Ottawa ankle rules and me

@ @ @ Ottawa Ankle Rules? People follow them? :) I try to explain to pts but really, they want an XR

This reminds me of my experience with the Ottawa Ankle Rules in the Navy.

USMC Infantry is designed to generate ankle sprains, and recurrent ones. Initial sprains as young athletic hard chargers are required to carry big loads over unimproved terrain in the dark, plus seemingly all the time not in direct training was spent running.

The larger problem, and one I was educated on by a fellow BN Surgeon (who was a physical therapist prior to med school) while in Okinawa is that there’s no ankle rehab after a sprain. As soon as you can run on it you do, despite having torn stabilizing ligaments and not having done the training and exercises to get the ankles’ accessory stabilizers up to speed. Then, another sprain. The story of how our medical department got this fixed later.

Sick Call was musculoskeletal city with daily ankle sprains, which by that time in the Marines were usually recurrent. About a year into my assignment, out came the Ottawa Ankle Rules. After a year of negative x-rays, finally, a clinical tool to cut down on useless imaging! I used it in practice, taught it to the Corpsmen (who also found it usable and liked it) and our x-ray utilization dropped hugely and AFAIK we didn’t miss any significant fractures. I was proud.

I was moonlighting (for free, I was that bored) in the Camp Pendleton Naval Hospital ED, and mentioned my new practice and how I was proud to have made an impact.

The response: Please stop doing that. Now when they get off duty they drive down here to get an x-ray”.

Humbled, we backed off a little, but not much.

My response to the above tweet (which I now think I recall as being an @nickgenes original) was “Canadians get exams, Americans get x-rays”, which sums it up nicely.