Changes in the Ankle Range of Motion Following Subtalar Joint Manipulation

NCT ID: NCT00981331

Last Updated: 2018-07-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-05-31

Study Completion Date

2018-07-16

Brief Summary

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The purpose of the study is to determine whether manipulation of the subtalar joint (one of the two joints of the ankle) has an effect on ankle range of motion in a group of ankles that have sustained a subacute inversion ankle sprain.

The investigators expect subtalar joint manipulation will increase ankle range of motion about the subtalar joint, but not at the talocrural joint (the other joint of the ankle).

Detailed Description

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Ankle inversion sprain is a common injury that can cause joint stiffness and range of motion deficits.(Holmer 1994, Beynnon 2001, Denegar 2002, Green 2001) Subtalar joint manipulation has been advocated as an intervention for inversion sprains to reduce pain, decrease joint stiffness, and improve range of motion.(Lopez-Rodriguez 2007)

The ankle is comprised of the talocrural and subtalar joints and their respective joint axes.(Hubbard 2006) Ankle rotation about these axes can be parameterized using quaternions, a four dimensional unit vector. Range of motion (ROM) about these axes can be determined by performing an eigen analysis of the quaternion matrices to determine the root mean squared values of the motion data about these axes.

The objective of the study is to investigate the immediate effects of subtalar joint manipulation on the ROM about the ankle's talocrural and subtalar joints on ankles that have sustained a subacute, grade II inversion sprain.

Forty patients with one sprained ankle and one asymptomatic ankle will be recruited. The subjects will be randomized into either a subtalar manipulation group or a sham manipulation group. The sprained ankle of each patient will receive either a standardized subtalar joint manipulation or a sham manipulation. The same patient's asymptomatic ankle will serve as the non-treatment control group. Range of motion pre- and post-manipulation will be quantified utilizing a quaternion eigen analysis. Kinematic and kinetic parameters will be collected during the manipulation to biomechanically characterize the manipulation. Pain pressure threshold and visual analog scale measurements for pain, stiffness, and quality of movement will be collected.

Our primary hypothesis is subtalar joint manipulation will increase subtalar ROM, but will have no effect on talocrural ROM. Our secondary hypothesis is subtalar joint manipulation will have positive effects on pain, stiffness, and quality of movement.

Conditions

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Ankle Inversion Sprain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Subtalar joint manipulation

Each subject in this group will recieve a subtalar joint manipulation to their symptomatic ankle

Group Type EXPERIMENTAL

Subtalar joint manipulation

Intervention Type PROCEDURE

The intervention is defined as a toggle-recoil, high-velocity, low-amplitude subtalar joint manipulation.

Sham Manipulation

Each subject in this group will recieve a sham subtalar joint manipulation to their symptomatic ankle

Group Type SHAM_COMPARATOR

Sham subtalar joint manipulation

Intervention Type PROCEDURE

The sham manipulation is conducted by placing the ankle in a non-manipulative position, and the operator simply engages the toggle board to simulate the audible noise of the toggle board dropping. No force or thrust is applied to the ankle.

Interventions

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Subtalar joint manipulation

The intervention is defined as a toggle-recoil, high-velocity, low-amplitude subtalar joint manipulation.

Intervention Type PROCEDURE

Sham subtalar joint manipulation

The sham manipulation is conducted by placing the ankle in a non-manipulative position, and the operator simply engages the toggle board to simulate the audible noise of the toggle board dropping. No force or thrust is applied to the ankle.

