Skip to main content
SpringerLink
Log in

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In the recent clinical guideline for acute lateral ankle sprain, the current best evidence for diagnosis, treatment and prevention strategies was evaluated. Key findings for treatment included the use of ice and compression in the initial phase of treatment, in combination with rest and elevation. A short period of taking non-steroidal anti-inflammatory drugs (NSAIDs) may facilitate a rapid decrease in pain and swelling can also be helpful in the acute phase. The objective was to assess the effectiveness and safety of oral and topical NSAID in the treatment for acute ankle sprains.

Methods

Randomised controlled trials comparing oral or topic NSAID treatment with placebo or each other were included. Primary outcome measures were pain at rest or at mobilisation and adverse events. Trials were assessed using the Cochrane risk of bias tool.

Results

Twenty-eight studies were included, and 22 were available for meta-analysis. Superior results were reported for oral NSAIDs when compared with placebo, concerning pain on weight bearing on short term, pain at rest on the short term, and less swelling on short- and intermediate term. For topical NSAIDs, superior results compared with placebo were found for pain at rest (short term), persistent pain (intermediate term), pain on weight bearing (short- and intermediate term) and for swelling (short and intermediate term). No trials were included comparing oral with topic NSAIDs, so conclusions regarding this comparison are not realistic.

Conclusions

The current evidence is limited due to the low number of studies, lack of methodological quality of the included studies as well as the small sample size of the included studies. Nevertheless, the findings from this review support the use of NSAIDs for the initial treatment for acute ankle sprains.

Level of evidence

Meta-analysis of RCTs, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Almekinders LC, Baynes AJ, Bracey LW (1995) An in vitro investigation into the effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. Am J Sports Med 23:119–123

    Article  CAS  PubMed  Google Scholar 

  2. Andersson S, Fredin H, Lindberg H, Sanzén L, Westlin N (1983) Ibuprofen and compression bandage in the treatment of ankle sprains. Acta Orthop Scand 54:322–325

    Article  CAS  PubMed  Google Scholar 

  3. Ascherl R, Schlemmer H, Blümel G, Lechner F (1982) The effectiveness of etofenamate in minor sports injuries of the knee and ankle joint. A double-blind study. Fortschr Med 100:1729–1734

    CAS  PubMed  Google Scholar 

  4. Bahamonde LA, Saavedra H (1990) Comparison of the analgesic and anti-inflammatory effects of diclofenac potassium versus piroxicam versus placebo in ankle sprain patients. J Int Med Res 18:104–111

    CAS  PubMed  Google Scholar 

  5. Billigmann P (1996) Treatment of ankle sprains with ibuprofen microgel. Therapiewoche 21:1187–1192

    Google Scholar 

  6. Billigmann P, Vogtle-Junkert U (1993) Results from a placebo-controlled double-blind study with ibuprofen 600 mg tablets. Injuries of the upper ankle joint. Ther Osterr 8:227–230

    Google Scholar 

  7. Campbell J, Dunn T (1994) Evaluation of topical ibuprofen cream in the treatment of acute ankle sprains. J Accid Emerg Med 11:178–182

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Costantino C, Kwarecki J, Samokhin AV, Mautone G, Rovati S (2011) Diclofenac epolamine plus heparin plaster versus diclofenac epolamine plaster in mild to moderate ankle sprain: a randomized, double-blind, parallel-group, placebo-controlled, multicentre, phase III trial. Clin Drug Investig 31:15–26

    Article  CAS  PubMed  Google Scholar 

  9. Coudreuse J-M, de Vathaire F (2010) Effect of a plaster containing DHEP and heparin in acute ankle sprains with oedema: a randomized, double-blind, placebo-controlled, clinical study. Curr Med Res Opin 26:2221–2228

    Article  CAS  PubMed  Google Scholar 

  10. De Nies F, Lagrand WK, Patka P (1989) The effect of flurbiprofen in acute ankle distortions. Ned Tijdschr Geneeskd 133:449–451

    PubMed  Google Scholar 

  11. Diebschlag W (1986) Volumetric monitoring of swollen ankle. Joints treated with diclofenac emulgel. Fortschr Med 104:437–451

    CAS  PubMed  Google Scholar 

  12. Diebschlag W, Nocker W, Bullingham R (1990) A double-blind study of the efficacy of topical ketorolac tromethamine gel in the treatment of ankle sprain, in comparison to placebo and etofenamate. J Clin Pharmacol 30:82–89

