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Zesiger L, Rogan S, Taeymans J, Eichelberger P. Effects of ankle joint mobilization on dynamic balance muscle activity and dynamic balance in persons with chronic ankle instability - Feasibility of a cross-over study. J Bodyw Mov Ther 2024; 39:469-475. [PMID: 38876670 DOI: 10.1016/j.jbmt.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Studies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose of this study was to evaluate the feasibility of a planned cross-over study to assess efficacy of manual therapy techniques applications in patients with chronic ankle instability. METHODS This feasibility study used a randomized controlled, blinded assessor cross-over design. Criteria of success under evaluation were adherence and attrition rates and adverse events. while preliminary treatment effects of manual therapy techniques on muscular activity (measured by surface electromyography) and on dynamic balance (measured by time to stabilization test) were secondary aims. RESULTS Thirteen participants (mean age: 24.4 ± 3.8 years) with chronic ankle instability volunteered in this feasibility study. Success criteria showed a high adherence (98.7%) and low attrition (0%). No missing data were reported but four out of 26 data sets could not be used for statistical analysis because of non-readability of the recorded data. Preliminary treatment effect showed divergent results for surface electromyography and time to stabilization. One significant result (p = 0.03, ES = 1.48) in peroneus longus muscle activity after jump landing between 30 and 60 ms could be determined. CONCLUSIONS This study showed that the study protocol is feasible but should be modified by offering participants the opportunity to familiarize to the jumps and to the test repetitions. This study generates better understanding of manual therapy techniques for patients with chronic ankle instability.
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Affiliation(s)
| | - Slavko Rogan
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - Jan Taeymans
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patric Eichelberger
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Lin CW, Jankaew A, Lin CF. Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241253248. [PMID: 38804135 DOI: 10.1177/19417381241253248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
CONTEXT Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability. OBJECTIVE The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI. DATA SOURCES Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022. STUDY SELECTION A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 3a. DATA EXTRACTION A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale. RESULTS The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI. CONCLUSION The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy. PROSPERO REGISTRATION CRD42022372998.
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Affiliation(s)
- Chia-Wei Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Amornthep Jankaew
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
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Kim SY, Kim KS, Hwang YI. Effects of Manual Lymphatic Drainage with Mobilization and Myofascial Release on Muscle Activities during Dynamic Balance in Adults with Calf Muscle Shortening. Healthcare (Basel) 2024; 12:1038. [PMID: 38786448 PMCID: PMC11121053 DOI: 10.3390/healthcare12101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Mobilization with movement (MWM) and myofascial release (MFR) are treatment techniques that increase ankle dorsiflexion range of motion (DFROM). Manual lymphatic drainage (MLD) facilitates waste drainage and improves soft tissue tension in peripheral tissues. To date, no studies have investigated how the combination of MLD, MWM, and MFR influences the human body. The purpose of this study is to determine how the combination of MLD, MWM, and MFR affects DFROM and balance ability. We randomly assigned 16 individuals (26 feet) to one of three groups: MWM-MFR (MR), MWM-MLD (MD), or MWM-MFR-MLD (MRD) intervention. To confirm the intervention effect of each group, DFROM was assessed using a modified lunge test, and dynamic balance was measured using a modified star excursion balance test. In the results, differences were found between the MR and MRD groups in PL and mGCM activities in the 1 section (p = 0.008, p = 0.036) and between the MD and MRD groups in mGCM activity in the 4 and 5 sections (p = 0.049, p = 0.004). We suggest that the application of MRD is the most effective intervention for increasing muscle activation of the PL and mGCM during the modified star excursion balance test.
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Affiliation(s)
- Se-Yeon Kim
- Department of Physical Therapy, Smart Healthcare Convergence Research Center, Research Institute for Basic Sciences, The Graduate School, Hoseo University, Asan 31499, Republic of Korea;
| | - Ki-Song Kim
- Department of Physical Therapy, Smart Healthcare Convergence Research Center, Research Institute for Basic Sciences, College of Life and Health Sciences, Hoseo University, Asan 31499, Republic of Korea;
| | - Young-In Hwang
- Department of Physical Therapy, Smart Healthcare Convergence Research Center, Research Institute for Basic Sciences, College of Life and Health Sciences, Hoseo University, Asan 31499, Republic of Korea;
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Rajfur J, Rajfur K, Matusz T, Malarska M, Walewicz K, Ptaszkowski K, Dymarek R, Taradaj J. Dry Needling with the Use of FRSc Technique in Addition to Standard Rehabilitation Program for Chronic Low Back Pain: A Randomized Controlled Trial Using Both PROMs and Measurement Tools. J Pain Res 2024; 17:1041-1053. [PMID: 38510562 PMCID: PMC10950681 DOI: 10.2147/jpr.s450119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/02/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose Dry needling (DN) has gained popularity for musculoskeletal conditions, but its commercial use often surpasses scientific evidence. The novel Five Regulatory Systems Concept (FRSc) of DN shows potential therapeutic mechanisms, including chronic low back pain (LBP). However, rigorous clinical assessment with patient-reported outcome measures (PROMs) and objective measures are necessary. This study aimed to evaluate the effect of DN according to pain levels, postural control and selected gait parameters in patients with chronic LBP. Patients and Methods This prospective, double-blinded, randomized controlled study involved 30 patients with LBP allocated in the experimental (n=15, rehabilitation+ FRSc DN) or control group (n=15, rehabilitation + sham DN). The Roland-Morris questionnaire (RMQ) and Visual Analog Scale (VAS) were used as PROMs. Moreover, the posturography method for posture and balance control and the treadmill for gait analysis were used as objective tools. Measurements were taken before and immediately after the intervention and during 1- and 3-month follow up. Results There was a statistically significantly greater improvement in the RMQ in the experimental group compared to the controls (p=0.923 before and p<0.001 after treatment, as well as p<0.001 after 1 and 3 months). Despite the favorable analgesic effect, a significant advantage of the experimental group over the controls in this respect is worth noting (p=0.001 in favor of DN in all intergroup comparisons concerning results from the subjective assessment of pain (VAS). A statistically insignificant post-treatment improvement in balance and postural stability was noted in both groups, although the effects appeared to be short-term. Surprisingly, again, DN had no advantage over sham interventions. In both groups, all changes in the swing phase were statistically insignificant (p=0.201 for the dominant and p=0.283 for the non-dominant side) for the initial swing phase. In both groups, all changes in the stance phase were statistically insignificant (p=0.480 for the dominant and p=0.410 for the non-dominant side of the body). Conclusion DN based on the FRSc appears promising as an effective adjunct to standard rehabilitation for LBP, showing improvements in functional performance and pain reduction.
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Affiliation(s)
- Joanna Rajfur
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Katarzyna Rajfur
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Tomasz Matusz
- Institute of Health Sciences, University of Opole, Opole, 45-040, Poland
| | - Maria Malarska
- Department of Clinical Genetics, Medical University of Lodz, Lodz, 90-419, Poland
| | - Karolina Walewicz
- Department of Physiotherapy, Jan Grodek State University, Sanok, 38-500, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Robert Dymarek
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, 40-065, Poland
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Mohammadi A, Sakhtemani SE, Trimmel L, Petricsevics K, Makai A, Zsenak I, Melczer C, Tardi PS. Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability. Sports (Basel) 2024; 12:33. [PMID: 38251307 PMCID: PMC10820242 DOI: 10.3390/sports12010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/01/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored. METHODS A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ. CONCLUSION Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.
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Affiliation(s)
- Amin Mohammadi
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
| | - Seyed Ehsan Sakhtemani
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
| | | | | | - Alexandra Makai
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
| | - Istvan Zsenak
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
| | - Csaba Melczer
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
| | - Péter Sándor Tardi
- Faculty of Health Sciences, Institute of Physiotherapy and Sports Science, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary; (A.M.); (S.E.S.); (A.M.); (I.Z.); (C.M.)
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Kim KM, Needle AR, Kim JS, An YW, Cruz-Díaz D, Taube W. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:241-256. [PMID: 36650898 DOI: 10.1080/09638288.2022.2161643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). MATERIALS AND METHODS Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. RESULTS Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior). CONCLUSIONS FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
| | - Joo-Sung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
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Tang Y, Liang P, Pan J, Zhang C, Ren H, Cheng S, Kong PW. Effects of Ankle Orthoses, Taping, and Insoles on Postural Stability of Individuals with Chronic Ankle Instability: A Systematic Review. Healthcare (Basel) 2023; 11:2570. [PMID: 37761767 PMCID: PMC10530830 DOI: 10.3390/healthcare11182570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and diminished function. Foot and ankle external supports are commonly used in clinical practice and research for treating CAI. This systematic review aimed to assess the effects of foot and ankle external supports on the postural stability of individuals with CAI to guide clinical practice and inform future research. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases from 1 January 2012 to 1 November 2022. Eighteen studies involving individuals with CAI were chosen in this systematic review. The quality of the included studies and risk of bias were assessed using Cochrane Collaboration's tool for randomized controlled trials, the Newcastle-Ottawa Scale for case-control studies, and the DELPHl-list for crossover trial studies. The external supports included in this review were ankle orthoses (elastic, semi-rigid, and active orthoses), taping (kinesiotaping and fibular reposition taping), and insoles (textured and supportive insoles). The outcome measures included static and dynamic postural stability tests, such as the single-leg stance test, star excursion balance test, Y-balance test, single-leg landing test, lateral jump test, walking test, and running test. The results showed that elastic orthoses, Kinesiotaping, and textured insoles demonstrated potential benefits in improving postural stability in individuals with CAI. Elastic orthoses decreased ankle joint motion variability, kinesiotaping facilitated cutaneous receptors and proprioceptive feedback, while textured insoles increased tactile stimulation and foot position awareness. However, the effects of semi-rigid orthoses, fibular reposition taping, and arch support insoles were inconsistent across studies. Future research should explore the long-term effects of these external supports, analyze the effects of different characteristics and combinations of supports, and employ standardized outcome measures and testing protocols for assessing postural stability.
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Affiliation(s)
- Yunqi Tang
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
| | - Peiyao Liang
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Jingwen Pan
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore 308232, Singapore
| | - Cui Zhang
- Sport Biomechanics Laboratory, Shandong Institute of Sports Science, Jinan 250014, China;
- Graduate School, Shandong Physical Education University, Jinan 250014, China
| | - Hui Ren
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Shizhe Cheng
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an 710021, China; (Y.T.); (P.L.); (H.R.); (S.C.)
| | - Pui Wah Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore;
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Prodhania MS, Ahsan GU, Ali M. Physiotherapy combined with dry needling among patients with chronic low back pain: Study protocol for a randomized controlled clinical trial. Contemp Clin Trials Commun 2023; 34:101170. [PMID: 37434861 PMCID: PMC10331288 DOI: 10.1016/j.conctc.2023.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/11/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023] Open
Abstract
Background Chronic low back pain (CLBP) is an extremely common public health concern responsible for pain-related disability. CLBP is challenging to manage despite having a plethora of treatment options. Physiotherapy is a guideline-recommended treatment for CLBP. Furthermore, some forms of complementary medicines, such as dry needling, spinal manipulation, Tai Chi, and yoga are also recommended for CLBP treatment. We hypothesized that the combined treatment would be more effective when managing CLBP. Therefore, this randomized clinical trial aims to examine the impact of combined therapy of dry needling and physiotherapy compared to the treatment effect of only physiotherapy among patients with CLBP. Methods The study is a two-armed single-center, randomized controlled clinical superiority trial where participants are randomized to combined therapy of usual care physiotherapy and dry needling or only usual care physiotherapy (1:1). Individuals who are 18 years or older and experiencing LBP with or without leg pain for a minimum of three months will be considered eligible for the study. Pain severity, pain affective and physical interference, activity limitation, and insomnia symptoms of patients with CLBP will be measured at the baseline after four, 12 and 24-week treatment started. Conclusion Finding a better management strategy for managing CLBP is an ongoing challenge. Most of the novel techniques that try to manage CLBP are limitedly tested. This study will allow testing of the combined effect of usual care physiotherapy and dry needling when managing CLBP in terms of clinical efficacy. If the combined therapy is proven significantly effective, compared to usual care physiotherapy alone will provide plausible evidence of an effective treatment option to manage CLBP. Trial registration Clinical Trial Registry-India; trial registration number- CTRI/2022/09/045625.
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Affiliation(s)
- Md Shafiullah Prodhania
- Dhaka Pain Physiotherapy and Rehabilitation Center, Dhaka, 1207, Bangladesh
- Department of Physiotherapy, International Institute of Health Sciences, Mirpur, Dhaka, 1216, Bangladesh
| | - Gias Uddin Ahsan
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Department of Physiotherapy, International Institute of Health Sciences, Mirpur, Dhaka, 1216, Bangladesh
| | - Mohammad Ali
- Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College Hospital, Dhaka, 1230, Bangladesh
- Hasna Hena Pain Physiotherapy and Public Health Research Center, Dhaka, 1230, Bangladesh
- Department of Physiotherapy, International Institute of Health Sciences, Mirpur, Dhaka, 1216, Bangladesh
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Sevik Kacmaz K, Unver B. Immediate Effects of Mulligan Mobilization on Elbow Proprioception in Healthy Individuals: A Randomized Placebo-Controlled Single-Blind Study. J Manipulative Physiol Ther 2023:S0161-4754(23)00027-1. [PMID: 37422752 DOI: 10.1016/j.jmpt.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/13/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the immediate effects of Mulligan's mobilization with movement (MWM) on elbow proprioception. METHODS The study included 26 participants in the intervention group and 30 participants in the control group. The intervention group received MWM, while the control group received a sham application. Proprioception was assessed with joint position sense error at baseline, immediately after mobilization, and 30 minutes after mobilization with 70° and 110° of elbow flexion. The hypothesis of interest was the group × time interaction. RESULTS At 110° of elbow flexion, group × time interaction was significant (F[2, 108] = 11.48, P = .001). In the paired comparisons, there was a statistically significant difference in favor of the control group in the first measurement (P = .003). No difference was detected in other time points (P = 1.00). At 70° of elbow flexion, there was no significant difference between the time point × group interaction (F[2, 108] = 1.37, P = .10). Therefore, no pairwise comparison was made. CONCLUSION In this study of healthy participants, no immediate difference was found between MWM and sham application on elbow proprioception.
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Affiliation(s)
- Kevser Sevik Kacmaz
- Department of Physical Therapy and Rehabilitation, Izmir Katip Celebi University, Cigli, Izmir, Turkey.
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
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Abbasi L, Panahi F, Zarei-Kurdshooli Z, Yazdi Yahya-Abadi F. The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain. J Bodyw Mov Ther 2023; 35:233-237. [PMID: 37330775 DOI: 10.1016/j.jbmt.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN Randomized clinical trial; assessor-blind; before and after comparison. SETTING Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S) Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.
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Affiliation(s)
- Leila Abbasi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Panahi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Zarei-Kurdshooli
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Yazdi Yahya-Abadi
- Student research committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Alomar AI, Nuhmani S, Ahsan M, Muaidi QI. A comparison of the range of motion and dynamic stability of the ankle joint of athletes with an ankle sprain as compared to healthy controls: A cross-sectional study. Int J Crit Illn Inj Sci 2023; 13:138-144. [PMID: 38023574 PMCID: PMC10664039 DOI: 10.4103/ijciis.ijciis_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ankle sprains are the most common lower-leg musculoskeletal injuries, frequently occurring among athletes and other physical activity individuals. The objective of this study was to compare the ankle range of motion and dynamic stability of healthy and injured athletes for their dominant and nondominant legs. Methods A cross-sectional study design was selected to investigate this study with 32 male soccer players with average age: 22.6 ± 3.3 years, weight: 69.6 ± 5.7 kg, height: 176.8 ± 5.32 cm, with a history of a lateral ankle sprain on the dominant leg for the past 2 years. Ankle range of motion was determined using dorsiflexion and plantar flexion by a goniometer. The dynamic stability was determined using the SWAY medical system. An independent t-test was used to study the differences between healthy and injured groups and between dominant and nondominant legs for dynamic stability, dorsiflexion, and plantar flexion range. Results There were higher significant differences for dynamic stability in healthy participants than in injured participants for their dominant (P = 0.001) and nondominant (P = 0.001) legs. There were significant differences in dynamic stability in the dominant and nondominant leg (healthy [P = 0.033] and injured [P = 0.000] participants). The dominant leg shows higher dynamic stability in healthy group, whereas nondominant leg shows higher dynamic stability in the injured group. Conclusion The study found significant differences between the injured and sound legs. The injured dominant and nondominant leg revealed a striking disparity in the ankle range of motion. Therefore, the study demonstrated that ankle sprain causes due to less stability of the ankle joint, which limits ankle movements.
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Affiliation(s)
- Ahmed I. Alomar
- Department of Physical Therapy, Security Force Hospital, Dammam, Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Qassim I. Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Wang X, Shao X, Yu R, Wang Y, Deng F, Adams R, Han J. Acute effects of kinesiology tape on dynamic balance control in chronic ankle instability: An exploratory study. Phys Ther Sport 2023; 62:65-70. [PMID: 37399706 DOI: 10.1016/j.ptsp.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To investigate the acute effect of the four-strip kinesiology taping (KT) technique on dynamic balance control in the Y Balance Test (YBT), and to explore the relationship between the YBT and Cumberland Ankle Instability Tool (CAIT) scores in individuals with and without chronic ankle instability (CAI). METHODS 16 CAI and 16 non-CAI participants were involved. Two groups completed the YBT in the no-tape barefoot and the KT condition at random. The CAIT was completed on the first day. Bonferroni test was used to analyze YBT scores in three directions for post hoc analysis. Spearman's correlation was used to analyze the relationship between YBT scores in the no-tape barefoot condition and CAIT scores. RESULTS This KT application significantly improved YBT performance. The YBT scores in the anterior direction (YBT-A), posteromedial direction (YBT-PM), and posterolateral direction (YBT-PL) for the CAI group were significantly improved after taping. However, in the non-CAI group, only YBT-PM score was significantly improved after taping. Three YBT scores were all moderately correlated with the CAIT score. CONCLUSION This KT technique can immediately improve dynamic balance in CAI patients. Dynamic balance performance was moderately related to the degree of self-perceived instability in individuals with and without CAI.
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Affiliation(s)
- Xiaotian Wang
- Department of Orthopedics and Traumatology, Jinhua Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang, China
| | - Xuerong Shao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Ruoni Yu
- School of Medicine, Jinhua Polytechnic, Jinhua, Zhejiang, China
| | - Yudi Wang
- School of Physical Education and Nursing, Chengdu College of Arts and Sciences, Chengdu, Sichuan, China
| | - Fawei Deng
- Department of Rehabilitation, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Roger Adams
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, ACT, Australia.
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Chen RP, Wang QH, Li MY, Su XF, Wang DY, Liu XH, Li ZL. Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament. World J Clin Cases 2023; 11:3395-3407. [PMID: 37383912 PMCID: PMC10294195 DOI: 10.12998/wjcc.v11.i15.3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Injury to the anterior talofibular ligament (ATFL) is a common acute injury of the lateral foot ligament. Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients. The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL. The clinical manifestations of acute injury to the ATFL include pain, swelling, and dysfunction. At present, non-surgical treatment is the first choice for acute injury of the ATFL. The standard treatment strategy involves the “peace and love” principle. After initial treatment in the acute phase, personalized rehabilitation training programs can be followed. These may involve proprioception training, muscle training, and functional exercise to restore limb coordination and muscle strength. Static stretching and other techniques to loosen joints, acupuncture, moxibustion massage, and other traditional medical treatments can relieve pain, restore range of motion, and prevent joint stiffness. If the non-surgical treatment is not ideal or fails, surgical treatment is feasible. Currently, arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice. Although open Broström surgery provides good results, the modified arthroscopic Broström surgery has many advantages, such as less trauma, rapid pain relief, rapid postoperative recovery, and fewer complications, and is more popular with patients. In general, when treating acute injury to the ATFL, treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.
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Affiliation(s)
- Run-Peng Chen
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Qing-Hua Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Ming-Yue Li
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Xiao-Fang Su
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Dong-Yang Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Xing-Hui Liu
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
| | - Zhi-Li Li
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
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Kang M, Zhang T, Yu R, Ganderton C, Adams R, Han J. Effect of Different Landing Heights and Loads on Ankle Inversion Proprioception during Landing in Individuals with and without Chronic Ankle Instability. Bioengineering (Basel) 2022; 9:bioengineering9120743. [PMID: 36550949 PMCID: PMC9774139 DOI: 10.3390/bioengineering9120743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Proprioception is essential for neuromuscular control in relation to sport injury and performance. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. Forty-three participants (21 CAI and 22 non-CAI) volunteered for this study. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL), with one foot landing on a horizontal surface and the test foot landing on an angled surface (10°, 12°, 14°, 16°), was utilized to assess ankle proprioception during landing. All participants performed the task from a landing height of 10 cm and 20 cm with 100% and 110% body weight loading. The four testing conditions were randomized. A repeated measures ANOVA was used for data analysis. The result showed that individuals with CAI performed significantly worse across the four testing conditions (p = 0.018). In addition, an increased landing height (p = 0.010), not loading (p > 0.05), significantly impaired ankle inversion discrimination sensitivity. In conclusion, compared to non-CAI, individuals with CAI showed significantly worse ankle inversion proprioceptive performance during landing. An increased landing height, not loading, resulted in decreased ankle proprioceptive sensitivity. These findings suggest that landing from a higher platform may increase the uncertainty of judging ankle positions in space, which may increase the risk of ankle injury.
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Affiliation(s)
- Ming Kang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Tongzhou Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Ruoni Yu
- School of Medicine, Jinhua Polytechnic, Jinhua 321000, China
| | - Charlotte Ganderton
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2234, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
- Correspondence:
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Koshino Y, Kobayashi T. Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 104:673-685. [PMID: 36417970 DOI: 10.1016/j.apmr.2022.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI). DATA SOURCES PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022. STUDY SELECTION Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included. DATA EXTRACTION Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach. DATA SYNTHESIS Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence). CONCLUSIONS The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Takumi Kobayashi
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
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The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study. Sci Rep 2022; 12:15803. [PMID: 36138055 PMCID: PMC9500077 DOI: 10.1038/s41598-022-19980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Dry needling (DN) is a standard procedure for treating musculoskeletal disorders. However, there are no clear recommendations for using DN in low back pain (LBP). Therefore, this study aimed to assess the effectiveness of the novel DN program for reducing pain intensity and improving functional efficiency in patients with chronic LBP. A group of 40 patients with chronic LBP due to the L5-S1 discopathy were eligible and randomized into experimental (n = 20) and control (n = 20) groups. The DN program was performed for the experimental group according to the Five Regulatory Systems (FRS) concept. The control group received sham therapy using placebo needles. DN sessions were performed twice a week for 4 weeks. A single needling application lasted 60 min. Both groups received standard treatment and physical exercise of LBP for 1 month. Subjective pain was measured by a visual analog scale (VAS), functional efficiency was assessed with the Oswestry Disability Index (ODI), and the lower spine range of motion was measured with the Schober test. There were significant differences in pain reduction (VAS) in both groups (p < 0.001). The strongest analgesic effect in the DN group yielded 6.45 points immediately after the therapy, 6.2 points after 1 month, and 6 points after 3 months. The DN group scored higher VAS reduction than the control group (p < 0.001). There were significant differences in the functional state (ODI) in the experimental group (p < 0.001). There was a significant ODI decrease by 18.1 points, after 1 month by 18.9 points, and after 3 months by 17.6 points. No significant differences were found in the control group (p > 0.05). Intergroup differences were observed in the functional efficiency in ODI in all measurement time-points (p < 0.001). There were significant differences in the range of motion (Schober test) in the DN group (main effect: p < 0.001). For all measurements, differences (p < 0.001) were observed in favor of DN compared to the control. In conclusion, DN program according to the FRS concept stands for the novel treatment method supplemented by an exercise program, effectively reducing pain and improving functional efficiency in LBP patients.
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Ke XH, Huang DB, Li YY, Li XM, Guo JH, Guo MM, Yu SX, Ma SC, Jiang C, Lin ZH. Effects of 12 weeks of Tai Chi Chuan intervention on the postural stability and self-reported instability in subjects with functional ankle instability: Study protocol for a randomized controlled trial. Front Neurol 2022; 13:923669. [PMID: 36212637 PMCID: PMC9535359 DOI: 10.3389/fneur.2022.923669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tai Chi Chuan (TCC) is a physical activity modality that originated in China and is now widely popular around the world. Although there are a series of articles reporting that TCC can improve balance and other functional symptoms in a variety of populations, including the elderly, patients with stroke, and patients with Parkinson's disease, its efficiency has not been scientifically and methodically evaluated in subjects with functional ankle instability (FAI). Moreover, there is no literature directly comparing TCC and conventional balance training (CBT) interventions for FAI. The objective of this study is to investigate the comparative effects of TCC intervention and CBT protocols in improving postural balance and subjective instability feelings in patients with FAI. Methods This study will be a single-center, parallel group, randomized controlled trial. Sixty-eight patients with FAI will be included and randomly assigned in a 1:1 ratio to either an intervention group (n =34) or a control group (n = 34). The participants in the intervention group will complete 12 weeks of TCC intervention (40 min/time, 3 times/week for 12 weeks) on the basis of health education treatment. The control group will receive health education and 36 CBT sessions during a 12-week period. Outcome measures include postural stability and self-reported feelings of instability at baseline, after the end of the intervention, and 3-month follow-up. The postural stability assessment of patients with FAI will be detected by performing static and dynamic postural tests, which will be carried out through a specific balance platform (TecnoBody ProKin). Self-reported feelings of instability will be assessed by Cumberland Ankle Instability Tool (CAIT), American Orthopedics Foot and Ankle Society's Ankle–Hindfoot Evaluation Scale (AOFAS-AHES), and the MOS item Short Form Health Survey (SF-36). Discussion This trial will demonstrate whether a 12-week TCC intervention positively affects postural stability and self-reported outcomes in patients with FAI. At the same time, the superiority of its clinical efficacy will also be compared with that of CBT. This study may also help to redefine the value of traditional Chinese exercises in the treatment of chronic ankle instability. Clinical trial registration Chinese Clinical Trial Registry: ChiCTR2100041790. Registration date: 22 March 2021. http://www.chictr.org.cn/edit.aspx?pid=119501&htm=4.
