Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

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.

Assessing the Effects of Aging on Muscle Stiffness Using Shear Wave Elastography and Myotonometer

“…Muscle strength peaks in an individual’s 20s or 30s, decreases 1.5% per year in one’s 50s to 60s, and decreases 3% per year thereafter [ 6 , 7 ]. A greater decline occurs in the lower extremities than in the upper extremities, creating a functional decrease in the ankle joint stabilizers such as the tibialis anterior (TA), gastrocnemius, and soleus [ 8 , 9 , 10 , 11 ]. The TA is an ankle stabilizer and support of the peroneus muscle that maintains balance and locomotion [ 12 ].…”

The Effect of Single High-Velocity, Low-Amplitude Spine Manipulation on Posture, Functional State of Torso, Thigh Muscles, and Vertical Jump Height

“…The authors confirm that this manipulative effect does not always have a sufficiently large positive effect on the functional segments, which, for example, is very important for athletes in terms of the optimal amount of movement in a particular segment. Thus, the researchers confirm that in addition to the manipulative effects on the joints, other manipulative effects on the surrounding tissues (massage, active stretching, exercises) are needed to optimize the volume of movement in the larger segment (Schmid, Brunner, Wright & Bachmann, 2008;Sharma et al, 2012;Pedak et al, 2019;Gouttebarge et al, 2017;Nagy et al, 2017).…”

“…High-velocity, low-amplitude (HVLA) manipulation has been studied for its effects on athletes' mobility and stability. A randomized pilot study found that HVLA applied to the thoracic spine increased spine mobility, but this increase in mobility did not lead to improved gait initiation performance, such as speed and step length (Ditcharles, Yiou, Delafontaine & Hamaoui, 2017);Shin, Kim, Jung, Cho, & Hahm, 2020).…”

“…The results of researches show the influence of various manipulations and exercises on the mobility, stability, and height of the vertical jump of volleyball players (Leporace et al, 2011;Sharma, Geovinson & Singh Sandhu, 2012;Pedak, Port, Rannama & Bazanov, 2019;Gouttebarge, van Sluis, Verhagen & Zwerver, 2017). During the training process, deviations in the functional state of the athlete's musculoskeletal system from the optimal position are often associated with soft tissue overload, which can lead to incorrect loading of the involved joint in both statics and dynamics.…”

Construction and validation of a nomogram prediction model for axillary lymph node metastasis of cT1 invasive breast cancer

“…MRI is expensive and has high sensitivity but low specificity (Kuijs et al ., 2015; Zhou et al, 2018), and PET-computed tomography (PET-CT) has low sensitivity and high specificity (Marino et al, 2020). While ultrasound has high sensitivity and specificity (Garcia Fernandez et al ., 2011; Shin et al, 2020). Ultrasound, with its noninvasive, real-time and low-cost advantages, has become the most commonly used modality for preoperative evaluation of breast masses and axillary lymph nodes.…”