been observed since, just 'bad luck' may be a contributory factor! Depending upon severity, recurrence may possibly lead t o absence f rom work as well as interfering with everyday activit ies.

Question 4: In this study there was a noticeable difference between the referral t ime for t he t w o sexes, men wait ing an average of 5.5 weeks, while for women the average t ime between injury and physiotherapy was 10.5 weeks. The chronic swell ing and stiffness, joint irritability, l ow confidence and other factors wh ich promote recurrence (Aston, 1976; Cyriax, 1985; Williams, 1987) would be well established by this t ime in many patients.

This unfortunate delay can only be the result of several factors, eg initial lack of act ion or referral f rom the accident and emergency department or GP; waiting for an orthopaedic clinic appointment; wait ing t o see a doctor wil l ing t o make a physiotherapy referral. On the other hand it mus t be said tha t some patients will be unable t o attend clinic or initial physiotherapy appointments due t o work, family or holiday commitments. But, overall the average wait for treatment of nearly eight weeks may be viewed as a disadvantage for bo th patient and therapist with respect to rehabilitation.

A higher percentage of men were seen in the important acute stage of the first three days and also by the first week. This is diff icult t o explain. Are men more assertive in seeking help? Are women more under pressure f rom family commitments and so less able t o f ind t ime for early treatment? It has even been suggested that women generally have a higher pain tolerance!

Question 5: Over one-third of patients (38) received no previous advice or information from medical staff concerning the treatment of their injury. This may be due t o the shortage or unavailability of relevant people in hospital departments. Some probably did not seek advice because they knew f rom previous experience h o w t o cope w i th their injury. However, recommending tha t the patient rest the ankle for a couple of days w i t h common cooling methods and frequent elevation, then starting simple mobil i ty exercises, would take only a f e w seconds.

Only one ou t of the hundred was advised t o regain ankle mobil i ty while awaiting physiotherapy. Of the eight immobilised in plaster, only three were advised t o move the foot and ankle routinely fol lowing i ts removal. This absence

of advice t o achieve joint mobil ity as soon as possible, could lead t o a compromise in the balance, support and propulsive functional aspects of the lower limb.

Conclusion

This descriptive study was directed simply t o highlight the patients with this particular type of injury and h o w they may have fared before coming through the physiotherapy department door. Due to the large number of staff involved, accurate collection of data was inevitably compromised by less than perfect uniformity and consistency. However, some interesting themes do appear and it may help fulf i l the need for such ' l ight research' as identif ied in the June 1988 Physiotherapy J ou r na I editorial.

No attempt was made t o examine the treatment methods used by either physiotherapy or accident and emergency departments. Much research is needed and perhaps could be directed t o the specific factors leading t o injury recurrence; the working t ime lost due t o inappropriate management of the patient; and finally, although difficult, a comparison of the efficiency of different treatment regimes in both the short and long terms, ranging from simple advice t o the intensive treatment that would be expected for a professional athlete with the same injury (Leaman and Simpson, 1988) .

ACKNOWLEDGMENT

Thanks are expressed to past and present staff of the physiotherapy department at the Royal Liverpool Hospital for their help in acquiring the data.

REFERENCES

Aston, J N (1976). A Short Textbook of Orthopaedics and Traumatology, Hodder and Stoughton Educational, London.

Cyriax, J and Cyriax, P (1985). lllustrated Manual of Orthopaedic Medicine, Butterworth, London.

Leaman, A M and Simpson, D E (1988). 'Treatment of sprained ankles by physiotherapists a t professional soccer clubs', Archives of Emergency Medicine, 3, 177-179.

Lester, A A (1981). 'Management of sprained ankles - A double blind study', The Practitioner, 225, 935-936.

Williams, J (1987). 'Problems of mobility and immobility: The management of sprained ankles', Education in Practice, Medical Tribune Group, Southampton Street, London.

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316 Physiotherapy, May 1991, vol 77, no 5