Zesiger L1,2, Rogan S3,4,5, Leiser L3, Müller M3, Eichelberger P3
1Hirslanden Klinik Linde, Physiotherapy, Biel, Switzerland, 2University of Salzburg, Department of Sport Science and Kinesiolgy, Salzburg, Austria, 3University of Applied Sciences, Health, Discipline Physiotherapy, Bern, Switzerland, 4Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussel, Switzerland, 5Academy for Physiotherapy and Integrated Training Education, Grenzach-Wyhlen, Germany
Background: Ankle injuries are one of the most common acute sports injuries, which often lead to chronic ankle instability (CAI). The literature shows evidence that persons with CAI have a reduced postural and neuromuscular control. Wheras the reasons for this dysfunction are not completely resolved, there is evidence that the joint receptors have an impact on this dysfunction. Manual mobilization of a joint stimulates the mechanoreceptors of the joint capsule. Time to stabilization (TTS) is a parameter which quantifies the dynamic postural control. TTS measures the time needed to get a stable position for example during a landing following a jump.
Purpose: The objective of this study was to examine the feasibility and the effects of manual therapy on dynamic postural control and muscular activity in persons with CAI.
Methods: A randomized controlled cross-over pilot study was applied to divided participants in group one (N= 7) or group two (N= 6) to participate six manual therapy ankle joint treatments during 3-weeks intervention period. Study design: three week of manual therapy treatment (group one) or no treatment (group two), followed by a ten-day washout period and three weeks of the opposite treatment.
Primary outcome was the feasibility: recruitment (target number of participants = 10), retention (target 10%), treatment adherence (target > 90%) and safety (no side effects). Secondary outcomes were dynamic postural control measured by TTS and muscle activity measured by electromyography (EMG) of the M. peroneus longus (PL) and M. tibialis anterior (TA).
Results: The pilot study could determine for the primary outcomes: high recruitment with 13 (30%), low retention (0%) and high treatment adherence (94.1%). There were no differences between pre and post intervention in TTS and EMG activity of PL and TA.
Conclusion(s): This pilot study examined evidence that the study program was feasible.
The study design can be chosen in this form with small modifications and a larger sample of 150-200 people for future studies. For the next study, there must be strict monitoring of the data transfer from the EMG sensor to the Vicon software program from the start of the study. The current pilot study could not find an optimal threshold to determine TTS in persons with CAI following a jump landing. This should be considered for future studies.
It is preliminarily suggested that no significant effects of manual mobilization on postural control and muscle activity could be determined.
Implications: Due to the conflicting results, the effect of ankle mobilization on the postural control and muscle activity cannot be clarified conclusively. For this reason joint mobilization should may not be used as a unique treatment to improve the dynamic postural control in patients with CAI.
Keywords: chronic ankle instability, manual therapy, postural control
Funding acknowledgements: None
Purpose: The objective of this study was to examine the feasibility and the effects of manual therapy on dynamic postural control and muscular activity in persons with CAI.
Methods: A randomized controlled cross-over pilot study was applied to divided participants in group one (N= 7) or group two (N= 6) to participate six manual therapy ankle joint treatments during 3-weeks intervention period. Study design: three week of manual therapy treatment (group one) or no treatment (group two), followed by a ten-day washout period and three weeks of the opposite treatment.
Primary outcome was the feasibility: recruitment (target number of participants = 10), retention (target 10%), treatment adherence (target > 90%) and safety (no side effects). Secondary outcomes were dynamic postural control measured by TTS and muscle activity measured by electromyography (EMG) of the M. peroneus longus (PL) and M. tibialis anterior (TA).
Results: The pilot study could determine for the primary outcomes: high recruitment with 13 (30%), low retention (0%) and high treatment adherence (94.1%). There were no differences between pre and post intervention in TTS and EMG activity of PL and TA.
Conclusion(s): This pilot study examined evidence that the study program was feasible.
The study design can be chosen in this form with small modifications and a larger sample of 150-200 people for future studies. For the next study, there must be strict monitoring of the data transfer from the EMG sensor to the Vicon software program from the start of the study. The current pilot study could not find an optimal threshold to determine TTS in persons with CAI following a jump landing. This should be considered for future studies.
It is preliminarily suggested that no significant effects of manual mobilization on postural control and muscle activity could be determined.
Implications: Due to the conflicting results, the effect of ankle mobilization on the postural control and muscle activity cannot be clarified conclusively. For this reason joint mobilization should may not be used as a unique treatment to improve the dynamic postural control in patients with CAI.
Keywords: chronic ankle instability, manual therapy, postural control
Funding acknowledgements: None
Topic: Musculoskeletal: lower limb; Sport & sports injuries
Ethics approval required: Yes
Institution: Gesundheits- und Fürsorgedirektion des Kantons Bern
Ethics committee: KEK-BE: 2017/00203
Ethics number: Main ID: DRKS00012299
All authors, affiliations and abstracts have been published as submitted.
