Sports Medicine Research: In the Lab & In the Field: Ankle Joint Mobilizations: What are They Good for? (Sports Med Res)
Wednesday, November 15, 2017

Ankle Joint Mobilizations: What are They Good for?

Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis

Weerasekara I, Osmotherly P, Snodgrass S, Marquez J, Zoete R, Rivett D. Archives of Physical Medicine and Rehabilitation. 2017;[Epub ahead of print] doi: 10.1016/j.apmr.2017.07.019

Take Home Message: Ankle joint mobilizations improve dynamic balance and weight-bearing dorsiflexion range of motion in patients with chronic ankle sprains.

Joint mobilizations are recommended for the management of a grade 1 or 2 lateral or medial ankle sprain. Current systematic reviews are limited as they include studies that did not evaluate the efficacy joint mobilizations in isolation, and rather as an adjunct to other interventions (e.g. rest, ice, compression, elevation). Moreover, these systematic reviews have a narrow focus on improving outcomes in patients with a lateral ankle sprain. Therefore, Weerasekara and colleagues undertook a systematic review and meta-analysis to synthesize the available literature examining the efficacy of joint mobilizations as a unique intervention in patients with a grade 1 or 2 lateral or medial ankle sprain during any stage of recovery (acute, subacute or chronic). Included studies assessed the immediate, short-term (up to 3 months after the intervention) and long-term (3 months or more) effects of joint mobilization on ankle range of motion, pain, quality of life, and function (static and dynamic balance, proprioception, talar stiffness). The authors were unable to identify any study that measured the effectiveness of mobilization in isolation for acute ankle sprains. Mulligan mobilization with movement (video) or taping (video) produced greater clinical benefits compared with Maitland technique’s, Maitland with traction, and manipulation (video). In summary, the meta-analysis demonstrated that joint mobilizations have an immediate effect on balance and a short-term benefit for weight-bearing dorsiflexion range of motion in patients with chronic ankle sprains. There is little evidence to support the long-term effects of joint mobilizations on any clinical outcome measure.

Findings from this systematic review strengthen current clinical practice by demonstrating the efficacy of joint mobilizations to improve sensorimotor function and ankle range of motion in patients with chronic ankle sprains. The talus and fibula have been shown to be mal-positioned in patients with chronic ankle sprains. A mal-position of either the talus or fibula are hypothesized to restrict ankle range of motion and impact sensorimotor function. Joint mobilizations are purported to restore these positional faults and subsequently improve ankle range of motion and sensorimotor function in patients with chronic ankle sprains. Unfortunately, the current systematic review was unable to determine if mobilizing the talus or fibula produced the greatest clinical benefit. Therefore, clinicians should consider assessing each patient individually to determine if he/she has a mal-positioned talus or fibula. This will help direct which positional fault to target when performing a joint mobilization.
  
Questions for Discussion: Do you assess for a positional fault in patients with chronic ankle sprains before mobilizing? What kind of clinical outcome measures do you use to determine if a patient will benefit from a joint mobilization? Which mobilization technique (Mulligan or Maitland) do you find produces the greatest clinical benefit? 

Written by: Kyle Kosik
Reviewed by: Jeffrey Driban

Related Posts:




0 comments:

Post a Comment

When you submit a comment please click 'Subscribe by Email" (just below the comments) or "Subscribe to: Post Comments (Atom)" (at the bottom of this page) if you would like to receive a notification when another comment has been submitted to this post.

Please note that if you are using Safari and have problems submitting comments you may need to go to your preferences (privacy tab) and stop blocking third party cookies. Sorry for any inconvenience this may pose.