Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus

Smith, Michelle D.; Vicenzino, Bill; Bahr, Roald; Bandholm, Thomas; Cooke, Rosalyn; Mendonça, Luciana De Michelis; Fourchet, François; Glasgow, Philip; Gribble, Phillip A.; Herrington, Lee; Hiller, Claire E.; Lee, Sae Yong; Macaluso, Andrea; Meeusen, Romain; Owoeye, Oluwatoyosi; Reid, Duncan; Tassignon, Bruno; Terada, Masafumi; Thorborg, Kristian; Verhagen, Evert; Verschueren, Jo; Wang, Dan; Whiteley, Rod; Wikstrom, Erik A.; Delahunt, Eamonn

doi:10.1136/bjsports-2021-104087

Cited by 49 publications

(60 citation statements)

References 39 publications

(40 reference statements)

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“…Rehabilitation is mostly still time‐based and controlled by the experience of the physician and therapist. Although guidelines for RTC decisions have been developed in the past, 85 there are currently few criteria‐based step‐by‐step approaches to guide the rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Time‐loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta‐analysis

Flore

Hambly

Coninck

et al. 2022

Scandinavian Med Sci Sports

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A literature search was conducted to systematically review and meta‐analyze time‐loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time‐loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case–control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time‐loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time‐loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta‐analyzed. A recurrence rate of 17.11% (95% CI: 13.31–20.92%; df = 12; Q = 19.53; I2 = 38.57%) based on the random‐effects model was determined. A total of 7736 participants were part of the time‐loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time‐loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15–22.08; df = 11; Q = 158; I2 = 93%), so that the data on time‐loss are only presented descriptively. There is an average time‐loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%–12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long‐term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.

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Section: Discussionmentioning

confidence: 99%

Time‐loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta‐analysis

Flore

Hambly

Coninck

et al. 2022

Scandinavian Med Sci Sports

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“…Education is provided on the natural history of ankle sprains, the encouragement of early weightbearing and returning to sport when able to meet the Pain, Ankle impairments, Athlete perception, Sensorimotor control, Sport functional performance (PAASS) criteria. 19,63 The athlete follows up with the physical therapist prior to competition. Manual therapy is provided again, with the prior two techniques performed prior to assessment of the PAASS constructs with further reduction in pain on all assessment.…”

Section: Interventionmentioning

confidence: 99%

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Short

Tuttle²,

Youngman

2023

International Journal of Sports Physical Therapy

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Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while “passive” therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white “sides,” a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active. Level of Evidence 5

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“…9, 59, 60 Current consensus guidelines such as ROAST and PAAS also highlight the importance of using patient-reported outcome measures in the rehabilitation process and return-to-sports decision making. 17, 61 Future research should consider which psychosocial impairments are addressed by the prescribed exercises in rehabilitation programs.…”

Section: Limitationsmentioning

confidence: 99%

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

Wagemans

Bleakley

Taeymans

et al. 2022

Preprint

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Research questions 1) What is the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients who suffered an acute ankle sprain? 2) Do prescribed exercises incorporate complex tasks associated with common ankle sprain injury mechanisms? Methods We searched six electronic databases (CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar) for randomized controlled trials including patients with acute ankle sprains, managed through exercise-based rehabilitation. Exercises were analysed based on: the primary impairment(s) addressed (muscle strength, mobility, neuromuscular training, performance); direction of movement (uni- vs multiplanar); base of support (single vs double limb); weightbearing status (open vs closed chain); and use of a flight phase.(PROSPERO: CRD42020210858) Results We included fourteen randomized controlled trials comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises (34/177) incorporated a flight phase. Conclusions Rehabilitation after LAS largely comprises simple exercises in the sagittal plane that do not reflect established mechanisms of re-injury. Future interventions can be enhanced by incorporating more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.

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Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus

Cited by 49 publications

References 39 publications

Time‐loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta‐analysis

Time‐loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta‐analysis

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review

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