Proprioceptive training reduces the risk of ankle sprain recurrence in athletes

Abstract

Question

Does a home-based proprioceptive exercise program reduce the one-year incidence of recurrent lateral ankle sprain in athletes?

Design

Randomised controlled trial.

Setting

Participants were recruited through primary care clinics as well as through advertisements in magazines, on the internet, and at sports tournaments in The Netherlands.

Participants

522 athletes aged 12–70 years with a lateral ankle sprain in the preceding 2 months were allocated to one of two groups, using concealed allocation. The groups were comparable at baseline with respect to age, sex, hours of sports exposure, and history of ankle sprains.

Interventions

Athletes in both groups were free to seek and use any treatment they chose for their original ankle sprain. When any such interventions were complete and the athlete had returned to sport, only the intervention group additionally received an 8-week, unsupervised home-based proprioceptive training program, designed by physiotherapists. The program consisted of 3 sessions per week of up to 30 minutes each. An instructional DVD, exercise sheets, balance board, and web-based resources were provided to the intervention group. Exercises were gradually increased in difficulty and training load during the 8-week program.

Outcomes

The primary outcome was incidence of ankle sprain in the 1-year follow-up period, reported monthly on a web-based questionnaire. Reported ankle injury data were rated by a blinded assessor as acute ankle sprains or other ankle injuries. Participants who reported an ankle injury also completed a cost diary to record costs of healthcare and lost productivity until recovery.

Results

86% of participants were followed up at 12 months. 33% of athletes in the control group reported an ankle sprain during follow-up, compared with 22% in the intervention group, which is an absolute risk reduction of 12% (95% CI 4 to 19) and number needed to treat of 9 (95% CI 26 to 5). Ankle sprains were further classified as those leading to loss of sports time, and those leading to costs of healthcare or lost productivity. Regardless of the classification used, significant reductions in the risk of ankle sprain were still evident after adjustment for age, type of sport, and level of sport.

Conclusion

A home-based proprioceptive training program for athletes reduces the risk of ankle re-sprain in the following year, particularly for those who do not seek other treatment.