Knee Osteoarthritis: Managing Symptoms to Delay Progression

SCIENTIFIC UPDATE

Issue RS2026/3 - September 2026

Recovery Sciences

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Ankle Sprains: More than "just a twist"

After a summer dominated by international football, interest in the sport extends far beyond the professional stage. Recreational players return to the pitch, young athletes prepare for school and club competition, and more people take part in running, hiking and court sports. With that increase in activity comes one of the most familiar injuries in sport: the ankle sprain.

A study analyzing sports injuries across 38 countries identified the ankle as the second most commonly injured body site after the knee, with ankle sprains representing the most common type of ankle injury. The incidence was particularly high in team and court sports, including football, rugby, volleyball, handball and basketball.

Yet despite their frequency, ankle sprains are still commonly dismissed as "just a twist."

Beyond the Sprain: Understanding the True Risk

"It's just a sprain" may reassure patients, but it can also send the wrong message."

A sprain isn't simply a rolled ankle. It involves ligament damage and may also affect the joint capsule, cartilage and surrounding structures. When patients don't understand the true nature of the injury, they're less likely to commit to the rehabilitation needed for a full recovery.

Using a recognized grading system (Grade I-III) does more than classify severity - it helps set realistic recovery expectations and reinforces why rehabilitation shouldn't stop when the pain does.

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PHASE I: Protection

The first days after an ankle sprain are about more than reducing pain—they're about creating the right conditions for healing.

⇒ Protection First

A semi-rigid brace protects damaged ligaments from further stress while allowing early, controlled rehabilitation. Managing swelling and pain creates the optimal environment for tissue repair.

⇒ Photobiomodulation Therapy (PBMT)

Growing evidence suggests PBMT can enhance mitochondrial activity, modulate inflammation and promote tissue healing. A 2024 systematic review by Alayet et al. reported moderate evidence for meaningful pain reduction following ankle sprains.

⇒ Shockwave Therapy

Emerging evidence suggests very low-energy ESWT can stimulate macrophage and stem cell activity, supporting acute soft tissue healing and potentially accelerating return to play.

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PHASE II: Strength

Pain and swelling don't just affect movement—they inhibit muscle function.

As the ligaments heal, restoring strength becomes a priority. The Peroneus Longus plays a vital role in stabilizing the ankle during this phase, but conventional strengthening can be challenging while healing tissues still require protection.

Neuromuscular Electrical Stimulation (NMES) offers a practical solution by activating key stabilizing muscles, even during periods of immobilization. Research has also shown that combining isometric exercise with NMES can improve ankle range of motion and shorten the time needed to return to activities of daily living.

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PHASE III: Return to Activity

Returning to sport isn't the finish line. Returning with confidence is.

#1 Functional Strength & Movement Quality

The final stage of rehabilitation should focus on restoring functional strength, balance and movement quality. Progressive loading that reflects the demands of everyday life and sport helps prepare the athlete for a safe return to activity. Current evidence suggests that combining functional exercise with NMES enhances neural drive and muscle activation more effectively than exercise alone.

#2 Proprioception & Sensorimotor Control

Persistent deficits in sensorimotor control are one of the leading contributors to recurrent ankle sprains and chronic ankle instability. Choi et al. (2024) demonstrated that combining rehabilitation exercises with low-frequency NMES significantly improved muscle morphology and dynamic balance, reinforcing the importance of restoring control, not just strength.

The Takeaway

When patients understand that an ankle sprain is more than "just a twist", they're more likely to engage with rehabilitation, complete every phase of recovery, and reduce their risk of chronic ankle instability.

As summer activities continue and athletes prepare for the new sporting season, ankle sprains will once again become one of the most common injuries seen in clinics.

The opportunity for clinicians isn't simply to treat the injury.

It's to change the conversation around it.

Because successful rehabilitation starts long before the patient returns to sport. It starts with the diagnosis.

Schedule a demonstration to discover how shockwave and high-intensity laser therapy can support ankle sprain rehabilitation and recovery in your clinic.

Request a Demonstration

Want to explore more insights on modern rehabilitation technologies for clinical practice?

Webinar: Supporting Canada's Men's National Team: Lessons from International Tournament Football

Ebook: Ankle Sprain Rehabilitation from First Steps to Full Activity

References

1.Delahunt E, Bleakley CM, Bossard DS, Caulfield BM, Docherty CL, Doherty C, Fourchet F, Fong DT, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Remus A, Verhagen E, Vicenzino BT, Wikstrom EA, Gribble PA. (2018), Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018 Oct;52(20):1304-1310

2.Wang X, Zhao C, Yang L. (2026), Photobiomodulation in skeletal muscle repair: Mechanisms, parameters, and therapeutic potential. Biochem Biophys Res Commun. Apr 30;811:153562

3.Alayat MS, Takaroni A, Elsodany AM, AlMatrafi NA, Subahi MS, Battecha KH. 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

4.Rhim HC, Borg Stein J, Sampson S, Tenforde AS. Utilizing extracorporeal shockwave therapy for in season athletes. Healthcare. 2023;11(7):1006.

5.Toyoshima Y, Akagi R, Nabeshima K. (2021), Isometric exercise during immobilization reduces the time to return to play after lateral ankle sprain. Phys Ther Sport. Nov;52:168-172

6.Borzuola R, Nuccio S, Scalia M, Parrella M, Del Vecchio A, Bazzucchi I, Felici F, Macaluso A. (2023), Adjustments in the motor unit discharge behavior following neuromuscular electrical stimulation compared to voluntary contractions. Front Physiol. Jun 1;14:1212453

7.Choi S, Jun HP. (2024), Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability. Medicina (Kaunas). Jul 22;60(7):1187

8.Bossard DS, Remus A, Doherty C, et al., (2018), Developing consensus on clinical assessment of acute lateral ankle sprain injuries: protocol for an international and multidisciplinary modified Delphi process, British Journal of Sports Medicine 52:1539

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