Acute Ankle Sprain Research Articles

Effects of Dangguixu-san on acute lateral ankle sprain: study protocol for a randomized controlled trial

BackgroundAnkle sprain is a common musculoskeletal injury. In Korean medicine, blood stasis is thought to be the main cause of pain and swelling in patients with ankle sprain. Dangguixu-san (DS), a herbal extract, is widely used in Korean medicine for the treatment of traumatic ecchymosis and pain by promoting blood circulation and relieving blood stasis. However, the effects of DS on ankle sprain have not been evaluated in a randomized clinical trial. Here, we describe the protocol for a randomized controlled trial that will evaluate the efficacy and safety of DS for the treatment of ankle sprain.Methods/designIn this randomized, double-blinded, placebo-controlled, parallel-arm clinical trial with a 1:1 allocation ratio, participants (n = 48) with acute lateral ankle sprain (ALAS) that occurred within 72 h before enrollment will be randomly assigned to a DS (n = 24) or a placebo (n = 24) group. Both groups will receive acupuncture treatment once a day for 5 days a week (excluding Saturday and Sunday) and the trial medication (DS/placebo capsule) three times a day for seven consecutive days. The primary outcome measure will be pain relief evaluated using a Visual Analog Scale (VAS). Secondary outcome measures will include Foot and Ankle Outcome Scores (FAOS), edema, European Quality of Life Five-Dimension-Five-Level Scale (EQ-5D-5 L) scores, and the number of recurrent ankle sprains. VAS, FAOS, edema, and EQ-5D-5 L scores will be recorded before, at the end of, and at 4 weeks after treatment completion. EQ-5D-5 L scores will be additionally recorded at 26 weeks after treatment completion. The number of recurrent ankle sprains will be recorded at 4, 8, 12, and 26 weeks after treatment completion.DiscussionThis study is expected to provide evidence regarding the efficacy, safety, and usefulness of DS for the treatment of ALAS.Trial registrationcris.nih.go.kr, registration number: KCT 0002374. Registered on 11 July, 2017 and approved by the Ministry of Food and Drug Safety (registration number, 31244).

Functional treatment for acute ankle sprains: Softcast wrap versus MOK-cast. A prospective randomized single-center trial

BackgroundThe outcome of a removable (MOK-cast) versus a non-removable polyester wrap for acute lateral ankle ligament injury is unknown. MethodsPatients with grade II–III lateral ankle ligament injuries were randomized between treatment with a MOK-cast and a wrap. Primary outcome is the Karlsson score for function. Secondary outcomes are patient satisfaction and pain at 4 months follow-up. ResultsRandomisation resulted in 53 and 54 patients per arm. Four month follow up was completed by 92% (n=100). The mean Karlsson score improved from 20 to 87 (p<0.01) in the wrap group and 20 to 90 (p<0.01) in the MOK-cast group. In the MOK-cast group treatment satisfaction was higher (8.2 vs 7.8 p 0.04). Reported pain was higher in the first thirty days after injury (p<0.01). ConclusionsBoth wrap and MOK-cast are effective functional treatment options in acute lateral ankle ligament injury. MOK-cast is associated with increased patient satisfaction but higher VAS pain scores.Level of evidence: I.

Intraoperative Findings of Lateral Ligament Avulsion Fractures and Outcome After Refixation to the Fibula.

An acute ankle sprain can result in a bony avulsion of the lateral ankle ligaments. The extent of concomitant lesions and subsequent instability patterns are not clearly understood. The high incidence of old avulsion fractures found in symptomatic chronic ankle instability may indicate the need for primary fixation. Ten patients (5 male, 5 female; mean age, 34 years; range, 15-64 years) with bony avulsion fractures of the fibula after acute ankle sprains were included. All patients were treated after a mean of 7.7 days (range, 2-17 days) with screw fixation of the fragment to the fibula. Clinical and radiographic assessments were performed, and the extent of ligament injury was documented. The anterior talofibular ligament and calcaneofibular ligament were found to be attached to the avulsion fragment. The average size was 6.3 mm (range, 4-9 mm) in width from anterior to posterior and 5.2 mm (range, 4-7 mm) in length from superior to inferior. The displacement of the fragment increased under varus stress. Two patients had cartilage lesions in the lateral talus. After a mean follow-up period of 2.4 years (range, 2-4 years), all were clinically and radiographically stable, and patients were satisfied. It was observed arthroscopically that the anterior talofibular ligament and calcaneofibular ligament were attached to the fragment. This is critical because motion between the fragment and the fibula may prevent spontaneous healing. Primary fixation of the fragment prevented rotational instability and was efficient to restore function and stability. Level IV, retrospective case series.

Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain: A randomized controlled trial

Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain: A randomized controlled trial

The effects of Kinesiotape on acute lateral ankle sprain: study protocol for a randomized controlled trial

BackgroundAnkle sprains are some of the most frequent injuries of the musculoskeletal system. However, there is no substantive evidence supporting which treatment strategy is superior. Taping with Kinesiotape (KT) is a new method that is used as an alternative to the more established taping and bracing techniques used for the prophylaxis and treatment of ankle sprains. The aim of this study is to examine the efficacy of KT on ankle sprain by comparing acupuncture combined with KT (AcuKT) with acupuncture alone in patients with acute lateral ankle sprains.Methods/designThis study is a prospective, multi-center (DongShin University Gwangju Oriental Hospital, DongShin University Mokpo Oriental Hospital, and KyungHee Korean Medicine Hospital), outcome assessor-blinded, randomized controlled clinical trial with a 1:1 allocation ratio. Participants (n = 60) with a lateral ankle sprain occurring within 1 week of the study will be randomly assigned to either an acupuncture group (n = 10 at each center (total n = 30)) or an AcuKT group (n = 10 at each center (total n = 30)). The acupuncture group will receive acupuncture treatment at ST36, ST41, BL60, BL62, KI3, KI6, GB39, and GB40 once per day, 5 days per week (excluding Saturday and Sunday) for 1 week. The AcuKT group will receive acupuncture treatment at ST36, ST41, BL60, BL62, KI3, KI6, GB39, and GB40 and the ankle meridian tendino-musculature and a figure-of-eight shape form of KT treatment once per day, 5 days per week (excluding Saturday and Sunday) for 1 week. The primary outcome will be pain evaluation assessed according to a Visual Analogue Scale (VAS), while Foot and Ankle Outcome Score (FAOS), edema, European Quality of Life Five Dimension-Five Level Scale (EQ-5D-5 L) score, and number of recurrent ankle sprains will be considered as secondary outcome measures. VAS, FAOS, and edema measurements will be performed at baseline (before intervention), 5 days after the first intervention (i.e., at the end of the intervention), and 4 weeks after the completion of intervention. EQ-5D-5 L measurements will be conducted at baseline, 5 days after the first intervention, 4 weeks after the completion of intervention, and 26 weeks after the completion of intervention. The number of recurrent ankle sprains will be determined at 4, 8, 12, and 26 weeks after the completion of the intervention.DiscussionThis study will provide data regarding the efficacy of KT for the treatment of acute lateral ankle sprain. The results may lead to insights into the usefulness of KT in the treatment of acute lateral ankle sprain.Trial registrationcris.nih.go.kr, ID: KCT0002257. Registered on 27 February 2017, and approved by the Ministry of Food and Drug Safety (Medical Device Clinical Trial Plan Approval #737).

Evaluation of the therapeutic effects of led (λ627 ± 10nm) on the initial phase of ankle sprain treatment: a randomised placebo-controlled clinical trial.

