Effects of MET vs Mulligan MWM on Pain, Disability & Balance in Athletes With Ankle Sprain

Study Overview
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Brief Summary
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Ankle Sprains are the most common injury in Athletes and have a high rate of recurrence, pain, dynamic balance and disability is the leading cause of season break in athletes with chronic ankle sprain so as we see post isometric relaxation and Mulligan MWM are the useful techniques used to minimize pain, improve dynamic balance and to restrain athlete from disability due to chronic ankle sprain. This study will be a randomized clinical trial,non probability convenience sampling technique will be used to collect the data. The sample size of athletes will be taken in this study to find the effect of post isometric relaxation and mulligan mobilization with movement in athletes.

Detailed Description
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Ankle Sprains are the most common injury in Athletes and have a high rate of recurrence, pain, dynamic balance and disability is the leading cause of season break in athletes with chronic ankle sprain so as we see post isometric relaxation and Mulligan MWM are the useful techniques used to minimize pain, improve dynamic balance and to restrain athlete from disability due to chronic ankle sprain. As the effect of post isometric relaxation in comparison with Mulligan MWM has never been investigated in Athletes, the aim of this study is to investigate and compare the effect of these two techniques on athletes with chronic ankle sprain presented with pain, dynamic imbalance that leads to disability. This study will be a randomized clinical trial and will be conducted in Pakistan sports board and Multan sports complex. The study will be completed within the time duration of six months. Non probability convenience sampling technique will be used to collect the data. The sample size of athletes will be taken in this study to find the effect of post isometric relaxation and mulligan mobilization with movement in athletes of PSB and MSC, aged 20-35 years, were allocated to both intervention group. The participants will be divided into two groups i-e, MET group and MWM group. MET group will receive post-isometric relaxation technique for gastrocnemius and soleus muscle. Patient will be in prone lying with the ankle out of the bed. 30% of the available strength will applied by the patient against unyielding resistance towards plantarflexion. The therapist will ensure that foot will not actually move and only a static muscle contraction apply and held for 20 seconds. This will be followed by 2-3 second of relaxation, and then the foot passively stretched to dorsiflexion up to the palpated barrier and/or tolerance to stretch. This will continue until no further gains achieved 2 sets of 5 repetitions a day for 3 days a week for 4 weeks. MWM group will receive inferior tibiofibular, talocrural, or cubometatarsal MWM 2-8 treatment sessions over 4 weeks.

Official Title
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Effects of Post Isometric Relaxation Versus Mulligan Mobilization With Movement on Pain, Disability and Dynamic Balance in Athletes With Chronic Ankle Sprain

Conditions
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Chronic Ankle Sprain

Intervention / Treatment
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* Other: post isometric relaxation
* Other: MWM group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed cases of chronic ankle sprain (grade I or II) (3-4 months) Players have spent at least one year in sports Exclusion Criteria: • Players undergone surgery or had an accident. Any malignant or chronic disease Players with the history of fracture in the same ankle

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: post-isometric relaxation<br>effects of post-isometric relaxation on pain, disability and dynamic balance in athletes with chronic ankle sprain | Other: post isometric relaxation<br>* The therapist will apply Post isometric relaxation ensure that foot will not actually move and only a static muscle contraction apply and held for 20 seconds. This will be followed by 2-3 second of relaxation, and then the foot passively stretched to dorsiflexion up to the palpated barrier and/or tolerance to stretch. This will continue until no further gains achieved 2 sets of 5 repetitions a day for 3 days a week for 4 weeks<br>|
| Experimental: mulligan mobilization with movement<br>effects of mulligan mobilization with movement on pain, disability and dynamic balance in athletes with chronic ankle sprain | Other: MWM group<br>* MWM group will receive inferior tibiofibular, talocrural, or cubometatarsal MWM 2-8 treatment sessions over 4 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric pain rating scale | Changes from baseline numeric pain rating scale for pain from 0-10 (0 means no pain and 10 means worst pain) | 4th week | 
| Dorsiflexion lunge test | Participants are instructed to lunge forward until their knee touches the wall (vertical line). The heel is required to remain in contact with the floor at all times. The foot is moved away from the wall to the point where the knee can only make slight contact with the wall, while the heel remains in contact with the floor. This puts the ankle joint in maximal dorsiflexion. The leg not being tested can rest on the the floor and participants are allowed to hold onto the wall for support. The maximum distance from the wall to the tip of the big toe is recorded. The distance is measured in centimeters (cm) with each centimeter corresponding to approximately 3.6° of ankle dorsiflexion | 4th week | 
| star excursion balance test | The Star Excursion Balance Test is a dynamic test that requires strength, flexibility, and proprioception. | 4th week | 
| Foot and Ankle outcome score | ankle disability | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ankle sprain, mulligan MWM, METs