title: Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To determine whether manipulation of the proximal or distal tibiofibular joint would change ankle dorsiflexion range of motion and functional outcomes over a 3-week period in individuals with chronic ankle instability.
  
  
  BACKGROUND
  Altered joint arthrokinematics may play a role in chronic ankle instability dysfunction. Joint mobilization or manipulation may offer the ability to restore normal joint arthrokinematics and improve function.
  
  
  METHODS
  Forty-three participants (mean ± SD age, 25.6 ± 7.6 years; height, 174.3 ± 10.2 cm; mass, 74.6 ± 16.7 kg) with chronic ankle instability were randomized to proximal tibiofibular joint manipulation, distal tibiofibular joint manipulation, or a control group. Outcome measures included ankle dorsiflexion range of motion, the single-limb stance on foam component of the Balance Error Scoring System, the step-down test, and the Foot and Ankle Ability Measure sports subscale. Measurements were obtained prior to the intervention (before day 1) and following the intervention (on days 1, 7, 14, and 21).
  
  
  RESULTS
  There was no significant change in dorsiflexion between groups across time. When groups were pooled, there was a significant increase (P<.001) in dorsiflexion at each postintervention time interval. No differences were found among the Balance Error Scoring System foam, step-down test, and Foot and Ankle Ability Measure sports subscale scores.
  
  
  CONCLUSIONS
  The use of a proximal or distal tibiofibular joint manipulation in isolation did not enhance outcome effects beyond those of the control group. Collectively, all groups demonstrated increases in ankle dorsiflexion range of motion over the 3-week intervention period. These increases might have been due to practice effects associated with repeated testing.
  
  
  METHODS
  Therapy, level 2b-.
authors.affiliation: University of Virginia-HEALTHSOUTH, Charlottesville, VA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Beazell
authors.forename: Terry L
authors.initials: TL
authors.lastname: Grindstaff
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Sauer
authors.forename: Eric M
authors.initials: EM
authors.lastname: Magrum
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Ingersoll
authors.forename: Jay
authors.initials: J
authors.lastname: Hertel
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000628:therapy*; D000843:Ankle Joint / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000534:rehabilitation*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology*; D013180:Sprains and Strains / Q000628:therapy; D055815:Young Adult