Mechanisms of Manual Therapies in CAI Patients
Condition: Ankle Inversion Sprain; Chronic Instability of Joint
MeSH terms: Joint Instability
Study type: Interventional

Summary: 
      ABSTRACT:

      Injury associated with sport and recreation is a leading reason for physical activity
      cessation, which is linked with significant long-term negative consequences. Lateral ankle
      sprains are the most common injuries associated with physical activity and at least 40% of
      individuals who sprain their ankle will go on to develop chronic ankle instability (CAI), a
      multifaceted condition linked with life-long residual symptoms and post-traumatic ankle
      osteoarthritis. Our long term goal is to develop intervention strategies to decrease
      disability associated with acute and chronic ankle injury and prevent posttraumatic ankle
      osteoarthritis. Conventional rehabilitation strategies, are only moderately successful
      because they ignore the full spectrum of residual symptoms associated with CAI. Manual
      therapies such as ankle joint mobilizations and plantar massage target sensory pathways not
      addressed by conventional treatments and have been shown to improve patient-reported
      outcomes, dorsiflexion range of motion, and postural control in CAI patients. While these
      early results are promising, the underlying neuromuscular mechanisms of these manual
      therapies remain unknown. Therefore the objective of this R21 proposal is to determine the
      neuromuscular mechanisms underlying the improvements observed following independent ankle
      joint mobilization and plantar massage interventions in CAI patients. To comprehensively
      evaluate the neuromuscular mechanisms of the experimental treatments, baseline assessments of
      peripheral (ankle joint proprioception, light-touch detection thresholds, spinal (H-Reflex of
      the soleus and fibularis longus), and supraspinal mechanisms (cortical activation, cortical
      excitability, and cortical mapping, sensory organization) will be assessed. Participants will
      then be randomly assigned to receive ankle joint mobilizations (n=20), plantar massage
      (n=20), or a control intervention (n=20) which will consist of 6, 5-minute treatments over
      2-weeks. Post-intervention assessments will be completed within 48-hours of the final
      treatment session. Separate ANOVAs will assess the effects of treatment group (ankle joint
      mobilization, plantar massage, control) and time (baseline, post-treatment) on peripheral,
      spinal, and supraspinal neuromuscular mechanisms in CAI participants. Associations among
      neuromuscular mechanisms and secondary measures (biomechanics and postural control) will also
      be assessed. The results of this investigation will elucidate multifaceted mechanisms of
      novel and effective manual therapies (ankle joint mobilizations and plantar massage) in those
      with CAI.
    


Intervention name(s): Joint Mobilization; Massage
Intervention type(s): Other; Other
Intervention description(s): Participants will receive 6, 5-minute treatment sessions over 2-weeks. Each session will consist of 2, 2-minute bouts of Grade II anterior to posterior ankle joint mobilizations with 1-minute between sets. Mobilizations will be large-amplitude, 1-s rhythmic oscillations from the mid- to end range of arthrokinematic motion.; Participants will receive 6, 5-minute treatment sessions over 2-weeks. Each session will consist of 2, 2-minute bouts of plantar massage with 1-minute between sets. The massage will be a combination of petrissage and effleurage to the entire plantar surface.
Other intervention name(s): Ankle Joint Mobilization; Plantar Massage
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Ankle Instability; Manual Therapy; Massage; Ankle Joint Mobilization; Biomechanics; Neuromuscular