle sprain science, and a simple (yet research-based) strategy for optimizing recovery and preventing re-injury.


Buy the full eBook (.pdf) right now or keep reading the introduction as well as the entire first section in this free preview!

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Dealing with “twisted”, “rolled, or sprained ankles?

Sprained Ankle

Ankle sprains – one of the most common and frustrating injuries!

If you have one, or work with people who do, you’re not alone!

It’s estimated that each year one million people will go to a physician because of an ankle injury. 31 In young athletes, ankle injuries make up 10-30% of all sports injuries, and 75% of them are sprains. 31

What’s really frustrating is that more than 40% of ankle sprains potentially lead to chronic issues – like instability, re-injury, or persistent pain. 31 In fact, 34% of ankle sprains are re-injured within one year. 28

Not fun!

But it’s not the end of the world. Here’s a detailed, research-based (yet simple and easy to read) guide about what an ankle sprain is, how to recognize one, why it might have happened, how it heals, and how one can optimize recovery to prevent re-injury.

Let’s go!


Table of Contents

Introduction

  • How to use this book
  • About the Author
  • Disclaimer

Part I – Understanding Ankle Sprains

  • Ankle Sprains – What are they?
    - Ligaments
    - Grades I to III
  • Where do ankle sprains happen?
  • How do ankle sprains happen?
  • When do ankle sprains happen?
  • How do they heal?

Part II – Treatment and Recovery

  • Diagnosis
  • How Long Will This Last?
  • Will I Need Surgery?
  • Rehabilitation Strategy
  • About Pain
  • Recovery : Week 1 : (be careful)
    - Medications
  • Recovery : Weeks 1 – 3 : (early rehabilitation)
  • Recovery : Weeks 2 – 6 : (advanced rehabilitation)
  • Recovery : Weeks 3 – onward : (gradual return to athletics)
  • Recurring Sprains (re-injury)
  • Persistent Pain

Final Thoughts

  • Thank You!
  • F.A.Q.
  • References

 

 


Introduction


How to use this book

If you want to learn more about sprained ankles and how they should be treated, then you’ve come to the right place. This book is an educational resource on ankle sprain treatment and recovery. It’s written so anyone with a high-school education can understand it, but with scientific references for professionals and students.

It’s detailed, but not too long – only the important things are covered.

Features:

  • Clickable links: if you’re reading this on a computer or mobile device, such as an iPhone or iPad, there are links you can click on that lead to articles with more detail – like this.
  • YouTube Videos: when exercises are described, links to YouTube are occasionally provided.
  • Full Color Images:concepts and exercises are often illustrated through full color images to help the reader understand the ideas.
  • References: the information in this guide is based on numerous research studies. In case you want to check them, references are listed near the end, and numbered in superscript throughout, like this: 1

Here’s how you use this guide:

  1. First, skim the whole guide briefly to see what it’s all about. Get to know what sections exist, and how it’s organized.
  2. Read in detail the relevant sections as one progresses through their recovery. Yes, it’s long. But the more you learn, the better decisions you will make. For example: understanding how ligaments heal will keep you from doing stupid things (I hope).

If you want, you can just skim over what isn’t interesting. Use the table of contents to see where one might be in the recovery process, and skip to that section. However, much of it is written under the assumption that you’ve read the prior sections. We won’t be wasting time defining or explaining things twice.

Let’s be honest… if you are not going to take the time to read this guide, then you should probably just go get help face-to-face with a professional (not that this guide is a replacement for a professional consultation anyway – it’s not).

But like people who want to lose weight, but won’t even take the time to cook a proper meal… you probably aren’t going to get the best results you can unless you invest the necessary time.

I’ve seriously tried my best to keep things short and to the point. I may have even skipped some useful things in the effort of trying to be concise. This guide reviews the essentials, and little more. So stop complaining about the length!

Go on. Read. Now!


About the Author

Why should you listen to this guy?

Tony HeadshotTony Ingram is a licensed physical therapist and a dancer, currently living in St. John’s, Newfoundland, Canada. He has a bachelor’s degree in Behavioral Neuroscience, a master’s degree in Physiotherapy, and is currently completing another master’s in Kinesiology (Exercise Physiology) while working as a physical therapist full time.