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Affiliation(s)
- Xiao-hua Ke
- Department of Rehabilitation Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Dun-bing Huang
- Rehabilitation Center, Zhejiang Hospital, Hangzhou, China
| | - Yin-yan Li
- General Outpatient Department, Fujian Academy of Chinese Medical Sciences, Fuzhou, China
| | - Xiao-mei Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jin-hua Guo
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Miao-miao Guo
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Sheng-xian Yu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Sheng-chao Ma
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Cai Jiang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- The Second Rehabilitation Department, Fujian Provincial Hospital, Fuzhou, China
- Fujian Institute of Clinical Geriatric, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Cai Jiang
| | - Zhong-hua Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- The Second Rehabilitation Department, Fujian Provincial Hospital, Fuzhou, China
- Fujian Institute of Clinical Geriatric, Fujian Provincial Hospital, Fuzhou, China
- Zhong-hua Lin
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Kim H, Moon S. Effect of Joint Mobilization in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol 2022; 7:66. [PMID: 36135424 PMCID: PMC9505831 DOI: 10.3390/jfmk7030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/05/2022] Open
Abstract
Sensorimotor and range of motion deficits due to chronic ankle instability (CAI) are abnormalities of the movement system that make postural control difficult. This review aimed to quantify the effect of joint mobilization on the range of motion, dynamic balance, and function in individuals with CAI. Randomized controlled trials in which joint mobilization was performed in individuals with CAI were searched for in five international databases (CENTRAL, CINAHL, Embase, MEDLINE, PEDro). Qualitative and quantitative analyses were performed using the risk of bias tool and RevMan 5.4 provided by the Cochrane Library. Nine studies with 364 individuals with CAI were included in this study. This meta-analysis reported that joint mobilization showed significant improvement in the dorsiflexion range of motion (standardized mean difference [SMD] = 1.02, 95% confidence interval [CI]: 0.41 to 1.63) and dynamic balance (SMD = 0.49, 95% CI: 0.06 to 0.78) in individuals with CAI. However, there was no significant improvement in function (patient-oriented outcomes) (SMD = 0.76, 95% CI: -0.00 to 1.52). For individuals with CAI, joint mobilization has limited function but has positive benefits for the dorsiflexion range of motion and dynamic balance.
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Affiliation(s)
- Hyunjoong Kim
- Neuromusculoskeletal Science Laboratory, Gwangju 62287, Korea
| | - Seoyoung Moon
- Department of Research, Good Morning Nursing Hospital, Gwangju 61102, Korea
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19
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Kim KM, Estepa-Gallego A, Estudillo-Martínez MD, Castellote-Caballero Y, Cruz-Díaz D. Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Controlled Trial. Healthcare (Basel) 2022; 10:1364. [PMID: 35893186 PMCID: PMC9394255 DOI: 10.3390/healthcare10081364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Chronic ankle instability (CAI) is a complex condition that includes limited mobility, perceived instability, and recurrent ankle sprains are common characteristics that reduce the quality of life in subjects who suffer from CAI. Neuromuscular training and strength training have been recommended in CAI management interventions. However, there are contradictory findings on results when comparing neuromuscular training, strength training, and the control group. The objective of this study was to compare the effectiveness of 8 weeks of neuromuscular intervention training, strength training, and no intervention in a sporting population with reported CAI. (2) Methods: Sixty-seven athletes with CAI were randomly assigned to a neuromuscular training group (NG), strength training group (SG), or control group (CG). Participants completed 8 weeks of neuromuscular training (a combination of static and dynamic exercises), strength training (resistance band exercises), or no training. Outcome measures were assessed at baseline and after 8 weeks and included selfs-reported instability feeling (CAIT), dynamic balance (SEBT), ankle dorsiflexion range of motion (WBLT), and functional status (FAAM and FAAM-SPORT). (3) Results: There were significant differences between strength and control groups in the posteromedial direction of SEBT, FAAM, and FAAM-SPORT after 8 weeks of intervention. (4) Conclusions: Neuromuscular training and strength training based on resistance bands exercises showed significant improvements in ankle dorsiflexion, subjective feeling of instability, functional status, and dynamic balance in patients with CAI.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si 16419, Gyeonggi-do, Korea;
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Alejandro Estepa-Gallego
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (A.E.-G.); (D.C.-D.)
| | | | - Yolanda Castellote-Caballero
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (A.E.-G.); (D.C.-D.)
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain; (A.E.-G.); (D.C.-D.)
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus of Excellence Mare Nostrum, Universidad de Murcia, E-30720 Murcia, Spain
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20
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Estepa-Gallego A, Ibañez-Vera AJ, Estudillo-Martínez MD, Castellote-Caballero Y, Bergamin M, Gobbo S, Lérida-Ortega MÁ, Cruz-Díaz D. Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial. J Orthop Res 2022; 40:1436-1445. [PMID: 34370331 DOI: 10.1002/jor.25156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Hallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight-Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = -2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = -2.292, p = .028, d = 0.23); SEBT.PM (t(36) = -4.075, p < .001, d = 0.43); SEBT.PL (t(62) = -3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM.
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Affiliation(s)
| | | | | | | | - Marco Bergamin
- Department of Medicine, University of Padova Palazzina ex SemeioticaMedica-Via Ospedale Civile, Padova, Italy
| | - Stefano Gobbo
- Department of Medicine, University of Padova Palazzina ex SemeioticaMedica-Via Ospedale Civile, Padova, Italy
| | | | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain.,Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus of Excellence Mare Nostrum, Universidad de Murcia, Murcia, Spain
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21
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Rajfur J, Rajfur K. Selected needling techniques in pain associated with musculoskeletal disorders: a narrative review. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0015.8247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joanna Rajfur
- Institute of Health Sciences, University of Opole, Poland
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Immediate Effect of Ankle Mobilization on Range of Motion, Dynamic Knee Valgus, and Knee Pain in Women With Patellofemoral Pain and Ankle Dorsiflexion Restriction: A Randomized Controlled Trial With 48-Hour Follow-Up. J Sport Rehabil 2021; 30:697-706. [PMID: 33373976 DOI: 10.1123/jsr.2020-0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. OBJECTIVES To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. DESIGN Randomized controlled trial with 3 arms. SETTING Biomechanics laboratory. PARTICIPANTS A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). INTERVENTION(S) The participants received a single session of ankle mobilization with movement technique. MAIN OUTCOME MEASURES Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). RESULTS There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. CONCLUSION In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.
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Wang J, Zhang D, Zhao T, Ma J, Jin S. Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e053755. [PMID: 34548370 PMCID: PMC8458363 DOI: 10.1136/bmjopen-2021-053755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI. METHODS AND ANALYSIS We will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Ju Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Di Zhang
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianyu Zhao
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiang Ma
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Song Jin
- Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Zordão CC, Mendonça Junior ES, Valério PM, Perez CS, Ferro AP, Guirro ECDO. Immediate Effect of Manual Therapy on Tibiotarsal Joint Mobility and Static Balance in Individuals With Diabetes. J Chiropr Med 2021; 20:128-137. [PMID: 35463843 PMCID: PMC9023131 DOI: 10.1016/j.jcm.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives The objective of this study was to evaluate the immediate effect of manual therapy on ankle joint mobility and static balance in patients with diabetes. Methods Forty patients, at a mean age of 59.35 ± 7.85, with type 2 diabetes mellitus and neurologic symptoms according to a Neuropathy Symptom Score protocol with amplitude, were included. The patients were divided into 2 groups: sham group and intervention group, which underwent manual manipulation intervention and 7-day follow-up. Joint range-of-motion analysis was performed using digital goniometry and static discharge of weights assessed by computerized baropodometry with open and closed eyes. The Shapiro-Wilk normality test was used to analyze the distribution. The data showed normal distribution, so the analysis of variance tests followed by Tukey's tests were used. SAS statistical software was used and the significance level was 5%. Results The results of the intervention group showed an increase in the variable ankle goniometry over time compared to the sham group. The dorsiflexion movement on the right side obtained major gains over time; in addition, plantar flexion increased. Conclusion Based on the participants evaluated in this study, manual therapy increased the ankle joint amplitude and improved the static balance in individuals with diabetes.
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Affiliation(s)
- Catarina Clapis Zordão
- Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Emilson Sodré Mendonça Junior
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Paola Marini Valério
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla Silva Perez
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Paula Ferro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elaine Caldeira de Oliveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Kobayashi T, Koshino Y, Miki T. Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review. BMC Musculoskelet Disord 2021; 22:683. [PMID: 34384403 PMCID: PMC8361650 DOI: 10.1186/s12891-021-04537-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. Methods A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. Results Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. Conclusions This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04537-6.