    Article  CAS  PubMed  Google Scholar 

  13. Dreiser RL, Riebenfeld D (1993) A double-blind study of the efficacy of nimesulide in the treatment of ankle sprain in comparison with placebo. Drugs 46(Suppl 1):183–186

    Article  PubMed  Google Scholar 

  14. Dreiser RE, Charlot J, Lopez A, Ditisheim A (1990) Clinical evaluation of niflumic acid gel in the treatment of uncomplicated ankle sprains. Curr Med Res Opin 12:93–99

    Article  CAS  PubMed  Google Scholar 

  15. Dreiser RL, Roche R, De Sahb R, Thomas F, Leutenegger E (1994) Flurbiprofen local action transcutaneous (LAT): clinical evaluation in the treatment of acute ankle sprains. Eur J Rheumatol Inflamm 14:9–13

    CAS  PubMed  Google Scholar 

  16. Dupont M, Béliveau P, Thériault G (1987) The efficacy of antiinflammatory medication in the treatment of the acutely sprained ankle. Am J Sports Med 15:41–45

    Article  CAS  PubMed  Google Scholar 

  17. Ekman EF, Fiechtner JJ, Levy S, Fort JG (2002) Efficacy of celecoxib versus ibuprofen in the treatment of acute pain: a multicenter, double-blind, randomized controlled trial in acute ankle sprain. Am J Orthop (Belle Mead NJ) 31:445–451

    Google Scholar 

  18. Ekman EF, Ruoff G, Kuehl K, Ralph L, Hormbrey P, Fiechtner J, Berger MF (2006) The COX-2 specific inhibitor Valdecoxib versus tramadol in acute ankle sprain: a multicenter randomized, controlled trial. Am J Sports Med 34:945–955

    Article  PubMed  Google Scholar 

  19. Elswood R, MacLeod DA (1985) Treatment of ankle sprains with benzydamine. Practitioner 229:70–71

    CAS  PubMed  Google Scholar 

  20. Ferry ST, Dahners LE, Afshari HM, Weinhold PS (2007) The effects of common anti-inflammatory drugs on the healing rat patellar tendon. Am J Sports Med 35:1326–1333

    Article  PubMed  Google Scholar 

  21. Fredberg U, Hansen PA, Skinhøj A (1989) Ibuprofen in the treatment of acute ankle joint injuries. A double-blind study. Am J Sports Med 17:564–566

    Article  CAS  PubMed  Google Scholar 

  22. Goldie IF, Gunterberg B, Jacobson C (1974) Foot volumetry as an objective test of the effect of antiphlogistic drugs in ankle sprains. A preliminary study. Rheumatol Rehabil 13:204–207

    Article  CAS  PubMed  Google Scholar 

  23. Higgins J, Green S (Eds) (2008) Cochrane Handbook for systematic reviews of interventions version 5.0.2. The Cochrane Collaboration

  24. Jones P, Lamdin R (2010) Oral cyclo-oxygenase 2 inhibitors versus other oral analgesics for acute soft tissue injury: systematic review and meta-analysis. Clin Drug Investig 30:419–437

    Article  CAS  PubMed  Google Scholar 

  25. Joussellin E (2003) Flector Tissugel in the treatment of painful ankle sprains [Flector Tissugel dans le traitement des entorses douloureuses de la cheville]. J Traumatol Sport 20:15–19

    Google Scholar 

  26. Kerkhoffs GMMJ, Tol JL (2012) A twist on the athlete’s ankle twist: some ankles are more equal than others. Br J Sports Med 46:835–836

    Article  PubMed  Google Scholar 

  27. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly K, Struijs PAA, van Dijk CN (2002) Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane database Syst Rev (3):CD003762

  28. Kerkhoffs GMMJ, Struijs PAA, Marti RK, Assendelft WJJ, Blankevoort L, van Dijk CN (2002) Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev (3):CD002938

  29. Kerkhoffs GM, van den Bekerom M, Elders LAM, van Beek PA, Hullegie WAM, Bloemers GMFM, de Heus EM, Loogman MCM, Rosenbrand KCJGM, Kuipers T, Hoogstraten JWAP, Dekker R, Ten Duis H-J, van Dijk CN, van Tulder MW, van der Wees PJ, de Bie RA (2012) Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med 46:854–860

    Article  PubMed  Google Scholar 

  30. Lester AA (1981) Management of sprained ankles. A double-blind study. Practitioner 225:935–936

    CAS  PubMed  Google Scholar 

  31. Lin C-WC, Uegaki K, Coupé VMH, Kerkhoffs GM, van Tulder MW (2013) Economic evaluations of diagnostic tests, treatment and prevention for lateral ankle sprains: a systematic review. Br J Sports Med 47(18):1144–1149