He remains very active in the dance world as well. Currently, Tony directs two dance companies whose mission is youth outreach through providing school programs. He also consults with dancers around the world, and provides workshops on injury prevention. He started bboyscience.com to write about science, training, injuries, and dancing.

And… he’s sprained both his ankles (not at the same time)and survived!

Thanks for reading!

Tony Ingram Signature

 

 

Tony Ingram


Disclaimer

Author’s notes:

As expected with any credible health advice you find on the Internet, there’s a disclaimer: by reading this document, you here-by agree not to sue me for any reason at all for the rest of eternity. But seriously…

Even though I’m a physical therapist, buying this book doesn’t mean you’re receiving physical therapy service from me – just information. Therefore, my insurance doesn’t cover this book, and suing me is a waste of time.

What you purchased is my opinion on how a person should approach his or her recovery – in general (this is not individualized just for you). It’s based on scientific research, but science is constantly updating and changing (which is a good thing). This was last updated in July 2013, so if it’s more than two years old, it’s probably out of date! Therefore, before trying anything in this book, discuss it with your medical professional first.

Disclaimer

The material presented in this document is intended for informational purposes only. The information represents the opinion of the author, and does not constitute medical advice. This document is not intended to replace medical advice, nor to diagnose, prescribe or treat any illness, disease, or injury. The author expressly disclaims liability for any adverse effects that may result from the use, application or interpretation of the material in this book.


Part I – Understanding Ankle Sprains


Ankle Sprains – What are they?

Sprains are ligament injuries. Ligament injuries include sprained ankles and wrists, and arguably more serious things like tears of the knee menisci or ACL (anterior cruciate ligament).

Notice from these examples that ligament injuries occur at joints, as opposed to occurring “in muscle” like muscle strains. See: Strains vs. Sprains for a quick review of the differences between them.

Why joints? Time for a quick anatomy lesson!

Ligaments

Take a second to look at the following picture. It’s someone’s right ankle – if you were looking at it from the outside.

Ankle Ligaments – Lateral View (photo from Gray’s Anatomy, 1918).

Those little white bands are called ligaments. They look like little pieces of tape holding your bones together. And that’s what they do, sort of. That’s why you find them in joints.

Ligaments are a kind of ‘connective tissue’ – not bone, not muscle, not organ. They’re a pretty tough tissue, not flexible like skin. Next time you eat a chicken wing, look for them – if that sort of thing doesn’t gross you out.

Clearly, they come in a wide array of shapes and sizes. What are they for?

  • Joint Stability – Obviously, they limit the movement at joints. The primary cause of ligament injury is forcefully moving in ways that ligaments are supposed to prevent. See ‘How do ankle sprains happen?’ below.
  • Guide Movement – Ligaments (as well as the shapes of your bones) make you move in a particular way, even when muscles look like they’re pulling in a different direction. This is important, because as we’ll review later, loose ligaments (due to injury) can noticeably change your joint bio-mechanics. 2
  • Sensory Reception – For a long time, ligaments were thought to be inert (didn’t do anything; just held stuff together). But it is now well known that ligaments are filled with important sensory receptors. 25, 26

Sensory receptors are nerve endings that sense important information about your body and its surrounding environment, then send it to your brain. One of the important receptor types found in ligaments is the ‘mechano-receptor’. Mechano-receptors are heavily involved in ‘proprioception’ (your sense of position) and ‘kinesthesia’ (your sense of movement – speed, direction, etc.).

Proprioception and kinesthesia, as you can imagine, are two very important senses involved in coordination, and therefore stability / agility. When you injure a ligament, you can disrupt these receptors, causing deficits in your sense of position and movement. 25, 26

That might be one of the reasons why it’s so easy to become re-injured!

Remember this when coordination training is discussed below.

Grades of Ankle Sprains

The severity of sprains can vary widely. Here’s a simple three grade system, but note there are different grading systems out there.  31

  • Grade I – ‘Stretched’ / partial tear.
  • Grade II – Incomplete tear.
  • Grade III – Complete tear.

Expected healing times are different between grades. We’ll go over this in more detail in a later section.


Where do ankle sprains happen?

Usually, ankle sprains occur in the lateral (outside) aspect of the lower ankle. 31

The ligaments here are 1. the Anterior Talofibular Ligament (ATFL), 2. the Calcaneofibular Ligament, 3. the Posterior Talofibular Ligament, and 4. the Posterior Tibiofibular Ligament.

Of these ligaments, the most commonly injured is by far the ‘ATFL’.

the lateral (outside) ankle ligaments.

Injuries can also happen at the medial (inside) aspect of your ankle too. 31 Ligaments here make up the ‘deltoid complex’. But because of positioning of the bones, this area is much less likely to become injured.

the medial (inside) ankle ligaments.

Another type of sprain is known as the high ankle sprain – aka ‘syndesmotic’. 31,30 They make up between 10 and 20% of all ankle sprains. 30 They occur in the ligament between the two bones of the lower leg, the tibia, and the fibula.

the location of a ‘high ankle sprain’.

 


How do ankle sprains happen?

How do ligaments become injured? Usually because of:

  1. an excessive force in an abnormal direction, or
  2. an excessive force in a normal direction – but too far.

See: ‘How Injuries Happen‘ for more info on injuries in general.

For low ankle sprains specifically, the typical mechanism of injury seems to be a combination of pointing your foot downward and inward (‘plantarflexion’ and ‘inversion’, respectively), and applying excessive force. 31,7 This is why the ATFL is the most effected. It’s by far the most common way to sprain your ankle. If you see it happen, it looks like the ankle “rolls” under the leg.

For high ankle sprains specifically, the typical mechanism of injury seems to be a combination of pointing your foot upward and outward (‘dorsiflexion’ and ‘eversion’, respectively), and applying excessive force. 31, 30, 27 This causes an inward rotation force that sprains the syndesmosis between the two lower leg bones. Likewise, having your toe planted on the ground and applying a force to the outside of your knee can cause the same rotation.

injuriesInteresting Science – from a Lab Accident!

Recently, researchers in Germany were doing a study with soccer players performing a run and cut maneuver while being recorded with 3D motion capture and EMG (electromyography – which measures muscle activity)8

During one of the run and cut trials, a soccer player rolled their ankle by accident – while being recorded! Luckily it wasn’t severe – the player recovered after a week.

When the researchers looked at the lab data, they discovered that the problem was actually right before the foot hit the ground! The biomechanics of the pelvis, hip, and knee were different, but not the ankle! Basically, the foot hit the ground with the whole leg in an awkwardly rotated and excessively straight position – which caused the ankle to roll.

Unfortunate… but interesting!


When do ankle sprains happen?

fast moving sports with quick direction switches = lots of sprained ankles

When would such an accident occur? Almost everyone has rolled their ankle to some degree… whether playing a sport, or simply tripping over a side-walk.

It just happens.

Most commonly, ankle sprains happen in sports that involve running and switching directions quickly – fast moving field / court sports like soccer, football, basketball, etc. Dancers can also be at high risk, especially classically trained styles like ballet.

Of course, no matter what you do, injuries are usually just accidents. Stop feeling sorry about not stretching enough, or whatever you think you could have done differently. Unless, of course, you did something stupid. :)

For some general info on prevention read: ‘Injury Prevention Research – What works, and what doesn’t?


Healing

Here’s what’s frustrating about ligament injuries. They are not great at healing.

It could be because the tissue itself doesn’t have much of a blood supply (low capillarization), or perhaps because the tissue has a relatively slow rate of replacing itself (turnover). This is all theoretical. Here’s what research has shown:

It takes anywhere from 6 weeks to 3 months for ligaments to heal after an acute ankle sprain. 13 But even after that, it’s still not done. One year later, ligament laxity (looseness) and feelings of pain and instability can remain. 13 It’s estimated that within three years, only 36% to 85% of people with ankle sprains report full recovery. 28

Compare that to how muscle strains heal, and you see why ligaments are considered “bad” healers. Unfortunately, you can’t magically speed up your body’s natural healing process. See: What affects healing?

But it’s not all bad. Here’s the good news (sort of):

Ligament healing isn’t quite as easily disrupted as muscle healing. Any time you move in a way that activates a strained muscle, you end up applying force through the healing tissue. However, if you are careful, you can be active with a sprain while avoiding too much stress to it. You just have to be very careful not to enter those positions that caused the sprain in the first place.

With Grade I – II sprains, people usually return to sport anywhere between 3-6 weeks after injury. For really minor ones, just a week off may suffice (although it may still be wise to wear a brace for a few weeks and do the rehabilitation exercises as described below).

