Intended for healthcare professionals

CCBYNC Open access

Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial

BMJ 2010; 340 doi: (Published 10 May 2010) Cite this as: BMJ 2010;340:c1964
  1. Chris M Bleakley, research associate1,
  2. Seán R O’Connor, research assistant1,
  3. Mark A Tully, research fellow2,
  4. Laurence G Rocke, consultant in emergency medicine3,
  5. Domhnall C MacAuley, visiting professor of health sciences1,
  6. Ian Bradbury, assistant director of statistics4,
  7. Stephen Keegan, statistician4,
  8. Suzanne M McDonough, professor of health and rehabilitation sciences1
  1. 1Health and Rehabilitation Sciences Research Institute, School of Health Sciences, University of Ulster, Jordanstown, Newtownabbey, Co Antrim BT37 0QB
  2. 2UKCRC Centre of Excellence for Public Health (NI), Queen’s University Belfast, Royal Victoria Hospital, Belfast
  3. 3Department of Emergency Medicine, Royal Victoria Hospital, Belfast
  4. 4Frontier Science (Scotland), Kincraig, Inverness-shire
  1. Correspondence to: C M Bleakley chrisbleakley{at}
  • Accepted 16 February 2010


Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

Design Randomised controlled trial with blinded outcome assessor.

Setting Accident and emergency department and university based sports injury clinic.

Participants 101 patients with an acute grade 1 or 2 ankle sprain.

Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks.

Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.

Trial registration Current Controlled Trials ISRCTN13903946.


  • We thank Roisin Devlin, Martina Dunlop, and Michael Turner (emergency nurse practitioners, Royal Victoria Hospital, Belfast), and staff of the physiotherapy department at the Royal Victoria Hospital for their assistance with recruiting patients for the study.

  • Contributors: CMB wrote the original protocol, secured funding, assisted in the treatment intervention during the trial, wrote the final manuscript, and is the guarantor. SRO’C helped develop the protocol and was responsible for recruitment and treatment during the trial. MAT helped develop the protocol and was responsible for data handling during the trial. LGR was coprincipal investigator and was responsible for the overall management of the clinical setting in which the research took place. DCM helped write the original protocol and the final paper, and secured funding. SMD wrote the original protocol, secured funding, and was coprincipal investigator. IB and SM were responsible for data analysis; CMB, SRO’C, MAT, and SMD assisted with data analysis and interpretation of results. All authors contributed to and approved the final version of this manuscript.

  • Funding: This trial was funded by grants from the Physiotherapy Research Foundation and Strategic Priority Fund (Department of Employment and Learning, Northern Ireland). The researchers were independent of the funding agency.

  • Competing interests: All authors have completed the unified competing interest form at (available on request from the corresponding author) and declare (1) no financial support for the submitted work from anyone other than their employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: This study was approved by the office of research ethics committee Northern Ireland.

  • Data sharing: No additional data available.

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

View Full Text