EFFECTS OF MULLIGAN'S MOBILIZATION WITH MOVEMENT IN CHRONIC ANKLE INSTABILITY: A SYSTEMATIC REVIEW

R. Aiguade Aiguade¹, C. Teruel Alarcon², E. Sempere Garcia², B. Roman Guzon², L. Moure Romero², C. Casanova Gonzalvo¹

Background: The ankle plays a primary role in the maintenance and correction of the balance during standing gait. A normal gait requires an ankle dorsiflexion passive range of motion (DF-PROM) ranging from 10º to 15º. Ankle sprain is the most common injury in the active population with 600-700 cases per 100.000 people per year generating $4 billion in the US alone. 70-80% of all patients with previous history of ankle sprain developed residual symptoms such as ligament laxity, loss of proprioception, decreased range of motion (ROM), recurrent swelling, pain during activity and feelings of ankle instability. Neural factors, such as spasticity, or an increase in the sensitivity of the myotatic reflex, can contribute significantly to calf muscle stiffness. Non-neural factors, such as immobilization and age-induced changes in the mechanical properties of muscle, and connective tissue, are known to increase resistance to joint movement and to contribute to the limited DF-ROM. Mulligan's mobilization with movement for the ankle is a joint mobilization technique that attempts to address arthrokinematic positional faults, which occur following injury, by correcting the misaligned joint surfaces using a passive mobilization combined with an active movement.

Purpose: The objective of this systematic review is to examine the effects of Mulligan's mobilization with movement in people with chronic ankle instability (CAI).

Methods: Study design: Systematic review
Databases used: PubMed, ScienceDirect and Cochrane Search
Strategy: Keywords chronic ankle instability AND mulligan OR mobilization with movement in Title / Abstract
Inclusion criteria: Observational cohort studies.
Language used: English
Exclusion criteria: Do not record number of injuries. Comparation between different techniques. Do not manage the ankle. Duplicate studies were excluded.

Results: Analyzing the results of the seven studies included, they found significant differences in ankle DF-PROM except a study in which they used a weiht-bearing mobilization with movement technique and found a moderate increase in DF after 48h. Two studies utilized different scoring tools for measuring CAI. Two studies observed significant changes in posterior talar glide. A study observed significantly improvements in static balance ability, gait speed and step lenght. A study did not found significantly improvements in pain. Different analysis methods were observed, that causes difficulties to draw general conclusions.

Conclusion(s): There is evidence that MWM by Mulligan is useful in individuals with CAI. It is necessary to investigate the mechanisms by which the effects of the technique appear. MWM by Mulligan is a technique that could be added to CAI rehabilitation protocols. It is necessary more studies that analyzes different parametres to observe all the effects of this technique.

Implications: This technique is an appropriate way to treat chronic stroke of the ankle, specially in the improvement of movement and gait normality and could be an effective help in addition to the protocols used with this injury.

Funding, acknowledgements: Not funding acknowledgements required

Keywords: Manual Therapy, Mulligan Concept, Ankle

Topic: Musculoskeletal: lower limb

Did this work require ethics approval? No

Institution: It's a systematic review

Committee: It's a systematic review

Reason: It's a systematic review