However, in the case of very severe sprains – like Grade III tears – it may be more beneficial to immobilize the joint in a cast (similar to taking care of a bone fracture). 19 It appears that the two ends of the torn ligament need to stay close enough together to heal properly during the early stages. Less severe sprains are still connected – just partially torn.

Once it’s safe to move, it’s time to start rehabilitation. Remember, proper rehabilitation is essential – 40% of ankle sprains potentially lead to chronic issues – like instability, re-injury, or persistent pain. 31

Which leads us to our next section: rehabilitation!

Time to get to work!


Part II – Treatment and Rehabilitation


Diagnosis

First, are we sure this is an ankle sprain? Let’s see.

But first… re-read the disclaimer! The following information is provided to help you better understand ankle sprains. This is in no way a replacement for a real professional diagnosis. Even professionals can get confused, and they may need to get you an X-ray, MRI or CT scan to be sure. Now that I’ve written that to cover my butt, let’s proceed:

Here are the key points to consider in deciding whether an injury is an ankle sprain or not. 31 Remember, a person may have one of these things, or all of these things, or none. It’s always unique: so see a physician!

less severe sprains may be hard to notice in the heat of competition!

  • History – Most acute ligament sprains have a clear incident of injury – if someone rolled or twisted their ankle, they’ll know it! They may feel or hear some kind of pop, rip, tear, pull, stretch, or another similarly uncomfortable sensation. It’s usually followed immediately with pain in the ankle. However, some grade I sprains may not involve a sound or feeling, and may go unnoticed until after the exercise session has calmed down.
  • Location – One would feel a sprain ‘in a joint’, but not ‘in a muscle’ – in the case of an ankle sprain, one would feel it very close to one of the areas described above. It could be a low sprain, or a high sprain – but sometimes it’s hard to tell on the first day.
  • When it hurts – Ankle sprains usually hurt when bearing body weight on them. It might be hard to take a step, and if it’s moderate to severe, a person might need crutches to walk in the first week. It’s usually always painful to stretch any direction – but especially in the direction that caused the sprain (see ‘How do ankle sprains happen?’ above). In the first few days, it may be painful or ‘throb’ even when one isn’t moving. Furthermore, it will probably hurt to press on the specific area of the injured ligament – see locations on the photos above.
  • Swelling, redness, or bruising – As inflammation and swelling sets in, one will probably have one of more of these signs as well. It’s not likely to see any observable ‘deformity’, as can occur with a broken bone. Of course, many things can cause these symptoms, so the other points are important to consider when trying to make a specific sprain diagnosis.
  • Ligament Tests – There are specific tests to see how tight or loose ligaments are. For example, one would test the ATFL with the ‘anterior drawer test’, or the ‘squeeze test’ for high ankle sprains. A professional who would know whether the results were normal should carry out these tests. Therefore, we won’t describe them here.

Symptoms differ depending on the severity. The following table describes the typical symptoms associated with Grade I to III sprains.31

 

Severity Signs and Symptoms
Grade I -
‘Stretched’ / partial tear
- Mild swelling and tenderness to touch.
- Minimal pain on weight-bearing.
- No instability (ligament tests normal).
Grade II -
Incomplete tear
- Moderate swelling and tenderness to touch.
- Some bruising.
- Pain on weight-bearing.
- Some loss of range of motion.
- Mild to moderate instability (ligament tests mildly positive).
Grade III -
Complete tear
- Severe swelling and pain to touch.
- Significant bruising.
- Severe pain on weight-bearing (may need crutches to walk).
- Significant loss of range of motion.
- Mechanical instability (ligament tests clearly positive).

 

If you suspect a Grade III sprain, please – go see a Doctor. These severe sprains are very hard to distinguish from bone fractures, so your Doctor may decide to give you an X-Ray. Even if it’s not a fracture, it’s a severe injury and you should get professional help, not try to help yourself on the Internet. Once the acute (first week) phase is over, the exercises and guidelines described below should be safe.

Disclaimer: Even if you’re confident you have this injury, please see a Doctor (Physician) or Physical Therapist for a qualified clinical diagnosis. While I strive to provide the best, most up-to-date and accurate health information possible, I can’t personally see and assess your problem.


How long will this last?