Various therapies for the treatment of sprains have emerged as advances occur in biomedical engineering and photobiology. Therapy with coherent and non-coherent light is a treatment modality for various musculoskeletal injuries. The main certified phototherapy benefits are the reduction of nociceptive processes and the modulation of the inflammatory process, among others. The objective of this study was to analyse the changes caused by the use of light-emitting diodes (LED) (λ627 ± 10nm) with an energy density of 10J/cm2 in 40 subjects divided into two groups (20 placebo and 20 LED). All of the volunteers had acute ankle sprains by inversion of grade II treated with the PRICE (protection, rest, ice, compression and elevation) technique and were treated for 6days with LED therapy and LED therapy turned off (placebo). Pain assessment was performed on the 1st, 3rd and 6th days using the visual analogue scale (VAS) of pain, the McGill Pain Questionnaire and volumetry. The group treated with LED showed statistically decreased pain compared to the placebo group in both the VAS (85.79 vs 55.73%) and McGill questionnaire (83.33 vs 52.52%). The reduction of oedema in the LED group on the 3rd and 6th days after therapy was statistically superior to that in the placebo (p < 0.0001). Based on the results of this study, treatment with LED, using the tested dose, is effective for pain and oedema in the initial phase of ankle sprains.

EFFICACY OF THE STRETCH BAND ANKLE TRACTION TECHNIQUE IN THE TREATMENT OF PEDIATRIC PATIENTS WITH ACUTE ANKLE SPRAINS: A RANDOMIZED CONTROL TRIAL

Ankle injuries account for up to 40% of all sport related injuries. These injuries can result in weeks to months of missed sport or work. The PRICE (Protection, Rest, Ice, Compression, Elevation) treatment is standard care for most acute ankle sprains. Recently, early mobilization in adults has been shown to decrease time off from sport or work, and the likelihood of developing chronic instability. To date, no research has been performed assessing the effectiveness of early mobilization in pediatric patients (<18 years). Purpose: There were two objectives of this study: (1) to determine if early ankle joint mobilization using elastic band traction is effective and (2) assess the occurrence of adverse events with this technique in the pediatric population. Patients with an acute ankle sprain of <7 days referred to physical therapy were randomly assigned to receive early mobilization or PRICE. Early mobilization was performed using a stretch band ankle traction technique. Both groups received a standardized rehabilitation program. Pain, edema, ankle strength using hand-held dynamometry, and Foot and Ankle Disability Index (FADI) were measured at both initial evaluation and at discharge. The number of days before return to sport and the number of treatment sessions were also variables of interest. Forty-one pediatric patients were recruited for participation (mean age 14.6 + 1.9 years). Both treatment groups had clinically significant improvements in pain, edema, strength, and FADI scores. No significant differences in outcomes were noted between treatment groups. Mean number of days for return to sport for the PRICE group was 26.33 + 7.14 and the early mobilization group was 26.63 + 14.82, the difference between groups was not significant (p = 0.607). The number of total visits for the PRICE group of 8.07 + 2.63 and the early mobilization groups of 8.5 + 1.57, was also not statistically significantly different (p = 0.762). There were no reported adverse events with early mobilization. Early mobilization appears to be a safe intervention in pediatric patients with an acute ankle sprain. Early mobilization resulted in similar outcomes when compared to traditional PRICE treatment. A high drop-out rate in both treatment groups was a limitation of this randomized trial. 1b.

Stratification of injuries to the lateral collateral ligament of the ankle using ultrasound: protocol of a prospective, open-label, diagnostic trial and preliminary results

Background and objectives: Patients with ankle sprain most commonly experience injuries to the lateral collateral ligament (LCL) complex, which affects the stability and function of the ankle. Early diagnosis of LCL complex injuries is extremely important. In clinical practice, magnetic resonance imaging (MRI) displays the soft tissues of the ankle well, but it is expensive and cannot be used for real-time evaluation. Ultrasound (US) has the advantages of ease of operation, low cost, and real-time capability. Some studies have reported on the stratification of injuries to the LCL complex using US. However, there is controversy regarding the injury grading. The purpose of this study was to investigate the grading of LCL complex injuries (sprain, partial tear, and complete tear) using US. Design: A prospective, open-label, diagnostic trial. Methods: Seventy patients with suspected ankle sprain who have an acute ankle sprain history and present with surgical indicators will be scheduled to receive ankle ligament repair surgery in the Guangzhou Orthopedics Hospital, China. On the day after admission, these patients will undergo US and magnetic resonance imaging (MRI) of the injured ankle prior to ankle ligament repair surgery (test group). The contralateral ankle will be included in the control group and will also undergo MRI and US examination prior to surgery. MRI or surgical results will be used as the gold standard for diagnosing LCL complex injuries. The feasibility of stratification of LCL complex injuries (sprain, partial tear, and complete tear) using US will be evaluated. Outcome measures and preliminary results: The primary outcome measure of this study is the sensitivity of US in the diagnosis of complete LCL complex tear. The secondary outcome measures are the sensitivity of US in the diagnosis of sprain and partial tear of the LCL complex; the specificity, positive predictive value, negative predictive value, accuracy, area under the ROC curve (AUC), and cut-off value of US in the diagnosis of sprain, partial tear, and complete tear of the LCL; and US imaging for the anatomy of the LCL complex. The results of 53 patients with acute ankle sprain included in the preliminary study suggest that there is no significant difference in the type of injuries to the talofibular ligament and calcaneofibular ligament between ultrasound diagnosis results and surgical or MRI findings (P > 0.05). Discussion: The results of this study will reveal whether US has a higher diagnostic value than MRI in the diagnosis of injuries to the LCL complex. Ethics and dissemination: This study was approved by Medical Ethics Committee of Guangzhou Orthopedics Hospital, China in May, 2018 (approval No. 2018-05). This study protocol will be performed in strict accordance with the Declaration of Helsinki. The personal information and data of the testing subjects participating in the clinical trials will be confidential and will be protected in accordance with applicable laws and regulations. The study protocol was designed in February 2018. Patient recruitment will begin in August 2018 and end in August 2019. Data collection will begin in August 2018. Data analysis will be performed in December 2019. The study will end in March 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016244). Protocol version: 1.0.

The management of acute lateral ankle sprains: a survey of South African surgeons and best evidence available

Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilisation such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regard to professional athletes. The aim of the study was to assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa, by means of a descriptive cross-sectional survey analysis. Methods: This was a two-part study. First, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade three lateral ankle sprain in a non-professional athlete. Secondly, a literature review was undertaken to establish the current best practice concerning ankle sprain management. Results: A total of 129 responses was received out of the 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of six weeks was chosen by 49 (38%) and two to four weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding South African Orthopaedic Association members chose a short period of immobilisation followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence, there seems to be a lack of consensus in the management of grade three lateral ankle sprains. Level of evidence: Level 5

Evidence-based Treatment of Acute Lateral Ankle Sprain

Evidence-based Treatment of Acute Lateral Ankle Sprain

Clinical Tests Have Limited Predictive Value for Chronic Ankle Instability When Conducted in the Acute Phase of a First-Time Lateral Ankle Sprain Injury

ObjectiveTo evaluate whether a battery of clinical assessments for acute lateral ankle sprain (LAS) can be used to predict long-term recovery. DesignCohort study. SettingUniversity biomechanics laboratory. ParticipantsIndividuals (N=82) were assessed using a clinical test battery within 2 weeks of incurring a first-time LAS. InterventionsNot applicable. Main Outcome MeasuresThe clinical test battery included scores on the talar glide test (degrees), the anterior drawer, talar tilt, figure of 8 for swelling (millimeters) and knee to wall (millimeters) tests, and handheld goniometric range of motion (inversion, eversion, and plantarflexion [in degrees]). Scores on the Cumberland Ankle Instability Tool taken 12 months after the clinical test battery were used to classify participants as having chronic ankle instability (CAI) or as being LAS copers. ResultsForty percent of participants were designated as having CAI, with 60% being designated as LAS copers. A logistic regression analysis revealed that a combined model using scores from the talar glide, talar tilt, and anterior drawer tests in addition to plantarflexion range of motion was statistically significant (P<.01) and correctly classified cases with moderate accuracy (68.8%). The final model had moderate sensitivity (64%) and good specificity (72%). ConclusionsThe clinical tests used in this investigation have limited predictive value for CAI when conducted in the acute phase of a first-time LAS injury.

