Effects of joint mobilization on chronic ankle instability: a randomized controlled trial...
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Effects of joint mobilization on chronic ankle instability:a randomized controlled trial指導老師:蔡明倫報告學生:洪唯博
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OutlineA. Introduction
B. Method
C. Data analysis
D. Result
E. Discussion
F. Conclusion
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A. Introduction
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Ankle sprainThe most common injury in the active population
Accounts for 22% of all sports injuries 70~80% of all patients with a previous history of ankle sprain
Symptoms :
Ligament laxity Pain during activity
Loss of proprioception Feelings of “giving way”
Decreased range of motion Ankle instability
Recurrent swelling
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Chronic ankle instability(CAI)Defined:
Repetitive bouts of lateral ankle instability resulting in numerous ankle sprains
Cause by :A. Functional instability(FI)
① Feeling of instability ② Proprioceptive and neuromuscular dysfunction③ Feeling of giving away
B. Mechanical instability(MI):
① Movement of the ankle joint beyond the physiologic ROM② More laxity than normal
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Intrinsic factors Extrinsic factors
eversion to inversion strength ratio plantarflexion strength physical activitydorsiflexion to plantarflexion strength ratio
limb dominance type of ground
lower leg alignment decreased ROM Shoes wornpostural control
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A lack of DFROM can predispose to re-injury (as a risk factor)
Alteration in talar arthokinematics:
1. Posterior talar glide↓2. Positional alteration:
talas in relation with ankle jointTherapy:
Restore DFROM by increasing the extensibility of non-contractile tissues(ex, joint capsule,ligament)
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Mobilization with movement(MWM)1. Reducing pain and swelling 4. Improving function2. Postural control impairment3. Ankle DFROM in lateral ankle sprain patients
Balance: dynamic balance tasks
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B. Method
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ParticipantsRandomized double-blind placebo-controlled trial
102 patients
Inclusion criteria
Exclusion criteria
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Inclusion criteria1. Previous history of ankle sprain (at least two sprains on the same side
in the last 2 years)
2. Asymmetry than 2 cm on the weight-bearing lunge test (WBLT) for ankle dorsiflexion
3. No history of lateral ankle sprain on the contralateral side
4. Feeling of “giving way” and instability
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Exclusion criteria1. Acute ankle sprain within the previous 6 months2. History of bilateral ankle injury3. Bony injury associated with ankle sprain such as avulsion
fracture or ankle osteochondral lesion4. Previous injury or surgery to the back, hip, or knee
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Outcome measureAnkle DFROM
1) Weight-bearing lunge test(WBLT)2) Assesses the maximal advancement of tibia over the talus in a weight-bearing position3) Practice and three analysis trials
Self-reported ankle instability1) Cumberland Ankle Instability Tool (CAIT)
Dynamic postural control1) Star Excursion Balance Test (SEBT)
• anterior, posteromedial, posterolateral
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TreatmentManipulation group
◦ Weight-bearing MWM◦ 10 repetitions/set, 2 minutes rest, 2 set/session, 2 session/week, 3-week
Placebo group◦ 10 repetitions/set, 2 minutes rest, 2 set/session, 2 session/week, 3-week
Control group◦ No treatment
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Data analysisSPSS 17.0
1) ANOVA
2) Categorical variable : Chi-squared
3) Continuous variable: One-way analysis
P<0.05
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C. Result
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C. Result(1) Total of 81 patients completed the study and were analyzed
47 males, 34 females, mean age of 27.7 years
Group N= Percentage of males
Manipulation group 30 56.7
Placebo group 31 54.8
Control group 29 58.6
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No differences were observed between groups at baseline.
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Discussion
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The effectiveness of MWM has been reported in acute and subacute ankle sprain
The present study deems joint MWM a useful therapeutic tool that provides good results in ◦ DFROM◦ Dynamic postural control◦ Self-reported feelings of instability
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It was observed that there is a deficit in DFROM in patients with CAI, which could be associated with functional impairments such as
◦ Sensorimotor alterations◦ Subjective feeling of “giving way”◦ Muscle activation
DFROM is deemed to be due to the alteration of normal arthrokinematics of the ankle as a consequence of the joint disrupting the normal transmission of afferent information available to the sensorimotor system.
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Thus, it could be hypothesized that MWM could enhance the subjective feeling of stability.
This study has shown the long term effects of WB_MWM joint mobilization on patients with CAI.
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ConclusionWeight bearing MWM joint mobilization seems to be effective in the treatment of
DFROMDynamic postural controlSelf-reported instability
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Thank you for your attention