A Note On Recovery Time

Every injury, and every person will recover differently. The time course described below applies best to Grade I to II sprains, which are by far the most common.


END OF FREE INTRODUCTION


Purchase full access to the eBook for $9.95 CAD to continue reading. Access is instant – a printable .pdf file will be e-mailed to you immediately after purchase.

Ankle Sprain GuideYou’ll get full access to everything you’ve already read, as well as ‘Part II – Treatment and Recovery’.

  • Detailed strategy for optimizing ankle sprain recovery and minimizing the chance of re-injury.
  • Photos and videos of rehabilitative exercises with simple descriptions – no expertise required.
  • Exercises are based on research that demonstrated up to a 35% reduction in chance of re-injury using such methods! 10
  • 72 pages of easy to read, but highly researched information – understand why the exercises are important.
  • Download in printable .pdf format, with clickable links to further resources, videos, and more.
  • Professionals: this eBook is based on numerous peer reviewed articles – check out the references below. Purchase this eBook, and you have an evidence-based resource to give to your patients.

If you’ve enjoyed what you’ve read so far, let’s take a second look at the table of contents to see what else you’ll get after purchasing the full eBook:

So far, you’ve read:

Introduction

  • How to use this guide
  • About the Author
  • Disclaimer

Part I – Understanding Sprains

  • Ankle Sprains – What are they?
    - Ligaments
    - Grades I to III
  • Where do ankle sprains happen?
  • How do ankle sprains happen?
  • When do ankle sprains happen?
  • How do they heal?

After purchasing, you’ll also get:

Part II – Treatment and Recovery

  • Diagnosis
  • How Long Will This Last?
  • Will I Need Surgery?
  • Rehabilitation Strategy
  • About Pain
  • Recovery : Week 1 : (be careful)
    - Medications
  • Recovery : Weeks 1 – 3 : (early rehabilitation)
  • Recovery : Weeks 2 – 6 : (advanced rehabilitation)
  • Recovery : Weeks 3 – onward : (gradual return to athletics)
  • Recurring Sprains (re-injury)
  • Persistent Pain

Final Thoughts

  • Thank You!
  • F.A.Q.
  • References

Add to Cart

Much more information awaits. Go ahead – take some time to think about it – bookmark this page!

Meanwhile, if you haven’t already checked out my site bboyscience.com, please take a moment to visit! If you enjoy learning about the science of movement, I hope you find something interesting. :)

Lastly, you can also follow me through Twitter (@bboyscience) or ‘like’ my Facebook Page, where a community of brilliant healthcare and fitness professionals grows every day. Join the conversation!

Thanks for reading so far, and I wish you a swift recovery!

Tony Ingram Signature

Tony Ingram


References

Here’s the references from the full eBook. Go ahead, check my sources before purchasing!

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2. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley JA 2nd, DeFrate LE. In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med. 2009 Nov;37(11):2241-8. Epub 2009 Jul 21. PubMed PMID: 19622791

3. Collins NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emerg Med J. 2008 Feb;25(2):65-8. doi: 10.1136/emj.2007.051664. Review. PubMed PMID: 18212134.

4. de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Interventions for treating chronic ankle instability. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD004124. Review. PubMed PMID: 21833947.

5. Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010 May;13(3):309-17. Epub 2009 Jul 7. Review. PubMed PMID: 19586798.

6. Faria FE, Ferrari RJ, Distefano G, Ducatti AC, Soares KF, Montebelo MI, Minamoto VB. The onset and duration of mobilization affect the regeneration in the rat muscle. Histol Histopathol. 2008 May;23(5):565-71. PubMed PMID: 18283641.

7. Fong DT, Ha SC, Mok KM, Chan CW, Chan KM. Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: five cases from televised tennis competitions. Am J Sports Med. 2012 Nov;40(11):2627-32. doi:10.1177/0363546512458259. Epub 2012 Sep 11. PubMed PMID: 22967824.

8. Gehring D, Wissler S, Mornieux G, Gollhofer A. How to sprain your ankle – a biomechanical case report of an inversion trauma. J Biomech. 2013 Jan 4;46(1):175-8. doi: 10.1016/j.jbiomech.2012.09.016. Epub 2012 Oct 15. PubMed PMID: 23078945.

9. Hart JM, Pietrosimone B, Hertel J, Ingersoll CD. Quadriceps activation following knee injuries: a systematic review. J Athl Train. 2010 Jan-Feb;45(1):87-97. doi: 10.4085/1062-6050-45.1.87. Review. PubMed PMID: 20064053; PubMed Central PMCID: PMC2808760.

10. Hemphill B, Whitworth JD, Smith RF. Clinical inquiry: How can we minimize recurrent ankle sprains? J Fam Pract. 2011 Dec;60(12):759-60. Review. PubMed PMID: 22163361.

11. Hiller CE, Nightingale EJ, Lin CW, Coughlan GF, Caulfield B, Delahunt E. Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis. Br J Sports Med. 2011 Jun;45(8):660-72. Epub 2011 Jan 21. Review. PubMed PMID: 21257670.

12. Hoch MC, McKeon PO. Peroneal reaction time and ankle sprain risk in healthy adults: a critically appraised topic. J Sport Rehabil. 2011 Nov;20(4):505-11. Epub 2011 Aug 8. Review. PubMed PMID: 21904006.

13. Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008 Sep-Oct;43(5):523-9. Review. PubMed PMID: 18833315; PubMed Central PMCID: PMC2547872.

14. Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. Review. PubMed PMID: 17512485.

15. Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005 May;33(5):745-64. Review. PubMed PMID: 15851777.

16. Kamper SJ, Grootjans SJ. Surgical versus conservative treatment for acute ankle sprains. Br J Sports Med. 2012 Jan;46(1):77-8. Review. PubMed PMID: 22167718.

17. Kannus P, Parkkari J, Järvinen TL, Järvinen TA, Järvinen M. Basic science and clinical studies coincide: active treatment approach is needed after a sports injury. Scand J Med Sci Sports. 2003 Jun;13(3):150-4. Review. PubMed PMID: 12753486.

18. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD000380. Review. PubMed PMID: 17443501.

19. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW; Collaborative Ankle Support Trial (CAST Group). Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet. 2009 Feb 14;373(9663):575-81. PubMed PMID: 19217992.

20. Milner CE. Interlimb asymmetry during walking following unilateral total knee arthroplasty. Gait Posture. 2008 Jul;28(1):69-73. Epub 2007 Nov 19. PubMed PMID: 18024040.

21. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006 Jul;76(7):607-11. PubMed PMID: 16813627.

22. Olmsted LC, Vela LI, Denegar CR, Hertel J. Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis. J Athl Train. 2004 Mar;39(1):95-100. PubMed PMID: 15085217; PubMed Central PMCID: PMC385268.

23. Rice DA, McNair PJ, Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis Res Ther. 2011;13(5):R151. doi: 10.1186/ar3467. Epub 2011 Sep 20. PubMed PMID: 21933392; PubMed Central PMCID: PMC3308081.

24. Schaser KD, Disch AC, Stover JF, Lauffer A, Bail HJ, Mittlmeier T. Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. Am J Sports Med. 2007 Jan;35(1):93-102. Epub 2006 Dec 1. PubMed PMID: 17197574.

25. Sjölander P, Johansson H, Djupsjöbacka M. Spinal and supraspinal effects of activity in ligament afferents. J Electromyogr Kinesiol. 2002 Jun;12(3):167-76. Review. PubMed PMID: 12086810.

26. Solomonow M, Krogsgaard M. Sensorimotor control of knee stability. A review. Scand J Med Sci Sports. 2001 Apr;11(2):64-80. Review. PubMed PMID: 11252464.

27. van den Bekerom MP, van Dijk CN. Re: Syndesmotic ankle sprains in athletes. Am J Sports Med. 2008 Dec;36(12):E1; author reply E1. PubMed PMID: 19074400.

28. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331.e6. doi: 10.1016/j.amjmed.2007.11.018. Review. PubMed PMID: 18374692.

29. Wikstrom EA, Naik S, Lodha N, Cauraugh JH. Bilateral balance impairments after lateral ankle trauma: a systematic review and meta-analysis. Gait Posture. 2010 Apr;31(4):407-14. doi: 10.1016/j.gaitpost.2010.02.004. Epub 2010 Mar 19. Review. PubMed PMID: 20303759.

30. Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007 Jul;35(7):1197-207. Epub 2007 May 22. Review. PubMed PMID: 17519439.

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Ankle Sprain Guide

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