Intervention Type PROCEDURE

Other Intervention Names

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Ankle manipulation Sham manipulation

Eligibility Criteria

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Inclusion Criteria

* Must have 1 ankle diagnosed with a subacute, grade II inversion ankle sprain and 1 asymptomatic ankle
* Pain on palpation of the medial subtalar joint line
* Manual restriction of subtalar eversion as assessed by a passive joint play test of subtalar joint mobility

Exclusion Criteria

* Acute ankle or foot trauma occurring within 7 days of injury incident
* Acute or healing fracture
* Gross ligamentous mechanical instability (grade III ankle sprains)
* Syndesmosis injury
* Inflammatory arthritis
* History of previous medial ankle sprain
* Medial ankle instability
* Severely pronated feet determined by Foot Posture Index score \> +9 (Redmond 2006)
* Connective tissue disorder (Grahame 2000)
* Benign joint hypermobility syndrome (Grahame 2000)
Minimum Eligible Age

16 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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McMaster University

OTHER

Sponsor Role collaborator

Canadian Memorial Chiropractic College

OTHER

Sponsor Role lead

Responsible Party

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Alex Lee

Clinician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexander D Lee, BSc, DC

Role: PRINCIPAL_INVESTIGATOR

Canadian Memorial Chiropractic College

John J Triano, DC, PhD

Role: STUDY_DIRECTOR

Canadian Memorial Chiropractic College

Locations

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McMaster University

Hamilton, Ontario, Canada

Site Status

Canadian Memorial Chiropractic College

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Holmer P, Sondergaard L, Konradsen L, Nielsen PT, Jorgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994 Feb;15(2):72-4. doi: 10.1177/107110079401500204.

Reference Type BACKGROUND
PMID: 7981804 (View on PubMed)

Beynnon BD, Renstrom PA, Alosa DM, Baumhauer JF, Vacek PM. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001 Mar;19(2):213-20. doi: 10.1016/S0736-0266(00)90004-4.

Reference Type BACKGROUND
PMID: 11347693 (View on PubMed)

Denegar CR, Miller SJ 3rd. Can Chronic Ankle Instability Be Prevented? Rethinking Management of Lateral Ankle Sprains. J Athl Train. 2002 Dec;37(4):430-435.

Reference Type BACKGROUND
PMID: 12937564 (View on PubMed)

Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002 Apr;32(4):166-73. doi: 10.2519/jospt.2002.32.4.166.

Reference Type BACKGROUND
PMID: 11949665 (View on PubMed)

Green T, Refshauge K, Crosbie J, Adams R. A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Phys Ther. 2001 Apr;81(4):984-94.

Reference Type BACKGROUND
PMID: 11276181 (View on PubMed)

Lopez-Rodriguez S, Fernandez de-Las-Penas C, Alburquerque-Sendin F, Rodriguez-Blanco C, Palomeque-del-Cerro L. Immediate effects of manipulation of the talocrural joint on stabilometry and baropodometry in patients with ankle sprain. J Manipulative Physiol Ther. 2007 Mar-Apr;30(3):186-92. doi: 10.1016/j.jmpt.2007.01.011.

Reference Type BACKGROUND
PMID: 17416272 (View on PubMed)

Hubbard TJ, Hertel J. Mechanical contributions to chronic lateral ankle instability. Sports Med. 2006;36(3):263-77. doi: 10.2165/00007256-200636030-00006.

Reference Type BACKGROUND
PMID: 16526836 (View on PubMed)

Pellow JE, Brantingham JW. The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. J Manipulative Physiol Ther. 2001 Jan;24(1):17-24. doi: 10.1067/mmt.2001.112015.

Reference Type BACKGROUND
PMID: 11174691 (View on PubMed)

Fryer GA, Mudge JM, McLaughlin PA. The effect of talocrural joint manipulation on range of motion at the ankle. J Manipulative Physiol Ther. 2002 Jul-Aug;25(6):384-90. doi: 10.1067/mmt.2002.126129.

Reference Type BACKGROUND
PMID: 12183696 (View on PubMed)

Grahame R, Bird HA, Child A. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000 Jul;27(7):1777-9. No abstract available.

Reference Type BACKGROUND
PMID: 10914867 (View on PubMed)

Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol). 2006 Jan;21(1):89-98. doi: 10.1016/j.clinbiomech.2005.08.002. Epub 2005 Sep 21.

Reference Type BACKGROUND
PMID: 16182419 (View on PubMed)

Other Identifiers

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092025

Identifier Type: -

Identifier Source: org_study_id

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