Treatment Of Acute Ankle Sprains Research Articles

Discussion on the Theoretical Basis and Mechanism of Shenting Zhigu Method in the Treatment of Acute Ankle Sprain and Contusion

Discussion on the Theoretical Basis and Mechanism of Shenting Zhigu Method in the Treatment of Acute Ankle Sprain and Contusion

A Randomized, Clinical Trial Comparing the Efficacy of a Fascia Release Technique for the Treatment of Acute Ankle Sprains

Acute ankle sprains are treated with ice, elevation, immobilization, and non-steroidal anti-inflammatory drugs. Resolution typically takes days. Osteopathic physicians utilize manipulation for a variety of joint disorders and injuries. Few have been studied in randomized controlled trials and many allopathic physicians are unaware of their utility. One manipulation, a modified muscle energy release technique, appears to offer promise for the treatment of acute ankle injuries, potentially returning patients to function more quickly than standard treatment alone. This study involved a comparison of a modified muscle energy release technique with standard treatment to standard treatment alone in the emergency department (ED) setting for patients with acute ankle injuries. This is an IRB approved, randomized single-blind sham-controlled study on a convenience sample of ED patients with pain from acute inversion injury. The study was set in a suburban ED with a 3-year Emergency Medicine Residency and an annual volume of 80,000. Inclusion criteria were patients aged 18-55 years; a Grade I or II acute ankle sprain less than 48 hours old; initial VAS scores ≥ 35; and being able to take 4 steps in the ED. We excluded fractures and Grade III injuries. The experimental manipulation technique involved placing the ankle into position of injury (inversion) for over 90 seconds and then bringing the ankle back to a neutral position over 90 seconds against mild hand resistance. The sham manipulation was similar but with plantar-flexion manipulation instead Patients were evaluated pre and 5 minutes after manipulation and 2 days later with a 100mm VAS pain scale completed by the patient after taking 4 steps. 17 patients were enrolled, 7 in the experimental (E) and 10 in the sham (S) group; 7 (41%) were female. There was no difference between groups for age (E=32; S=32 years p=0.9), gender (p=0.9), time from injury (E=7 vs S=11 hours; p=0.4) or initial VAS (E= 51 mm (SD 27); S= 57 mm (SD 20) (p=0.7). Both groups had similar distributions of pain (see schematic). There was no difference in mean pain relief between groups immediately after manipulation E=2.4mm (-11.0-15.88, 95%CI) vs S= 7.2mm (0.08-14.8, 95%CI) (p=0.4) or 2 days later E=29.1mm 1mm (8.5-49.7, 95%CI) S=26 (7.7 95%CI (p=0.8). Muscle energy release for acute ankle sprain does not improve pain immediately or in 2 days compared to standard treatment.

Consecutive Ankle Sprain Classification and Injury Systematization (CASCaIS), A New Lateral Ankle Sprain Classification Based on the Pivot Test: A Prospective Cohort Study

The biggest challenge in the treatment of acute ankle sprain is the uncertainty of the prognosis. The traditional classifications have several interpretations and little correlation with prognosis. In this study we propose a new classification for acute ankle sprain only based on clinical criteria. We prospectively evaluated all patients with an ankle sprain, aged between 18 and 45 years, admitted to a hospital during a 24 month period. The minimum follow-up period was 12 months. The sprains were classified, in the first few days (CASCaIS-Initial), according to autonomous gait capacity, inspection and palpation. After a few weeks (CASCaIS-Deferred), it was complemented with the mechanical evaluation of ligaments through the ankle pivot test. Among the 49 patients who completed the follow-up, none of those who had a pivot-negative test progressed to chronic ankle instability (CAI). Nine of the 33 patients (27%) with a positive pivot progressed to CAI (p = 0.022). The evaluation of CASCaIS-Deferred demonstrated an association with CAI (p = 0.018). This classification proved to be a simple, inexpensive, and reliable tool that clinicians can use to determine the prognosis of the sprain.

Clinical efficacy of sticking-needle acupuncture plus tendon-regulating manipulation in the treatment of acute ankle sprain

Clinical efficacy of sticking-needle acupuncture plus tendon-regulating manipulation in the treatment of acute ankle sprain

Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review.

