title: A modified mobilization-with-movement to treat a lateral ankle sprain.
abstract: BACKGROUND
  Lateral ankle sprains (LAS) are common in sports medicine and can result in a high rate of re-injury and chronic ankle instability (CAI). Recent evidence supports the use on mobilizations directed at the ankle in patients who have suffered a LAS. The Mulligan Concept of Mobilization-with-Movement (MWM) provides an intervention strategy for LASs, but requires pain-free mobilization application and little literature exists on modifications of these techniques.
  
  
  OBJECTIVE
  To present the use of a modified MWM to treat LASs when the traditional MWM technique could not be performed due to patient reported pain and to assess outcomes of the treatment.
  
  
  METHODS
  The subject of this case report is a 23 year-old female collegiate basketball player who had failed to respond to initial conservative treatments after being diagnosed with a lateral ankle sprain. The initial management and subsequent interventions are presented. After re-examination, the addition of a modification of a MWM technique produced immediate and clinically significant changes in patient symptoms. The use of the modified-MWM resulted in full resolution of symptoms and a rapid return to full athletic participation.
  
  
  RESULTS
  After the initial application of the modified-MWM, the patient reported immediate pain-free ankle motion and ambulation. Following a total of 5 treatments, using only the modified MWM and taping technique, the patient was discharged with equal range of motion (ROM) bilaterally, a decreased Disablement in the Physically Active (DPA) Scale score, and an asymptomatic physical exam. Follow-up exam 6 weeks later indicated a full maintenance of these results.
  
  
  CONCLUSIONS
  Recent evidence has been presented to support the use of mobilization techniques to treat patient limitations following ankle injury; however, the majority of evidence is associated with addressing the talar and dorsiflexion limitations. Currently, little evidence is available regarding the use of the MWM technique designed for LASs and the expected outcomes. This case adds to the emerging evidence supporting the use for MWMs to treat ankle pathology and introduces a modification that may be applied in cases where patient reported pain prevents traditional application.
  
  
  METHODS
  Level 5; Single case report.
authors.affiliation: University of California - Riverside, Riverside, CA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Mau
authors.affiliation: University of Idaho, Moscow, ID, USA.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Baker
keywords: Lateral ankle sprain; mobilization with movement