Intended for healthcare professionals


Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial

BMJ 2009; 339 doi: (Published 09 July 2009) Cite this as: BMJ 2009;339:b2684
  1. Maarten D W Hupperets, PhD student1,
  2. Evert A L M Verhagen, senior researcher12,
  3. Willem van Mechelen, professor12
  1. 1Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
  2. 2Body@Work Research Centre for Physical Activity, Work and Health, TNO VUmc, Amsterdam, Netherlands
  1. Correspondence to: W van Mechelen w.vanmechelen{at}
  • Accepted 26 February 2009


Objective To evaluate the effectiveness of an unsupervised proprioceptive training programme on recurrences of ankle sprain after usual care in athletes who had sustained an acute sports related injury to the lateral ankle ligament.

Design Randomised controlled trial, with one year follow-up.

Setting Primary care.

Participants 522 athletes, aged 12-70, who had sustained a lateral ankle sprain up to two months before inclusion; 256 (120 female and 136 male) in the intervention group; 266 (128 female and 138 male) in the control group.

Intervention Both groups received treatment according to usual care. Athletes allocated to the intervention group additionally received an eight week home based proprioceptive training programme.

Main outcome measure Self reported recurrence of ankle sprain.

Results During the one year follow-up, 145 athletes reported a recurrent ankle sprain: 56 (22%) in the intervention group and 89 (33%) in the control group. Nine athletes needed to be treated to prevent one recurrence (number needed to treat). The intervention programme was associated with a 35% reduction in risk of recurrence. Cox regression analysis showed significantly fewer recurrent ankle sprains in the intervention than in the control group. This effect was found for self reported recurrent ankle sprains (relative risk 0.63, 95% confidence interval 0.45 to 0.88), recurrent ankle sprains leading to loss of sports time (0.53, 0.32 to 0.88), and recurrent ankle sprains resulting in healthcare costs or lost productivity costs (0.25, 0.12 to 0.50). No significant differences were found between medically treated athletes in the intervention group and medically treated controls. Athletes in the intervention group who were not medically treated had a significantly lower risk of recurrence than controls who were not medically treated.

Conclusions The use of a proprioceptive training programme after usual care of an ankle sprain is effective for the prevention of self reported recurrences. This proprioceptive training was specifically beneficial in athletes whose original sprain was not medically treated.

Trial registration ISTRCN34177180


  • Contributors: MDWH participated in formulating the study hypothesis, registered, analysed, and interpreted the data, discussed core ideas and participated in writing the paper. EALMV initiated and coordinated the formulation of the study hypothesis, registered, analysed, and interpreted the data, discussed core ideas and participated in writing the paper. WvM discussed core ideas, contributed to writing the paper, and is guarantor.

  • Funding: This study was supported by a grant from the Netherlands Organization for Health Research and Development (ZonMw), grant number 750-20-002. No author or related institution has received any financial benefit from research in this study.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the medical ethics committee of the VU University Medical Center, Amsterdam, Netherlands. All athletes gave individual informed consent. Additional parental informed consent was given for athletes under the age of 18.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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