Development and external validation of a prognostic model for predicting poor outcome in patients with acute ankle sprains

Purpose: Ankle sprains are one of the most common musculoskeletal injuries. Although recovery can occur within weeks, a third of patients still have problems with their ankle at one year. In the acute phase there is no reliable way of establishing which patients are at risk of having a poor outcome. We aimed to develop and externally validate a prognostic model for identifying patients at increased risk of poor outcome after an acute ankle sprain.

Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review

BackgroundOne-third of individuals who sustain an acute lateral ankle ligament sprain suffer significant disability due to pain, functional instability, mechanical instability or recurrent sprain after recovery plateaus at 1 to 5 years post injury. The identification of early prognostic factors associated with poor recovery may provide an opportunity for early-targeted intervention and improve outcome.MethodsWe performed a comprehensive search of AMED, EMBASE, Psych Info, CINAHL, SportDiscus, PubMed, CENTRAL, PEDro, OpenGrey, abstracts and conference proceedings from inception to September 2016. Prospective studies investigating the association between baseline prognostic factors and recovery over time were included. Two independent assessors performed the study selection, data extraction and quality assessment of the studies. A narrative synthesis is presented due to inability to meta-analyse results due to clinical and statistical heterogeneity.ResultsThe search strategy yielded 3396 titles/abstracts after duplicates were removed. Thirty-six full text articles were then assessed, nine of which met the study inclusion criteria. Six were prospective cohorts, and three were secondary analyses of randomised controlled trials. Results are presented for nine studies that presented baseline prognostic factors for recovery after an acute ankle sprain. Age, female gender, swelling, restricted range of motion, limited weight bearing ability, pain (at the medial joint line and on weight-bearing dorsi-flexion at 4 weeks, and pain at rest at 3 months), higher injury severity rating, palpation/stress score, non-inversion mechanism injury, lower self-reported recovery, re-sprain within 3 months, MRI determined number of sprained ligaments, severity and bone bruise were found to be independent predictors of poor recovery. Age was one prognostic factor that demonstrated a consistent association with outcome in three studies, however cautious interpretation is advised.ConclusionsThe associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive. At present, there is insufficient evidence to recommend any factor as an independent predictor of outcome. There is a need for well-conducted prospective cohort studies with adequate sample size and long-term follow-up to provide robust evidence on prognostic factors of recovery following an acute lateral ankle sprain.Trial registrationProspero registration: CRD42014014471

What is the best initial management of grade 1 or grade 2 ankle sprains?

EVIDENCE-BASED ANSWER Nonsteroidal anti-inflammatory drugs (NSAIDs), either oral or topical, are modestly effective for decreasing pain and swelling in acute ankle sprains (SOR: A, metaanalysis of consistent RCTs). Supervised rehabilitation is slightly better than home exercises for reducing pain and improving ankle stability in the short term, but these differences disappear over time (SOR: B, systematic review of inconsistent RCTs). Current guidelines recommend NSAIDS, acetaminophen, and early mobilization as part of the initial management of ankle sprains. Evidence is insufficient regarding the value of rest, ice, compression, and elevation (RICE) (SOR: C, consensus and evidence-based clinical guideline).

Two genetic loci associated with ankle injury.

Ankle injuries, including sprains, strains and other joint derangements and instability, are common, especially for athletes involved in indoor court or jumping sports. Identifying genetic loci associated with these ankle injuries could shed light on their etiologies. A genome-wide association screen was performed using publicly available data from the Research Program in Genes, Environment and Health (RPGEH) including 1,694 cases of ankle injury and 97,646 controls. An indel (chr21:47156779:D) that lies close to a collagen gene, COL18A1, showed an association with ankle injury at genome-wide significance (p = 3.8x10-8; OR = 1.99; 95% CI = 1.75–2.23). A second DNA variant (rs13286037 on chromosome 9) that lies within an intron of the transcription factor gene NFIB showed an association that was nearly genome-wide significant (p = 5.1x10-8; OR = 1.63; 95% CI = 1.46–1.80). The ACTN3 R577X mutation was previously reported to show an association with acute ankle sprains, but did not show an association in this cohort. This study is the first genome-wide screen for ankle injury that yields insights regarding the genetic etiology of ankle injuries and provides DNA markers with the potential to inform athletes about their genetic risk for ankle injury.