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Affiliation(s)
- Takumi Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan.
| | - Yuta Koshino
- Rehabilitation Center, NTT Medical Center Sapporo, Sapporo, Hokkaido, Japan
| | - Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Hokkaido, Japan
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Pereira BS, Andrade R, Espregueira-Mendes J, Marano RPC, Oliva XM, Karlsson J. Current Concepts on Subtalar Instability. Orthop J Sports Med 2021; 9:23259671211021352. [PMID: 34435065 PMCID: PMC8381447 DOI: 10.1177/23259671211021352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
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Affiliation(s)
- Bruno S. Pereira
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Hospital Privado de Braga, Lugar da Igreja Nogueira, Braga,
Portugal
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports,
University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto,
Porto, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, Minho University, Braga, Portugal
- 3B’s–PT Government Associate Laboratory, Braga/Guimarães,
Portugal
- 3B’s Research Group– Biomaterials, Biodegradables and Biomimetics,
University of Minho, Headquarters of the European Institute of Excellence on Tissue
Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
| | | | - Xavier Martin Oliva
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei,
Barcelona, Spain
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden
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Abassi M, Whiteley R. Serial Within-Session Improvements in Ankle Dorsiflexion During Clinical Interventions Including Mobilization-With-Movement and A Novel Manipulation Intervention - A Case Series. Int J Sports Phys Ther 2021; 16:1158-1168. [PMID: 34386293 PMCID: PMC8329314 DOI: 10.26603/001c.25544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Persisting reductions in ankle dorsiflexion range of motion are commonly encountered clinically and seen to be associated with adverse outcomes after ankle and other lower extremity injuries. Accordingly improving identified deficits is a common goal for rehabilitation; however, little data exists documenting any improvement related to interventions in these patients. PURPOSE To document the change in dorsiflexion range of motion after stretching and mobilization-with-movement and exercise and a novel manipulation intervention in a population of injured athletes. DESIGN Case series in 38 consecutive injured athletes with persisting reductions in ankle dorsiflexion range of motion (42 "stiff" ankles, 34 uninjured) in an outpatient sports physiotherapy clinic. METHOD During a single treatment session, two baseline measurements of weight-bearing dorsiflexion were taken at the start of the session to establish reliability and minimum detectable change, and then the same measures were performed after stretching and a mobilization-with-movement intervention, and again after clinical exercise and a novel manipulation which was applied on both ankles. RESULTS Excellent reliability was demonstrated (ICC2,1>0.93, MDC=3.5°) for the dorsiflexion measure. Statistically significant (p<0.01), but clinically meaningless improvements were seen after stretching and the mobilization-with-movement intervention on the injured and uninjured legs (1.9° and 1.4° respectively) with greater improvements seen after exercise and the subsequent manipulation (6.9° and 4.7°). CONCLUSIONS The relatively simple clinical exercise and manipulation intervention program was associated improvement in dorsiflexion range of motion in this cohort with persisting ankle stiffness. The interventions described largely restored range of motion consistent with baseline levels of the uninjured ankles. Improvements were also seen in the uninjured ankles following intervention.
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Norouzi A, Delkhoush CT, Mirmohammadkhani M, Bagheri R. A comparison of mobilization and mobilization with movement on pain and range of motion in people with lateral ankle sprain: A randomized clinical trial. J Bodyw Mov Ther 2021; 27:654-660. [PMID: 34391302 DOI: 10.1016/j.jbmt.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Maitland and Mulligan mobilization techniques are two manual therapy methods to increase the range of motion following immobility treatment. The present study was conducted to compare two therapeutic methods, namely mobilization and mobilization with movement (MWM), on the pain and range of motion in people with lateral ankle sprain. METHODS A total of 40 individuals with grade two lateral ankle sprain were randomly divided into two groups, including the Maitland's mobilization intervention group, and the Mulligan's mobilization intervention group. Both groups underwent treatment every other day for two consecutive weeks. The pain intensity was measured using the Visual Analogue Scale (VAS), and the ankle dorsiflexion movement range using the Weight Bearing Lunge Test (WBLT) before and one day after the intervention. RESULTS There were no significant differences between the two groups in terms of pain (P = 0.297) and range of motion (P = 0.294) before the intervention. Meanwhile, after the intervention, a significant change was observed in both groups in terms of these variables, which indicates the effectiveness of both interventions (P < 0.001) and the greater effect of the mobilization with movement in reducing pain (P = 0.037) and increasing the range of motion (P = 0.021). CONCLUSIONS Both techniques significantly improved the range of motion and reduced pain in people with lateral ankle sprain, but Mulligan's technique was significantly more effective among the two, perhaps due to joining active and passive mobilizing tensile forces as well as interaction of afferents and efferents in the reflex arc.
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Affiliation(s)
- Adeleh Norouzi
- Department of Physiotherapy, Rehabilitation Faculty, Semnan University of Medical Sciences, Semnan, Iran.
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
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Rogan S, Taeymans J, Eggertswyler B, Zuber S, Eichelberger P. Effect of finding-oriented manual therapy techniques on muscle activity and postural control in patients with chronic ankle instability - A randomized controlled feasibility study. J Bodyw Mov Ther 2021; 27:402-409. [PMID: 34391263 DOI: 10.1016/j.jbmt.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/19/2020] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Previous studies have analyzed the effects of manual therapy techniques (MTT) in patients with chronic ankle instability (CAI). Clinicians treat patients according the finding-oriented MTT approach. This approach is seldom pursued in research. The purpose of this study was to evaluate the feasibility and efficacy of finding-oriented MTT applications in patients with CAI. METHOD In this randomized controlled, blinded assessor crossover feasibility trial, participants were randomized to receive nine finding-oriented MTT treatments or no treatment during a three-week period, followed by a six-day washout period after which participants were crossed-over. Criteria under evaluation were adherence and attrition rates, safety (adverse events (AEs)) and acceptability and preliminary effects of finding-oriented MTT on muscular activity (measured by surface Electromyography (sEMG)) and on dynamic balance (measured by time to stabilization (TTS) and the modified Star Excursion Balance Test (modified STBT)). RESULTS Seven women and two men (mean age: 26 ± 6.1 years) with CAI enrolled in this feasibility study. Success criteria showed a high adherence (90%) and low attrition rate (10%). All data could be used for analysis. AEs such as tingling in the foot during a short time frame were reported after four finding-oriented MTT interventions. Preliminary effect sizes showed divergence and few statistically significant results for sEMG. CONCLUSION The participants were adherent to the finding-oriented MTT intervention. The acceptability of data recording and data analysis was good. In addition, the study protocol should be adapted by adding a 10-min warm up period, a participant familiarization to TTS and modified STBT, and test repetitions.
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Affiliation(s)
- Slavko Rogan
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Akademie für Integrative Physiotherapie und Trainingslehre, Grenzach-Wyhlen, Germany; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Jan Taeymans
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Beatrice Eggertswyler
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Stefan Zuber
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
| | - Patric Eichelberger
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
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Rodríguez-Sanz D, García-Sánchez A, Becerro-de-Bengoa-Vallejo R, Martínez-Jiménez EM, Calvo-Lobo C, Fernández-Carnero J, Losa-Iglesias ME, López-López D. Eyes-Open Versus Eyes-Closed Somatosensory Motor Balance in Professional Soccer Players With Chronic Ankle Instability: A Case-Control Study. Orthop J Sports Med 2021; 9:2325967120983606. [PMID: 33763496 PMCID: PMC7944533 DOI: 10.1177/2325967120983606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control. Purpose: To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI. Study Design: Cohort study; Level of evidence, 2. Methods: For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups. Results: Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable. Conclusion: In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players.
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Affiliation(s)
- David Rodríguez-Sanz
- Facultad de enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Eva María Martínez-Jiménez
- Facultad de enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.,Faculty of Sports, Universidad Europea de Madrid, Spain.,Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, Spain.,Nursing and Stomatology Department, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.,Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.,Investigation performed at Universidad Complutense de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Facultad de enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Marta Elena Losa-Iglesias
- Nursing and Stomatology Department, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
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Bolton C, Hale S, Telemeco T. The Effects of Therapeutic Exercise With and Without Mobilization in Participants With Chronic Ankle Instability: A Randomized Controlled Trial. J Sport Rehabil 2021; 30:206-213. [PMID: 37159607 DOI: 10.1123/jsr.2019-0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.
