Table 3.
Supporting evidence in each of the seven clinical practice guidelines for acute treatment of lateral ankle ligament sprains
| Acute Treatment | 1 [36] (2006) | 2 [37] (2006) | 3 [38] (2009) | 4 [39] (2011) | 5 [40] (2012) | 6 [41] (2013) |
7 [42] (2013) |
|---|---|---|---|---|---|---|---|
| Progressive weight bearing with support depending on severity (tape, brace, boot, casting) | R [43–45] | R [45, 46] | R | R | R [45–48] | R [45, 47, 49] | R [47, 48, 50-56] |
| Ice | R | R [57] | R | R | R [57, 58] | R [57-61] | R [57, 58] |
| Compression | R | R | R | R | R [62–64] | R [65] | |
| Elevation | R | R | R | R | R | R | |
| Progressive strengthening exercises | R | R | R | R [66–70] | R [45, 49, 66, 71] | R [66–68, 72, 73] | |
| Balance exercises | R | R | R | R [66–69] | R [74–76] | R [74–77] | |
| NSAIDs/paracetamol | R# [78–83] | R | R | R [69, 84, 85] | |||
| Refer on to another discipline | R | R | R | ||||
| Advice DVT risk with immobilisation | R | R | |||||
| Foot circle exercises | R | R | |||||
| Alphabet exercises | R | ||||||
| Lymphatic drainage/soft tissue mobilisations | R [86] | ||||||
| Graded joint mobilisations or mobilisation with movement | R [73] | X [69, 73, 87] | R [88, 89] | R [44, 73, 90] | |||
| Pulsating short wave diathermy | X [91, 92] | X [91, 92] | R [92] | ||||
| Electrotherapy | X | X [93-97] | R [98, 99] | R [97, 100] | |||
| Low-level laser | X | X [101] | R [101, 102] | ||||
| Heat | X | X | X [103] | ||||
| Ultrasound | X [104] | X [105] | X [104] | X [104, 105] |
Key: R = CPG recommends treatment, X = CPG does not recommend treatment, # = analgesic dose. Blank = this acute treatment choice was not included in CPG.