To determine the effectiveness of manual therapy with or without exercise therapy in CAI.
MEDLINE, Pubmed, Scopus, PEDro, EBSCOhost and Cochrane CENTRAL were searched from January 2000 to December 2023 for studies on the manual therapy in the treatment of CAI. The studies that fulfilled the criteria of CAI, investigated manual therapy and primary outcome measures were ankle range of motion (ROM), pain and self-perceived function. A minimal clinically important difference (MCID) or minimal detectable change (MDC) were used for each outcome measure to define smallest meaningful score change.
The quality of evidence was assessed using a risk of bias tool 1 (RoB 1) version 1 of the Cochrane collaboration.
A final review included 10 randomized clinical trials and a total of 411 patients. There was a lot of variation on risk of bias of the included trials. Manual therapy interventions were compared with exercise therapy, sham therapy or no intervention (control group).
Eight out of ten of the trials assessed ankle dorsiflexion ROM, five used Foot and Ankle Ability Measure and Sports Subscales (FAAM/FAAMS), four used Cumberland Ankle Instability tool (CAIT) and one trial used Visual Analogue Scale (VAS). In manual therapy group, two trials reached the MDC values in ankle dorsiflexion range of motion, one trial in FAAM/FAAMS and two trials in CAIT exceeded the MCID values.
Manual therapy with exercise therapy, such as balance and strength training, have some positive impact on pain, ankle ROM and self-perceived function although results remained mostly under the MCID values.
Manual therapy can be used together with exercise therapy as one method to increase ankle ROM, improve pain and function in patients with CAI. However, the effects seem to be quite low at the moment and, therefore, more research with higher number of participants and higher quality is needed.
Lower limb
