Effects of Manual Therapy and Exercise in the Treatment of Ankle Sprains
Condition: Ankle Sprains
MeSH terms: Sprains and Strains; Ankle Injuries
Study type: Interventional

Summary: 
      Objectives: To analyze the effects of proprioceptive and strengthening exercises versus the
      same exercises and manual therapy on the recurrent ankle sprain management.

      Design: A randomized clinical trial with two intervention groups and triple blind.

      Settings: University Hospital.

      Participants: Fifty-four patients with previous history of recurrent ankle sprains, regular
      sports practice and pain during the physical activity, randomly assigned to experimental or
      control group.

      Intervention: Control group performed 4 weeks of proprioceptive and strengthening exercises;
      experimental group performed 4 weeks of the same exercises combined with manual therapy.

      Main Outcomes Measures: Pain, ankle instability, pressure pain threshold (PPT), ankle
      eversion strength, and active range of motion in ankle joint. The measures were taken before,
      after and one month after the interventions.
    

Detailed description: 
      The recurrent ankle sprain means the most frequent complication from the ankle sprain and the
      previous phase of the chronic ankle stability (CAI), which involves between 20 - 41% of all
      ankle sprains.

      Residual pain concerns the first symptom after instability in most of the cases, but patients
      also show reduced ankle joint position sense, ankle range of motion, and strength of ankle
      inversion muscles.

      Proprioception exercises on multiplane and unstable platforms, as well as strengthening
      through eccentric exercises report benefits in pain and function, suggesting the active
      therapy as the most effective treatment instead of passive manual therapy in chronic phases.

      However, several studies analyzed the effects of the manual therapy in the management of the
      ankle sprain recurrence: the posterior gliding of astragalus and the tibiotarsal joint
      coaptation improved the ankle range of motion, which was related with recurrent ankle sprain
      and its residual symptoms.

      Despite the benefits from active and passive therapy, very few authors up to date
      investigated the combination of both clinical approach in the recurrent ankle sprain.
      Literature analyzed the effects of a combined program including exercises to the manual
      therapy in acute ankle sprain and concluded that the variety in the manual therapy techniques
      reported more pain release and improved function.

      Besides, based on the effects of joint mobilization techniques, the neurodynamic mobilization
      could be an appropriate therapy, due to the neural distribution of fibular nerve through the
      ankle joint, but no studies to date to our knowledge included this technique as part of the
      recurrent ankle sprain management.

      This study aimed to analyze the effects of proprioceptive and strengthening exercises versus
      the same exercises and manual therapy on the recurrent ankle sprain management.
    

Intervention name(s): Experimental (proprioception exercises, muscle strengthening, joint mobilization); Control (proprioception exercises, muscle strengthening)
Intervention type(s): Procedure; Procedure
Intervention description(s): The experimental group performed a combined protocol of proprioception (the patient doing exercises standing on an unstable plane)exercises and muscle strengthening (The patient performed eccentric exercises to work the movement inversion of ankle), and joint mobilization techniques of the ankle joint two session per week, during four weeks; The control group performed only proprioception exercises (the patient doing exercises standing on an unstable plane) and muscle strengthening (The patient performed eccentric exercises to work the movement inversion of ankle). Two sessión per week during four weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Manual therapy; proprioception; exercises; ankle sprain