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Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial. J Sport Rehabil 2020; 29:1060-1068. [PMID: 31754078 DOI: 10.1123/jsr.2019-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Ankle proprioception is one of the crucial components contributing to postural control. Although the effects of Mulligan's mobilization with movement (MWM) on postural control, ankle dorsiflexion range of motion (DFROM), and muscle strength in people with ankle disorders have previously been investigated, it is still unclear whether ankle MWM had ability to change postural control, DFROM, and muscle strength. OBJECTIVES To reveal pure effects of MWM on postural control, ankle DFROM, and muscle strength in healthy individuals. DESIGN A prospective, randomized, double-blinded, sham-controlled study. SETTING Musculoskeletal laboratory, Dokuz Eylul University, Turkey. PARTICIPANTS Forty students in good health recruited from a local university. INTERVENTIONS Mulligan's MWM or sham application over ankle joint. MAIN OUTCOME MEASURES The primary outcome was postural control and measured using limits of stability (LOS) test. The secondary outcomes were tibialis anterior muscle strength and ankle DFROM, which were measured using handheld dynamometer and weight-bearing lunge test, respectively. All outcomes were assessed before and immediately after intervention. RESULTS Left and right ankle DFROM and LOS overall score showed a statistically significant improvement compared with first measurement in both groups (P < .05). However, LOS time was significantly improved only in the MWM group (P < .05). Statistical analyses of between-group mean differences showed that Mulligan's MWM provided significant improvement in the LOS in forward-right direction compared with sham application (P = .03). CONCLUSIONS The results of this study suggest that the application of Mulligan's MWM on ankle joint might be beneficial to improve postural control in forward right direction in individuals with healthy ankles. On the other hand, both MWM and sham application were able to increase overall postural control and DFROM, and MWM had no superiority over sham application for increasing these 2 variables.
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The Examination of Repeated Self-Mobilizations With Movement and Joint Mobilizations on Individuals With Chronic Ankle Instability. J Sport Rehabil 2020; 30:458-466. [PMID: 33049708 DOI: 10.1123/jsr.2019-0363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 06/01/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic ankle instability (CAI) is one of the most common chronic conditions in the world, resulting in millions of dollars contributed to the health care system. Joint mobilizations have been shown to effectively improve patient and disease-specific impairments secondary to CAI. The ability for patients to complete an effective manual therapy intervention without the need for continuous visits to a health care provider can alleviate burdens on the health care system and improve patient satisfaction. OBJECTIVE To examine the effect of clinician-applied Maitland talocrural joint mobilization and self-mobilization (Self-Mob) on dorsiflexion range of motion (DFROM), dynamic balance, strength, and perceived function in those with CAI. DESIGN Single-blind randomized trial. SETTING Research laboratory. PARTICIPANTS A total of 18 participants (7 males and 11 females; age = 20.78 [2.02] y, height = 67.66 [3.83] cm, limb length = 87.74 [5.05] cm) with self-reported CAI participated. INTERVENTIONS The participants received 6 interventions over a 2-week period. The participants received either Maitland grade III anterior-to-posterior talocrural joint mobilizations or weight-bearing lunge Self-Mob. Each intervention consisted of four 2-minute sets, with a 1-minute rest between sets. MAIN OUTCOME MEASURES The DFROM (weight-bearing lunge), dynamic balance (Y-Balance Test), isometric strength, Foot and Ankle Ability Measure Quick, Disablement of the Physically Active modified, Fear Avoidance Beliefs Questionnaire, and Tampa Scale of Kinesiophobia-11 were measured preintervention and postintervention. RESULTS Dynamic balance, isometric strength, and perceived function significantly improved in both groups at postintervention. The DFROM significantly improved in the Self-Mob group. Higher individual responder rates were demonstrated within the Self-Mob group compared with clinician-applied mobilizations. CONCLUSIONS Clinician-applied mobilizations and Self-Mobs are effective interventions for improving dynamic balance, isometric strength, and perceived function. Application of Self-Mobs can effectively improve DFROM compared with joint mobilization. Self-Mobs may be an effective intervention to incorporate into a home care plan.
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The Evaluation of Joint Mobilization Dosage on Ankle Range of Motion in Individuals With Decreased Dorsiflexion and a History of Ankle Sprain. J Sport Rehabil 2020; 30:347-352. [PMID: 32971515 DOI: 10.1123/jsr.2020-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/21/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Mulligan's Mobilization with Movement (MWM) is a common intervention used to address dorsiflexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature. OBJECTIVE The aim of this study was to examine the effect of serial MWM application on DFROM. DESIGN Repeated-measures cohort. SETTING A Midwestern University and the surrounding community. PARTICIPANTS A total of 18 adults (13 females; age = 29 [12.87] y; DFROM = 30.26° [4.60°]) with decrease dorsiflexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6 months, and no history of foot/ankle surgery. INTERVENTION Participants completed a single data collection session consisting of 10 individual sets of MWMs. MAIN OUTCOME MEASURES DFROM was taken at baseline and immediately after each intervention set (post 1, post 2, … post 10). DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point. RESULTS Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P < .001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P > .417). CONCLUSIONS MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages.
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Nozu S, Takemura M, Sole G. Assessments of Sensorimotor Deficits Used in Randomized Clinical Trials With Individuals With Ankle Sprains and Chronic Ankle Instability: A Scoping Review. PM R 2020; 13:901-914. [PMID: 32902164 DOI: 10.1002/pmrj.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022]
Abstract
The main purpose of this scoping review was to summarize the most common tasks and outcome measures in randomized control trials (RCTs) used to assess sensorimotor function following ankle sprain and chronic ankle instability (CAI). We also aimed to summarize the description of inclusion criteria used in articles. We searched for RCTs published between 2008 and 2018 using the following databases: MEDLINE, PubMed, SPORTDiscus, and Web of Science. Eligible studies included participants of either sex who had had at least one ankle sprain with/without subsequent CAI. All articles assessed sensorimotor function. The tasks, outcome measures, and inclusion criteria were categorized, and frequencies of use in each category were calculated. Of 272 publications, 31 met the eligibility criteria. The most common task was single-limb stance (58% of 31). The most common outcome measure was the posterior-medial reach distance of the Star Excursion Balance Test (SEBT) (13 of 16 articles, 81%). Different inclusion criteria for a history of ankle sprains or CAI were used. A wide range of sensorimotor assessments and inclusion criteria was used among studies involving individuals with a history of ankle sprain with or without CAI, which could make it difficult to compare and generalize study results. This scoping review provides a baseline for planning future studies exploring outcome measures to assess sensorimotor function of individuals with a history of ankle sprain with or without CAI.
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Affiliation(s)
- Shojiro Nozu
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Takemura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Sault JD, Jayaseelan DJ, Mischke JJ, Post AA. The Utilization of Joint Mobilization As Part of a Comprehensive Program to Manage Carpal Tunnel Syndrome: A Systematic Review. J Manipulative Physiol Ther 2020; 43:356-370. [PMID: 32861521 DOI: 10.1016/j.jmpt.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/23/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this review is to identify the role of joint mobilization for individuals with Carpal tunnel syndrome (CTS). METHODS A systematic search of 5 electronic databases (PubMed, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and SPORTDiscus) was performed to identify eligible full-text randomized clinical trials related to the clinical question. Joint mobilization had to be included in one arm of the randomized clinical trials to be included. Two reviewers independently participated in each step of the screening process. A blinded third reviewer assisted in cases of discrepancy. The PEDro scale was used to assess quality. RESULTS Ten articles were included after screening 2068 titles. In each article where joint mobilization was used, positive effects in pain, function, or additional outcomes were noted. In most cases, the intervention group integrating joint mobilization performed better than the comparison group not receiving joint techniques. CONCLUSION In the articles reviewed, joint mobilization was associated with positive clinical effects for persons with CTS. No studies used joint mobilization in isolation; therefore, results must be interpreted cautiously. This review indicates that joint mobilization might be a useful adjunctive intervention in the management of CTS.
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Affiliation(s)
- Josiah D Sault
- University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC.
| | - John J Mischke
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
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Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144997. [PMID: 32664535 PMCID: PMC7399978 DOI: 10.3390/ijerph17144997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/26/2022]
Abstract
Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.
