New York State Medical Treatment Guidelines
for Ankle Sprain in workers compensation patients
The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Ankle Sprain.
These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.
The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.
Ankle Sprain
Ankle injuries are commonplace and frequently lead to the need for urgent care. One or more ligaments in any of the three ligaments might be torn in an ankle sprain injury groups. Only the lateral ligaments are involved in the majority of ankle sprains. 15% or so of injuries involve the medial ankle.
The lateral ankle’s natural course Sprain is quickly recovering. Acute ankle sprain patients between 10% and 20% may develop persistent ankle instability
Based on physical examination results, classification methods for lateral ankle sprain severity are employed to specify the level of ligament damage.
Sprain: A ligament injury that isn’t always permanent.
Grade I: overstretching or slight tearing without instability.
Grade II: incomplete tearing.
Grade III: complete tear or rupture.
Red signs should be taken into account, including fracture.
Diagnostic Studies for Ankle Sprain in workers compensation patients
- Routine Stress X-Ray for Evaluation of Ligament Rupture in Acute Ankle Sprain
Routine Stress X-Ray for Evaluation of Ligament Rupture in Acute Ankle Sprain is not recommended to assess a severe ankle ligament tear.
- Regular Stress X-Ray for Ligament Rupture Evaluation in Chronic or Subacute Ankle Sprain
Regular Stress X-Ray for Ligament Rupture Evaluation in Chronic or Subacute Ankle Sprain are not recommended for evaluation of subacute or chronic ankle pain.
Rationale for Recommendations: No need for plain films is necessary for the diagnosis of an acute ankle sprain since x-rays are ineffective at detecting soft tissue injuries disorders.
Instead, plain film x-rays are used for the examination of the presence of an ankle or foot fracture, the direction of the fracture planes, and the extent to which the articular surfaces are affected, if any may change treatment to favour surgery. X-rays are recommended based on a significant level of clinical suspicion Consequently, x-ray is advised for assessment. of a possible foot or ankle fracture.
- CT for Assessment of Subacute or Chronic Ankle Sprain
CT for Assessment of Subacute or Chronic Ankle Sprain are recommended for the evaluation of a subset of patients with acute or persistent ankle sprain.
Indications – Patients who do not improve after non-operative treatment chronic discomfort with weight bearing, therapy after four to six weeks, or persistent sense of instability; crepitus and catching injuries to the ankles or locking, as these signs would indicate a displaced chondral bone fragment.
- CT for Assessment of Acute Ankle Sprain
CT for Assessment of Acute Ankle Sprain is not recommended for assessment of patients with acute ankle Sprain.
- Magnetic Resonance Arthrography (MRA) for Assessment of Subacute or Chronic Ankle Sprain
Magnetic Resonance Arthrography (MRA) for Assessment of Subacute or Chronic Ankle Sprain is not recommended for the assessment of subacute or chronic ankle Sprain.
- MRA for Assessment of Acute Ankle Sprain
MRA for Assessment of Acute Ankle Sprain is not recommended for the assessment of acute ankle sprain.
- Magnetic Resonance Imaging (MRI) for Assessment of Subacute or Chronic Ankle Sprain
Magnetic Resonance Imaging (MRI) for Assessment of Subacute or Chronic Ankle Sprain are recommended for evaluating certain patients with acute or recurring ankle sprain.
Indications: Patients who do not improve after non-operative treatment chronic discomfort with weight bearing, therapy after four to six weeks, or persistent sense of instability; crepitus and catching injuries to the ankles or locking, as these signs would indicate a displaced chondral bone fragment.
Rationale For Recommendation: In order to assess ligament, osteochondral damage caused by fractures, ankle sprains, and lesions of the talus and other soft tissue injuries, such as impingement.
- MRI for Assessment of Acute Ankle Sprain
MRI for Assessment of Acute Ankle Sprain is not recommended for the assessment of acute ankle sprain.
- Bone Scans for Assessment of Acute Ankle Sprain
Bone Scans for Assessment of Acute Ankle Sprain is recommended for select patients with acute ankle sprain.
