title: Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To compare the effects of thrust and nonthrust manipulation and exercises with and without the addition of myofascial therapy for the treatment of acute inversion ankle sprain.
  
  
  BACKGROUND
  Studies have reported that thrust and nonthrust manipulations of the ankle joint are effective for the management of patients post-ankle sprain. However, it is not known whether the inclusion of soft tissue myofascial therapy could further improve clinical and functional outcomes.
  
  
  METHODS
  Fifty patients (37 men and 13 women; mean ± SD age, 33 ± 10 years) post-acute inversion ankle sprain were randomly assigned to 2 groups: a comparison group that received a thrust and nonthrust manipulation and exercise intervention, and an experimental group that received the same protocol and myofascial therapy. The primary outcomes were ankle pain at rest and functional ability. Additionally, ankle mobility and pressure pain threshold over the ankle were assessed by a clinician who was blinded to the treatment allocation. Outcomes of interest were captured at baseline, immediately after the treatment period, and at a 1-month follow-up. The primary analysis was the group-by-time interaction.
  
  
  RESULTS
  The 2-by-3 mixed-model analyses of variance revealed a significant group-by-time interaction for ankle pain (P<.001) and functional score (P = .002), with the patients who received the combination of nonthrust and thrust manipulation and myofascial intervention experiencing a greater improvement in pain and function than those who received the nonthrust and thrust manipulation intervention alone. Significant group-by-time interactions were also observed for ankle mobility (P<.001) and pressure pain thresholds (all, P<.01), with those in the experimental group experiencing greater increases in ankle mobility and pressure pain thresholds. Between-group effect sizes were large (d>0.85) for all outcomes.
  
  
  CONCLUSIONS
  This study provides evidence that, in the treatment of individuals post-inversion ankle sprain, the addition of myofascial therapy to a plan of care consisting of thrust and nonthrust manipulation and exercise may further improve outcomes compared to a plan of care solely consisting of thrust and nonthrust manipulation and exercise. However, though statistically significant, the difference in improvement in the primary outcome between groups was not greater than what would be considered a minimal clinically important difference. Future studies should examine the long-term effects of these interventions in this population.
  
  
  METHODS
  Therapy, level 1b-.
authors.affiliation: Department of Physical Therapy, Universidad Camilo José Cela, Madrid, Spain.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Truyols-Domí Nguez
authors.forename: Jaime
authors.initials: J
authors.lastname: Salom-Moreno
authors.forename: Javier
authors.initials: J
authors.lastname: Abian-Vicen
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000534:rehabilitation*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations; D020127:Recovery of Function; D013180:Sprains and Strains / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult