Clinical Benefits of
Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis
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
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 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.
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.
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?
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
by: Kyle Kosik
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
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