Indications: stress fracture, infection, or malignancy suspected.
- Bone Scans for Assessment of Subacute or Chronic Ankle Sprain
Bone Scans for Assessment of Subacute or Chronic Ankle Sprain is not recommended for patients with subacute or chronic ankle sprain.
- Ultrasound for Diagnosis of Subacute or Chronic Ankle Sprain
Ultrasound for Diagnosis of Subacute or Chronic Ankle Sprain is not recommended for the assessment of patients with chronic or subacute sprained ankle.
- Electrodiagnostic Studies of the Peroneal nerve
Electrodiagnostic Studies of the Peroneal nerve is recommended for select patients with recurrent / recalcitrant lateral Sprains.
Indications – lateral patients with peroneal neuropathy should be ruled out sprains due to a clear inversion damage.
Medications for Ankle Sprain
Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.
There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.
- Acetaminophen for Treatment of Acute, Subacute, or Chronic Sprain Injury Pain
Acetaminophen for Treatment of Acute, Subacute, or Chronic Sprain Injury Pain are recommended to treat acute, subacute, or persistent ankle pain sprain injury pain, especially in people who shouldn’t use nonsteroidal anti-inflammatory drugs (NSAIDs).
Indications:Acute, subacute, chronic, and postoperative patients with foot/ankle pain.
Dose/Frequency: Depending on the manufacturer’s guidelines; applicable on a need-to-know basis. Hepatic toxicity is demonstrated when greater than 4 g/day.
Indications for Discontinuation: relief from discomfort, negative effects, or intolerance.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic Ankle Sprain
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic Ankle Sprain is recommended for the treatment of severe, mild, chronic, or Ankle Sprain after Surgery
Indications: NSAIDs are advised for ankle sprain pain. treatment. Over-the-counter (OTC) medications can and should be used. first try.
Frequency/Duration: Use as needed may be appropriate for many. Patients.
Indications for Discontinuation: resolution of ankle/foot discomfort, absence effectiveness, or the emergence of unfavourable effects that are necessary Discontinuation.
- NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding
NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding is recommended simultaneous application of cytoprotective groups of medications such as histamine Type 2 receptor blockers, sucralfate, misoprostol, and proton pump inhibitors for people who are at high risk for digestive problems Bleeding.
Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.
Frequency/Dose/Duration: Misoprostol, proton pump inhibitors, Sucralfate and H2 blockers are advised. dosage and repetitions per manufacturer. There isn’t typically thought to be anything there. varying degrees of effectiveness in preventing gastrointestinal bleeding
Indications for Discontinuation: Intolerance, the emergence of side symptoms or NSAID cessation.
- NSAIDs for Patients at Risk for Cardiovascular Adverse Effects
NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Aspirin or acetaminophen as the initial course of treatment seem to be the least harmful in terms of cardiovascular issues.
Non-selective NSAIDs are used as necessary. preferable to COX-2-specific medications when administering low-dose aspirin for the prevention of primary or secondary cardiovascular disease, to lessen the risk that the NSAID will have the opposite of the desired effects. The NSAID should be given at least 30 minutes after or eight hours after aspirin. a day’s worth of aspirin.
- Opioids for Select Acute or Postoperative Ankle Sprain
Opioids for Select Acute or Postoperative Ankle Sprain is recommended for a maximum of one week for selected patients acute ankle sprain-related extreme discomfort. little opioid drug use for no For those who have undergone surgery, more than one week may be recommended. surgery to restore the ankle ligaments or those who have undergone surgical Complications.
Indication: extremely judicious use acute ankle sprain and severe discomfort for pain control following surgery. Usually only to be used with either exhibited acute pain that NSAIDs were unable to control or Sprain/post-surgical discomfort.
Frequency/Dose/Duration: frequency and dosage as directed by the manufacturer recommendations; generally taken on a scheduled basis or as needed advised to be taken for brief, a few-day courses.
Indications for Discontinuation:Resolution of pain, adequate pain management with other treatments such NSAIDs, intolerance, negative side effects, lack of benefits, or failure to make progress after a few weeks.
