Effects of Proximal and Distal Tibiofibular Joint Manipulation on Lower Extremity Muscle Activation, Ankle Range of Motion, and Functional Outcome Scores in Individuals With Chronic Ankle Instability
Condition: Ankle Sprain; Ankle Injuries; Sprain
MeSH terms: Sprains and Strains; Ankle Injuries
Study type: Interventional

Summary: 
      The overall aim of this project is to determine the effect of a tibiofibular joint
      manipulation on the neuromuscular response of the fibularis longus and soleus muscles in
      individuals with chronic ankle instability. Another aim of this study is to determine the
      long term effects of a tibiofibular joint manipulation on range of motion and self-reported
      function.

      We hypothesize that a manipulation applied at the distal tibiofibular joint will result in
      greater muscle activation, improved functional dorsiflexion ROM, and increases in FAAM scores
      compared to a tibiofibular joint manipulation applied at the proximal joint. We further
      hypothesize that both distal and proximal tibiofibular joint manipulations will result in
      greater muscle activation, improved functional dorsiflexion ROM, and increases in FAAM scores
      than no treatment at all.
    

Detailed description: 
      Muscle weakness is a common impairment following injury to a joint. Individuals with lateral
      ankle sprains have been shown to demonstrate weakness and inhibition of the fibularis longus
      and soleus muscles. Recently, changes in the positional alignment of the talus, tibia, and
      fibula have been implicated in a subpopulation of individuals with chronic ankle instability
      (CAI). Clinically this manifests as a decrease in the posterior glide of the talus and
      decreased dorsiflexion ROM. Another positional fault has been noted to occur between the
      distal tibiofibular joint. A subpopulation of individuals with a history of CAI have
      demonstrated a slight anterior displacement of the fibula relative to the tibia. The cause of
      the malpositioning is unknown, but manual therapeutic interventions may offer the ability to
      restore normal joint arthrokinematics and muscle function. It is unknown if the correction of
      this positional fault will have an effect on muscle inhibition about the ankle.

      Since muscle inhibition is a neurological reflexive reaction, it is thought that traditional
      strengthening treatment techniques may not fully address this dysfunction. Manual therapeutic
      interventions can have dual effects on the neuromuscular system and restore normal joint
      arthrokinematics. Evidence suggests a joint manipulation is able to disinhibit or even
      facilitate local and distant muscles. This likely occurs due to the afferent response from
      the structures in and around the manipulated joint. Comprehensive treatment interventions
      which restore normal joint function, optimal motoneuron pool excitability, strength, and
      pain-free previous level of function need to be developed to prevent future dysfunction and
      osteoarthritis.

      Currently no study has examined the effects of tibiofibular joint manipulation on the
      neuromuscular response of ankle musculature or the effects on range of motion and function.
      The purpose of this study is to examine the acute effects of a tibiofibular joint
      manipulation on the neuromuscular response of the fibularis longus and soleus muscles and to
      determine the long term effects on range of motion and function in individuals with CAI.

      The first research question will address how a tibiofibular joint manipulation immediately
      affects the activation of the fibularis longus and soleus muscles. The second question will
      address how this joint manipulation affects range of motion and functional outcomes over a
      three week period. Changes in ankle dorsiflexion range of motion (ROM), navicular drop, Step
      Down Test, Balance Error Scoring System, and the Foot and Ankle Ability Measure (FAAM) will
      be used to determine if clinically significant changes occurred during the intervention
      period.
    

Intervention name(s): proximal tibiofibular manipulation; distal tibiofibular manipulation; no intervention
Intervention type(s): Other; Other; Other
Intervention description(s): proximal tibiofibular manipulation; distal tibiofibular manipulation; no intervention / control
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: ankle sprain; ankle injuries; sprains and strains