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Holland CJ, Hughes JD, De Ste Croix MBA. Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability. Orthop J Sports Med 2020; 8:2325967120927371. [PMID: 32613023 PMCID: PMC7309406 DOI: 10.1177/2325967120927371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Chronic ankle instability (CAI) is linked to mechanical and functional insufficiencies. Joint mobilization is purported to be effective at treating these deficits. Purpose: To examine the effect of different treatment durations of a grade IV anterior-to-posterior ankle joint mobilization on weightbearing dorsiflexion range of motion (WB-DFROM), posterior talar glide (PG), and dynamic postural control in individuals with CAI. Study Design: Controlled laboratory study. Methods: A total of 48 female athletes (mean age, 22.8 ± 4.8 years) with unilateral CAI participated in this study. Participants were randomly assigned to 1 of 3 treatment conditions: 30 seconds, 60 seconds, and 120 seconds. Treatment was provided to the injured limb on 3 separate occasions 48 hours apart and consisted of a Maitland grade IV anterior-to-posterior talar joint mobilization based on the participant’s initial group assignment. WB-DFROM; PG; and the anterior (ANT), posteromedial (PM), and posterolateral (PL) reach directions of the Star Excursion Balance Test were measured bilaterally before and after each treatment. The uninjured limb acted as a control. Data were analyzed using 2-way mixed-model analyses of variance, and effect sizes were calculated through use of Hedges g. Results: Significant differences were detected after all treatment sessions for all outcome measures (P ≤ .001) and between treatment groups after sessions 1, 2, and 3 for all outcome measures (P ≤ .001). Effect sizes were very large or huge for all treatment groups for WB-DFROM, PG, and ANT reach direction. Substantial variation was found in effect sizes for PM and PL measures. Conclusion: Accessory mobilization is an effective treatment to induce acute changes in ankle motion and dynamic postural control in patients with CAI, with longer treatment durations conferring greater improvements. Clinical Relevance: This study adds clarity to the use of joint mobilization treatments and will add to the current clinical practice strategy for patients with CAI.
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Büttner F, Winters M, Delahunt E, Elbers R, Lura CB, Khan KM, Weir A, Ardern CL. Identifying the 'incredible'! Part 2: Spot the difference - a rigorous risk of bias assessment can alter the main findings of a systematic review. Br J Sports Med 2020; 54:801-808. [PMID: 31871014 DOI: 10.1136/bjsports-2019-101675] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marinus Winters
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport & Health, University College Dublin, Dublin, Ireland
| | - Roy Elbers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolina B Lura
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedics, Erasmus MC University Medical Center for Groin Injuries, Rotterdam, The Netherlands
- Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Clare L Ardern
- Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Department of Medicine and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
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Weerasekara I, Deam H, Bamborough N, Brown S, Donnelly J, Thorp N, Rivett DA. Effect of Mobilisation with Movement (MWM) on clinical outcomes in lateral ankle sprains: A systematic review and meta-analysis. Foot (Edinb) 2020; 43:101657. [PMID: 32247262 DOI: 10.1016/j.foot.2019.101657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/09/2019] [Accepted: 11/26/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the evidence for the effectiveness of MWM's in isolation for ankle sprains. MATERIALS AND METHODS Medline, Embase, CINHAL and SPORTDiscuss were searched. Any RCT or cross-over trial assessing adolescents to adults with grade I/II lateral ankle sprains, and treated with any MWM technique was included. Any conservative intervention was chosen as the comparator, and any clinical outcome was eligible as the outcome. Methodological quality was determined using the Cochrane Handbook risk of bias assessment tool. RESULTS Eighty-two full-texts were included after screening 1707 of title and abstracts. Six full-texts were included and data were extracted based on the outcomes of range of movement, balance or pain from patients with sub-acute to chronic sprains. Pooled data from four studies with 201 participants with chronic recurrent sprains were grouped for analysis of the effects of weight-bearing MWM on dorsiflexion range and has shown significant immediate improvements after treatment (MD = 0.91, CI = 0.06-1.76, p = 0.04). There was insufficient data to permit analysis for evaluation of immediate or short-term benefits of MWM on other assessed outcomes. CONCLUSION Weight-bearing MWM appears to be beneficial for improving weight-bearing dorsiflexion immediately after application for chronic recurrent ankle sprains compared to no treatment or sham. Long-term benefits have not been adequately investigated.
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Affiliation(s)
- Ishanka Weerasekara
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia; Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka.
| | - Hayley Deam
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Nathan Bamborough
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Sarah Brown
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Josh Donnelly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Nicholas Thorp
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Darren A Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Australia
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Hadadi M, Haghighat F, Sobhani S. Can fibular reposition taping improve balance performance in individuals with chronic ankle instability? A randomized controlled trial. Musculoskelet Sci Pract 2020; 46:102128. [PMID: 32217274 DOI: 10.1016/j.msksp.2020.102128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive. OBJECTIVE This study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability. DESIGN Randomized controlled trial. METHODS Sixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT). RESULTS The results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03). CONCLUSION Applying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population. CLINICAL TRIAL REGISTRATION NUMBER IRCT20171122037576N2.
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Affiliation(s)
- Mohammad Hadadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Haghighat
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sobhan Sobhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Effects of 12 Weeks of Tai Chi Intervention in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. J Sport Rehabil 2020; 29:326-331. [PMID: 30747567 DOI: 10.1123/jsr.2018-0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/11/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Tai Chi is a physical activity modality which is widely practiced over the world. The effectiveness of Tai Chi on postural control and balance has been described in older population, but until recently there are no studies that include patients with chronic ankle instability. OBJECTIVES The aim of this study was to evaluate the effectiveness of 12 weeks of Tai Chi intervention on dynamic balance and self-reported instability in patients with chronic ankle instability. STUDY DESIGN A randomized controlled trial was carried out. SETTING University physical therapy facility. PARTICIPANTS Fifty-two participants were allocated to an intervention group (n = 26) based on Tai Chi training or a control group (n = 26) who received no intervention. INTERVENTION The participants completed 12 weeks of Tai Chi intervention (1 h session/2 times per week) or no intervention in the control group. MAIN OUTCOME MEASURES Outcome measures included postural control and self-reported instability feeling assessed by the Star Excursion Balance Test and the Cumberland Ankle Instability Tool, respectively. RESULTS There was observed significant improvement in all Star Excursion Balance Test reach distances (anterior [F = 6.26, P < .01]; posteromedial [F = 9.58, P < .01], and posterolateral [F = 8.42, P < .01]) in the Tai Chi group with no change in the control group (P < .01). The intervention group demonstrated significant improvement on self-reported instability feeling assessed by the Cumberland Ankle Instability Tool questionnaire (F = 21.36, P < .01). CONCLUSION The obtained results suggested that 12 weeks of Tai Chi intervention have positive effects on postural control and self-reported instability feeling in patients with chronic ankle instability.
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Cruz-Díaz D, Hita-Contreras F, Martínez-Amat A, Aibar-Almazán A, Kim KM. Ankle-Joint Self-Mobilization and CrossFit Training in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. J Athl Train 2020; 55:159-168. [PMID: 31935136 DOI: 10.4085/1062-6050-181-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Ankle-joint mobilization and neuromuscular and strength training have been deemed beneficial in the management of patients with chronic ankle instability (CAI). CrossFit training is a sport modality that involves these techniques. OBJECTIVE To determine and compare the influence of adding self-mobilization of the ankle joint to CrossFit training versus CrossFit alone or no intervention in patients with CAI. DESIGN Randomized controlled clinical trial. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy recreational athletes with CAI were randomly allocated to either self-mobilization plus CrossFit training, CrossFit training alone, or a control group. INTERVENTION(S) Participants in the self-mobilization plus CrossFit group and the CrossFit training-alone group pursued a CrossFit training program twice a week for 12 weeks. The self-mobilization plus CrossFit group performed an ankle self-mobilization protocol before their CrossFit training, and the control group received no intervention. MAIN OUTCOME MEASURE(S) Ankle-dorsiflexion range of motion (DFROM), subjective feeling of instability, and dynamic postural control were assessed via the weight-bearing lunge test, Cumberland Ankle Instability Tool, and Star Excursion Balance Test (SEBT), respectively. RESULTS After 12 weeks of the intervention, both the self-mobilization plus CrossFit and CrossFit training-alone groups improved compared with the control group (P < .001). The self-mobilization plus CrossFit intervention was superior to the CrossFit training-alone intervention regarding ankle DFROM as well as the posterolateral- and posteromedial-reach distances of the SEBT but not for the anterior-reach distance of the SEBT or the Cumberland Ankle Instability Tool. CONCLUSIONS Ankle-joint self-mobilization and CrossFit training were effective in improving ankle DFROM, dynamic postural control and self-reported instability in patients with CAI.
