Ankle Injuries Clinical Trial
Official title:
Effects of Proximal and Distal Tibiofibular Joint Manipulation on Lower Extremity Muscle Activation, Ankle Range of Motion, and Functional Outcome Scores in Individuals With Chronic Ankle Instability
The overall aim of this project is to determine the effect of a tibiofibular joint
manipulation on the neuromuscular response of the fibularis longus and soleus muscles in
individuals with chronic ankle instability. Another aim of this study is to determine the
long term effects of a tibiofibular joint manipulation on range of motion and self-reported
function.
We hypothesize that a manipulation applied at the distal tibiofibular joint will result in
greater muscle activation, improved functional dorsiflexion ROM, and increases in FAAM
scores compared to a tibiofibular joint manipulation applied at the proximal joint. We
further hypothesize that both distal and proximal tibiofibular joint manipulations will
result in greater muscle activation, improved functional dorsiflexion ROM, and increases in
FAAM scores than no treatment at all.
Muscle weakness is a common impairment following injury to a joint. Individuals with lateral
ankle sprains have been shown to demonstrate weakness and inhibition of the fibularis longus
and soleus muscles. Recently, changes in the positional alignment of the talus, tibia, and
fibula have been implicated in a subpopulation of individuals with chronic ankle instability
(CAI). Clinically this manifests as a decrease in the posterior glide of the talus and
decreased dorsiflexion ROM. Another positional fault has been noted to occur between the
distal tibiofibular joint. A subpopulation of individuals with a history of CAI have
demonstrated a slight anterior displacement of the fibula relative to the tibia. The cause
of the malpositioning is unknown, but manual therapeutic interventions may offer the ability
to restore normal joint arthrokinematics and muscle function. It is unknown if the
correction of this positional fault will have an effect on muscle inhibition about the
ankle.
Since muscle inhibition is a neurological reflexive reaction, it is thought that traditional
strengthening treatment techniques may not fully address this dysfunction. Manual
therapeutic interventions can have dual effects on the neuromuscular system and restore
normal joint arthrokinematics. Evidence suggests a joint manipulation is able to disinhibit
or even facilitate local and distant muscles. This likely occurs due to the afferent
response from the structures in and around the manipulated joint. Comprehensive treatment
interventions which restore normal joint function, optimal motoneuron pool excitability,
strength, and pain-free previous level of function need to be developed to prevent future
dysfunction and osteoarthritis.
Currently no study has examined the effects of tibiofibular joint manipulation on the
neuromuscular response of ankle musculature or the effects on range of motion and function.
The purpose of this study is to examine the acute effects of a tibiofibular joint
manipulation on the neuromuscular response of the fibularis longus and soleus muscles and to
determine the long term effects on range of motion and function in individuals with CAI.
The first research question will address how a tibiofibular joint manipulation immediately
affects the activation of the fibularis longus and soleus muscles. The second question will
address how this joint manipulation affects range of motion and functional outcomes over a
three week period. Changes in ankle dorsiflexion range of motion (ROM), navicular drop, Step
Down Test, Balance Error Scoring System, and the Foot and Ankle Ability Measure (FAAM) will
be used to determine if clinically significant changes occurred during the intervention
period.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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