Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021

This APTA Orthopaedic academy guideline, revised in 2021 and published in JOSPT, covers physical therapy for acute lateral ankle sprains and for chronic ankle instability. It spans prognosis, diagnosis, examination measures, prevention and treatment, and endorses the Ottawa ankle rules for deciding whether an x-ray is needed after an acute sprain.

For prevention, it gives strong support to prophylactic bracing against a first sprain and to bracing plus balance-focused exercise after a first sprain. After an acute sprain, it supports external support with progressive weight bearing, structured therapeutic exercise, and manual therapy, including joint mobilization, combined with exercise. It recommends against ultrasound and finds conflicting evidence for electrotherapy.

For chronic instability, it strongly favors proprioceptive and neuromuscular exercise and manual therapy, such as joint mobilization, manipulation and mobilization with movement, to improve dorsiflexion and balance in the short term. Dry needling of the fibularis muscles alongside proprioceptive training is a weaker option, and bracing or taping alone is not recommended to improve balance.