Effectiveness of Joint Mobilization in Patients With Chronic Ankle Instability: A Review of the Literature

Ankle joint mobilization has been shown to be effective at improving outcomes in those with chronic ankle instability (CAI), but the neuromuscular mechanisms are still unknown. We aimed to determine the immediate effect of a single Grade III anterior-to-posterior ankle joint mobilization bout on ankle musculotendinous stiffness (MTS) in those with CAI. Seventeen CAI participants had plantar flexor and fibularis MTS assessed before and after a 5-min joint mobilization treatment. MTS outcomes were estimated using the damped oscillation method. Fibularis (0.25 ± 0.41 N/m/kg, p = .028) but not plantar flexor MTS (−2.18 ± 14.35 N/m/kg, p = .539) changed following mobilization and exceeded the calculated minimal detectable change score (0.12 N/m/kg). Increased fibularis MTS may represent a neuromuscular mechanism by which ankle joint mobilizations improve postural control in those with CAI.

Download Full-text

The Immediate Effects of an Anterior-To-Posterior Talar Mobilization on Neural Excitability, Dorsiflexion Range of Motion, and Dynamic Balance in Patients With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2013-0085 ◽

2014 ◽

Vol 23 (4) ◽

pp. 351-359 ◽

Cited By ~ 15

Author(s):

Matthew Harkey ◽

Michelle McLeod ◽

Ashley Van Scoit ◽

Masafumi Terada ◽

Michael Tevald ◽

...

Keyword(s):

Postural Control ◽

Range Of Motion ◽

Outcome Measures ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Corticospinal Excitability ◽

Spinal Reflex ◽

Control Group ◽

Joint Mobilization ◽

Grade Iii

Context:Altered neuromuscular function and decreased dorsiflexion range of motion (DFROM) have been observed in patients with chronic ankle instability (CAI). Joint mobilizations are indicated for restoring DFROM and dynamic postural control, yet it remains unknown if a mobilization can alter neuromuscular excitability in muscles surrounding the ankle.Objective:To determine the immediate effects of a Maitland grade III anterior-to-posterior joint mobilization on spinal-reflex and corticospinal excitability in the fibularis longus (FL) and soleus (SOL), DFROM, and dynamic postural control.Design:Single-blinded randomized control trial.Setting:Research laboratory.Patients:30 patients with CAI randomized into a mobilization (n = 15) or control (n = 15) group.Intervention:Maitland grade III anterior-to-posterior joint mobilization.Main Outcome Measures:Spinal-reflex excitability was measured with the Hoffmann reflex, while corticospinal excitability was evaluated with transcranial magnetic stimulation. DFROM was measured seated with the knee extended, and dynamic postural control was quantified with the Star Excursion Balance Test. Separate 2 × 2 repeated-measures ANOVAs were performed for each outcome measure. Dependent t tests were used to evaluate individual differences within groups in the presence of significance.Results:Spinal-reflex and corticospinal excitability of the SOL and FL were not altered in the mobilization or control group (P > .05). DFROM increased immediately after the mobilization (P = .05) but not in the control group, while dynamic postural control was unchanged in both groups (P > .05).Conclusion:A single joint-mobilization treatment was efficacious at restoring DFROM in participants with CAI; however, excitability of spinal reflex and corticospinal pathways at the ankle and dynamic postural control were unaffected.

Download Full-text

Effect of a 2-Week Joint-Mobilization Intervention on Single-Limb Balance and Ankle Arthrokinematics in Those With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2012-0125 ◽

2014 ◽

Vol 23 (1) ◽

pp. 18-26 ◽

Cited By ~ 17

Author(s):

Matthew C. Hoch ◽

David R. Mullineaux ◽

Richard D. Andreatta ◽

Robert A. English ◽

Jennifer M. Medina-McKeon ◽

...

Keyword(s):

Postural Control ◽

Outcome Measures ◽

Repeated Measures ◽

Center Of Pressure ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Talocrural Joint ◽

Joint Mobilization ◽

Multiple Treatment ◽

Eyes Open

Context:A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.Objective:To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.Design:Repeated measures.Setting:Research laboratory.Participants:12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).Intervention:Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.Main Outcome Measures:Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.Results:No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).Conclusions:The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

Download Full-text

Joint Mobilization Acutely Improves Landing Kinematics in Chronic Ankle Instability

Medicine & Science in Sports & Exercise ◽

10.1249/mss.0b013e3182746d0a ◽

2013 ◽

Vol 45 (3) ◽

pp. 514-519 ◽

Cited By ~ 18

Author(s):

EAMONN DELAHUNT ◽

KIM CUSACK ◽

LAURA WILSON ◽

CAILBHE DOHERTY

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

Joint Mobilization

Download Full-text

Erratum: Harkey et al (2014)

