title: What does therapeutic ultrasound add to recovery from acute ankle sprain? A review.
abstract: OBJECTIVE
  To evaluate the effectiveness of therapeutic ultrasound (US) for acute ankle sprains.
  
  
  METHODS
  The Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched to September 2010, for trials in any language; CINAHL to 2004, and PEDro to 2009. The Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and the World Health Organization International Clinical Trials Registry Platform were also searched for additional trials.
  
  
  METHODS
  Criteria for selection were randomized or quasi-randomized trials; $1 study group was treated with therapeutic US; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Two authors independently selected the studies, and disagreements were resolved by consensus. Of 9 potentially relevant studies, 6 (4 from MEDLINE and 2 from other sources) met selection criteria.
  
  
  METHODS
  Data on participants, treatments, outcomes, duration of followup,and study methods (using the 10-point Amsterdam-Maastricht Consensus List for Quality Assessment) were independently extracted by the investigators who selected the studies. Results were pooled if the data were sufficiently homogeneous.
  
  
  RESULTS
  The trials included 606 participants in 5 comparisons of US therapy with sham US (placebo) and 3 comparisons with 3 other treatments(immobilizing elastic bandage, Felbinac anti-inflammatory gel, or electrotherapy). The studies varied in time since injury(<48-100 hours), final assessments (1-4 weeks), and number and spacing of US treatments (3-10 sessions over 3 days-2 weeks). Studies varied in using pulsed or continuous US. None of the studies comparing US therapy with sham US reported statistically significant differences on any outcome, but most participants were fully recovered at final follow-up. For the 3 homogeneous studies, the pooled risk ratio after US therapy for general improvement was 1.04 (95% confidence interval [CI], 0.92-1.17), and the pooled risk difference was 3.0% (95% CI, 26%-12%). In 3 studies, no differences in pain at 7, 14, or 21 days or in swelling were found. In 4 studies, differences in functional disability(ability to walk or bear weight or postural stability) were small and nonsignificant.No significant differences were found in range of motion or plantar or dorsal flexion in 2 studies. Adverse reactions were only documented in 1 study (11 nonserious gastrointestinal events and skin reactions and 1 skin reaction that caused the participant to withdraw). In the comparison between US therapy and immobilization with elastic bandage,estimated risk difference in recovery favored US therapy after 2 weeks(27%; 95% CI, 8%-46%). The comparison between US therapy and Felbinac gel detected no differences after 1 week in overall improvement, pain, or ability to bear weight. The comparison between US therapy and electrotherapy found no significant differences after 1 week in pain-free status, minimal swelling, or ability to walk. The methods of the studies were lacking in details of allocation concealment, baseline similarity of groups, and adherence to treatment. Follow-up of participants was, except for 1 study, inadequate or not reported.
  
  
  CONCLUSIONS
  Ultrasound therapy had few beneficial effects on overall improvement,pain, or ability to bear weight in acute ankle sprain. Follow-up of 2 to 4 weeks suggested that most participants would recover regardless of intervention.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute VU University Medical Center Amsterdam, Netherlands. m.p.vandenbekerom@amc.uva.nl
authors.forename: Evert A L M
authors.initials: EA
authors.lastname: Verhagen