Ankle sprains are common injuries that often require effective and timely treatment to minimize pain and inflammation and promote optimal healing. Ankle sprains are among the most common musculoskeletal injuries, with a significant prevalence among athletes and physically active individuals. About 30,000 ankle injuries happen every day in the U.S., but the true incidence is higher, as fewer than half of those with ankle sprains seek medical attention.1
Ankle sprains account for half of all sports injuries and carry an estimated economic burden of $4 billion annually. Lateral ankle sprains (LAS), which involve the ligaments on the outside of the ankle, are the most common type, constituting 85-90% of all ankle sprains, and three-fourths of those lead to recurrence and instability. Although most individuals experiencing an LAS return to activity within six weeks, continued pain, diminished function, and instability are common.2
Conventional Prevention / Treatment
A significant number of individuals who suffer an ankle sprain will experience recurrent sprains due to incomplete rehabilitation, leading to weakened ankle muscles, poor balance, and reduced proprioception. Preventive measures include proprioceptive training exercises, the use of ankle supports or braces during high-risk activities, and targeted strength and flexibility training.3
Historically, health care practitioners followed the RICE protocol (Rest, Ice, Compression, Elevation) to manage swelling and discomfort. However, in recent years, even the developer of the RICE protocol, Dr. Gabe Mirkin, has concluded that ice delays recovery.
He states, “Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.”4
Mirkin points out that anything that reduces inflammation also delays healing, such as pain-relieving medication, non-steroidal anti-inflammatories, and cortisone drugs, along with ice. Published studies indicate that ice has been found to not only delay recovery, but also damage tissue.5-6 The evidence indicates that the application of ice is only necessary if pain reduction is the only desired outcome.7-8
Photobiomodulation Case Study
Photobiomodulation has emerged as a promising modality for accelerating the healing process in various musculoskeletal injuries, including ankle sprains.9 Class 4 laser therapy is one form of photobiomodulation used in health care.10 This case study presents an assessment of class 4 laser therapy in the treatment of a grade II ankle sprain, discussing its mechanism of action, clinical implementation, and outcomes.
Ankle sprains are prevalent injuries, frequently encountered in sports and everyday activities. They result from the stretching or tearing of ligaments around the ankle joint. Classically categorized into three grades based on the severity of ligament damage, grade II ankle sprains involve partial tearing of the ligaments with mild to moderate instability and swelling.
Photobiomodulation with a class 4 therapy laser has gained attention as a non-invasive, painless, and potentially effective treatment option for accelerating the healing process in ankle sprains.
The therapeutic effects of photobiomodulation encompass the interaction of light with cellular components, such as mitochondria, triggering a cascade of biochemical responses that facilitate tissue repair, resolve inflammation,11 and alleviate pain.12-13
A 28-year-old recreational soccer player presented with a grade II lateral ankle sprain sustained during a match. The patient reported immediate pain, swelling, and difficulty bearing weight on the affected ankle. Clinical examination revealed tenderness, swelling, and bruising along the lateral aspect of the ankle, with positive anterior drawer and talar tilt tests, indicating ligamentous instability.
Following initial assessment and diagnosis, the patient’s treatment plan included class 4 laser therapy, along with a gradual progression of active range-of-motion exercises, proprioceptive rehabilitation and strengthening. The class 4 laser therapy sessions were scheduled three times a week for three weeks. During each session, laser treatment was applied by a trained chiropractic assistant to the affected leg and ankle.
A class 4 therapy laser device emitting laser wavelengths of 650, 810, 915 and 980 nanometers (nm) was applied in a proximal to distal fashion, starting just below the knee. Treatment was delivered circumferentially around the leg, with progression slowly toward the ankle.
The laser was set at a power output of 6.8 watts for the leg and 4.8 watts over the ankle, delivering continuous wave mode and various pulse frequencies. At these power output levels, there is zero to minimal tissue heating.
After three weeks of treatment, the patient reported significant improvements in pain, swelling, and functional mobility. Objective measurements, including ankle range of motion (ROM) and gait analysis, showed notable enhancements compared to baseline measurements. The patient’s Visual Analog Scale (VAS) pain score decreased from 8/10 at initial presentation to 2/10 after the treatment period. The patient also reported improved overall satisfaction with the treatment process.
Clinical Pearls
The outcomes of this case study suggest that class 4 laser therapy, when integrated into a comprehensive treatment plan, can lead to positive results in the management of grade II ankle sprains. The mechanism of action of class 4 laser therapy aligns with the goals of ankle sprain treatment by promoting tissue healing, modulating inflammation, and mitigating pain. The photobiomodulation effects of laser therapy may stimulate cellular activities essential for tissue repair and regeneration.
Class 4 laser therapy appears to be a viable adjunctive treatment option for accelerating the healing process and alleviating pain in grade II ankle sprains. The therapy’s non-invasive nature, absence of reported adverse effects, and potential benefits make it an attractive choice for both athletes and non-athletes seeking expedited recovery.
However, more rigorous research is essential to validate these findings and to establish clear guidelines for the clinical implementation of class 4 laser therapy in ankle sprain management. Health care providers should consider the integration of class 4 laser therapy into a comprehensive treatment plan for ankle sprains based on individual patient needs and preferences.
References
- Cavazos GJ Jr., Harkless LB. The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes. J Sports Med Ther, 2021;6:008-017.
- Ibid.
- Rivera MJ, Winkelmann ZK, Powden CJ, Games KE. Proprioceptive training for the prevention of ankle sprains: an evidence-based review. J Athl Train, 2017 Nov;52(11):1065-1067.
- https://drmirkin.com/fitness/why-ice-delays-recovery.html
- Crystal NJ, et al. Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise. Euro J Appl Physiol, 2013;113:2577-2586.
- Khoshnevis S, Craik N, Diller K. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surg, Sports Traumatol, Arthrosc, 2015;23(9):2475-2483.
- Bleakley C, McDonough S, MacAuley D. Cryotherapy for acute ankle sprains: a randomized controlled study for two different icing protocols. Brit J Sports Med, 2006;40(8):700-705.
- Hubbard T, Aronson S, Denegar C. Does cryotherapy hasten return to participation? A systemic review. J Athl Train, 2004;39(1):88-94.
- Alayat MS, Takaroni A, Elsodany AM, et al. Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis. Lasers Med Sci, 2024 Apr 26;39(1):116.
- Anders JJ, Arany PR, Baxter GD, Lanzafame RJ. Light-emitting diode therapy and low-level light therapy are photobiomodulation therapy. Photobiomodul Photomed Laser Surg, 2019 Feb;37(2):63-65.
- Lopes-Martins RAB, Leonardo PS, Bjordal JM, Marcos RL. Photobiomodulation: inhibition or resolution of the inflammatory process? Photobiomodul Photomed Laser Surg, 2020 Aug;38(8):453-454.
- Dompe C, Moncrieff L, Matys J, et al. Photobiomodulation - underlying mechanism and clinical applications. J Clin Med, 2020 Jun 3;9(6):1724.
- Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys, 2017;4(3):337-361.
