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I was interested to read the article by Watts and Armstrong on a randomised controlled trial to determine the effectiveness of double Tubigrip in mild to moderate ankle sprains.1
I agree completely and have shown in my previous research, which was quoted as a reference, that the mainstay of treatment in incomplete tears of the lateral ligament should be early mobilisation with pain relief as required. I am fully prepared to accept their findings that the use of double Tubigrip does not actually improve this healing process. However, to achieve the desired mobilisation I have found in clinical experience that the application of a double Tubigrip support provides the patient with a feeling of comfort and confidence that allows the patient to begin this early mobilisation. I should be interested to know from the authors whether they experienced any difficulty in persuading patients to mobilise on a painful ankle without any apparent benefit of support or immediate pain relief being offered. Certainly there are many patients that I have seen who while totally “unable” to weightbear on initial presentation to the department after reassurance and the application of double Tubigrip were able to walk out immediately and thereafter made good progress. I think the move in all departments towards non-use of supportive bandaging will require a great deal of patient education to obtain their cooperation with the treatment or in their eyes lack of treatment.
We thank Dr Brooks for his comments on our paper.1 In answer to his question, we have consistently found that a full explanation of the nature of the injury, with advice on immediate and subsequent rehabilitation (how much to weight bear, elevation, ice treatment, and analgesia) and a statement as to why “those stretchy bandages” are not recommended, satisfies our patients with ankle sprains. This advice takes approximately one minute to give and is supplemented by a written advice card.
We would like to point out that all the patients in our study were given analgesia on presentation and those who were genuinely unable to weight bear were given crutches to aid mobilisation. This is our standard practice and we would suggest that it is the reassurance and explanation that encourages those patients who are “unable” to weight bear initially to walk out of the department, rather than the “comfort” of a support bandage. Indeed we would like to draw attention to the finding in our study that the double Tubigrip group required significantly more analgesia than the control group. Although the factors responsible for this may be varied, we already know that the use of a cylindrical bandage where the ankle has a 90° angle tends to produce a compressive band across the front of the joint, essentially causing a “tourniquet effect”. Hence it is debatable how much “comfort” patients derive from this treatment and we feel that the potential for harm should not be dismissed.
Finally we would certainly agree with Dr Brooks that patient education is vital for any call for the cessation of routine double Tubigrip use to succeed. However, we suggest that this is easily and rapidly achievable at the initial presentation, by taking a little time to give a full explanation to the patient.