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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