Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability

Christopher J Holland; Jonathan D Hughes; Mark B A De Ste Croix

doi:10.1177/2325967120927371

Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability

Orthop J Sports Med. 2020 Jun 22;8(6):2325967120927371. doi: 10.1177/2325967120927371. eCollection 2020 Jun.

Authors

Christopher J Holland¹, Jonathan D Hughes², Mark B A De Ste Croix²

Affiliations

¹ University of Worcester, Worcester, UK.
² University of Gloucestershire, Gloucestershire, UK.

Abstract

Background: Chronic ankle instability (CAI) is linked to mechanical and functional insufficiencies. Joint mobilization is purported to be effective at treating these deficits.

Purpose: To examine the effect of different treatment durations of a grade IV anterior-to-posterior ankle joint mobilization on weightbearing dorsiflexion range of motion (WB-DFROM), posterior talar glide (PG), and dynamic postural control in individuals with CAI.

Study design: Controlled laboratory study.

Methods: A total of 48 female athletes (mean age, 22.8 ± 4.8 years) with unilateral CAI participated in this study. Participants were randomly assigned to 1 of 3 treatment conditions: 30 seconds, 60 seconds, and 120 seconds. Treatment was provided to the injured limb on 3 separate occasions 48 hours apart and consisted of a Maitland grade IV anterior-to-posterior talar joint mobilization based on the participant's initial group assignment. WB-DFROM; PG; and the anterior (ANT), posteromedial (PM), and posterolateral (PL) reach directions of the Star Excursion Balance Test were measured bilaterally before and after each treatment. The uninjured limb acted as a control. Data were analyzed using 2-way mixed-model analyses of variance, and effect sizes were calculated through use of Hedges g.

Results: Significant differences were detected after all treatment sessions for all outcome measures (P ≤ .001) and between treatment groups after sessions 1, 2, and 3 for all outcome measures (P ≤ .001). Effect sizes were very large or huge for all treatment groups for WB-DFROM, PG, and ANT reach direction. Substantial variation was found in effect sizes for PM and PL measures.

Conclusion: Accessory mobilization is an effective treatment to induce acute changes in ankle motion and dynamic postural control in patients with CAI, with longer treatment durations conferring greater improvements.

Clinical relevance: This study adds clarity to the use of joint mobilization treatments and will add to the current clinical practice strategy for patients with CAI.

Keywords: Maitland; chronic ankle instability; dorsiflexion; manual therapy; mobilization.