Current prehospital recommendations for an acute closed extremity joint injury (ACEJI) are to apply compression in some manner. However, the effectiveness of compression is unclear. We performed a systematic review to summarize and synthesize the evidence for the use of a compression bandage for ACEJI in the prehospital setting. Cochrane Library, PubMed, and Embase were searched for relevant literature in November 2019. Controlled trials involving adults in the prehospital setting with a recent ACEJI were included when compressive, nonimmobilizing interventions, feasible in a first aid setting, were applied and compared with no compression or any noncompressive intervention, such as braces, splints, or noncompressive stockings. Articles in all languages were included if an English abstract was available. Data on study design, study population, intervention, outcome measures, and methodologic quality were extracted from each included article. Eight studies out of 1193 possibly relevant articles were included. All authors examined compression in the treatment of acute ankle sprains; no studies involved compression for the treatment of other ACEJIs. No difference in the major outcomes of pain reduction or swelling, ankle-joint function, or range of motion could be demonstrated. For the outcome of recovery time, no benefit was shown when comparing compression with no compression. Evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low certainty. The evidence for the use of a compression wrap was limited to patients with closed ankle injuries. In this systematic review, we could not demonstrate either a beneficial or harmful effect from the application of a compression or elastic bandage compared with no compression or a noncompressive stocking, splint, or brace as a first aid treatment in the prehospital environment.

Observation of curative effect on lumbar facet joint syndrome by palace bonesetting therapeutic combined with lumbar medial branch nerve block

Objective To observe the clinical effect of palace bone-setting Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation in the treatment of acute ankle sprain. Methods A total of 60 patients with acute ankle sprain were collected and randomly divided into observation group and control group according to the random number table method, with 30 cases in each group. The observation group was treated with Palace Bone-setting Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi for fixation. The control group was treated with external application of diclofenac diethylamine emulsion and fixation of elastic bandage. Two groups were treated for 14 days. The patients pain disappeared time and the swelling subsided, the VAS scale for assessment of ankle pain observed. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-after scoring system was used to assess the Ankle function, evaluation of clinical curative effect. Results The pain disappear time (9.7 ± 1.6 d vs. 13.4 ± 3.5 d, t=5.638), regression and time (3.5 ± 1.3 d vs. 6.7 ± 1.1 d, t=10.292) in the observation group were significantly earlier than those in the control group (P<0.01). After treatment, VAS score (1.9 ± 1.1 vs. 3.3 ± 1.3, t=4.503) of the observation group significantly lower than that of the control group (P<0.01); AOFAS score (93.6 ± 3.9 vs. 84.2 ± 5.1, t=8.019) significantly higher than the control group (P<0.01). Total effective rate in the observation group was 96.7% (29/30), and the control group was 80.0% (24/30), which the difference was statistically significant (χ2=4.043, P=0.044). Conclusions The Palace Bone-setting Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation has definite curative effect on acute ankle sprain, relieve pain, swelling and promote the ankle function. Key words: Ankle joint; Sprains and strains; Dieda-Wanying cream; Yuan Shu Zhi Pai Zi; Palace bonesetting; Comparative effectiveness research

Primary Treatment of Acute Ankle Sprain: Retrospective Comparison of Cast Immobilization and Functional Ankle Brace

Primary Treatment of Acute Ankle Sprain: Retrospective Comparison of Cast Immobilization and Functional Ankle Brace

Restrictions in the Ankle Sagittal- and Frontal-Plane Range of Movement during Simulated Walking with Different Types of Orthoses

