title: Effects of joint mobilization on chronic ankle instability: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effects of joint mobilization, in which movement is applied to the ankle's dorsiflexion range of motion, on dynamic postural control and on the self-reported instability of patients with chronic ankle instability (CAI).
  
  
  METHODS
  A double-blind, placebo-controlled, randomized trial with repeated measures and a follow-up period. Ninety patients with a history of recurrent ankle sprain, self-reported instability, and a limited dorsiflexion range of motion, were randomly assigned to either the intervention group (Joint Mobilizations, 3 weeks, two sessions per week) the placebo group (Sham Mobilizations, same duration as joint mobilization) or the control group, with a 6 months follow-up. Dorsiflexion Range of Motion (DFROM), Star Excursion Balance Test (SEBT) and CAI Tool (CAIT) were outcome measures. A separate 3 × 4 mixed model analysis of variance was performed to examine the effect of treatment conditions and time, and intention-to-treat (ITT) analysis was applied to evaluate the effect of the independent variable.
  
  
  RESULTS
  The application of joint mobilization resulted in better scores of DFROM, CAIT, and SEBTs in the intervention group when compared with the placebo or the control groups (p < 0.001). The effect sizes of group-by-time interaction, measured with eta-squared, oscillated between 0.954 for DFROM and 0.288 for SEBT posteromedial distance. In within-group analysis, the manipulation group showed an improvement at 6 months follow-up in CAIT [mean = 5.23, CI 95% (4.63-5.84)], DFROM [mean = 6.77, CI 95% (6.45-7.08)], anterior SEBT [mean = 7.35, CI 95% (6.59-8.12)], posteromedial SEBT [mean = 3.32, CI 95% (0.95-5.69)], and posterolateral SEBT [mean = 2.55, CI 95% (2.20-2.89)].
  
  
  CONCLUSIONS
  Joint mobilization techniques applied to subjects suffering from CAI were able to improve ankle DFROM, postural control, and self-reported instability. These results suggest that joint mobilization could be applied to patients with recurrent ankle sprain to help restore their functional stability. Implications for Rehabilitation Functional instability is a very common sequela in patients with CAI, resulting in reduced quality of living due to the limitations it imposes on daily life activities. The mobilization with movement technique presented by Mulligan, and based on the joint mobilization accompanied by active movement, appears as a valuable tool to be employed by physical therapists to restore ankle function after a recurrent ankle sprain history. ROM restriction, subjective feeling of instability and dynamic postural control are benefiting from the joint mobilization application.
authors.affiliation: Department of Health Sciences, Faculty of Health Sciences, University of Jaén , Jaén , Spain and.
authors.forename: David
authors.initials: D
authors.lastname: Cruz-Díaz
authors.forename: Rafael
authors.initials: R
authors.lastname: Lomas Vega
authors.forename: Maria Catalina
authors.initials: MC
authors.lastname: Osuna-Pérez
authors.forename: Fidel
authors.initials: F
authors.lastname: Hita-Contreras
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Amat
mesh_terms: D000328:Adult; D000842:Ankle / Q000503:physiopathology; D016512:Ankle Injuries / Q000534:rehabilitation*; D000843:Ankle Joint / Q000503:physiopathology*; D002908:Chronic Disease; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000628:therapy*; D008297:Male; D009068:Movement; D004856:Postural Balance; D016059:Range of Motion, Articular; D057566:Self Report; D016474:Weight-Bearing; D055815:Young Adult
keywords: Chronic ankle instability; dorsiflexion; dynamic postural control; manual therapy; self-reported instability