Rationale for Recommendation: most patients with ankle problems. Sprains typically don’t cause enough pain to warrant taking painkillers.
When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. Opioids are primarily prescribed at night to help postoperative patients get some rest after surgery.
- Lidocaine Patches for Acute, Subacute, or Chronic Ankle Sprain
Lidocaine Patches for Acute, Subacute, or Chronic Ankle Sprain is not recommended to treat acute, subacute, or chronic conditions of a sprained ankle.
- Topical NSAIDs for Acute Ankle Sprain
Topical NSAIDs for Acute Ankle Sprain is recommended for the quick relief of an ankle sprain.
Indications: persons with a recent ankle sprain or those who should not take oral who are undergoing treatment or who avoid taking oral drugs. no proof of superiority of one topical NSAID over another in comparison.
Frequency/Duration: as recommended by the manufacturer. There have been reports of one to three weeks of topical NSAID usage.
Indications for Discontinuation: Problem-solving, intolerance, negative impacts, or absence of advantages.
Rationale for Recommendation: NSAIDs are applied topically to deliver when treating musculoskeletal diseases with localised and superficial medicines, including sprains of the ankle.
- Topical NSAIDs for Subacute or Chronic Ankle Sprain
Topical NSAIDs for Subacute or Chronic Ankle Sprain is not recommended for the treatment of chronic or subacute ankle Sprain.
Treatments for Ankle Sprain
- Immediate Non-weight Bearing (Rest) for Acute Ankle Sprain
Immediate Non-weight Bearing (Rest) for Acute Ankle Sprain is recommended as a first line of defence against acute ankle sprain for people who can’t handle weight.
Indications: Acute ankle sprains can range from minor to severe. patients who are unable to support their own weight. a brief depending on a predetermined time frame of up to 48 hours. Tolerance and weight-bearing capacity. Early activation is Recommended.
Frequency/Duration: up to 48 hours without bearing any weight; increasing weight bearing as tolerated, early mobilisation adding therapeutic exercises to be done at home
Indications for Discontinuation: Willingness, tolerance of weight
- Cryotherapy for Acute Ankle Sprain
Cryotherapy for Acute Ankle Sprain is recommended for the quick treatment of ankle sprains. An acute ankle sprain is a sign.
Frequency/Duration: Applying oneself for 10 to 20 minutes every two hours as needed for up to three days. Resolutions or unfavourable results are indications to stop. consequences, non-compliance
Cryotherapy / Heat for Ankle Sprain
Heat for Acute Ankle Sprain
Heat for Acute Ankle Sprain is not recommended to treat severe ankle pain
Immobilization for Ankle Sprain
- Ankle Brace (Orthosis) for Acute Ankle Sprain
Ankle Brace (Orthosis) for Acute Ankle Sprain is recommended for the treatment of a severe ankle sprain optional use for mild and moderate pain as required by the patient.
- Walking Boot for Acute Ankle Sprain
Walking Boot for Acute Ankle Sprain is not recommended of acute ankle sprains.
- Walking Boot for Select Cases of Severe Ankle Sprain
Walking Boot for Select Cases of Severe Ankle Sprain is recommended for some severe ankle sprain patients.
- Early Mobilization for Acute Ankle Sprain
Early Mobilization for Acute Ankle Sprain is recommended for acute ankle sprains without fracture.
Indications: Acute ankle sprains (severe sprains should undergo no more than three weeks of immobilisation, splints should be sufficient for immobilisation; ankle sprains that are mild or moderate should not undergo immobilisation.
Rationale for Recommendations: Early mobilisation is recommended over immobilisation for most patients
- Immobilization for Acute Mild to Moderate Ankle Sprain
Immobilization for Acute Mild to Moderate Ankle Sprain is not recommended Splints should be effective for people with mild to moderate ankle injuries.
Rationale for Recommendation: Casting is not advisable for acute mild sprains because they are typically self-limited and rapidly mobilise when initially exposed to other therapies.
- Immobilization for Severe Ankle Sprain
Immobilization for Severe Ankle Sprain is recommended splinting for immobilisation for severe ankle sprain.
Indications: Severe ankle sprain.
Frequency/Duration: Application of a splint for ten days to three weeks following a 48-hour period spent elevated and not bearing any weight.
Rationale for Recommendation: Casting has limitations on driving is impaired by exercise, even returning to work. performance is more important than bracing and carries a risk. to treat deep vein thrombosis Cast-induced immobility is consequently not advised. It is advised to use splints for incapacitation of a severely sprained ankle.
Rehabilitation for Ankle Sprain
Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.
Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.
Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.
To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.
To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.
Therapy – Active for Ankle Sprain
Therapeutic Exercise
Therapeutic Exercise is recommended – for a specific group of individuals with an acute, subacute, or persistent ankle sprain.
Frequency/Dose/Duration – With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.
If there is evidence of functional improvement toward particular objective functional goals (such as increasing range of motion or improving capacity to conduct work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments. A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.
Therapy – Passive for Ankle Sprain
- Immediate Non-weight Bearing (Rest) for Acute Ankle Sprain is recommended as an initial intervention for acute ankle sprain for patients unable to tolerate weight.
Indications: Acute ankle sprain patients who can’t bear weight include those with mild, moderate, and severe sprains. Depending on tolerance and the patient’s capacity to bear weight, a brief time of up to 48 hours may be recommended. An early mobilization is advised.
Frequency/Duration: Non Weight-bearing for up to 48 hours; early mobilization; gradual weight-bearing as tolerated; addition of rehabilitative activities done at home.
Signals of Discontinuation Willingness, tolerance of weight RICE for Ankle Sprain:
- Cryotherapy for Acute Ankle Sprain
Cryotherapy for Acute Ankle Sprain is recommended for treatment of acute ankle sprains.
Indications: Acute ankle sprain.
Frequency/Duration: Application for 10 to 20 by oneself minutes for up to three days at a time, every two hours as Needed.
Indications for Discontinuation: Resolution, negative consequences, and noncompliance.
Cryotherapy / Heat for Ankle Sprain
- Heat for Acute Ankle Sprain
Heat for Acute Ankle Sprain is not recommended for the treatment of acute ankle sprain.
- Compression Therapy for Acute Ankle Sprain
Compression Therapy for Acute Ankle Sprain is not recommended for acute ankle sprains.
- Tubigrip for Acute Ankle Sprain
Tubigrip for Acute Ankle Sprain is not recommended for acute ankle sprains.
- Tape, Elastic Wrap or Tubular Elastic for Acute Ankle Sprain
Tape, Elastic Wrap or Tubular Elastic for Acute Ankle Sprain is not recommended for acute ankle sprains.
- Intermittent Elevation for Acute Ankle Sprain
Intermittent Elevation for Acute Ankle Sprain is recommended for controlling edema of acute ankle sprains.
Indications:acute ankle sprain with severe symptoms Edema.
Indications for Discontinuation: resolution, negative consequences, Noncompliance.
- Contrast Bath Therapy for Acute Ankle Sprain
Contrast Bath Therapy for Acute Ankle Sprain is not recommended to treat severe ankle pain Sprain.
- High-Voltage Pulsed Current for Acute Ankle Sprain
High-Voltage Pulsed Current for Acute Ankle Sprain is not recommended for severely sprained ankles.
- Magnets for Acute, Subacute, or Chronic Ankle Sprain
Magnets for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of severe, moderate, or persistent ankle sprain.
- Diathermy for Acute, Subacute, or Chronic Ankle Sprain
Diathermy for Acute, Subacute, or Chronic Ankle Sprain is not recommended there is Support for Using Magnets for Ankle Sprain
- Low Frequency Electrical Stimulation for Acute, Subacute, or Chronic Ankle Sprain
Low Frequency Electrical Stimulation for Acute, Subacute, or Chronic Ankle Sprain are not recommended for chronic, acute, or subacute ankle pain
- High-voltage Pulsed Electrical Stimulation for Acute, Subacute, or Chronic Ankle Sprain
High-voltage Pulsed Electrical Stimulation for Acute, Subacute, or Chronic Ankle Sprain are not recommended as a treatment for an ankle injury that is either recent or lingering.
- Iontophoresis for Ankle Sprain, Acute, Subacute, or Chronic
Iontophoresis for Ankle Sprain, Acute, Subacute, or Chronic are not recommended for the treatment of ankle sprains that are acute, subacute, or chronic.
Low-level Laser Therapy for Acute, Subacute, or Chronic Ankle Sprain
Low-level Laser Therapy for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of ankle sprains that are acute, subacute, or chronic.
- Phonophoresis for Acute, Subacute, or Chronic Ankle Sprain
Phonophoresis for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of an ankle sprain that is severe, moderate, or long-lasting.
- Therapeutic Ultrasound for Acute, Subacute, or Chronic Ankle Sprain
Therapeutic Ultrasound for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of an acute, subacute, or chronic ankle sprain.
- Acupuncture for Acute, Subacute, or Chronic Ankle Sprain
Acupuncture for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of ankle sprains that are acute, subacute, or chronic.
- Hyperbaric Oxygen Therapy for Acute, Subacute, or Chronic Ankle Sprain
Hyperbaric Oxygen Therapy for Acute, Subacute, or Chronic Ankle Sprain are not recommended for the treatment of ankle sprains that are acute, subacute, or chronic.
- Manipulation or Mobilization for Acute or Subacute Ankle Sprain
Manipulation or Mobilization for Acute or Subacute Ankle Sprain are not recommended in order to treat acute or subacute sprained ankles.
- Manipulation or Mobilization for Chronic Recurrent Ankle
Manipulation or Mobilization for Chronic Recurrent Ankle is not recommended to treat persistent ankle sprains that repeat often.
Injection Therapy Ankle Sprain
- Ankle Sprain: Acute, Subacute, or Chronic: Autologous Blood Injection
Ankle Sprain: Acute, Subacute, or Chronic: Autologous Blood Injection are not recommended as a remedy for an ankle injury that is acute, subacute, or persistent.
- Glucocorticosteroid Injections for Acute, Subacute, or Chronic Ankle Sprain
Glucocorticosteroid Injections for Acute, Subacute, or Chronic Ankle Sprain is not recommended for the treatment of ankle sprains that are acute, subacute, or chronic.
- Hyaluronic Acid Injections for Acute, Subacute, or Chronic Ankle Sprain
Hyaluronic Acid Injections for Acute, Subacute, or Chronic Ankle Sprain are not recommended in order to treat acute, subacute, or recurrent sprained ankles.
- Prolotherapy Injections for Acute, Subacute, Chronic or Ankle Sprains
Prolotherapy Injections for Acute, Subacute, Chronic or Ankle Sprains are not recommended for the most severe cases, ankle sprains that are subacute, chronic, or postoperative.
- Platelet Rich Plasma Injections for Acute, Subacute, or Chronic Ankle Sprain
Platelet Rich Plasma Injections for Acute, Subacute, or Chronic Ankle Sprain are not recommended in order to treat acute, subacute, or persistent sprained ankles.
Surgery Ankle Sprain
- Surgery for Treatment of Acute or Subacute Ankle Ligament Tear
Surgery for Treatment of Acute or Subacute Ankle Ligament Tear are not recommended to treat a common lateral ligament injury brought on by an acute or subacute ankle sprain.
- Surgery for Treatment of Chronic Ankle Instability (CAI)
Surgery for Treatment of Chronic Ankle Instability (CAI) is recommended for a few specific situations of long-term ankle instability.
Indications: Failure of non-operative treatments, such as therapy and the use of an ankle orthosis, along with chronic ankle instability lasting at least three months.
Recommendations are justified by persistent functional Chronic instability may be taken into consideration for reconstruction of a ligament.
- Postoperative Management of Ankle Instability
Postoperative Management of Ankle Instability is recommended ankle instability can be treated by short-term cast immobilisation, early mobilisation, and treatment.
Rationale for Recommendation:Therapy and early motion are listed as common postoperative treatment strategies.
What our office can do if you have Ankle Sprain
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