    Google Scholar 

  32. Linde F, Hvass I, Jürgensen U, Madsen F (1985) Treatment of sprained ankles with 5 % benzydamine creme. A double-blind study. Ugeskr Laeger 148:12–13

    CAS  PubMed  Google Scholar 

  33. Lionberger DR, Joussellin E, Lanzarotti A, Yanchick J, Magelli M (2011) Diclofenac epolamine topical patch relieves pain associated with ankle sprain. J Pain Res 4:47–53

    PubMed Central  PubMed  Google Scholar 

  34. Lopez Vera H (1984) Valoracion de ketoprofen sodico versus placebo en el tratamiento del esguince de tobillo. Investig Med Int 11:102–104

    Google Scholar 

  35. Mazières B, Rouanet S, Velicy J, Scarsi C, Reiner V (2005) Topical ketoprofen patch (100 mg) for the treatment of ankle sprain: a randomized, double-blind, placebo-controlled study. Am J Sports Med 33:515–523

    Article  PubMed  Google Scholar 

  36. McLatchie GR, Allister C, MacEwen C, Hamilton G, McGregor H, Colquhuon I, Pickvance NJ (1985) Variable schedules of ibuprofen for ankle sprains. Br J Sports Med 19:203–206

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Morán M (1990) An observer-blind comparison of diclofenac potassium, piroxicam and placebo in the treatment of ankle sprains. Curr Med Res Opin 12:268–274

    Article  PubMed  Google Scholar 

  38. Morán M (1991) Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains. J Int Med Res 19:121–130

    PubMed  Google Scholar 

  39. Oakland C, Rapier C (1993) A comparison of the efficacy of thetopical NSAID felbinac and ultrasound in the treatment of acute ankle injuries. British J Clin Res 4:89–96

    Google Scholar 

  40. Oian P, Kleive I, Lereim P (1981) [Indomethacin in acute ankle torsion]. Tidsskr. den Nor. lægeforening Tidsskr Prakt Med ny række 101:91–2

  41. Predel H-G, Hamelsky S, Gold M, Giannetti B (2012) Efficacy and safety of diclofenac diethylamine 2.32 % gel in acute ankle sprain. Med Sci Sports Exerc 44:1629–1636

    Article  CAS  PubMed  Google Scholar 

  42. Schmidt M, Pedersen L, Maeng M, Lassen JF, Lash TL, Nielsen TT, Sørensen HT (2011) Nonsteroidal antiinflammatory drug use and cardiovascular risks after coronary stent implantation. Pharmacotherapy 31:458–468

    Article  PubMed  Google Scholar 

  43. Slatyer MA, Hensley MJ, Lopert R (1997) A randomized controlled trial of piroxicam in the management of acute ankle sprain in Australian Regular Army recruits. The Kapooka Ankle Sprain Study. Am J Sports Med 25:544–553

    Article  CAS  PubMed  Google Scholar 

  44. van den Bekerom MPJ, Kerkhoffs GMMJ, McCollum GA, Calder JDF, van Dijk CN (2013) Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc 21:1390–1395

    Article  PubMed  Google Scholar 

  45. Viljakka T, Rokkanen P (1983) The treatment of ankle sprain by bandaging and antiphlogistic drugs. Ann Chir Gynaecol 72:66–70

    CAS  PubMed  Google Scholar 

  46. Slimmon D, Brukner P (2010) Sports ankle injuries—assessment and management. Aust Fam Physician 39:18–22

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. OLVG, Amsterdam, The Netherlands

    Michel P. J. van den Bekerom & Gythe H. Bulstra

  2. MCA, Alkmaar, The Netherlands

    Arnout Sjer

  3. Amphia hospital, Breda, The Netherlands

    Matthijs P. Somford

  4. AMC, Amsterdam, The Netherlands

    Peter A. A. Struijs & Gino M. M. J. Kerkhoffs

Authors
  1. Michel P. J. van den Bekerom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnout Sjer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthijs P. Somford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gythe H. Bulstra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter A. A. Struijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gino M. M. J. Kerkhoffs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel P. J. van den Bekerom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van den Bekerom, M.P.J., Sjer, A., Somford, M.P. et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events. Knee Surg Sports Traumatol Arthrosc 23, 2390–2399 (2015). https://doi.org/10.1007/s00167-014-2851-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2851-6

Keywords

Search

Navigation