Ottawa Ankle Rules – Recognising the Red Flags

 In Foot

Ottawa Ankle Rules: 

As we’ve discussed over the course of our Knee and Foot month – Ankle injuries, specifically sprains are so, so common and really overlooked especially when it comes to inefficient rehabilitation. We’ve all got clients who can describe their history or tell us of an event where they sprained their ankle maybe a few years ago but what about when a client presents in your class with a recent or suspected ankle sprain…

How many people have you heard say, “It’s just an ankle sprain, I don’t need to go to the hospital”

And they may be right – Wait times at A&E can be long and the worry that we may be wasting valuable NHS time is ever increasing, so we can’t necessarily blame anyone for trying to shrug off your ‘run of the mill’ ankle sprain.

So you have a client who’s rolled their ankle over the weekend – They haven’t gone to A&E because they don’t think it’s a significant injury, or they don’t feel it warrants a check over. That client might be right, they may just have a typical ankle sprain and think that by moving it, it will help to rehabilitate it in some way.

In this instance, should we just take our client’s word for it? What they feel and what’s actually going on in that foot can be totally different – and let’s not forget that everyone’s pain threshold is different.

Wouldn’t it be nice if there was a test or a screen which could help you to decide whether the joint should be imaged or not?

Indeed, it would…

Fractures are commonly diagnosed through a clinical examination and an x-ray. But Ottawa Ankle Rules provide clinicians with a tool to decide whether the joint should be imaged or not.

The Ottawa Ankle Rules really gives you a basic indication that the joint needs to be assessed by a medical practitioner and x-rayed. It won’t necessarily tell you what type of fracture this person has but really we don’t need to know that since this is not within our remit as Pilates Therapists.

Our job is to keep our clients safe and if we find anything during our screens which tests positively, or doesn’t look right – then we can refer onto a medical practitioner.

The last thing we want to do is assume that it’s just a sprain only to find this person has a fracture and should be resting up in a cast for the next 6 weeks…

How to Screen: 

This screen is actually really easy and doesn’t involve much of a hands on approach. Essentially, this is more of an honest verbal conversation with your client to ascertain what their pain level is and what they can or can’t do.

If your client has pain over the lateral malleolus, or tenderness over the posterolateral edge of the tibia or fibula and they’re having trouble weight-bearing then this would tell you to refer your client on to A&E for an x-ray or back to their GP.

It would be counterintuitive to allow this client to participate in one of your sessions if they have presented with the above symptoms.

Once your client has seen a medical practitioner and has been cleared for Pilates exercise, there are many things you can do to help and potentially improve their condition. We delve deeper into this on our Knee and Foot courses and we still have a few spaces free should you wish to join us and learn more! So if you’re interested, please feel free to visit our Courses page or why not drop us an email at

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