The Thrust Technique of Tibiotarsal Joint on the Symptomatology of Pain at Classical Ballet Dancers
Condition: Pain; Osteopathia; Ankle Injuries
MeSH terms: Ankle Injuries
Study type: Interventional

Summary: 
      Classical ballet is a type of high performance dance that requires great effort and extreme
      joint positions by its dancers, not to mention a precise control of the ankle joint when on
      pointe position. Ballet dancers excessively dorsiflex, and especially plantar flex the ankle,
      which predisposes anterior displacement of the talus, possibly causing mobility restrictions
      of the tibiotarsal articulation and making it difficult and painful to move the ankle while
      dancing. The Thrust technique of tibiotarsal joint is a manipulation that aim to improve
      mobility and articular function through a high-speed and short-range movement. The purpose of
      the study is to verify the effect of the Thrust technique of tibiotarsal joint on the pain
      symptomatology in classical ballet dancers. Ballerinas included in the study presented pain
      in the ankle when dancing classical ballet, tenderness to palpation in the anterior and
      posterior tibiotarsal articulation, and dysfunction after compression of the tibiotarsal
      articulation. The sample consisted of 20 ballerinas, out of which 10 were subjected to
      manipulation (IG) and 10 formed the control group (CG). Algic symptomatology in classical
      ballet dance was assessed after some practice with the Visual Analogue Scale (VAS). After
      that, an algometer was used to quantify the threshold of pain in the anterior and posterior
      ankle joint that presented restrictions in mobility. The Tug technique was performed in the
      tibiotarsal articulation in the IG, and in the CG it was simulated. The threshold of pain in
      the anterior and posterior tibiotalar joint was measured again immediately after the
      intervention or simulation. The ballerinas were reassessed using algometry and the Visual
      Analogue Scale (VAS) one week after the manipulation.
    

Detailed description: 
      This is a randomized clinical trial of quantitative character, realized in a classical ballet
      school in Teresina, Piauí, Brazil, from June to October 2017. The present research was
      approved by the Ethics and Research Committee of State University of Piauí. The participants
      or their guardians signed the Term of Free and Informed Consent in accordance with Resolution
      466/12 of the National Health Council (CNS).

      The Random randomization in two groups (n=10, each) happens through drawing lots, with the
      intervention group (GI) submitted to the thrust technique of the tibiotarsal joint for
      decoaptation of this joint, and the control group (GC), to its simulation.

      The instruments used to data collect from the study were: (1) Visual Analog Scale (VAS), a
      scale that quantifies the intensity of pain through punctuated values, at one extreme of 0,
      indicating "no pain", to 10, pointing an "maximum pain" 19; (2) Digital algometer (Wagner
      Instuments®) with a capacity of ten kilograms-force (kgf) and compression deformation of 10
      cm, to evaluate the threshold of painful pressure; (3) Questionnaire, developed by the
      researchers, relating to personal and anthropometric data and related to the ballet practice.

      The data collection was carried out in an evaluation room at the ballet school, after the
      dancers had participated of the classical dance, by a research assistant that was blind to
      conditions for treatment. The evaluation of the dysfunction in compression of tibiotarsis and
      the osteopathic manipulation were performed by an experienced osteopath and familiarized with
      the technique.

      To determine the presence of tibiotarsal compression dysfunction in dancers who presented
      pain during dancing and on palpation at the anterior and posterior tibiotalar joint, the
      tibiotarsal coaptation and decoaptation test was performed20 (Figure 01): the participants
      were positioned in dorsal decubitus, already the osteopath, with the internal hand slipped
      the pinky finger on the medial edge of the foot to the talus neck, the other fingers on the
      dorsum of the foot and the thumbs on the sole of the foot, the ankle of the dancer was kept
      in slight inversion and plantar flexion, the therapist flexed his knees, until his forearms
      stay in the same level as the lower limbs of the participant. Shortly after tractioned and
      related the joint to perceive if there articulation mobility, or if the joint was fixed.

      The VAS was used to weighting (evaluate) the effects on pre and post-test of the osteopathic
      manipulation, and the algometer checked quantitatively. The points measured by this
      instrument were the anterior and posterior tibiotalar joint. Before the evaluation, the
      dancers were submitted to familiarity with the equipment in the triceps surae, in which they
      were orientated to inform when the pressure would become a painful sensation. In the
      assessment, the algometer was positioned perpendicularly at the aforementioned points (Figure
      01).

      The GI dancers, submitted to tibiotarsal thrust manipulation (Figure 02), were positioned in
      dorsal decubitus position with the heel outside the stretcher. The osteopath positioned in a
      lateral feint, inflected knees and forearms in the same plane as the participant's leg. With
      the internal hand slipped the pinky finger on the medial edge of the foot to the talus neck,
      the other fingers on the dorsum of the foot and the thumbs controlling the first metatarsus.
      The position of the talus in relation to the tibia was corrected, initially by placing the
      foot in eversion and then in dorsal flexion. The osteopath left the body weight behind,
      causing a traction in the joint. The thrust consisted of a impulse of high speed and low
      amplitude impulse in a caudal direction, closing the elbows20. The technique was performed
      until the obtainment (achieved) the joint noise only in the restricted foot, and only one
      service was performed. After one week, a reassessment of the painful sensation after the
      dance was performed.

      For the CG was performed the simulation of the technique, with the participants and the
      osteopath positioned in the same way as the IG, however there was no reproduction of joint
      noise.
    

Intervention name(s): Tibiotarsal Thrust Manipulation; Simulation Tibiotarsal Thrust Manipulation
Intervention type(s): Other; Other
Intervention description(s): The dancers were positioned in dorsal decubitus position with the heel outside the stretcher. The osteopath positioned in a lateral feint, inflected knees and forearms in the same plane as the participant's leg. With the internal hand slipped the pinky finger on the medial edge of the foot to the talus neck, the other fingers on the dorsum of the foot and the thumbs controlling the first metatarsus. The position of the talus in relation to the tibia was corrected, initially by placing the foot in eversion and then in dorsal flexion. The osteopath left the body weight behind, causing a traction in the joint. The thrust consisted of a impulse of high speed and low amplitude impulse in a caudal direction, closing the elbows20. The technique was performed until the obtainment (achieved) the joint noise only in the restricted foot, and only one service was performed. After one week, a reassessment of the painful sensation after the dance was performed.; Simulation of the technique Tibiotarsal Thrust Manipulation, with the participants and the osteopath positioned in the same way as the IG, however there was no reproduction of joint noise.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This is a randomized clinical trial of quantitative character.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Osteopathy; Thrust; Classical Ballet; Pain