The Effect of Fibular Reposition Taping on Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic.

Clinical Scenario: History of acute ankle sprains can result in chronic ankle instability (CAI). Arthrokinematic changes resulting from CAI may restrict range of motion and contribute to postural control deficits. Mulligan or fibular reposition taping (FRT) has been suggested as a means to realign fibular positional faults and may be an effective way to improve postural control and balance in patients with CAI. Clinical Question: Is there evidence to suggest that FRT will improve postural control for patients with CAI in the affected limb compared with no taping? Summary of Key Findings: Three of the 4 included studies found no significant difference in postural control in patients receiving FRT compared with sham or no tape. Clinical Bottom Line: There is moderate evidence refuting the use of FRT to improve postural control in patients with CAI. Strength of Recommendation: There is grade B evidence to support that FRT does not improve postural control in people with CAI.

The Role of the Accessory Malleolar Ossicles and Malleolar Avulsion Fractures in Lateral Ankle Ligament Reconstruction.

Level IV: Case series.

The Role of Calcaneofibular Ligament (CFL) Injury in Ankle Instability

Category: Ankle Introduction/Purpose: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, which include anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly problematic and often require surgical repair. The implications of CFL injury on ankle instability are unclear. We aim to evaluate the impact of CFL injury on ankle stability and subtalar joint biomechanics. We hypothesized that CFL injury will result in decreased stiffness and torque, and alteration of ankle contact mechanics compared to the uninjured ankle in a cadaveric model. Methods: Twenty matched cadaveric ankles dissected of skin and subcutaneous tissue were mounted to an Instron with 20° of ankle plantar flexion and 15° of internal rotation. Intact specimens were axially loaded to body weight, then underwent inversion stress along the anatomic axis of the ankle from 0 to 20° (simulating inversion injury) for three cycles. ATFL and CFL were sequentially sectioned, and inversion testing repeated for each condition. Stiffness and change in torque were recorded using an Instron, and pressure and contact area were recorded using a calibrated Tekscan sensor system. Inversion angle of the talus and calcaneus relative to the ankle mortise were recorded using a three-dimensional motion capture system. Paired t tests were performed for inter and intra-group comparisons. Results: Stiffness and torque did not significantly decrease after sectioning of the ATFL, but did decreased significantly after sectioning of CFL. Peak pressures in the tibiotalar joint decreased significantly following CFL release compared to both the uninjured ankle and ATFL-only release. Mean contact area significantly increased following CFL release compared to both the uninjured ankle and ATFL release. There was a concentration of force in the anteromedial ankle joint during weight-bearing inversion. However, the center-of-force shifts 1.22 mm posteromedial after CFL release relative to an intact ankle. Motion capture showed a significant and sequential increase in inversion angle of both the calcaneus and talus, after release of each ligament. There was significantly more inversion in the subtalar joint than the tibiotalar joint with weight-bearing inversion. Conclusion: There is significantly lower stiffness and torque with weight-bearing inversion of the ankle joint complex following injury to both ATFL and CFL, and sequentially greater inversion of the talus and calcaneus with progressive ligament injury. This corresponds to a significant shift in the center of force in the tibiotalar joint. CFL contributes considerably to lateral ankle stability, and sprains that include CFL injury result in substantial alteration of contact mechanics at the ankle and subtalar joints. Repair of CFL may be beneficial during lateral ligament reconstruction, potentially mitigating long-term consequences (e.g., articular damage) of a loose or incompetent CFL.

Prognostic factors of acute ankle sprain: Need for imaging diagnosis for proper management of acute

Prognostic factors of acute ankle sprain: Need for imaging diagnosis for proper management of acute

Effects of kinesiotaping therapy on the pain and discomfort of acute ankle sprains in Korean university students

Effects of kinesiotaping therapy on the pain and discomfort of acute ankle sprains in Korean university students