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Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review

BMJ 2010; 341 doi: (Published 26 October 2010) Cite this as: BMJ 2010;341:c5688
  1. Rogier M van Rijn, junior researcher,
  2. John van Ochten, general practitioner,
  3. Pim A J Luijsterburg, senior researcher,
  4. Marienke van Middelkoop, senior researcher,
  5. Bart W Koes, professor of research in general practice,
  6. Sita M A Bierma-Zeinstra, professor in osteoarthritis and related disorders
  1. 1Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, Rotterdam, Netherlands
  1. Correspondence to: R M van Rijn r.vanrijn{at}
  • Accepted 25 August 2010


Objective To summarise the effectiveness of adding supervised exercises to conventional treatment compared with conventional treatment alone in patients with acute lateral ankle sprains.

Design Systematic review.

Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Cinahl, and reference screening.

Study selection Included studies were randomised controlled trials, quasi-randomised controlled trials, or clinical trials. Patients were adolescents or adults with an acute lateral ankle sprain. The treatment options were conventional treatment alone or conventional treatment combined with supervised exercises. Two reviewers independently assessed the risk of bias, and one reviewer extracted data. Because of clinical heterogeneity we analysed the data using a best evidence synthesis. Follow-up was classified as short term (up to two weeks), intermediate (two weeks to three months), and long term (more than three months).

Results 11 studies were included. There was limited to moderate evidence to suggest that the addition of supervised exercises to conventional treatment leads to faster and better recovery and a faster return to sport at short term follow-up than conventional treatment alone. In specific populations (athletes, soldiers, and patients with severe injuries) this evidence was restricted to a faster return to work and sport only. There was no strong evidence of effectiveness for any of the outcome measures. Most of the included studies had a high risk of bias, with few having adequate statistical power to detect clinically relevant differences.

Conclusion Additional supervised exercises compared with conventional treatment alone have some benefit for recovery and return to sport in patients with ankle sprain, though the evidence is limited or moderate and many studies are subject to bias.


  • Contributors: RMvR performed the literature search, selected articles for inclusion, extracted the data, assessed the risk of bias, and performed the analysis. JvO and MvM assessed the risk of bias. PAJL selected articles for inclusion. BWK and SMAB-Z supervised the study, All authors wrote the article. RMvR is guarantor.

  • Funding: This study was funded by the Department of General Practice, Erasmus MC University Medical Center.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

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