Effect of Joint Mobilization in the Treatment of Chronic Ankle Instability

This study has been completed.
Sponsor:
Collaborator:
Nebraska Foundation for Physical Therapy
Information provided by (Responsible Party):
Creighton University
ClinicalTrials.gov Identifier:
NCT01438905
First received: September 14, 2011
Last updated: December 7, 2012
Last verified: December 2012
  Purpose

The purpose of this study is to examine the effects of a gentle pressure movement performed at the ankle by a physical therapist on muscle function and ankle motion in individuals who frequently twist (sprain) their ankle.


Condition Intervention
Ankle Sprain
Other: Small amplitude (Grade IV) mobilization
Other: High velocity, low amplitude (Grade V) mobilization

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effect of Joint Mobilization on Muscle Activation and Function in Individuals With Chronic Ankle Instability

Further study details as provided by Creighton University:

Primary Outcome Measures:
  • Changes in Muscle activation [ Time Frame: Baseline and immediately after each manual therapy intervention; 1 week study ] [ Designated as safety issue: No ]

    To determine cortical and spinal changes in muscle activation of the fibularis longus and soleus following one of three intervention protocols. Changes in cortical and spinal muscle activation will be measured by examining resting motor threshold via Transcranial Magnetic Stimulation and the H-reflex technique, respectively.

    The investigators hypothesize that the higher intensity talocrural joint mobilization will result in a greater increase in cortical and spinal activation of the fibularis longus and soleus muscles than the lower intensity talocrural joint mobilization.


  • Changes in Ankle dorsiflexion ROM [ Time Frame: Baseline and immediately after each manual therapy intervention; 1 week study ] [ Designated as safety issue: No ]

    To determine the changes in ankle dorsiflexion ROM following one of two talocrural joint mobilization techniques (higher or lower intensity) or control intervention in individuals with CAI. Changes in ankle dorsiflexion ROM will be quantified using a weight bearing lunge.

    The investigators hypothesize that the higher intensity (Grade V) talocrural joint mobilization will result in a greater improvement in ankle dorsiflexion ROM than the lower intensity (Grade IV) talocrural joint mobilization and the control intervention will result in no change in ROM.


  • Changes in Dynamic Balance [ Time Frame: Baseline and immediately after each manual therapy intervention; 1 week study ] [ Designated as safety issue: No ]

    To determine the acute changes in balance following one of two talocrural joint mobilization techniques or control intervention in individuals with CAI. Changes in balance will be quantified using the anterior, posteromedial, and posterolateral components of the Star Excursion Balance Test.

    The investigators hypothesize that the higher intensity talocrural joint mobilization will result in greater improvements in reach distance in all three SEBT directions compared to the lower intensity talocrural joint mobilization.



Estimated Enrollment: 30
Study Start Date: September 2011
Study Completion Date: December 2012
Primary Completion Date: November 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Control
Parameters will be identical to the lower intensity (Small amplitude oscillation mobilization; Grade IV) talocrural mobilization. No force, other than light hand contact will be applied by the therapist.
Experimental: Lower intensity mobilization
The subject will be in a seated position and the therapist will stabilize the distal tibia with one hand and make contact the anterior talus with the opposite hand. Three 60-second anterior to posterior joint mobilizations of the talus (small amplitude at end range; Grade IV) will be applied by the therapist with one minute rest in between sets.
Other: Small amplitude (Grade IV) mobilization
The subject will be in a seated position and the therapist will stabilize the distal tibia with one hand and make contact the anterior talus with the opposite hand. Three 60-second anterior to posterior joint mobilizations of the talus (small amplitude at end range; Grade IV) will be applied by the therapist with one minute rest in between sets.
Experimental: Higher intensity mobilization
The subject will be in a seated position and the therapist will grasp the dorsum of the foot with their fingers. The ankle will be dorsiflexed until the restrictive barrier is reached. A small amplitude, quick thrust at end of range (High velocity, low amplitude; Grade V mobilization/manipulation) will be applied. If joint cavitation is not felt or heard by the therapist or subject the technique will be repeated one additional time.
Other: High velocity, low amplitude (Grade V) mobilization
The subject will be in a seated position and the therapist will grasp the dorsum of the foot with their fingers. The ankle will be dorsiflexed until the restrictive barrier is reached. A small amplitude, quick thrust at end of range (High velocity, low amplitude; Grade V mobilization/manipulation) will be applied. If joint cavitation is not felt or heard by the therapist or subject the technique will be repeated one additional time.
Other Names:
  • Manipulation
  • Grade V mobilization
  • High velocity, low amplitude thrust

Detailed Description:

Novel rehabilitation methods, that specifically target decreased muscle activation due to joint pathology prior to strength training, have elicited greater improvements in muscle function and self-reported disability compared to traditional therapies. Preliminary evidence suggests ankle joint mobilization can improve contributions of spinal influences on ankle muscle activation in individuals with ankle joint pathology, but there is a considerable gap in understanding cortical contributions to muscle activation following joint injury. It is unknown how joint mobilization concurrently affects cortical and spinal neural motor pathways, as well as clinical measures of patient function. The overall aim of this grant is to determine the immediate effects of talocrural joint mobilization on cortical and spinal muscle activation of the fibularis longus (peroneus) and soleus muscles in individuals with chronic ankle instability (CAI). The secondary aims of this study will examine changes in ankle dorsiflexion range of motion (ROM) and dynamic balance. This innovate approach will provide the necessary scientific knowledge regarding the potential mechanism and efficacy of joint mobilization.

  Eligibility

Ages Eligible for Study:   19 Years to 45 Years
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Age 16-45 years
  • History of one or more ankle sprains
  • Scoring at least an 85% on the Foot and Ankle Ability Measure (FAAM) Sport or at least 3 on the Modified Ankle Instability Instrument (AII).
  • At least 5° ankle dorsiflexion asymmetry compared to the contralateral limb OR ankle dorsiflexion ROM less than 21°

Exclusion Criteria:

  • Lower extremity injury or surgery within the past 6 months (including lateral ankle sprain)
  • Diagnosed ankle osteoarthritis
  • History of ankle surgery that involves intra-articular fixation
  • Medical conditions which would be contraindications to mobilization/manipulation and/or transcranial magnetic stimulation, including cardiac pacemaker, metal implants in the head, current pregnancy, neurological disorders, recent use of stimulants or medications known to lower seizure threshold, and personal or family history of seizures
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01438905

Locations
United States, Nebraska
Creighton University
Omaha, Nebraska, United States, 68178
Sponsors and Collaborators
Creighton University
Nebraska Foundation for Physical Therapy
Investigators
Principal Investigator: Terry L Grindstaff, PhD, PT, ATC Creighton University
  More Information

No publications provided

Responsible Party: Creighton University
ClinicalTrials.gov Identifier: NCT01438905     History of Changes
Other Study ID Numbers: NCT1116058
Study First Received: September 14, 2011
Last Updated: December 7, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by Creighton University:
Ankle Sprain
Chronic Ankle Instability
Ankle Mobilization
Talocrural Joint Mobilization
Cortical Muscle Activation
Spinal Muscle Activation

ClinicalTrials.gov processed this record on October 23, 2014