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Affiliation(s)
- David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Spain
| | - Agustin Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Spain
| | - Kyung-Min Kim
- Department of Kinesiology and Sport Sciences, University of Miami, FL
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Lam KC, Bacon CEW, Sauers EL, Bay RC. Point-of-Care Clinical Trials in Sports Medicine Research: Identifying Effective Treatment Interventions Through Comparative Effectiveness Research. J Athl Train 2019; 55:217-228. [PMID: 31618071 DOI: 10.4085/1062-6050-307-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Recently, calls to conduct comparative effectiveness research (CER) in athletic training to better support patient care decisions have been circulated. Traditional research methods (eg, randomized controlled trials [RCTs], observational studies) may be ill suited for CER. Thus, innovative research methods are needed to support CER efforts. OBJECTIVES To discuss the limitations of traditional research designs in CER studies, describe a novel methodologic approach called the point-of-care clinical trial (POC-CT), and highlight components of the POC-CT (eg, incorporation of an electronic medical record [EMR], Bayesian adaptive feature) that allow investigators to conduct scientifically rigorous studies at the point of care. DESCRIPTION Practical concerns (eg, high costs and limited generalizability of RCTs, the inability to control for bias in observational studies) may stall CER efforts in athletic training. In short, the aim of the POC-CT is to embed a randomized pragmatic trial into routine care; thus, patients are randomized to minimize potential bias, but the study is conducted at the point of care to limit cost and improve the generalizability of the findings. Furthermore, the POC-CT uses an EMR to replace much of the infrastructure associated with a traditional RCT (eg, research team, patient and clinician reminders) and a Bayesian adaptive feature to help limit the number of patients needed for the study. Together, the EMR and Bayesian adaptive feature can improve the overall feasibility of the study and preserve the typical clinical experiences of the patient and clinician. CLINICAL ADVANTAGES The POC-CT includes the basic tenets of practice-based research because studies are conducted at the point of care, in real-life settings, and during routine clinical practice. If implemented effectively, the POC-CT can be seamlessly integrated into daily clinical practice, allowing investigators to establish patient-reported evidence that may be quickly applied to patient care decisions. This design appears to be a promising approach for CER investigations and may help establish a "learning health care system" in the sports medicine community.
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Affiliation(s)
- Kenneth C Lam
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa
| | - Cailee E Welch Bacon
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Eric L Sauers
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018. J Manipulative Physiol Ther 2019; 42:439-449. [DOI: 10.1016/j.jmpt.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
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McKeon PO, Donovan L. A Perceptual Framework for Conservative Treatment and Rehabilitation of Ankle Sprains: An Evidence-Based Paradigm Shift. J Athl Train 2019; 54:628-638. [PMID: 31135210 PMCID: PMC6602398 DOI: 10.4085/1062-6050-474-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lateral ankle sprains are the most common injuries sustained during physical activity. The epidemiologic trends associated with chronic ankle instability (CAI) suggest that current rehabilitation approaches may be inadequate. We sought to synthesize best-practices evidence for the rehabilitation of patients with acute ankle sprains and CAI through the integration of emerging paradigms in perception, the dynamics of skill acquisition, and the biopsychosocial model of function, disability, and health. From the best available evidence, 4 key factors emerged for effective treatment and rehabilitation strategies: pain reduction, external ankle support for up to 1 year, progressive return to motion, and coordination training. We combined these factors into a meta-theoretical framework that centers on the perceptual interdependence of the cellular, local, and global functioning levels by linking insights from the body-self neuromatrix, the dynamics of skill acquisition, and the biopsychosocial model. Based on the best-practice recommendations from systematic reviews, ankle-sprain rehabilitation represents a multidimensional phenomenon governed by perception. The impairments, activity limitations, and participation restrictions associated with CAI may be linked to perceptual-interdependence alterations. Pain and edema reduction, the use of external ankle support for up to 1 year, progressive return to motion, and coordination training foster enhanced perceptual interdependence from cells to society. Using the perceptual-interdependence framework for ankle-sprain rehabilitation, we offer new insights for charting the course of effective strategies for enhancing function, reducing disability, and preventing the long-term sequelae associated with CAI.
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Affiliation(s)
- Patrick O. McKeon
- Department of Exercise Science and Athletic Training, Ithaca College, NY
| | - Luke Donovan
- Department of Kinesiology, University of North Carolina at Charlotte
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Six Sessions of Anterior-to-Posterior Ankle Joint Mobilizations Improve Patient-Reported Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Topic. J Sport Rehabil 2019; 28:381-384. [PMID: 29364036 DOI: 10.1123/jsr.2016-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Chronic ankle instability (CAI) is a complex musculoskeletal condition that results in sensorimotor and mechanical alterations. Manual therapies, such as ankle joint mobilizations, are known to improve clinician-oriented outcomes like dorsiflexion range of motion, but their impact on patient-reported outcomes remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve patient-reported outcomes in patients with chronic ankle instability? Summary of Key Findings: Three studies (2 randomized controlled trials and 1 prospective cohort) quantified the effect of at least 2 weeks of anterior-to-posterior ankle joint mobilizations on improving patient-reported outcomes immediately after the intervention and at a follow-up assessment. All 3 studies demonstrated significant improvements in at least 1 patient-reported outcome immediately after the intervention and at the follow-up assessment. Clinical Bottom Line: At least 2 weeks of ankle joint mobilization improves patient-reported outcomes in patients with chronic ankle instability, and these benefits are retained for at least a week following the termination of the intervention. Strength of Recommendation: Strength of recommendation is grade A due to consistent good-quality patient-oriented evidence.
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Shi X, Han J, Witchalls J, Waddington G, Adams R. Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: A systematic review with meta-analysis? Musculoskelet Sci Pract 2019; 40:87-95. [PMID: 30753998 DOI: 10.1016/j.msksp.2019.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
Abstract
QUESTION Can manual therapy improve functional outcomes for individuals with chronic ankle instability? DESIGN Systematic review with meta-analysis of randomized controlled trials. PARTICIPANTS Individuals with chronic ankle instability. INTERVENTION Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement. OUTCOME MEASURE The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control. RESULTS Four studies were included (n = 208, mean age = 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6-8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies, n = 147, SMD = 1.24 (95%CI -0.87 to 3.36), I2 = 96%) or non-weight-bearing inclinometer test (2 studies, n = 47, MD = 3.41° (95%CI -0.26 to 7.09),I2 = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT(2 studies, n = 80, SMD = 2.39, (95% CI 0.55, to 4.23), I2 = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies, n = 137,MD = 2.05,95%CI (-0.96,5.05), I2 = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT). CONCLUSIONS Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI. TRIAL REGISTRATION NUMBER PROSPERO CRD42017054715.
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Affiliation(s)
- Xiaojian Shi
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China.
| | - Jia Han
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China; Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
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Vallandingham RA, Gaven SL, Powden CJ. Changes in Dorsiflexion and Dynamic Postural Control After Mobilizations in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis. J Athl Train 2019; 54:403-417. [PMID: 30870009 DOI: 10.4085/1062-6050-380-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability. DATA SOURCES Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017. STUDY SELECTION Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs). DATA EXTRACTION Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons. DATA SYNTHESIS We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%-80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P < .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = -0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = -0.12, 0.87; P = .14) analyses. CONCLUSIONS We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.
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Affiliation(s)
- Robert A Vallandingham
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute. Dr Gaven is now with the College of Health Sciences, University of Indianapolis, IN
| | - Stacey L Gaven
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute. Dr Gaven is now with the College of Health Sciences, University of Indianapolis, IN
| | - Cameron J Powden
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute. Dr Gaven is now with the College of Health Sciences, University of Indianapolis, IN
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Weerasekara I, Osmotherly PG, Snodgrass SJ, Tessier J, Rivett DA. Effects of mobilisation with movement (MWM) on anatomical and clinical characteristics of chronic ankle instability: a randomised controlled trial protocol. BMC Musculoskelet Disord 2019; 20:75. [PMID: 30760256 PMCID: PMC6375188 DOI: 10.1186/s12891-019-2447-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/01/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Up to 40% of individuals who sprain their ankle develop chronic ankle instability (CAI). One treatment option for this debilitating condition is joint mobilisation. There is preliminary evidence that Mulligan's Mobilisation With Movement (MWM) is effective for treating patients with CAI, but the mechanisms by which it works are unclear, with Mulligan suggesting a repositioning of the fibula. This randomised controlled trial aims to determine the effects of MWM on anatomical and clinical characteristics of CAI. METHODS Participants 18 years or over with CAI will be accepted into the study if they satisfy the inclusion and exclusion criteria endorsed by the International Ankle Consortium. They will be randomised into the experimental group (MWM) or the placebo group (detuned laser) and will receive the assigned intervention over 4 weeks. General joint hypermobility and the presence of mechanical instability of the ankle will be recorded during the first visit. Further, position of the fibula, self-reported function, ankle dorsiflexion range, pressure pain threshold, pain intensity, and static and dynamic balance will be assessed at baseline, and at the conclusion of course of intervention. Follow-up data will be collected at the twelfth week and at the twelfth month following intervention. DISCUSSION Effectiveness of MWM on clinically relevant outcomes, including long term benefits will be evaluated. The capacity of MWM to reverse any positional fault of the fibula and the association of any positional fault with other clinically important outcomes for CAI will be explored. Proposed biomechanical mechanisms of fibular positional fault and other neurophysiological mechanisms that may explain the treatment effects of MWM will be further explored. The long term effectiveness of MWM in CAI will also be assessed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12617001467325 (17/10/2017).
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Affiliation(s)
- Ishanka Weerasekara
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Peter Grant Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Suzanne Jordan Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - John Tessier
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Darren Anthony Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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