Different types of orthoses are available to clinicians for non-surgical treatment of acute ankle sprains. The goal of this study was to scientifically compare the movement restrictions in the sagittal and frontal plane during simulated walking between one adaptable semi-rigid brace (OrthoTri-PhaseTM), four non-adaptable semi-rigid braces (OrthoStandardTM, MalleoLocTM, MalleoSprintTM, VACOankleTM), and one rigid cast. Predefined time sequences of rotational moments and axial loading during gait were applied via an ankle joint simulator, with the pneumatic pressure inside the orthoses kept constant to ensure the same condition for different trials and orthoses. The peak ranges of motion (RoMs) in the frontal and sagittal plane during gait were analyzed for statistically significant differences using single-factorial ANOVA with post-hoc Bonferroni analysis. Significant differences in peak plantar-/dorsiflexion and in-/eversion RoM during gait were found between different types of orthoses. In the sagittal plane, the rigid cast most significantly restricted overall RoM followed by the Ortho Tri-PhaseTM in Phase 1 and the Ortho StandardTM. The peak restriction in-/eversion RoM of the VACOankleTM came closest to the rigid cast, with a shift towards inversion. The VACOankleTM allowed for significantly larger dorsiflexion movement compared to all other orthoses. The present results may help clinicians in the decision-making process of finding the optimal orthosis for individual patients.

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.

Progress on diagnosis and treatment for chronic ankle instability

Chronic ankle instability is a common disease which is caused by missed diagnosis or inappropriate treatment of acute ankle sprain. It could lead to long-term pain, traumatic arthritis and malfunctions. While the consistent standard for its diagnosis and treatment has not yet formed. There are a lot of inspection items, such as X-ray, MRI, B ultrasoud. For the treatment of CAI, surgery is the primary method for treatment of chronic ankle instability, but clinicians may be confused with variety operation ways, which were reported with different clinical efficacy. In recent years, the non-anatomical repair has been turn to anatomy reconstruction in the surgical treatment of CAI.

Management of acute ankle sprain: A literature review

Among musculoskeletal injuries, the incidence of ankle sprains is between 15% and 20% of sports injuries. The ankle is supported laterally by the anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament, whilst the medial aspect is supported by the deltoid ligament. Ankle sprains can be either acute sprains, which can be further classified into three grades depending on the severity of the injury, or chronic instability. Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention. Successful treatment of acute ankle sprain can be achieved with individualized, aggressive and non-operative measures. Surgery should always be indicated on an individual basis

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BackgroundAnkle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise...

Topical Ketoprofen Versus Placebo in Treatment of Acute Ankle Sprain in the Emergency Department.

Topical agents have been shown to be effective in soft tissue injuries and commonly used in outpatient clinics. However, the data regarding topical agents in the emergency department is insufficient, and they are not used often in the emergency department setting. The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in patients presenting with ankle sprain to the emergency department. Patients presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered over a 5-cm area locally. Pain alleviation was measured by visual analog scale at 15 and 30 minutes. A total of 100 patients were included in the final analysis. The median pain reduction in ketoprofen and placebo groups at 15 minutes was 27 (19.8-33.4) and 9 (7.6-17), respectively. The median pain reduction at 30 minutes for both groups was 42 (36-50.8) and 20 (17.6-24.4), respectively. Pain improvement either at 15 minutes (median difference: 16 [9-22]) or 30 minutes (median difference: 21 [15-27]) was better in the ketoprofen group than placebo. There were no adverse effects in either group. Ketoprofen gel was superior to placebo at 30 minutes in alleviating pain secondary to ankle sprain in the ED with a high safety profile. Further studies are needed concerning the effect of ketoprofen gel for long-term effects. Level I, high quality prospective randomized study.

The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains

Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p < 0.0005 for each). Conclusions These data provide preliminary evidence of the efficacy of Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results.Implications for RehabilitationAnkle sprains are common acute injuries among professional and recreational sports players but also among people in general.Cryotherapy is the first-standard treatment of acute ankle sprains.Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains.The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.

The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial.

BackgroundAnkle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice, however promising results were achieved in a preventive trial among athletes. Therefore, the objective is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice.Method/DesignThis study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement.DiscussionFor general practitioners the treatment of acute ankle sprains is a challenge. A neuromuscular training program that has proven to be effective for athletes might be a direct treatment tool for acute ankle sprains in general practice. Positive results of this randomized controlled trial can lead to changes in practice guidelines for general practitioners. In addition, since this training program is e-health supported, positive results can also lead to a novel way of injury prevention.Trial registrationDutch Trial Registration: NTR4765.