Journal of Sport Rehabilitation ◽

10.1123/jsr.2015-0084 ◽

2015 ◽

Vol 24 (2) ◽

pp. 197

Keyword(s):

Range Of Motion ◽

Ankle Instability ◽

Dynamic Balance ◽

Chronic Ankle Instability ◽

Correct Version ◽

Balance Test ◽

Neural Excitability ◽

Joint Mobilization ◽

Star Excursion Balance Test

In Table 2 in the article by Harkey M, McLeod M, Van Scoit A, et al, “The Immediate Effects of an Anterior-to-Posterior Talar Mobilization on Neural Excitability, Dorsiflexion Range of Motion, and Dynamic Balance in Patients With Chronic Ankle Instability,” in J Sport Rehabil. 23(4):351–359, the composite and anterior scores for the Star Excursion Balance Test in the joint-mobilization group were transposed. Printed here is the correct version of the table.

Download Full-text

Dynamic Systems Theory as a Guide to Balance Training Development for Chronic Ankle Instability: A Review of the Literature

Athletic Training & Sports Health Care ◽

10.3928/19425864-20120731-04 ◽

2012 ◽

Vol 4 (5) ◽

pp. 230-236 ◽

Cited By ~ 10

Author(s):

Patrick O. McKeon

Keyword(s):

Systems Theory ◽

Dynamic Systems ◽

Ankle Instability ◽

Balance Training ◽

Chronic Ankle Instability ◽

Dynamic Systems Theory ◽

Review Of The Literature ◽

Training Development

Download Full-text

Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120927371 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092737 ◽

Cited By ~ 1

Author(s):

Christopher J. Holland ◽

Jonathan D. Hughes ◽

Mark B.A. De Ste Croix

Keyword(s):

Postural Control ◽

Outcome Measures ◽

Mixed Model ◽

Female Athletes ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Effect Sizes ◽

Treatment Groups ◽

Joint Mobilization ◽

All Treatment

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.

Download Full-text

Effects of midfoot joint mobilization on perceived ankle-foot function in chronic ankle instability. A crossover clinical trial

10.1101/2021.12.08.21267445 ◽

2021 ◽

Author(s):

Abbis Jaffri ◽

John J. Fraser ◽

Rachel M. Koldenhoven ◽

Jay Hertel

Keyword(s):

Ankle Instability ◽

Dynamic Balance ◽

Chronic Ankle Instability ◽

Post Treatment ◽

Home Exercise ◽

Pain Patient ◽

Joint Mobility ◽

Joint Mobilization ◽

Patient Reported ◽

To Receive

AbstractBackgroundChronic ankle instability (CAI) is a complex clinical entity that commonly includes ankle-foot impairment.ObjectiveTo investigate the effects of midfoot joint mobilizations and a one-week home exercise program (HEP) compared to a sham intervention and HEP on pain, patient-reported outcomes (PROs), ankle-foot joint mobility, and neuromotor function in young adults with CAI.MethodsTwenty participants with CAI were instructed in a stretching, strengthening, and balance HEP and were randomized a priori to receive midfoot joint mobilizations (forefoot supination, cuboid glide and plantar 1st tarsometatarsal) or a sham laying-of-hands. Changes in foot morphology, joint mobility, strength, dynamic balance, and PROs assessing pain, physical, and psychological function were assessed pre-to-post treatment and one-week following. Participants crossed-over to receive the alternate treatment and were assessed pre-to-post treatment and one-week following. Linear modelling was used to assess changes in outcomes.ResultsParticipants who received midfoot mobilization demonstrated significantly greater perceived improvement immediately posttreatment in the single assessment numeric evaluation (Sham: 5.0±10.2%; Mobilization: 43.9±26.2%; β: 6.8 p<0.001, Adj R2:0.17) and Global Rating of Change (Sham: −0.1±1.1; Mobilization: 1.1±3.0; β: 1.8 p=0.01, Adj R2:0.12). Following the mobilization intervention, participants demonstrated greater improved rearfoot inversion mobility (Sham: 4.4±8.4°; Mobilization: −1.6±6.1°; β: −6.37, p=0.01, Adj R2:0.19), plantarflexion mobility (Sham: 2.7°±6.4; Mobilization: −1.7°±4.3; β: −4.36, p=0.02, Adj R2:0.07), and posteromedial dynamic balance (Sham: 2.4±5.9%; Mobilization: 6.0±5.4%; β: 3.88, p=0.04, Adj R2:0.10) compared to controls at 1-week post-treatment.ConclusionParticipants with CAI who received midfoot joint mobilization had greater perceived improvement and physical signs that may benefit this clinical population.

Download Full-text