Effects of Mobilization in Conjunction With Therapeutic Exercise in Participants With a History of Ankle Sprain

NCT ID: NCT02945943

Last Updated: 2016-10-26

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

COMPLETED

Clinical Phase

NA

Total Enrollment

19 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-02-29

Study Completion Date

2013-10-31

Brief Summary

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Our purpose was to examine the combined effects of thrust mobilization of the proximal and distal ankle joints in conjunction with a six-week rehabilitation program on ankle function in subjects reporting chronic ankle instability (CAI).

Detailed Description

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Joint mobilizations are reported to increase range of motion (ROM), postural control and proprioception, and decrease pain in individuals with CAI. There is no research supporting the combined effects of thrust mobilization and exercise on function in this population.

Inclusion and exclusion criterion were established and a convenience sample was performed. 19 subjects were randomized into the exercise only or mobilization (experimental) and exercise group. Both groups underwent 12 supervised training sessions across a six-week period. The mobilization (experimental) group also received high-velocity-low-amplitude (HVLA) thrust mobilizations at the talocrural, proximal, and distal tibiofibular joints prior to the first three treatment sessions.

An examiner blinded to involved limb and group allocation performed a baseline and six-week follow-up examination of muscle strength, joint mobility, range of motion, and/or functional performance. The participants completed subjective outcome measures at baseline, 2 weeks, 4 weeks, and finally at 6 weeks including the Functional Ankle Disability Index (FADI), FADI-Sport, and the Ankle Joint Functional Assessment Tool (AJFAT). Participants also completed baseline and a six-week follow up assessments of the figure-of-8 hop test, side hop test, and three directions of the Star Excursion Balance test (SEBT).

The exercise protocol is a modified version of the balance training program described by McKeon et al. Participants completed this protocol twice a week, for six weeks. Treatment sessions lasted approximately 30 minutes. Participants were individually progressed on particular exercises if zero errors were observed. In addition, all participants were given a home exercise program (HEP) to complete every day of the week excluding treatment days.

The mobilization (experimental) group received HVLA thrust mobilizations at the three joints stated above for the first three sessions prior to completing the exercise protocol. Each mobilization was performed one time at each joint. The order of joint mobilizations was randomized prior to administering.

Data analysis was performed using International Business Machines Statistical Package for the Social Sciences (SPSS) version (22). Alpha level was set p\<0.05. Separate 2 x 2 repeated measures analysis of variance (ANOVA) were used to assess changes in the FADI, FADI-Sport, figure-of-8 hop test, side hop test, and three directions of the SEBT.

Conditions

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Functional Deficits Manipulation Rehabilitation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Mobilization

High Velocity Low Amplitude mobilization group. The three joints manipulated included proximal tibiofibular, the distal tibiofibular, and talocrural joints and were mobilized the first three sessions prior to the participants performing the exercise protocol.

Group Type EXPERIMENTAL

High Velocity Low Amplitude mobilization

Intervention Type OTHER

Mobilizations were performed one time at each joint, prior to completing the exercise protocol during the first three treatment sessions.

Exercise Protocol

Intervention Type OTHER

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Exercise Protocol

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Group Type ACTIVE_COMPARATOR

Exercise Protocol

Intervention Type OTHER

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Interventions

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High Velocity Low Amplitude mobilization

Mobilizations were performed one time at each joint, prior to completing the exercise protocol during the first three treatment sessions.

Intervention Type OTHER

Exercise Protocol

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Intervention Type OTHER

Other Intervention Names

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HVLA thrust mobilization Control

Eligibility Criteria

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Inclusion Criteria

* 16 to 35 years old age
* Self-reported history of an ankle sprain
* Reports of "giving way" or a "loose" ankle within the past 6 months and/or decrease in functional status as compared to the uninvolved ankle

Exclusion Criteria

* Lower extremity injury within the past 3 months
* History of vestibular dysfunction, neuromuscular diagnosis, mental illness, or if the participant was currently participating in another supervised rehabilitation program for the involved ankle.
Minimum Eligible Age

16 Years

Maximum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Shenandoah University

OTHER

Sponsor Role lead

Responsible Party

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Cameron Jones

Assistant Professor Division of Physical Therapy

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Cameron R Jones, DPT

Role: PRINCIPAL_INVESTIGATOR

Shenandoah University Division of Physical Therapy

Sheri Hale, PhD, PT

Role: PRINCIPAL_INVESTIGATOR

Shenandoah University Division of Physical Therapy

Locations

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Shenandoah University Division of Physical Therapy

Winchester, Virginia, United States

Site Status

Countries

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United States

References

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McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008 Oct;40(10):1810-9. doi: 10.1249/MSS.0b013e31817e0f92.

Reference Type BACKGROUND
PMID: 18799992 (View on PubMed)

Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010 Oct 6;92(13):2279-84. doi: 10.2106/JBJS.I.01537.

Reference Type BACKGROUND
PMID: 20926721 (View on PubMed)

Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med. 2008 Jul;27(3):353-70, vii. doi: 10.1016/j.csm.2008.03.006.

Reference Type BACKGROUND
PMID: 18503872 (View on PubMed)

Wikstrom EA, Hubbard TJ. Talar positional fault in persons with chronic ankle instability. Arch Phys Med Rehabil. 2010 Aug;91(8):1267-71. doi: 10.1016/j.apmr.2010.04.022.

Reference Type BACKGROUND
PMID: 20684909 (View on PubMed)

Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2007 Jun;37(6):303-11. doi: 10.2519/jospt.2007.2322.

Reference Type BACKGROUND
PMID: 17612356 (View on PubMed)

Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009 Jul 9;339:b2684. doi: 10.1136/bmj.b2684.

Reference Type BACKGROUND
PMID: 19589822 (View on PubMed)

Beazell JR, Grindstaff TL, Sauer LD, Magrum EM, Ingersoll CD, Hertel J. Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2012 Feb;42(2):125-34. doi: 10.2519/jospt.2012.3729. Epub 2012 Feb 1.

Reference Type BACKGROUND
PMID: 22333567 (View on PubMed)

Hubbard TJ, Hertel J. Anterior positional fault of the fibula after sub-acute lateral ankle sprains. Man Ther. 2008 Feb;13(1):63-7. doi: 10.1016/j.math.2006.09.008. Epub 2006 Dec 26.

Reference Type BACKGROUND
PMID: 17188923 (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)

Grindstaff TL, Beazell JR, Sauer LD, Magrum EM, Ingersoll CD, Hertel J. Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability. J Electromyogr Kinesiol. 2011 Aug;21(4):652-8. doi: 10.1016/j.jelekin.2011.03.011. Epub 2011 May 4.

Reference Type BACKGROUND
PMID: 21546263 (View on PubMed)

Whitman JM, Childs JD, Walker V. The use of manipulation in a patient with an ankle sprain injury not responding to conventional management: a case report. Man Ther. 2005 Aug;10(3):224-31. doi: 10.1016/j.math.2004.10.003. Epub 2005 Jan 21. No abstract available.

Reference Type BACKGROUND
PMID: 16038858 (View on PubMed)

Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009 Oct;14(5):531-8. doi: 10.1016/j.math.2008.09.001. Epub 2008 Nov 21.

Reference Type BACKGROUND
PMID: 19027342 (View on PubMed)

Other Identifiers

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12-1627

Identifier Type: -

Identifier Source: org_study_id