Comparison of two main treatment modalities for acute ankle sprain.

Objective:Acute ankle sprains are one of the most common injuries in emergency departments. Immobilization is widely accepted as the basic treatment modality for acute ankle sprains; however, immobilization method remains controversial. In this study, we aimed to compare two treatment modalities: splint and elastic bandage for the management of acute ankle sprains.Methods:This prospective study was conducted in the emergency department. Fifty-one consecutive patients who were admitted to the emergency department owing to the complaint of ankle sprain and who were treated with an elastic bandage or a splint were included in the study. After bone injury was ruled out, treatment choice was left to the on-shift physicians’ discretion. The extent of edema was evaluated before and after the treatment by using a small, graduated container filled with warm water. Volume differences were calculated by immersing both lower extremities in a container filled to a constant level. Pain was evaluated using the visual analogue scale.Results:There were 25 patients in the elastic bandage group and 26 patients in the splint group. VAS scores of these groups before and after the treatment were similar. Although edema size before and after the treatment were similar between the groups, edema size reduction was significantly more in the elastic bandage group [p=0,025].Conclusions:This study showed that treatment of acute ankle sprains with an elastic bandage was more effective than splint in reducing edema. Therefore, an elastic bandage could be preferred over a splint for the treatment of acute ankle sprains.

Diagnosis and Treatment of Acute Ankle Sprain

ⓒAcute sprain of the ankle requires comprehensive history taking and physical examination in diagnosing the type of severity and deciding on the plan of treatment. Literature supports functional treatment as the treatment of choice for grade I and II injuries. During the acute phase, the goal of treatment focuses on controlling pain and swelling. PRICE (protection, rest, ice, compression, and elevation) is a well-established protocol at this phase. There is some evidence that application of ice and use of nonsteroidal anti-inflammatory drugs improves healing and speeds recovery. Then the functional treatment (motion restoration and strengthening exercises) is administered to progress the rehabilitation appropriately in order to facilitate healing and restore the mechanical strength and proprioception. Early mobilization has been shown to result in more rapid return to work and daily activities than immobilization. Grade III injuries still generate controversy in terms of the best management available, and more studies on early mobilization, cast immobilization, or surgery are needed. Even the Cochrane reviews published to date are not conclusive.

Acupuncture for treating acute ankle sprains in adults.

