Comparison of Two Manual Therapy Techniques on Ankle Dorsiflexion
Condition: Ankle Stiffness
Study type: Interventional

Summary: 
      Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can
      impair weight-bearing ankle dorsiflexion (WBADF). The objective was to compare the efficacy
      of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving
      ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS).
    

Detailed description: 
      Increased musculoarticular stiffness (MAS) of the talocrural joint is a frequently
      encountered problem, identified during evaluation of weight bearing ankle dorsiflexion
      (WBADF). Such stiffness may follow ankle injury such as ankle sprain. In such a situation,
      MAS could be increased and might leads to a lack of joint flexibility as well as decreased
      dorsiflexion range-of-motion (ROM), however asymmetric rigidity does not necessarily always
      follow ankle sprain. Nevertheless, MAS is an important and necessary component of normal
      stability of the talocrural joint and could help to prevent abnormal ankle joint movement and
      ankle sprains.

      Measurement of MAS can be determined by a technique known as free-oscillation, which is a
      comprehensive measure of joint stiffness comprising the stiffness of the muscle-tendon unit,
      skin, ligaments and joint capsule, along with a number of other mechanical and neuromuscular
      factors. The assessment of MAS is important when evaluating muscular performance, injury
      prevention and gender differences in flexibility. For example, men, as well as older people,
      are known to present with greater MAS than women and young people.

      MAS of the talocrural joint can be objectively measured using an electromechanical device
      that imparts a passive oscillatory dorsiflexion movement, but also by means of clinical tests
      such as toe-wall distance and angular goniometric measurement during the weight bearing lunge
      test. Electromechanical measurement of ankle MAS has been used in several previous studies of
      asymptomatic participants and in patients with fibromyalgia syndrome, and spasticity after a
      stroke.

      In orthopaedic manual therapy, different methods have been proposed to treat MAS associated
      with loss of dorsiflexion ROM at the talocrural joint. These include single session of
      Mulligan's Mobilization with Movement (MWM), anteroposterior mobilization of the talus, high
      velocity thrust, and Osteopathic Mobilization (OM). These methods have been described in
      clinical practice manuals, with greater proportion of studies reporting on the effects of MWM
      in comparison to high velocity thrust for improving ankle dorsiflexion ROM in chronic ankle
      instability or to study MWM efficacy in isolation for subacute or recurrent ankle sprains and
      for chronic ankle instability. With the exception of one study the results are generally in
      favor of MWM.

      Generally MWM is an increasingly popular form of manual therapy for musculoskeletal
      disorders, concerning the ankle MWM try to improve talocrural ROM. MWM is a combination of
      accessory joint glide of the talus combined with active ankle dorsiflexion movement. The
      patient performs active WBADF while the therapist simultaneously applies an anteroposterior
      glide of the talus with respective posteroanterior tibial glide with the aid of a manual
      therapy belt. OM is a purely passive anteroposterior mobilization of the talus with respect
      to tibia, performed in a non weight-bearing position. To date, there have been no studies
      comparing the effectiveness of each technique with respect to electromechanically determined
      ankle MAS or ankle joint ROM determined by the WBADF lunge test.

      Therefore, the aim of the study was to investigate the relative efficacy of MWM and OM on MAS
      as the primary outcome measurement and joint ROM during the WBADF lunge test as the secondary
      outcome measurement. The hypothesis was that MWM would produce significantly greater
      reduction in MAS and increased ankle joint ROM when compared to OM.
    

Intervention name(s): mobilization with movement; osteopathic mobilization
Intervention type(s): Other; Other
Intervention description(s): manual therapy intervention; manual therapy intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: manual therapy; osteopathy; mobilization with movement; ankle; stiffness