Does Talocrural Joint-Thrust Manipulation Improve Outcomes After Inversion Ankle Sprain?

Abstract

Clinical Scenario: Ankle sprains account for roughly 10% of sport-related injuries in the active population. The majority of these injuries occur from excessive ankle inversion, leading to lateral ligamentous injury. In addition to pain and swelling, limitations in ankle range of motion (ROM) and self-reported function are common findings. These limitations are thought to be due in part to loss of mobility in the talocrural joint. Accordingly, some investigators have reported using high-velocity, low-amplitude thrust-manipulation techniques directed at the talocrural joint to address deficits in dorsiflexion (DF) ROM and function. This review was conducted to ascertain the impact of talocrural joint-thrust manipulation (TJM) on DF ROM, selfreported function, and pain in patients with a history of ankle sprain. Focused Clinical Question: In patients with a history of inversion ankle sprain, does TJM improve outcomes in DF ROM, self-reported function, and/or pain?Keywords: exercise, injury management, rehabilitation, range of motion, physical therapy Clinical ScenarioAnkle sprains account for roughly 10% of sport-related injuries in the active population. 1 The majority of these injuries occur from excessive ankle inversion, leading to lateral ligamentous injury. In addition to pain and swelling, limitations in ankle range of motion (ROM) and self-reported function are common findings. These limitations are thought to be due in part to loss of mobility in the talocrural joint. Accordingly, some investigators have reported using high-velocity, low-amplitude thrust manipulation techniques directed at the talocrural joint to address deficits in dorsiflexion (DF) ROM and function. 2,3 This review was conducted to ascertain the impact of talocrural joint-thrust manipulation (TJM) on DF ROM, self-reported function, and pain in patients with a history of ankle sprain. Focused Clinical QuestionIn patients with a history of inversion ankle sprain, does TJM improve outcomes in DF ROM, self-reported function, and/or pain? Summary of Search, "Best Evidence" appraised, and Key Findings• The literature was searched for studies that investigated the effect of TJM on DF ROM, self-reported function, and/or pain in patients with a history of inversion ankle sprain.• Three moderate-to high-quality randomized controlled trials (RCTs) were included. • The authors of 1 RCT reported that patients treated up to 8 times with TJM had greater improvements in function and pain at the 1-month follow-up than patients who received multiple detuned (sham) ultrasound treatments.• In another study, improvements in pain, patient-perceived progress, and ankle-specific functional scales were reportedly superior at 4-week and 6-month follow-up in patients treated with a combination of exercise, TJM, nonthrust talocrural and subtalar posterior joint mobilizations, weight-bearing talocrural joint mobilization with movement, and proximal and distal tibiofibular joint mobilization or manipulation to those of patients treated with home exercise alone. • In...

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Ambulosono-Enhanced Ankle Rotation Training Leads to Significant Gains in Balance Among Healthy Adults

“…Limited ankle ROM has been associated with an increased risk of balance-related challenges, including instability during daily movements and activities. Evaluating lower extremity ROM is therefore integral for assessing joint health and its impact on an individual’s ability to maintain balance, which is of particular concern for the elderly 19…”

“…Additionally, poor balance has been linked to a decrease in self-confidence and an increased fear of falling, which can lead to a sedentary lifestyle.14 Lastly, studies indicate that poor balance correlates with cognitive impairments, affecting attention, memory, and executive function 15, 16. In summary, the ramifications of poor balance go beyond mere physical limitations, significantly affecting an individual’s overall health and well-being Emerging evidence suggests that ankle range of motion (ROM) is a critical factor in maintaining balance and preventing further injuries, especially among older adults 17, 18. Limited ankle ROM has been associated with an increased risk of balance-related challenges, including instability during daily movements and activities.…”