An acute ankle sprain is a sudden-onset injury of one or more of the ankle ligaments. It is one of the most common musculoskeletal injuries in the general population as well as in athletes. In some countries, such as China and Korea, acupuncture is frequently used in the treatment of ankle sprains, either as a single treatment or a secondary intervention accompanied by standard medical treatment. To assess the effects (benefits and harms) of acupuncture for the treatment of ankle sprains in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 4), MEDLINE (1948 to May week 2 2013), EMBASE (1980 to May week 2 2013), China National Knowledge Infrastructure databases (1994 to August week 4 2013), the Cumulative Index to Nursing and Allied Health Literature (1937 to May 2013), the Allied and Complementary Medicine Database (1985 to May 2013), Science Links Japan (1996 to August week 4 2013), several Korean medical databases (August week 4 2013), the World Health Organization International Clinical Trials Registry Platform (August week 4 2013), the bibliographic references of included trials and conference proceedings. We included randomised and quasi-randomised controlled trials involving adults with acute ankle sprains. We included all types of acupuncture practices, such as needle acupuncture, electroacupuncture, laser acupuncture, pharmacoacupuncture, non-penetrating acupuncture point stimulation (e.g. acupressure and magnets) and moxibustion. Acupuncture could be compared with control (no treatment or placebo) or another standard non-surgical intervention. Two review authors independently screened the search results, assessed trial eligibility, assessed risk of bias and extracted data from the included trials. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences for continuous outcomes. We conducted meta-analyses using the fixed-effect method or, where appropriate, the random-effects method, and used 95% confidence intervals (CI) throughout. We included a total of 20 heterogeneous studies (2012 participants with acute ankle sprains); three of which included more than one comparison. Seventeen trials were conducted in China. All of the studies had a high risk of bias due to lack of blinding. The results may also have been affected by selection bias, particularly as five studies were quasi-randomised controlled trials and 12 studies gave no information on their method of randomisation. Of our three prespecified primary outcomes, only cure rate was reported by the majority of studies. No study reported on patient-reported assessment of function and only one reported on adverse events (in which three participants receiving a control intervention experienced skin problems from over-the-counter Chinese herbal patches). The other 19 studies did not record or report on adverse events. We assessed the quality of evidence for cure rates as very low for all comparisons, which means we are very uncertain about the reliability of any of the estimates.The single study comparing acupuncture treatment with no treatment found acupuncture to be more effective with regard to cure rate at five days (31/31 versus 1/30; RR 20.34, 95% CI 4.27 to 96.68). Acupuncture plus another standard treatment versus that standard treatment alone was tested in eight studies; with cure rate data available for seven. Most of these studies reported higher cure rates in the acupuncture plus another standard treatment group than in the standard treatment alone group. However, while the results of an exploratory meta-analysis of cure rate data from eight trials testing acupuncture versus no acupuncture tended to favour acupuncture, the results were very inconsistent across the studies and the estimated effect was very imprecise (383/396 versus 272/355; RR 1.32, 95% CI 0.95 to 1.84; P value = 0.1; I(2) = 98%).Fourteen studies compared acupuncture with a variety of other non-surgical treatments, such as Chinese drug patches, hot and cold water, ice packs, oral Chinese herbal medicine and elastic bandage. Some studies found in favour of acupuncture, some in favour of the other treatment and some found a lack of evidence for a difference between the two interventions under test. The results of an exploratory meta-analysis of cure rate data from 11 trials testing acupuncture versus another non-surgical intervention tended to slightly favour acupuncture, but these were not statistically significant and the data were very heterogeneous (404/509 versus 416/497; RR 1.07, 95% CI 0.94 to 1.22; P value = 0.30; I(2) = 92%). The currently available evidence from a very heterogeneous group of randomised and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions. Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.

Les entorses de la cheville et leurs séquelles

Ankle sprain are one of the most frequent sport injuries and can occur with every type of sport activity. The anterior talofibular ligament is the most injured ligament and can lead to sequelae (chronic pain, ankle instability). The severity of sprain is linked to the type of the lesion (partial or complete tear) and to the number of ligaments involved. Physical examination 4 to 5 days after the initial injury remains the most efficient way to assess the severity of the sprain and the eventual associated lesions. Treatment of acute ankle sprain is based on painkillers, anti-inflammatory with early mobilization and functional physiotherapy (postural control and proprioception) to enable a quick recovery and avoid chronic ankle instability.

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events

In the recent clinical guideline for acute lateral ankle sprain, the current best evidence for diagnosis, treatment and prevention strategies was evaluated. Key findings for treatment included the use of ice and compression in the initial phase of treatment, in combination with rest and elevation. A short period of taking non-steroidal anti-inflammatory drugs (NSAIDs) may facilitate a rapid decrease in pain and swelling can also be helpful in the acute phase. The objective was to assess the effectiveness and safety of oral and topical NSAID in the treatment for acute ankle sprains. Randomised controlled trials comparing oral or topic NSAID treatment with placebo or each other were included. Primary outcome measures were pain at rest or at mobilisation and adverse events. Trials were assessed using the Cochrane risk of bias tool. Twenty-eight studies were included, and 22 were available for meta-analysis. Superior results were reported for oral NSAIDs when compared with placebo, concerning pain on weight bearing on short term, pain at rest on the short term, and less swelling on short- and intermediate term. For topical NSAIDs, superior results compared with placebo were found for pain at rest (short term), persistent pain (intermediate term), pain on weight bearing (short- and intermediate term) and for swelling (short and intermediate term). No trials were included comparing oral with topic NSAIDs, so conclusions regarding this comparison are not realistic. The current evidence is limited due to the low number of studies, lack of methodological quality of the included studies as well as the small sample size of the included studies. Nevertheless, the findings from this review support the use of NSAIDs for the initial treatment for acute ankle sprains. Meta-analysis of RCTs, Level I.