Mulligan Concept in the Treatment of Ankle Sprains
Condition: Ankle Sprain 1St Degree; Ankle Sprain 2Nd Degree
MeSH terms: Sprains and Strains; Ankle Injuries
Study type: Interventional

Summary: 
      Aim of the study is to establish the efficiency of the mulligan concept vs a sham group (who
      will also serve as control). Patient with an subacute ankle sprains will be assess following
      the mulligan concept and then randomized in two groups: Mobilization with movement (MWM)
      group and Sham group. MWM group will receive 3 sets of 10 repetitions of treatment (i.e.
      passive accessory glide during an active dorsiflexion) while the sham treatment will do 3
      sets of 10 active dorsiflexion with the hand of the Physiotherapist only apply on the skin. 3
      sessions with 4 days apart will take place. outcomes will be measure before and after every
      sessions.
    

Detailed description: 
      All included subject will received the Mulligan concept assessment. First investigator will
      applied non-weight bearing inferior tibiofibular mobilization with movement (MWM), i.e.
      passive accessory glide in a posterior and superior direction on the inferior tibiofibular
      joint. If not painful, Weightbearing inferior tibiofibular MWM will be applied 6 times. it
      consist on applying a passive accessory glide on the subject while he/she is doing an active
      dorsiflexion of the injured ankle. Dorsiflexion range of motion, pain and function will be
      reassess. If either one of previously cited outcomes is improve, subject is considered
      respondents. If he/she feels any pain or no improvements at all, he/she will be considered
      non-respondents. If non-weight-bearing inferior tibiofibular MWM is painful, talocrural MWM
      will be apply, first in non-weightbearing and if painfree, in weight bearing position.
      Talocrural MWM consist on a posterior glide of the talus while the subject realized an active
      dorsiflexion of the injured ankle. Same outcomes as previsouly cited will be assess and will
      determine if the patient is respondent or non-respondent. If the subject is non-respondent of
      the talocrural MWM or if he/she felt any pain during the talocrural MWM, a non weightbearing
      cubometatarsal MWM, i.e. cranio-caudal glide of the lateral cubometatarsal joint during an
      active dorsiflexion of the injured ankle, will be applied. If painfree, a tape will be placed
      as to replicate the cubometatarsal MWM, and the patient will reassess ROM, pain and function
      with the tape to see whether he/she is a respondent or non respondent subject. If the subject
      is non-respondent to neither of the three MWM, he/she is considered a drop-out. Respondent
      patient will then be randomized into two groups: MWM group and Sham group. MWM group will
      receive 3 sessions with 4 days apart of 3 sets of 10 repetitions of preferential MWM
      (inferior tibiofibular, talocrural, cubometatarsal) while the sham group will receive 3
      sessions with 4 days apart of 3 sets of 10 repetitions with the first investigator doing a
      light touch during an active dorsiflexion, mimicking the real MWM techniques. Outcomes will
      be measures at T0 (beginning of the treatment-beginning of the first session), T1 (end of the
      first session), T2 (beginning of the second session), T3 (end of the second session), T4
      (beginning of the third session) and T5 (end of the treatment-end of the third session).
    

Intervention name(s): Mulligan concept; Placebo
Intervention type(s): Procedure; Procedure
Intervention description(s): Mobilization with movement during an active dorsi-flexion of the ankle; Sham mobilization with movement during an active dorsi-flexion of the ankle
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: ankle sprain; Mulligan; manual therapy