Ankle Stiffness Clinical Trial
Official title:
The Immediate Effects of Two Manual Therapy Techniques on Ankle Musculoarticular Stiffness and Dorsiflexion Range of Motion in People With Chronic Ankle Rigidity: A Randomized Clinical Trial
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).
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.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment